Ethical Dilemma During Community Nursing

Ethical Dilemma During Community Nursing This reflective account will discuss an ethical dilemma which arose during a placement within a community setting. To assist the reflection process, the Gibbs (1988) Reflective Cycle which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan will be used which will improve and strengthen my nursing skills by continuously learning from both good and bad experiences, and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the Nursing and Midwifery Code of Conduct (NMC) (2008) and maintain confidentiality all names have been changed and therefore for the purpose of this reflection the patient will be referred to as Bob. Bob is a forty four year old man who has been receiving aggressive and invasive treatment for several months in the form of chemotherapy in an attempt to cure his Hodgkinsons lymphoma cancer. Throughout the treatment Bob remained positive that he would be able to put the worries behind him and live a normal life with his partner and teenage daughter. However, Bob was unable to control his body temperature, which was a possible sign the chemotherapy had not been successful and was offered further investigations to establish his prognosis. Whilst my mentor who is a Community Matron, was talking to Bob, his partner Sue took me to one side and asked me if the investigations revealed bad news would it be possible to withhold this information from Bob because she felt he would not be able to deal with a poor prognosis and would give up hope. Prior to Bobs original admission the possibility of f the chemotherapy failing was discussed but he refused to consider this was an option and was convinced the condition could be treated successfully. I explained to Sue that this situation was outside of my area of expertise but with her permission would discuss it with my mentor and ask her to contact Sue at a mutually convenient time to discuss further. My mentor contacted Sue and advised her that she would discuss the situation with Bobs Consultant once they had received the results of his tests. However, my mentor diplomatically informed Sue that she has no legal right to insist that information be kept from Robert (Dimond 2005). As expected Bobs test results concluded the chemotherapy treatment was unsuccessful. Considering what he knew of Bob, the consultant agreed it would be advantageous to withhold the diagnosis from him. Therefore it was agreed to discuss Bobs test results with his partner. Thoughts and feelings In the first instance I felt that the Consultant was ethically wrong to withhold the results of the investigations from Bob and not necessarily acting in his best interests. I felt that in order to ensure Bobs rights were protected and to give him the opportunity to be involved in his own plan of care he should be informed of the outcome of the tests. Bob had the capacity to consent and as during my placement would be acting as an advocate for him. I felt that if I was in Bobs position, I would want to know what the outcome of any investigations were and it did not seen right that the diagnosis would be documented in his records and his family and possibly friends around him would be aware of his diagnosis whilst he was kept in the dark. I felt that if we were to visit on a regular basis that I would feel very uncomfortable knowing something that had been kept from him and possibly have to lie to him or avoid answering directly when asked difficult questions. I also felt that his fam ily were taking away his freedom to make an informed choice about his forthcoming care. Analysis Evaluation Barbosa da Silva (2002) defines an ethical dilemma as: A situation where a person experiences a conflict where he or she is obliged to perform two or more duties, but realizes that whoever action he or she chooses will be an ethically wrong one. Kuupelomaki and Lauri (1998) and Roy and MacDonald (1998) agree that health professionals are faced with many ethical dilemmas when caring for terminally ill cancer patients and communicating the diagnosis and subsequently prognosis is one of the most common dilemmas experienced. Alexander et al (2001) state that it is not unusual for relatives to ask a Consultant to withhold information. Kenworthy et al (2002) say that these requests are made out of compassion and love. However, Rumbold (2002) disagrees and suggests it is often the relatives who are unable to cope and have difficulty in coming to terms with the impending prognosis. Dimond (2005) agrees and adds that withholding the truth can be harmful or lead to a conspiracy of silence but may be justifiable if it is in the patients best interest not to know. Buckman (1988) also appears to agree pointing out receiving bad news can have a negative and drastic effect on a patients view of their future. The mentor acted in the correct manner speaking to Bobs consultant and agreeing with him to withhold the diagnosis from the patient. Dimond (2005) states that Nurses have a duty to adhere to the Consultants decision even when they are in disagreement. The Consultant made a professional decision to discuss the diagnosis and prognosis with Bobs partner. Rumbold (2002) identifies it is the correct decision to give information to family members when it is deemed that it is not medically advisable to inform the patient. Although patients may insist on being told of their diagnosis Consultants have the power to withhold information, there is no clear right in law even if the patient is exercising their right under the Data Protection Act 1998 (Dimond 2005). However, Harris (1994) argues that for Consultants to act in such a way is paternalistic. Paternalism