Nurses Are Often Placed In Situations Where They Are Expecte

Nurses Are Often Placed In Situations Where They Are Expected To Be A

Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals. Marquis, p. 84. You are the evening shift charge nurse of the postanesthesia care unit (PACU). You have just admitted a 32-year-old woman who 2 hours ago was thrown from a Jeep in which she was a passenger. She was rushed to the emergency department and subsequently to surgery, where cranial burr holes were completed and an intracranial monitor was placed. No further cranial exploration was attempted because the patient sustained extensive and massive neurologic damage. She will probably not survive your shift. The plan is to hold her in the PACU for 1 hour and, if she is still alive, transfer her to the intensive care unit (ICU). Shortly after receiving the patient, you are approached by the evening house supervisor, who says that the patient's sister is pleading to be allowed into the PACU. Normally, visitors are not allowed into the PACU when patients are being held there only temporarily, but occasionally exceptions are made. Tonight, the PACU is empty except for this patient. You decide to bend the rules and allow the young woman's sister to come in. The visiting sister is near collapse; it is obvious that she had been the driver of the Jeep. As the visitor continues to speak to the comatose patient, her behavior and words make you begin to wonder if she is indeed the sister. Within 15 minutes, the house supervisor returns and states, "I have made a terrible mistake. The patient's family just arrived, and they say that the visitor we just allowed into the PACU is not a member of the family, but it's the patient's lover. They are very angry and demand that this woman not be allowed to see the patient. You approach the visitor and confront her in a kindly manner regarding the information that you have just received. She looks at you with tears streaming down her face and says, "Yes, it is true. Mary and I have been together for 6 years. Her family disowned her because of it, but we were everything to each other. She has been my life, and I have been hers. Please, please let me stay. I will never see her again. I know the family will not allow me to attend the funeral. I need to say my goodbyes. Please let me stay. It is not fair that they have the legal right to be family when I have been the one to love and care for Mary."

Paper For Above instruction

The scenario presented involves complex ethical dilemmas faced by a nurse in a clinical setting, emphasizing principles of patient confidentiality, family integrity, professional duty, and personal moral values. As the charge nurse in a highly sensitive situation, the decisions made can significantly impact the patient's dignity, family dynamics, and the nurse's moral integrity. This paper analyzes various alternatives available to the nurse, considers relevant ethical frameworks that influence decision-making, and explores potential moral distress that could result from such an ethical conflict.

Initially, the nurse must weigh options that balance respect for patient confidentiality, the rights of the family, and the nurse’s moral convictions. The first alternative involves adhering strictly to hospital policies and denying the visitor entry, citing infection control and privacy concerns. This approach aligns with the principle of nonmaleficence—avoiding harm—by preventing potential disruptions or breaches of privacy. However, refusing entry might deny the visitor a meaningful farewell, raising questions about compassion and the moral obligation to alleviate suffering (Beauchamp & Childress, 2013).

Secondly, the nurse could choose to allow the visitor to remain in the room, recognizing the emotional need to say goodbye, which supports the principle of beneficence—promoting the well-being of the patient and family. This decision reflects a patient-centered care approach, acknowledging the patient's and loved one's emotional needs during end-of-life moments (Leininger, 2018). However, this may conflict with hospital policies and could expose the organization to liability or precedent-setting situations. The nurse must consider whether exceptional circumstances justify bending rules based on compassion and moral intuition.

A third alternative involves consulting with the healthcare team, including physicians, social workers, and ethics committees, to seek guidance and potentially institute a formal exception to visitation policies. Engaging a multidisciplinary team provides a balanced perspective and supports ethical legitimacy for decisions. Ethical frameworks such as principlism—balancing autonomy, beneficence, nonmaleficence, and justice—guide this approach (Beauchamp & Childress, 2013). By involving others, the nurse can also mitigate feelings of moral distress, knowing that the decision has collective ethical grounding and institutional backing.

Furthermore, the nurse might consider advocating for a compromise, such as allowing a brief, supervised visit to say goodbye but with clear boundaries to protect the patient's dignity and hospital policies. This aligns with the virtue ethics perspective, emphasizing compassion and prudence in balancing competing virtues and obligations (Hursthouse, 2013). Such an approach respects the emotional need while adhering to ethical standards and organizational protocols.

Each of these alternatives is influenced by ethical principles but also confronts potential moral distress—an internal conflict arising when a nurse knows the ethically appropriate action but feels constrained from acting accordingly (Corley, 2002). In this context, the nurse might experience distress if forced to deny the visitor, knowing it may cause emotional harm or suffering, especially considering the patient's critical condition and the significance of goodbyes. Conversely, allowing the visit without proper authorization could conflict with institutional policies and legal responsibilities, generating moral distress rooted in perceived compromise of professional standards.

This dilemma underscores how personal values, moral commitments, and institutional policies intersect, influencing decision-making. The nurse’s moral compass—shaped by cultural, personal, and professional values—may advocate for compassion and empathy, prompting a desire to grant the visitor's request. Simultaneously, adherence to policies, legal considerations, and organizational standards could compel the nurse to restrict access, thus creating moral tension.

In conclusion, navigating the ethical complexities in this scenario requires careful deliberation grounded in ethical frameworks and principles. The most balanced approach involves consulting with the healthcare team and ethics committee to decide on allowing a compassionate farewell within institutional guidelines. This process honors the patient's dignity, respects the emotional needs of loved ones, and maintains professional integrity, thereby alleviating potential moral distress for the nurse. Ultimately, fostering open communication, ethical deliberation, and compassionate care are essential in resolving such conflicts effectively and ethically.

References

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