The value dilemma that exists in the case study is whether the nurses involved in the care for Kevin should follow Steve’s advice that his father does not deserve care and that he needs to be taken to residential care. This is contrary to the fact that Kevin is reluctant to seek residential care because he believes that somebody might have the intention of causing harm to him.
Another value dilemma in the case analysis is whether nurses should work in accordance with the advice they receive from patients and their relatives. In the case study, nurses who take care of Kevin are constantly faced with the dilemma of whether to make their own decisions in taking care of Kevin or seek the advice of his wife Judith or his son, Steve. There is also the value dilemma whether the nurses should comply with the interests of Kevin who recommends that he should not be taken to residential care because he does not know who will be waiting to cause harm to him.
There is the value dilemma whether Steve should not be involved in the care for Kevin, yet he is a son of the family and his support is important in promoting the treatment of Kevin. There is a value dilemma whether Steve should undertake his individual activities while his father does not get the support from his family the way it would be expected simply because Steve believes that the tyrannical nature of his father does not warrant him to be taken care of at the healthcare facility.
A value dilemma exists on the case study in the form of lack of equity in government-funded healthcare services since the local residents do not benefit much compared with those who live outside their region. Judith complains that in spite of the existence of government sponsored healthcare programs, she has been forced to use Kevin’s personal savings to finance his medical needs.
How The Dilemmas would be approached
The above dilemmas can be addressed in terms of the following value principles in healthcare practice;
o Respect for the professional Roles of Nurses
Ethics in nursing practice requires that nurses must discharge their duties in accordance with the professional training they have undergone and the corresponding skills they have acquired. Nurses are professionally accountable for the tasks they perform in the provision of healthcare services to patients (Harris 2015, p. 120). In the case study, nurses involved in the provision of care to Kevin and professionally responsible for any health implications of his current treatment procedures by ensuring he gets quality healthcare for his dementia condition. Members of the nursing team have the right to implement their skills and competences in making decisions regarding the treatment that a patient should undergo. Failure to follow this guideline or an attempt to listen to influences from outside constitutes a violation of professional code of conduct and such a nurse is subject to legal action (Busquets and Caïs 2017, p. 430). Consequently, nurses at the facility should decline to follow Steve’s advice that the patient should be taken home to receive residential healthcare service. Furthermore, it is an ethical requirement that nurses must be willing to exercise conscientious objections to requests that are not within their codes of conduct. If the person making a suggestion is likely to recommend a wrong act, nurses have the right to object to their suggestions and inform them about the decision.
o Greater Involvement of Close Family members in the Care for a patient
There is greater value in family members to be involved in the care for one of them even if they are not in better relationships. The family members have the understanding of the weaknesses of one of them and they are able to provide supportive environment which ensures a patient feels comfortable while undergoing treatment or medical procedure (Mishra 2015, p. 414). The management of the health challenge that Kevin Underwent required an active participation of both his wife, Judith and his son, Steve. Their participation could contribute to improved psychological support and prevent the likelihood of loneliness as well as his ability to get other physical needs that only his family can provide. Furthermore, the act of involvement ensures the sick person gets company and provides a reminiscence of home environment which in turn eliminates fear of being in a healthcare facility. In the case study, it was the role of Steve to constantly visit his father at the facility where he was admitted even if he had a busy schedule of activities to undertake.
o Equity of Access to healthcare Services
The provision of healthcare services to patients needs to be equitable with greater emphasis on being beneficial to residents of a particular location. The funding of healthcare services by the government should be prioritized in such a manner that the local residents are enabled to access them more easily that people from other regions (Susiloet al.2013, p. 415). It is recommended that the complaint made by Judith that her husband has not benefited from government funding of healthcare services, should be addressed in the future by ensuring the local residents are able to benefit from them as means of reducing healthcare costs while addressing the rights of the local citizens.
o Respecting the Dignity of the Patient
Nursing practice requires that a patient should be treated with dignity and that any healthcare procedure that a patient undergoes should be according to his approval or interest (Khosravan et al. 2014, p. 12). For instance, nurses are required to promote confidentiality in addressing the needs of patients by ensuring non-disclosure of his health status or challenges to people who are not subject to the case of Kevin. Since Kevin has a sound mind, he may consent to particular healthcare procedures while may reject others. Nurses must observe his right of consent by acting according to his interest as an adult who has the ability to make decisions regarding the treatment he should undergo. According to Bivins, Tierney and Seers (2017, p.20), the nurses must also give him accurate information about his health so that he can make decisions about the procedures he would prefer to undergo to achieve health improvement from his current health condition. However, relatives and people who are closer to him can be given the opportunity to make decisions regarding the procedures that are recommended if his mental status does not enable him to make sound decisions.
Ethical Dilemmas in the Case
The ethical dilemma associated with the case study is whether Steve should insult a nurse who is taking care of Kevin because she has not complied with his view that his father does not deserve to be taken care of at the healthcare facility. As a client to the nursing organization in which his father is admitted, there is ethical concern whether he should impose his personal opinions on the strategy of caring for the patient.