is when others believe they are acting in the individuals own best interests, whilst not affording them individual control over their own life, although concern for the individuals welfare is paramount, it omits respect for the individuals autonomy (Harris, 1994). However, Tingle and Cribb (2005), argue that there are two types of paternalism. Hard paternalism is acting on an individuals behalf because they feel qualified to do so, whereas soft paternalism is about making decisions on behalf of the individual whilst they are unable to exercise their own autonomy and feel they are doing so in the best interests of the patient. My feelings were that Robert had a right to know the truth about his diagnosis, this is identified by Tingle and Cribb (2005) as a deontological position, whereby obligations and duties to tell the truth overrides the justification of behavior, even when that action can be justified to be in the best interests of the patients. The principles of beneficence (promote goodness) and non-malifience (cause no harm) are fundamental ethical principles surrounding the decision to tell or not to tell a patient the truth regarding their diagnosis (Alexander, Fawcett, Runciman, 2001). Rumbold (2002) identifies that health professionals should act according to the principles of beneficence and non-malifience, and states that withholding information or telling a lie is unethical and denies the individual autonomy. Rumbold (2002) argues that autonomy enables the individual to think, decide, and make decisions freely and independently based on information given. Nevertheless I felt that Bob could not be autonomous when he did not know the truth regarding his diagnosis and thus denying him the right to make informed decisions surrounding his death. Although my values and beliefs differed from the Consultants, I was aware that I had to uphold his decision. Essentially, the consultant has clinical responsibility for patients Rumbold (2002). However, Kenworthy, Snowley and Gilling (2002) state that professionals who override an individuals autonomy for doing good a dilemma exists. A dilemma can be described as a variance between personal beliefs, feelings and principles where different answers to a situation exists, although several courses of action may be taken each can be morally justified (Royal College of Nursing, 2000). Essentially the courses of action that could have been taken for Bob were to tell the truth or not, both positions could be morally justified, to tell the truth would enable Robert to be autonomous, however withholding the truth prevents Robert losing hope. Saunders (1991) however argues that healthcare professionals need to question whose needs they are seeking to meet. This is supported by McCarthy (1996) who states that healthcare professionals have a tendency to assume they know what there patients needs are. This made me feel that the Consultant and my mentor were colluding with Roberts wife and subsequently they were meeting her needs by withholding information thus ignoring Robertss right to be autonomous. I therefore found that I was involved in a personal ethical dilemma related to veracity (truth telling) honesty and withholding information (Begley and Blackwood, 2000). Fry and Johnstone (2002) believe the principle of veracity lies with the individual not to deceive or tell a lie therefore tell the truth to others. Research in to truth telling and patient diagnosis carried out by Sullivan (2001) suggests that ninety-nine per cent of patients want to be informed of their diagnosis and felt that Doctors had an obligation to tell them the truth. However, ten Have and Clark (2002) argue that when diagnosis is imparted abruptly it can provoke denial, impair adaptation and psychologically harm the patient. McGuigan (1999) states that it is difficult to predict how patients will react to bad news, she suggests that the procedure for news should be slow, this then enables the patient time to absorb information given. I believed that Robert had a right to know and felt that we would not be unduly harming him by informing him of his diagnosis. Anxiety, fear of death are all obvious signs when patients face life threatening illness Mason (2002). This is supported by Golds (2004) research who identifies that patients rarely suffer greater anxiety, depression, sadness, or despair on being informed of their diagnosis. Open honesty is encouraged by McGuigan (1999) who believes that as a result of being informed patients have a greater trust in the healthcare professionals treating them and are able to communicate more effectively with relatives and healthcare professionals as a result. This is agreed by Seale (1997) who advocates that an open awareness of diagnosis affords the individual to have control over circumstances surrounding their death. I had been reflecting over the situation and realised it was too complex for me to handle therefore I sought guidance from my mentor. Although she would normally take a deontological position, she informed me that she was taking a utilitarian position in this case therefore acting within the principle of beneficience (do good) and acting in the best interests of Robert. Tingle and Cribb (2005) state that individuals who act on the principle of utilitarianism are acting in a way which yields the greatest happiness to all parties concerned regardless of the motives for taking these actions. My mentor and I also reflected on the conversation she had with Roberts wife prior to his test results. It was felt that Robert was currently in denial and telling him of his diagnosis could potentially harm him, he may lose all hope therefore she was adhering to the principle