Reflective Account: Ethical Dilemma Treating Cancer

Reflective Account Ethical Dilemma Treating CancerThis brooding account pass oning question an respect subject dilemma which arose during a lieu within a community setting. To assist the reproof dish forbidden, the Gibbs (1988) Reflective cycles/ sulfur which encompasses 6 stages description, thoughts and feelings, evaluation, analysis, conclusion and reach political platform leave be use which will improve and strengthen my treat adroitnesss by continuously acquirement from twain good and bad experiences, and develop my self confidence in relation to caring for other(a)s (Siviter 2008). To comply with the Nursing and Midwifery recruit of mode wander (NMC) (2008) and maintain confidentiality exclusively names withdraw been changed and therefore for the purpose of this notice the longanimous will be refer cherry to as curtsey. sorrel is a 40 four year old man who has been receiving aggressive and invasive interposition for several months in the form of che motherapy in an try to cure his Hodgkinsons lymphoma tailcer. passim the treatment Bob remained positive that he would be up to(p) to consecrate the worries behind him and live a averageal life with his partitionner and teen daughter. but, Bob was unable to control his body temperature, which was a possible scrape the chemotherapy had non been successful and was produceed further investigations to establish his trickdidate.Whilst my mentor who is a conjunction Matron, was talking to Bob, his partner Sue took me to one side and asked me if the investigations revealed bad discussion would it be possible to reimburse this nurture from Bob because she mat he would not be able to deal with a s undersidet(p) prognosis and would give up hope. Prior to Bobs original admission the possibility of f the chemotherapy failing was discussed entirely he ref utilise to consider this was an option and was convinced the prepargon could be treated successfully. I explained to Sue that this occurrence was distant of my theater of operations of expertise still with her permission would discuss it with my mentor and ask her to conflict Sue at a mutually convenient succession to discuss further.My mentor contacted Sue and advised her that she would discuss the situation with Bobs consultant erstwhile they had received the outgrowths of his sieves. However, my mentor diplomatically sensible Sue that she has no statutory bored to insist that information be kept from Robert (Dimond 2005). As anticipate Bobs test results concluded the chemotherapy treatment was unsuccessful. Considering what he k tonic of Bob, the consultant agreed it would be advantageous to withhold the diagnosing from him. therefore it was agreed to discuss Bobs test results with his partner.Thoughts and feelingsIn the first instance I snarl that the Consultant was ethically wrong to withhold the results of the investigations from Bob and not necessarily acting in his outflank interests. I felt that in order to control Bobs sounds were protected and to give him the opportunity to be involved in his admit plan of do by he should be communicate of the outcome of the tests. Bob had the mental ability to take to and as during my placement would be acting as an counselling for him. I felt that if I was in Bobs position, I would regard to tell apart what the outcome of any investigations were and it did not seen right that the diagnosing would be document in his records and his family and possibly fri odditys around him would be aware of his diagnosis whilst he was kept in the dark. I felt that if we were to huckster on a regular basis that I would feel very uncomfortable penetrating something that had been kept from him and possibly get under ones skin to lie to him or avoid reply directly when asked difficult questions. I felt that I would be able to hire a better consanguinity and show the care he wanted if he was told the true democ racyment close to his condition. I also felt that his family were taking denying him the right to autonomy and th right to make aware choices in his demise of life care.AnalysisThe situation was interlocking in terms of ethical principles. It was not just a matter of clinical acts but providing the scoop holistic care to Bob during his forthcoming terminal unsoundness. This situation gave rise to multi-disciplinary team discussions to assess whether the diagnosis should have been delivered to Bob. standing(a) back from the situation, I realize that my own feelings were perhaps judgmental and that I should have interpreted a more(prenominal) holistic approach quite a than just clinical. It also make me aware of the immensity of promoting advance directives to diligents in situations where an illness whitethorn break down to terminal careEvaluation satisfying take away patient autonomy is a highly regarded principle that healthcare schoolmasters kick upstairs at a ll times and is vestigial for all patient interactions of which grievous the truth to a patient about their diagnosis and prognosis is part (Dimond 2005).Lo (2009) regularizes to be totally autonomous competent patients have to be told the spirit of their illness, recovery prospects, how their illness will develop, treatments available and the consequences of any such treatments to alter them to make an certified choice in order to grant consent to treatment of their choice or refuse treatment they do not want.However this has not always been the solecism, traditionally, paternalism, where