There is an ethical concern pertaining to the revelation that Kevin had suffered cigarette burns when he was admitted to the nursing care facility. While he is sick due to dementia and Schizophrenia, there is the likelihood that he has been subject of abuse by his family members who have burned parts of his body using cigarette ash. As a person who tries to bring her family together, Jane encounters the ethical dilemma whether she should disclose the contributing factors to her husband’s wounds or ignore the inquiry. This case also presents and ethical dilemma to Jane and Teresa whether they should inform the authorities about the physical abuse that Kevin has undergone due to the brutality of his wife and son.
There is an ethical dilemma whether Judith should continue using alcohol and other drugs that contribute to increased disagreement with her husband and promote division in her family or whether she should abandon them and focus on the care for Kevin. Judith also faces the ethical dilemma whether she should disclose to the nurses whether alcohol consumption has been the major contributing factor to disagreements and divisions in her family.
How the Ethical Dilemmas would be addressed
o The need to act with Sympathy, Empathy, and Compassion
Ethics in healthcare practice requires that nurses and relatives of a patient must act selflessly towards the management of an illness affecting him. The ethics of empathy requires that caregivers must put themselves in the situation of the patient and try to resolve the health issue in order to restore his health (Sinclair et al. 2017, p. 444). Compassion in healthcare practice requires that nurses should act in accordance with the value, interests and needs of the person who is provided with the healthcare services. The ethics of acting with sympathy enables nurses to develop emotional attachment to the changes experienced by the patient so that they can contribute towards the alleviation of the suffering. The nurses responsible for the care of Kevin should be available at any time when their participation is required because it ensures an emergency situation is addressed on time. Similarly, Judith and Steve should be responsive whenever Kevin needs their attention because they are his closest relatives who understand his concerns, likes, and dislikes while also able to provide him with physical and psychological support. Ethics of compassionate care recommends that a nurse should set aside personal commitment and interests in order to provide services to the needs of a patient adequately (Jonasson 2011, p. 18). Similarly, Steve and Judith should show compassion by abandoning their personal interests and commitments by visiting Kevin regularly and providing him with physical and psychological support.
o Documenting Incidences of Physical Abuse
Ethics in nursing practice requires that nurses must document any instance of physical abuse on a patient and report to the relevant authorities so that the perpetrators of the abuse can be held accountable (Post et al. 2014, p. 873). Nurses have the responsibility to act as advocates to patients who are subjected to physical and psychological abuse as well as protecting them from further abuse. In the case of Kevin, the discovery of the fact that he had sustained physical injuries caused by cigarette burns implies that his family members were responsible for his abuse. Nurses have the duty to report physical battering he underwent at his home as well as the exploitation by his wife. A nurse is required to create a document of these evidences and present them to court as well as state the people who are likely to be responsible for committing the abuse.
Ethics in nursing practice requires that nurses must provide physical care to victims of domestic violence by cleaning their wounds in emergency rooms and applying dressing. The patient should also undergo immediate repair of the affected tissues and nursing care should be provided during recovery period (Piltz and Wachtel 2009, p. 93). Nurse must also educate victims of abuse to undertake self-management if the injuries are more likely to take longer duration to health. Emotional support can be provided by an empathetic nurse by ensuring the experiences of the patient are understood. The nurses involved in the care for Kevin must respond to any physical care needs he requests or any difficulty he encounters. They must be willing to act as his confidant whenever he needs assistance (Skarsaune and Bondas 2015, p. 24). Since Kevin is the husband in his house, he may be ashamed to report a physical abuse. Nurses at the facility where he is admitted should be willing to provide an opportunity for sharing his experiences as well as suggesting his referral to a counseling professional.
o Acting with Non maleficence and beneficence
According to Albina (2016, p. 74), ethics of beneficence recommends that nurses and family members of a patient should act with the objective of promoting benefits while minimizing harm or act with the objective of improving a situation. Consequently, nurses involved in the care for Kevin must refrain from causing further harm to him (Punjani et al. 2014, p. 29). Nurses must assess the tasks they perform to determine the benefits and risks of their actions so that measures are put in place to reduce the risks. For instance, care needs to be taken to ensure no further physical harm is inflicted on Kevin.
The ethical dilemma in the case study can also be addressed by applying the ethics of non-maleficence which states that actions performed in nursing should not constitute the intention to cause harm to a patient (Pilon 2015, p. 26). The healthcare procedures that a patient undergoes should not constitute aspects of malice. Consequently, both nurses and Kevin’s family members must not provide intervention measures with the objective of causing harm to him. During the provision of physical and psychological support to him, there should be no intention of causing additional harm. For instance, his wife needs to avoid providing him with services under the influence of alcohol because she is likely to act without conscience, thus increasing the likelihood of maleficence. Nurses and Kevin’s family members must understand the risks of treatment he undergoes in light of the likely benefits.
o Being Accountable to the Patient and the community
Ethics in nursing practice requires that nurses must be accountable to a patient as well as the community in which they are assigned (King 2017, p. 550). Similarly, it is an ethical requirement that family members must be accountable to one of them in times of need. Nurses in the case study such as Teresa and Jane have the duty to respond to the health needs of Kevin because it is their professional obligation. Judith and Steve are accountable for the provision of physical and psychological support to Kevin and ignoring their interest and commitments when their participation is required.
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