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Definition of the Dilemma

An example of a patient care situation where a nurse can intervene and advocate for a patient is when the patient’s right to autonomy and informed consent is being violated. A patient has a right to make decisions concerning his/her healthcare based on the ethical principle of autonomy. The nurse can advocate by ensuring the patient’s wishes are respected at all times and communicating these wishes to other parties involved in the care of the patient such as the physician or the patient’s family (Davoodvand, Abbaszadeh, & Ahmadi, 2016). The patient’s right can be at stake when it is not in line with the views of the physician or when some family members disagree with the choices made by the patient. In this scenario, the patient was to undergo a blood transfusion but was not willing to give his consent due to his religious beliefs. The nurse was left in a dilemma on whether to go ahead with the procedure or to respect the patient’s right to autonomy. The nurse had to act as the patient's advocate by taking time to explain the benefits and risks involved with the procedure. The nurse, through the information provided, was able to convince the patient to undergo blood transfusion and this saved the patient's life.

Medical Facts Relevant to the Dilemma

The medical facts that relate to this dilemma include patient autonomy and the duty of the nurse to ensure patient safety. Diagnosis and prognosis are also medical facts. Facts are important because they prevent the nurses from basing their decisions on assumptions only. The elements of informed consent are that the patient should have the mental capacity to make sound decisions, the nurse should disclose all necessary information regarding the procedure in question to the patient, the consent should be given voluntarily and the process should be well-documented. Medical care should not begin before a patient gives their informed consent. Some of the common assumptions that relate to this dilemma are

Non-medical facts Relevant to the Dilemma

The non-medical facts that relate to this dilemma include cultural and religious influences. The patient was not willing to undergo a blood transfusion because he belonged to the Jehovah's Witness denomination which was against the procedure. These facts often result in medical dilemmas because they conflict with some nursing principles.

External Influences

There are external influences that can have an impact on the nurse's role as a patient advocate. Such influences include organizational policies and practice acts such as workload. Administrators need to understand that nurses have a unique role in advocating for patients apart from caring for them. They should, therefore, provide adequate staffing levels and create an environment that allows nurses to fully care and advocate for patients (Pecanac, & Schwarze, 2018). In case the administrators seem not to comprehend this, the nurses have an advocacy duty to enlighten them. The issue of informed consent requires nurses to have enough time to follow up on relevant paperwork and ensure it is completed before scheduled tests or treatment procedures. In the above-mentioned scenario, the nurse had to spend a lot of time educating the patient on the benefits of undergoing blood transfusion, and finally, the patient gave his informed consent.

Items that Require Clarification

There are grey areas in the issue of informed consent that need clarification. These are the areas that lead to ethical dilemmas. Sometimes, the decision made by the patient may put their health at risk. In this case, the nurse should step in to help the patient make a decision that will benefit their health and not worsen the situation.

Key Decision-Makers

The decision-makers in this scenario are the patient, his family, the physician, and relevant legislative bodies. The patient is the key decision-maker because they have the final say to the treatment procedure that they should undergo. The physicians and nurses can only make recommendations but the final word lies with the patient. In the scenario provided, the blood transfusion could not take place until the patient gave his informed consent. The nurse only acted as the patient's advocate by disclosing necessary information to the patient to enable him to make an informed decision.

Underlying Ethical Principles

The underlying ethical principles that are applicable in this case are patient autonomy and beneficence. Strong advocacy strategies are founded on ethical principles. The advocacy should be done in a way that adheres to the ethical standards set for nursing. According to the ANA Code of Ethics, nurses need to promote “respect for autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity,” putting the patient’s needs before their own. The nurse in this case respected the autonomy of the patient by not going ahead with the procedure without the consent of the patient. The nurse also applied the concept of beneficence during advocacy by putting the safety of the patient first and ensuring the patient understood the benefits of undergoing blood transfusion.

Alternatives and Follow-Up

In some instances, the ability of nurses to advocate for patients becomes compromised due to several factors. Factors such as patient load and nursing burnout can place too much pressure on the nurses thus giving them limited time to take care of the needs of the patient. It is important that healthcare organizations put this into consideration when planning for nursing staffing and other organizational policies to ensure the nurses have optimum time to care and advocate for patients.

Discussion

Nurses should speak up on behalf of patients and represent the best interests of the patient at all times. This obligation is not optional and it is provided for in the ANA code of ethics which states that "The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” The advocacy process involves evaluating the needs of the patient, identifying the specific patient goals, setting an advocacy plan to ensure that those goals are met, and assessing the results of the advocacy. The Healthcare industry is growing and becoming more complex. Nurses have to help patients navigate this complexity using their refined skills. Patients have the right to know the name of the condition that they are suffering from along with available treatment procedures and the one that the healthcare provider recommends. At this point, the patient can consent to the recommended procedure or request for more information. The nurse should provide information regarding the risks and benefits involved with the procedures as well as the risks and benefits of not getting any procedure. After this, the patient gets to decide which option they would prefer and the nurse goes ahead with it. The patient then signs an informed consent form.

REFERENCES

Kalaitzidis, E., & Jewell, P. (2020). The concept of advocacy in nursing: a critical analysis. The health care manager, 39(2), 77-84.