of non-malificence (prevent harm). Research carried out by Kubler-Ross (1969) (although an old reference it is still used today in Kenworthy, Snowley, Gilling, 2002), identified denial as being the first stage of adjustment to the prospect of death by patients, she believes that individuals deny the reality of the situation and are unable to face up to the prospect of death. She also argues that it is the retreat in to denial that isolates the individual and as a consequence, communication is compromised between patients and healthcare professionals. Kubler-Rosss research has been endorsed by Buckman (1988) research however he suggests that patients go through reactions as opposed to stages. Nonetheless, Evans and Walsh (2002) identify that it is often the healthcare professionals feelings of helplessness with the situation that leads them to believe that patients who hope for a cure are in denial of their disease. Nevertheless, Kenworthy, Snowley, Gilling (2002) argue that it would be unethical and damaging to forc e a patient in to facing the truth about their diagnosis. I therefore realised that it would be unethical and be detrimental to force Robert to face the truth about his diagnosis, if we took away his hope of a cure we would only leave him with fear. Mason (2002) believes that in terminal illness hope and fear are synonymous to each other if hope is taken away patients are only left with fear. She also states that a patients hope is fundamental and something to be protected. This is supported by Buckley and Herth (2004) who identify that hope of a cure in terminal illness is immeasurable. In addition, Mason (2002) argues that hope is an individuals right and even in the final stages of death patients hold on to hope. Conclusion Reflecting back we had not actually lied to Robert as I had once presumed, although he was aware that further tests had been carried out he had never enquired about the results. I believe that if I were ever faced with this type of situation again I would be more conscious of my patient feelings, listening and hearing what they are saying, thereby my approach would be more holistic rather than clinical. By analysing my decisions I realise that I was blinkered and had stuck rigidly to the NMC (2004), not fully appreciating that the NMC (2004) has policies and parameters for which a registered nurse can work within, which enables a nurse to be proactive and use their professional judgement (Seedhouse, 1998). Next time I would not be judgemental but look at the surrounding issues related to decision making. I had condemned the Consultant and my mentor for their decision and believed they were acting paternalistic, however I realise their decisions were based on their knowledge of Robert in addition to their experience and expertise. Benner (1984) suggests that an expert has the expertise and principles from which to make informed decisions based on their experience, training and practice which enables the expert to be holistic in their approach to patient care of which the novice has yet to gain and develop. Reflecting over my decisions and feelings made me realise that I was a complete novice. This is supported by Benner (1984) (in Baillie 2001), who states that novices have no basis from which to apply their principles it is only in a clinical setting that experience can be gained, however novice can also be applied to nurses working in unfamiliar surroundings. I now believe that I was guilty of paternalism believing my own beliefs and values were right. I had assumed that Robert needed to know of his diagnosis if he was to be autonomous. To conclude I now realise that in terminal illness it can be question of when to inform the patient of bad news. I believe that Robert was clearly not ready to accept the truth at that time therefore withholding information had been the right decision. Arguably Robert was autonomous, it was his decision to hope for a cure therefore it would have been unethical and morally wrong to take that away. However, the circumstances surrounding this decision could only be applied to Roberts 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. By using the Gibbs (1988) reflective framework cycle it has enabled me to analyse, question, move forward, learn and make sense of my actions. I am now aware that reflection is a continual learning process in nursing. Rather than condemn myself where I think I have failed I have been able to turn it in to a positive learning experience and apply this newly gained knowledge in to my future practices Action Plan

Review of Douglas E. Winter’s Thrilling Novel, Run Essay -- Run

Review of Douglas E. Winter’s Thrilling Novel, Run If you’re in the market for a good thriller, the kind that you don’t put down, the kind that releases its grip on you once it’s through, look no further. Run grabbed my attention with its opening sentence and I found myself slipping into that helpless, blissful state of complete submission to the book, confident I was in the hands of a master storyteller. I chose to review this book primarily because none of my friends had heard of it, despite its New York Times-bestseller status and cover, which is decorated with blurbs from literary illuminati as they gasp for superlatives in attempts to describe the story’s pace, which is breathless, to be sure. This is Winter’s debut novel (having previously collaborated with Clive Barker), and we are in the presence of an exciting new talent. The novel is told from the first-person perspective of Burdon Lane, an arms dealer of the less-than-legal variety, who finds himself in a classic noir predicament where the only person he can trust is himself, and only then ...

