As An Advanced Practice Nurse, You Will Run Into Situ 307783

As An Advanced Practice Nurse You Will Run Into Situations Where A Pa

As an advanced practice nurse, you will encounter situations where a patient's wishes about their health may conflict with available evidence, your own clinical experience, or the desires of their family. These situations often present ethical dilemmas that require careful consideration and navigation. Ethical conflicts in healthcare settings can involve issues such as respecting patient autonomy, beneficence, non-maleficence, and justice. Navigating these dilemmas necessitates a thorough understanding of evidence-based practice guidelines coupled with ethical principles to ensure patient-centered and ethically sound care.

This paper explores ethical considerations and evidence-based practice guidelines in the context of specific clinical scenarios, focusing on a case study of a young woman with advanced breast cancer who experiences a cardiac arrest and is admitted to the emergency room.

Paper For Above instruction

The case involves a 33-year-old woman with advanced-stage breast cancer who suffers a cardiac arrest and is brought to the emergency room. She is unmarried, and her boyfriend accompanies her during the emergency transport. This situation raises multiple ethical considerations, including respecting the patient's autonomy, understanding her wishes regarding resuscitation or life-sustaining treatments, and managing the involvement of the family or partner in her care.

Ethical principles and evidence-based practices

The foremost ethical principle in this scenario is respect for patient autonomy. Respecting the patient's autonomy involves honoring her right to make decisions about her healthcare, including preferences regarding resuscitation, intubation, and other life-sustaining interventions. Given her critical condition, obtaining informed consent or understanding her prior expressed wishes is vital. Advanced care planning and prior directives are essential in guiding immediate treatment decisions, but in their absence, proxies or surrogates may need to be involved, raising questions about who can serve as the decision-maker.

Respecting patient autonomy

In cases of critically ill patients unable to communicate, healthcare providers often seek to clarify the patient’s wishes through advance directives or prior conversations. If unavailable, a surrogate decision-maker is identified, yet in this case, the patient is unmarried, and her boyfriend is present, which may indicate an informal or non-legal relationship. The advanced practice nurse must determine whether the partner is recognized as a surrogate or if the healthcare team must act in the patient's best interest while considering ethical guidelines and hospital policies.

Balancing beneficence and non-maleficence

Healthcare providers are ethically obliged to act in the patient’s best interest (beneficence) and to do no harm (non-maleficence). In the context of a cardiac arrest, decisions about resuscitation must be made swiftly, often based on limited information. Evidence-based guidelines recommend that healthcare teams initiate or withhold resuscitative efforts based on the patient's previously expressed wishes, clinical context, and prognosis. For patients with advanced cancer and limited quality of life expectations, the potential benefits of aggressive interventions may be limited, and such interventions could contribute to additional suffering.

Involving family or partners in care

Surrogate decision-making often involves family members or legally appointed agents. In this case, the partner's role should be carefully evaluated, considering hospital policies, legal requirements, and the ethical obligation to respect the patient's privacy and preferences. Open communication is essential; the advanced practice nurse must facilitate discussions among the healthcare team, the partner, and possibly other family members if available, ensuring decisions align with the patient's values and wishes.

Evidence-based practice guidelines

Current guidelines recommend early evidence collection regarding patient preferences, such as advance directives, and the use of standard protocols for resuscitation decisions. The American College of Emergency Physicians and the American Heart Association emphasize respecting patient autonomy and utilizing do-not-resuscitate (DNR) orders when available. When no directives exist, clinicians must use clinical judgment to determine the most appropriate course of action aligned with ethical principles.

Conclusion

Managing ethical dilemmas in critical care requires a comprehensive understanding of ethical principles, effective communication skills, and adherence to evidence-based guidelines. In this case of a young woman with advanced cancer experiencing cardiac arrest, respecting her autonomy, understanding her wishes through prior conversations or surrogate input, and balancing beneficence and non-maleficence are essential. The advanced practice nurse plays a pivotal role in guiding ethical decision-making, advocating for the patient, and ensuring care aligns with her values and preferences, within the scope of legal and institutional policies.

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