Mr. Rodriquez, a 78-year-old man who recently immigrated to the United States, was admitted to the medical unit, and diagnosed with acute lymphocytic leukemia. The hematologist caring for this patient has explained reasonable treatment options for an individual of Mr. Rodriquez’s age and general medical condition. His daughter, who is distraught and unable to comprehend everything happening, tearfully asks the staff nurse, “If it were your father, what would you do?” The staff nurse repeats much of what the physician has said, attempting to clarify whether the daughter understood the recommended treatment and palliative care measures.
Although her father appears to accept these interventions, the daughter continues questioning the nurse, repeatedly asking the nurse what she would do if it were her father. She tells the nurse that she does not want her father to suffer, but she also wants her father to live as long as possible. She has also used the Internet to learn more about possible treatment options and has questioned many of the staff nurses on the unit about whether they would insist that more be done to preserve the life of a loved one.
The staff nurses have now come to you, the nurse manager, for advice on working with this patient and family.
1) Determine which ethical principle or principles are the most appropriate to consider in this instance and which principle or principles would best assist in guiding staff members.
2) What role if any does health literacy play in this scenario?
3) Are there additional resources within the facility that you might ask to assist in helping the staff care for this patient and family?
4) How might you begin to ensure that the staff nurses can better deal with such issues in the future?
This scenario involves complex ethical considerations, communication challenges, and the need for additional support and resources. Let’s break down your questions:
- Ethical Principles: The most relevant ethical principles in this situation are autonomy (respecting the patient’s wishes), beneficence (acting in the patient’s best interest), and non-maleficence (avoiding harm). In guiding staff members, emphasizing the importance of respecting the patient’s autonomy while also considering what would be in his best interest, given his medical condition and wishes, would be crucial.
- Health Literacy: Health literacy is a significant factor here. The daughter’s distress and continuous questioning might stem from a lack of understanding or conflicting information obtained from the internet. Addressing health literacy by providing accurate, understandable information about the condition, treatment options, and potential outcomes is vital to empower the family to make informed decisions.
- Additional Resources: The facility might have resources such as a medical ethicist or a patient advocate who can assist in explaining treatment options, clarifying doubts, and mediating discussions between the medical team and the family. Social workers or counselors can also help the family cope with emotional distress and facilitate decision-making.
- Staff Training and Support: To ensure better preparedness for similar situations in the future, staff training on communication skills, ethics in healthcare, and handling emotionally charged situations would be valuable. Conducting regular workshops, simulations, or case discussions can help staff members develop empathy, improve communication strategies, and navigate ethical dilemmas effectively.
As a nurse manager, fostering an environment where staff members feel supported and have access to resources for continuing education and guidance is essential. Encourage open discussions about challenging cases and provide debriefing sessions to help staff process their emotions and experiences. Moreover, create a supportive network within the team where nurses can seek advice and share insights from past experiences.