Diversity: Culture and America Essay

Beginning with the prospect of the American dream, diversity has been one of the most dominant characteristics of American society. During the nineteenth century, America was deemed a melting pot: a place where people of different ethnicities could co-exist. The idea of people being able to embrace commonalities without letting go of their culture has been the basis of the America that we live in today. This sense of collaboration, which comes with diversity, has created outlets for our citizens and opportunities for those foreign to our country. Diversity is one of the most beneficial aspects of not only America’s history, but its present and future. Diversity is what makes America unique. As said in Mirror on America by Leonard Pitts, â€Å"America is everyone else, a nation composed of other nations, a culture made of other cultures, a history built of other histories.† (Pitts, 82) Pitt’s statement clearly depicts the fact that although America is independent from other countries geographically, the integration of different ethnic groups defines American history. The acceptance of other cultures in America has not only brought over people from different countries, but also their: ideas, beliefs, and opinions. The rewards that we reap from foreign contributions are, but are not limited to, food variety, technological advances, open minded citizens and overall a more tolerant country. America is a place characterized as the land of the free; the diversity in our country is what keeps that statement relevant. Due to the effectiveness of diversity in the workplace, industries and organizations have spent an abundance of time incorporating diversity into their own companies. With the incorporation of diversity in advertisements, employees, and superior positions today’s workplace is more diverse than it has ever been. These implementations of diversity benefit companies by creating a comfortable environment for their buyers, thus stimulating the economy. Although some may argue that companies have not reached the goal of total equality, it has been said that immigrants do have a positive effect on America’s workplace. â€Å"Since the early days of the Republic, talented foreigners have streamed to our shores to till the soil, build industries, and turn the country into a scientific and technological powerhouse. They converted the U.S. into the first global nation, giving us adaptability, an intuitive feel for other cultures, and an innovative edge,† said David Gergen. ( Gergen, 93) In America, we have many immigrants who come here with the hope of becoming successful; those who strive to create a better America by working hard tend to achieve that goal. Those who are able to succeed in their endeavors have provided Americans with the adaptability that Gergen explains. Immigrants have been the brains and ideas of big named, American companies such as Intel, AT&T, Kraft, Google, Yahoo!, and eBay. To understand how immigrants make such an impact on America’s workforce and economy, one needs to think about why they come here in the first place. Immigrants leave their homelands to come to America because they think and believe that their skills will be put to the test. As also said by Gergen, â€Å"Talented foreigners are job creators, not job takers.† (Gergen, 94) Immigrants do bring new ideas and skills which can further create more, successful jobs. Based off of a June 2012 study published by the Fiscal Policy, they report that 18% of small business owners are immigrants. The same report found that among small businesses, for which at least half of the founders were immigrants, employed an estimated 4.7 million people. This diversity benefits America because it puts foreign skills and talents to the test in order to stimulate jobs as well as our economy. In conclusion, with allowing diversity to continue to be a part of America, we can encounter many things other countries cannot. We can continue to accept different people and their ideas to create new jobs and opportunities. We can also accept their opinions to allow America to grow and continue being a strong nation. Last but not least, we can give people from all around the world the â€Å"American dream.† Works Cited Gergen, David. â€Å"A Smart Exception.† Mirror on America: Essays and Images from Popular Culture. 5th ed. Ed Mims, Joan T, and Nollen, Elizabeth M. Boston: Bedford St Martin’s, 2012. 93-94. Print Pitts, Leonard Jr. â€Å"History Tells Hard Stories of Ethnic Clashes.† Mirror on America: Essays and Images from Popular Culture. 5th ed. Ed Mims, Jonas T, and Nollen, Elizabeth M. Boston, Bedford, 2012. 81-82. Print Denhart, Michael. â€Å"The U.S. Needs More Immigrants to Grow the Economy and Create Jobs.† Huffington Post 26 September 2012. Web

10 Job Search Rules You Need to Break 2019

For the most part rules are good, but some become outdated and can actually hinder you from reaching your goal. Certain job search rules that people still follow religiously do not apply anymore. They were devised in a different time and era and are no longer relevant. Lets take a look at 10 job search rules you need to break. 1. The one-page resume rule Youve probably heard that your resume should not be longer than one page. One page might work if you have no experience, but two page resumes are the norm nowadays. Be brief, but if you need two pages that is perfectly fine. Employers are used to seeing two page resumes. 