the doctor alone would make a decision about whether or not to inform their patient of the diagnosis used to be the prefer method of treating and caring for patients (Lo B 2009). It is save over the past 20 years or so where it is the norm to share decision making with the patient to enable them to make informed choices in their preferred care and treatment (Boyle 1995).However not all pa tients want to know their prognosis or take part in their extirpate of terminal treatment and care. A study which took place in 1995 concluded that some ethnic groups were less likely to approve of truth telling in respect of diagnosis than others (Blackwell 1995).The UK is culturally diverse and not all patients and families want or bring autonomy. When a person is excited in some cultures, the family prefers to take responsibility for the medical decisions and often craving to receive the diagnosis and nursing plan before the patient. Although this is often the case within Chinese and Japanese cultures, it does not automatically mean that the involve to withhold diagnosis from the patient will be upheld. To add to this complex issue, there may be differences within these cultures, such as youthful immigrants and older family members wishing to adhere to cultural traditions and younger family members wishing to practice autonomy (Lo B 2009).Advanced care directives definitio n are used to enable a person to have autonomy.These ethicalBarbosa da Silva (2002) defines an ethical dilemma asA situation where a person experiences a conflict where he or she is obliged to perform twain or more duties, but realizes that whoever action he or she makes will be an ethically wrog one.Many experts agree healthcare schoolmasters are lawsuit up with many an(prenominal) ethical dilemmas when caring for terminally ill cancer patients. Communicating the diagnosis and subsequent prognosis is one of the about common (Kuupelomaki and Lauri 1998)(Roy and MacDonald 1998). It is not comical for relatives to ask a Consultant to withhold information (Alexander et al 2006) which Kenworthy et al (2002) says family members pass along out of compassion and love. However, (2006) disagrees and suggests it is often the relatives who are unable to sell and have difficulty coming to terms with the impending prognosis. Dimond (2005) suggests withholding the truth can be harmful o r flatus to a federation of silence but may be justifiable if it is in the patients best interest not to know. In agreement, Lo (2009) points out receiving bad news can have a negative and drastic effect on a patients view of their future. fosters have a duty in accordance with their professional code of conduct to act as a patients advocate. Whatever their singularized thoughts are in relation to withholding diagnosis from a patient, if the Consultant deems it in the best interest of the patient then a value has a duty to adhere to the Consultants decision (Dimond 2005).However Georges and Grypdonk 2002 suggest this can film to maintains feeling powerless, frustrated and concern when involved in palliative care. shew suggests that if a Consultant establishes it is not advisable to inform the patient of the diagnosis or prognosis then it is right to give information to the family (Rumbold 2006). Dimond (2005) states patients have no legal rights to information and therefore i f a Consultants believes it is in the best interest of the patient they can refuse to give a diagnosis to them. However, some would argue to withhold information would be considered paternalism (Lo B 2009).Paternalism is when an individual, in this case the Consultant, believes they are in a position to act in the best interest of another individual. Although Bobs welfare is key, the consultant has taken forth his right to his autonomy to make future healthcare choices including Copernican end of life decisions by making the decision not to inform him of his diagnosis (Sandman and Munthe 2010). Tingle and Cribb (2005) define this as hard paternalism as opposed to loose paternalism in which Bob would not have the capacity to make an informed decision regarding treatment and care look outing his diagnosis. The may be in beneficience to the patient but conflicts with autonomy.While considering the decision to not tell Bob the truth regarding his diagnosis, the consultant would have taken into account the ethical principles of humanity (to do good) and non-malifience (to cause no harm) (Dimond 2005). In Rumbolds (2006) opinion it is wrong to not tell the truth or withhold information from a patient as it denies the patient autonomy and is in conflict with the ethical principles of benignity and non-malificience.Research carried out by Sullivan (2001) suggests patients believe that Doctors should tell them the truth with a staggering ninety nine per cent of patients wanting to be informed of their diagnosis. However there is evidence to suggest the consultant was right to withhold diagnosis as it can initiate denial, and cause the patient psychological damage (Kenworthy et al 2002). Patients react differently to bad news and Elliott and Oliver (2007) suggests information should given slowly enabling the patient to have enough time to absorb the information given.Sadness, despair, anxiety and depression are feelings patients suffer when faced with life threate ning illness. believes that if healthcare professionals have an open and honest relationship with their patients it enables greater intrust (Elliott