Monday, November 7, 2011

Ethical Dilemma: Forming Biases and Judgments Towards Patients

As I was doing my patient research for one of my patients who had hepatic encephalopathy, I had found my self forming judgment and biases against my patient. I read that EMS had to transport her from her house because her home care aide reported that she had increased confusion. The EMS report stated that they found empty beer cans in her room and she reeked of alcohol. When I read this, I quickly remembered a discussion I had with a classmate about a doctor who told his patient that "She did it to herself". I couldn't help but agree with how the doctor thought. Here is a person who was terribly sick because of years of abusing alcohol, smoking, and doing street drugs. She is in the hospital occupying a bed and using up so much resources, which could have been better allocated to someone whose illness wasn't self-inflicted.

That would have been my thoughts if I wasn't more aware of the determinants of health and other ethical principles such as not judging a person by pure face value. As I have learned from my past clinical experiences, what is said on the chart is not always 100% accurate and there are other vital information that aren't included and can only be known from the patient themselves. It is very easy to fall into the trap of forming hasty generalizations because of a limited information provided to us. I do not know my patient very well but I am sure that there is a reason behind the self-abuse. Although the information was limited, I have noticed that she has bipolar disorder. From the mental health course that I have taken, I have learned that substance abuse is one way for people to self-medicate. Bipolar disorder is a condition in which people go back and forth between periods of a very good or irritable mood and depression. Mental illness is not something that people chose out of their free will and they deserve the help that they need without the negative attitude that some people would have because of the misconception that "they did it to themselves".

Some would argue that they did have a choice to abuse substances, but again as a health professional, our role is to promote health and help a patient to the best of our resources and abilities. Just like a person who smokes, we cannot change them through force, we have to form a partnership and work with them towards mutually set goals when they are willing and more accepting to learn. It is difficult not to form biases, but we have to wear our nursing caps and leave our personal biases out the door.

These are just my thoughts on this subject.

Sunday, November 6, 2011

Thoughts on Dying and Upholding the RN Image

http://www.pbs.org/wgbh/pages/frontline/facing-death/

Watching the Frontline video titled "Facing Death" has brought about questions regarding morality and ethics: How far will you go to sustain the life of someone you love or even your life? Dying is a normal part of the life cycle, but no one wants to die. The program has showcased how modern  medicine can keep a human body functioning for years but the poor quality of life of someone who is on life support sometimes outweighs being alive. Prolonging someone's life could actually be more harm especially if someone is always suffering from excruciating pain or worst, brain dead. But again I always believe that the right to live belongs to everyone, therefore it is also their right to decide what happens to them. This is why I think it is important for everyone to have personal directive, so that one's wishes will be respected during an event that someone loses the ability to choose. The video didn't talk about euthanasia, or assisted death, but this will always be a topic of controversy around end of life care. No one wants to be in excruciating agony, therefore making sure that someone is comfortable during the last hours of their life is important. Again if we look back on the principles of beneficence and non-maleficence, letting people die with dignity and peace seems to be the right thing to do. Also, if treatment will only cause more pain and suffering for a patient with little to no chance of surviving, that treatment plan should be revised or all out discontinued. Morality will always have a grey area and much discussions about this topic should be pursued for improvements in end of life care to occur. I also find it important for a nurse to be aware of the process of grieving (Denial, Anger, Bargaining, Depression, and Acceptance) so that a nurse can find the right timing to talk about options left for the patient.

For the journal that I have read regarding the impressions we leave, I find it important for nurses to always be professional with their interactions with their patients. This is especially true for registered nurses as they now have to prove their contribution to health care as licensed practical nurses are able to do what they do and are paid significantly less. Registered nurses should always let their patients know that they are registered nurses, and by informing their patient's this, nurses should definitely need to leave a good impression. As I have seen in clinical, socializing and chatting at the nursing station should be only done when one has made sure that absolutely everything is done for the patient and that one actually spent time to know the patient so that one will have the necessary information to plan competent and compassionate care. Excellent communication skill is really highlighted as this determines the majority of the patient's first impression for the nurse.
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