2. Formal language Your resume should be free from slang, but not so formal that it sounds like it was written by a business jargon machine. Stuffy corporate language is often times too dry. Write in a formal yet natural tone as if you were talking to a friend about what you have accomplished. .ua5d6877f171889e99d46dae2cf6f1ebb { padding:0px; margin: 0; padding-top:1em!important; padding-bottom:1em!important; width:100%; display: block; font-weight:bold; background-color:#eaeaea; border:0!important; border-left:4px solid #34495E!important; box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -moz-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -o-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -webkit-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); text-decoration:none; } .ua5d6877f171889e99d46dae2cf6f1ebb:active, .ua5d6877f171889e99d46dae2cf6f1ebb:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; text-decoration:none; } .ua5d6877f171889e99d46dae2cf6f1ebb { transition: background-color 250ms; webkit-transition: background-color 250ms; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; } .ua5d6877f171889e99d46dae2cf6f1ebb .ctaText { font-weight:bold; color:inherit; text-decoration:none; font-size: 16px; } .ua5d6877f171889e99d46dae2cf6f1ebb .post Title { color:#000000; text-decoration: underline!important; font-size: 16px; } .ua5d6877f171889e99d46dae2cf6f1ebb:hover .postTitle { text-decoration: underline!important; } READ Online Master of Science Nursing Program Offers 5 Popular Specialties3. Writing an objective Resume objectives hurt more than they do help – especially if they are not written specifically for the job you are applying to. Employers care more about what you can do for them – not your objective. 4. Education first Most people commonly put their education first because thats the way it has always been. Most resumes should not be the other way around with the education beneath the work experience portion. Your work experience means more to most employers. 5. References available on request This is sort of like the one page resume rule. Its an old school thing thats somehow hung on but is not relevant. No need to put this on your resume anymore. 6. Follow up call to employer Many employees wait a few days after they have turned in their resume and call the employer to schedule a job interview. This is very pushy and annoying to the employer. Besides, once you submit your resume to an organization they have all the leverage. Its in their court and theres nothing you can do but wait. .uf782d8a7086ccd319470938b3ead1dd5 { padding:0px; margin: 0; padding-top:1em!important; padding-bottom:1em!important; width:100%; display: block; font-weight:bold; background-color:#eaeaea; border:0!important; border-left:4px solid #34495E!important; box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -moz-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -o-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -webkit-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); text-decoration:none; } .uf782d8a7086ccd319470938b3ead1dd5:active, .uf782d8a7086ccd319470938b3ead1dd5:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; text-decoration:none; } .uf782d8a7086ccd319470938b3ead1dd5 { transition: background-color 250ms; webkit-transition: background-color 250ms; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; } .uf782d8a7086ccd319470938b3ead1dd5 .ctaText { font-weight:bold; color:inherit; text-decoration:none; font-size: 16px; } .uf782d8a7086ccd319470938b3ead1dd5 .post Title { color:#000000; text-decoration: underline!important; font-size: 16px; } .uf782d8a7086ccd319470938b3ead1dd5:hover .postTitle { text-decoration: underline!important; } READ Associate Criminal Justice Degree Checklist 7 Things to Consider Before Enrolling7. Arriving early Its good to be early, but theres no need to show up to the reception early. It may make the employer feel pressured to stop what they are doing and its pretty annoying to them. If youre early then hang out somewhere else other than the reception area. 8. Weaknesses Most savvy interviewers frame their weakness as something thats really more of a positive – such as I work too hard or Im a perfectionist. These answers have become very clichà © and the interviewer will know you are not telling the truth. Instead tell them about a genuine weakness you have and then explain how you are overcoming it. 9. Salary figures It used to be a major no-no to talk specific salaries at interviews. Nowadays you have to be prepared. Instead of using a specific figure like $70,000, use a range like 65-80. .ud2a511091692ef1ce3a532fd0ec0f209 { padding:0px; margin: 0; padding-top:1em!important; padding-bottom:1em!important; width:100%; display: block; font-weight:bold; background-color:#eaeaea; border:0!important; border-left:4px solid #34495E!important; box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -moz-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -o-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); -webkit-box-shadow: 0 1px 2px rgba(0, 0, 0, 0.17); text-decoration:none; } .ud2a511091692ef1ce3a532fd0ec0f209:active, .ud2a511091692ef1ce3a532fd0ec0f209:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; text-decoration:none; } .ud2a511091692ef1ce3a532fd0ec0f209 { transition: background-color 250ms; webkit-transition: background-color 250ms; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; } .ud2a511091692ef1ce3a532fd0ec0f209 .ctaText { font-weight:bold; color:inherit; text-decoration:none; font-size: 16px; } .ud2a511091692ef1ce3a532fd0ec0f209 .post Title { color:#000000; text-decoration: underline!important; font-size: 16px; } .ud2a511091692ef1ce3a532fd0ec0f209:hover .postTitle { text-decoration: underline!important; } READ Organizational Psychology and Development An Exciting Career Opportunity10. Hard sell Some job seekers utilize the hard sell tactic to make themselves seem confident. Never ask directly for the job. It puts the interviewer on the spot. They want to hire the best person, not the most aggressive and pushy one. Related ArticlesA Career in Accounting Can Really Add Up10 Job Tips for New GradsA Crash Course in Business AdministrationA Multi-Purpose Degree Bachelors in BusinessA Doctor of Business Administration Degree Unlocks the Door to the Global EconomyA Masters Degree in Health Care Management