and Oliver 2007). Bowers and Arnold (2010) agrees with this and adds that an open relationship based on trust enables healthcare professionals to support patients to be in control and make preferred choices with issues relating to their end of life care. However, Kenworthy, Snowley, Gilling (2002) are in disagreement with these statement say to force a patient into to face the trust regarding their diagnosis is both(prenominal) unethical wrong and damaging. Millard and Florin (2006) (nursingtimes) says that patients have different need which can often be complex and it is all important(p) to recognise that some patients choose not be involved, that some individuals do not want to be part of their care but put their trust in health care professionals who are trained in what they do.Elliott and Oliver (2007) states that a hope is fun damental to a terminally ill persons wellbeing and as such is something to be protected. She adds that hope of a cure whilst facing a terminal illness is an individuals right and helps them to face the final stages of life and points out that if hope is taken away it leaves a patient with wholly fear.ConclusionThis experience has made me aware that good listening, hearing and communication skills are vital to acquire a holistic view when dealing with patients and close ones in end of life care. It is also important to liaise with other members of the multi-disciplinary team to master that the best possible approach and care is delivered to the patient. It is important not to be judgemental but to incorporate all issues when taking a holistiv view in order to make the right decision. As this was my first experience of end of life care in the community, I was in unfamiliar environs and as such not experienced enough to make the right decision in Bobs case.The consultant was correc t in determining that Bob was not in a position to consume a poor diagnosis and therefore withholding the information was the correct decision.Action Plan. My action plan is to promote advanced decision and power of attorney tax holistically and taken into accountI also feel than advance directives may have cleared some of this issues and will aver about their immenseness in would have resolved some of this issues and read about their importance and promote their importance when the opportunity scratchsHowever, the circumstances surrounding this decision could only when be applied to Bobs situation. I believe that as a Nurse I will be involved in ethical dilemmas again however I feel that now I my decisions will be based on each unique patient recognising their own individual needs and wants. relegatingThis essay is a reflection of a situation I came across whilst on Community Placement. To assist with this process, Driscolls model of reflection will be used to sharpen my th ought processes whilst learning. Driscolls is a straight forward model which come ons one to return to a situation to chthonianstand it better and improve future experiences (Driscoll 2000). To comply with the Nursing and Midwifery Code of Conduct (NMC) (2008) and protect the confidentiality of patients pseudonyms have been used throughout.As required by the first stage of Driscolls model I will describe the outcome s which took place whilst my mentor was on annual leave and I was assigned to Dianne, another district nurse within the community team. The causal agent I have decided to return to this situation is because registered nurses should ensure their practice does not compromise duty of care to individuals and at the time I felt that Dianne was delegating duties in catchly and therefore may have been in breach of NMC requirements (NMC 2004).Whilst assigning the solar days work Dianne verbalise that it would be a good opportunity for my personal development to go out unsu pervised to visit patients within the area to submit out their care and treatment. I was asked to visit a 92 year old patient called arise who the team visited on two or three times a week to treat a couple of problems. Firstly, she had ulcerated legs which the team were treating with four layer coalition bandaging which evidence suggests is the best way to foster venous return in order to maximise the healing process (OMeara et al 2009). Secondly she had a small sacrum sinus which was packed and redressed. Diannes request put me in an awkward position as I had visited ruddiness on a number of occasions with my mentor and with her supervision had been able to assess, treat and care for Roses problems appropriately with the exception of applying compression bandages as my mentor had explained to me were only to be applied by staff who had received appropriate training. I am keen to take advantage of any professional development opportunities and improve my clinical skills. Howev er I felt that although I was able to manage most of the delivery of care to Rose as required by the NMC Code of Conduct (2008) applying the compression bandaging was outside my remit and would have been unsafe practice. My feelings were that Dianne was not doing this for my personal development but for her own personal reasons resulting in her abdicating her responsibilities. She did not ask me how I felt about attending patients without supervision or twin I had the prerequisite clinical skills.With this in mind I agreed I would visit Rose, take down her dressings, assess and debride the hurt, apply appropriate dressings and the first two layers of bandages. However I requested that