How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff and what are the positive actions that the nurses should begin to take to prevent moral distress?

Study No. 1

Mrs. R. (87 year old) is in hospital with aspiration pneumonia. At the moment, she is ventilator dependent and in an ICU. Family members informed the nursing staff that Mrs. R. wouldn’t have desired such care, and she would prefer to be taken off of life support. Dr. G. the primary physician has asked nurses to meet with the family and discuss the possibility of Mrs. R. being moved to a more advanced medical facility for intensive rehabilitation and therapy.

Guido’s MORAL model provides a framework for ethical decision-making in healthcare. Using this model, the nursing staff can respond to the physician’s request by following these steps:

M – Massage the dilemma: The nursing staff should identify and clarify the problem in the situation. The dilemma is whether to continue Mrs. R.’s life support, as per the physician’s request, or to respect the family’s wishes and discontinue the life support.

O – Outline options: The nursing staff should identify all the possible options available to them, including transferring the patient to another facility or consulting an ethics committee.

R – Resolve the dilemma: The nursing staff should make a decision and implement the best course of action. They should try to find a compromise between the physician’s request and the family’s wishes.

A – Act by applying the chosen option: The nursing staff should implement the decision and communicate it to all parties involved.

L – Look back and evaluate: The nursing staff should reflect on the decision and evaluate its outcome.

If the nursing staff continues to provide life support against the family’s wishes, it can cause moral distress among the staff. Moral distress can be prevented by the staff taking positive actions, including consulting an ethics panel or seeking help from a social worker or chaplain. Nurses can teach the family and physician about ethical principles such as autonomy, beneficence and justice.

2. Case Study

Tyrell Dueck, a competent 14-year-old boy, was diagnosed with bone cancer and decided to stop further therapy and leave his health in God’s hands, according to his parents’ religious beliefs. Healthcare team tried to force continued medical treatment, and they planned for amputation. The court battle ended when Tyrell’s cancer had spread to his lungs.

This case studies focuses on the rights to autonomy, informed consent and religious freedom. Tyrell’s right to determine his medical treatment conflicts with the healthcare team’s duty to provide the best possible medical care. Tyrell’s parents’ religious beliefs conflict with the healthcare team’s obligation to provide evidence-based medical treatment.

The ethical principle of autonomy suggests that Tyrell has the right to make his medical decisions, but as a minor, his parents’ consent is required. The healthcare team has an obligation to provide accurate information to the patient and parents and to ensure that the patient’s decision is informed. However, the healthcare team’s obligation to provide evidence-based medical treatment is important in this case, as the patient’s decision is not based on evidence but on religious beliefs.

If Tyrell’s disease had not intervened, it would have been ethically appropriate to respect his decision and allow him to stop further therapy. Tyrell had to be aware of all the potential risks and benefits, as well as the fact that he gave informed consent.

Healthcare policy can be used to assess the necessity of policies that balance religious belief and evidence-based medicine. These can be helped by Malone’s chapter 4 Guido textual framework questions.

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