Dianne called in after me to apply the compression bandages. Dianne did not appear to be very happy with my request but aversely agreed.When I arrived at Roses I introduced myself and explained the purpose of my visit and that Dianne would follow me to apply the compression bandages. I explained at each stage what I was doing, to put Rose at ease, remembering look up and face Rose, so that she could hear clearly what I was saying or read my lips and facial expression as she was partially deaf. As agreed with Dianne I took down the existing dressings, debrided and assessed the scandalize against the online wound care plan. The wound bed had reduced considerably and although an Inodine dressing had been applied previously, the wound had alter considerably and in my opinion did not require replacing. Therefore I telephone Dianne to let her know of my assessment and it was agreed to dress the wound with a simple NA dressing before bandaging. Whilst at Roses I took the opportunity to update the wound care plan and therefore documented the size of the wound, excudate, smell etc etc and documented all my findings and actions in the care plan.Whilst at Roses I also required to redress the sacral sinus in accordance with her care plan. When assessing the wound I noticed that althou gh her skin was not broken, her sacrum was very red. I had also previously noticed that although she had a squeeze cushion sitting on another leave I had neer actually seen her sat on it. Therefore I took the opportunity to encourage her to become involved in promoting her own health and explained that her sacrum was very red and that as she sat for long periods of time, it was possibly that her skin would break down, which was wherefore she had been issued with a pressure cushion. We discussed why she did not use the pressure cushion, she said that she did not find it very comfortable in her favourite chair, I explained the benefits of the pressure cushion and we agreed that she would sit in another chair with the pressure cushion in situ for a least part of the day and that we would discuss how she got on next time I visited. Before deviation Roses I documented my assessments, nursing interventions, evaluation and actions in her care plan.The second stage of Driscolls entitle d now what will look at the kitchen stove of events which has led me to reflect on when it is appropriate to put care.Delegation involves entrusting and transferring a project or responsibility to another person who is able to accept responsibility for the parturiency, typically one who is less senior than oneself (Sullivan and Decker 2005, Oxford dictionary 2011). However Wheeler (2004) argues that delegation and abdication amount to the same thing. On the other hand MacKenzie (1998) states that abdication is tolerant up either by renunciation or resignation and says that whilst delegation can offer potential benefits to both individuals and organisations, many nurses practice abdication which can be attributable to the current economic climate of underpaid and overstretched employees.Whilst I did appreciate that Dianne thought I was able to deliver appropriate care to Rose I also surmise that she thought it she would have an easier day if she asked me to carry out the more go and mundane tasks. The NMC standards of proficiency (2004) state whilst nurses should delegate care to others they should also accept responsibility and accountability for such delegation. As a registered nurse under the NMC Code of Conduct (2008) nurses have a duty of care to ensure that patients receive care in a safe and skilled manner. Dianne was not aware if I was competent or not to carry out compression bandaging as she had neither previously worked with me or questioned me about my clinical skills. In line with the NMC Code of Conduct (2008) I see that I must work within the scope of my professional competence and it is for this reason I refused to apply the compression layer.It is important for organisations and individuations to delegate in order for them to develop and function resourcefully and successfully (Ellis and Hartley 2004). legal Delegation requires skills in planning, analysis and self-confidence. The tasks to be delegated should be assessed, planned, co mmunicated, implemented, monitored and evaluated (Royal College of Nursing 2006).In the UK, the rate of change is accelerating and the delivery of services are regularly restructured in an attempt to provide the most trenchant and efficient care to patients (Shepherd 2008). This environment has lead to the evolvement of work from junior doctors to nursing staff such as giving intravenous therapy and with the evolvement of nursing practitioners many agree that the role of the nurse is occurively difficult to define as the boundaries are constantly changing (Shephard 2008, Spilbury and Meyer 2005, McKenna et al 2006). A study conducted by Ulster University condones that there is much ambiguity amongst the nursing role. It concluded that although nurses are happy with role extensions they have less patient contact as they would like. Some nurses like the role extension of proficient excogitates, however others see it at the menial tasks Doctors do not want to do (Allen 2002). Howe ver this was only a small survey of 26 nurses and therefore may not be a true agency of all RGNs (McKenna et al 2006). It can be assumed therefore that demands on nursing care at times are greater than RGNs can cope with, and therefore increasing expected to to delegate some tasks routinely, traditionally carried out by RGNs, such as personal care (Curtis and Nicholl 2004). Effective delegation can give RGNs more time for other activities which enables them to focus on doing fewer tasks well rather than many tasks poorly and offer HCAs the opportunity to become competent and improved confidence (Kourdi 1999).Shepherd (2008) articulates that it is important for these tasks to be defined and when devolved it should not be at the detriment to the patient. As a result health care assistant (HCA) roles have change magnitude in both numbers and cope of activity undertaken and it is therefore important that all health care staff understand their roles and accountability in the delegation process. Health care staff need to work together in order for patients to receive safe and effective care from the most appropriate personnel (Pearcey 2007). However some nurses find it difficult to antecede any part of their role and find it difficult to delegate (Wheeler 2004) Zimmerman (1996) suggests this major power be because some nurses were trained before delegation skills were required. However Nicholl and Curtis (2004) state that delegation is not an art and but a nursing skill which can be learned and is becoming increasing important in changing times.Delegation also enables health care professionals to train in new skills and broaden their skill range. However Wheeler argues that some could scream their power of delegation for example to provide themselves with extra breaks while their subordinates may have to forfeit theirs to complete additional tasks. Or one nurse could favour a subordinate resulting in some always receiving more appealing tasks than others. Dele gation is a complex process and to successfully delegate consideration should be given to both existing workload and skill mix of staff should be known.Delegation of too many tasks may result in loss of control, but failing to delegate may lead to one member of staff being overwhelmed, overworked and can lead to incompletion of duties and de-motivated and un-cooperative team.Most HCAs give personal care due to the fact they are usually more available than RGNS. Many studies have indicated that RGNS favour the function of HCAs (McKenna and Hansson 2002). However the MIDRIS (2001) study suggests that care provided by HCAS is task based and fragmented.There are many pros and cons for delegating tasks. Detailed Job Descriptions (JD) may result in staff being reluctant to take on new responsibilities that are not specified on their JD. Others will be reluctant and believe if you want a job done properly do it yourself. This can inhibit delegation leading to nurses being overworked stres sed with puny job satisfaction (Kourdi 1999). On the other hand Wheeler (2001) suggests effective delegation encourages staff to have a better understanding and be able to influence the way in which work is carried out. She also says that by participating in decision-making it will increase motivation, morale and ultimately job performance enabling the organisation to become more flexible and reactive to change.Effective delegation will enable a business to gesture forward as new ideas and viewpoints will be encourage and it will better prepare nurses to be able to cope when career opportunities arise (Wheeler 2001). Delegation frees up time to enable a nurse to carry out other duties which cannot be delegated. Although at first the time relieve might me minimal once the HCA becomes proficient more time will become available. Fewer tasks are better than many that are incompetent (Kourdi 1999).In order to delegate effectively it important to decide which task to delegate , selec t the best person to carry out that task, assessing the task in detail and offer clearly the level of authority associated with it, , check the skills and experience of the delegates, follow the task process and assess and discuss the progress (Curtis and Nicholl 2004).Cohen suggests it is right to delegate in order to carry out an organisations needs as long as certain criteria is met such as right task, right circumstance, right person right communication and right supervision.The third base stage, of the Driscolls reflection model requires what can be done differently in the future and what actions to be taken.Dianne was right to delegate the more junior tasks in order to ensure the fewer tasks she had were carried out more effectively. However should have verified my competence prior to delegating. If she had communicated with me effectively to assess my competence I would not have felt awkward having to point out that I did not have the skills to carry out compression bandagin g and only practice within my capabilities (NMC 2008).In the future in such a situation I would not do anything differently as I believe I have a responsibility for practicing within my own capabilities in line with the NMC Code of Conduct (2008). Had I been a perpetual member of staff I would have asked for compression training, however this would have been impractical as I was on placement for only a short period of time. When I qualify this situation I will be aware that I am ultimately responsible for the care of patients even when tasks are delegated to HCAs. I will also ensure that I do not delegate anything that involves critical thinking skills such as nursing assessments, planning and evaluation of patient care and nursing judgement.(take off 90 for references)