Advocacy is an important role for nurses, as they are in a unique position to speak up for and protect the well-being of their patients. In this paper, we will explore a patient-care situation in which the registered nurse (RN) should intervene and advocate for the patient. Specifically, we will examine a situation in which a patient has not been given complete informed consent.
The dilemma in this situation is that the patient has not been fully informed about their treatment options, potential risks and benefits, and alternatives. Informed consent is a fundamental ethical principle in healthcare, as it ensures that patients have the necessary information to make autonomous decisions about their healthcare. When patients are not provided with complete and accurate information, their autonomy is compromised, and they may be subjected to treatments that they would not have chosen if properly informed.
The medical facts relevant to this dilemma include the patient’s diagnosis, the proposed treatment, and the potential risks and benefits associated with the treatment. It is important for the RN to have a clear understanding of these facts in order to advocate effectively for the patient. Additionally, the nurse should be aware of any other medical information that may impact the patient’s decision-making process.
Non-medical facts also play a crucial role in this situation. These include the patient’s cultural, religious, social, and economic background, as well as the existence of an Advance Healthcare Directive or any verbal preferences expressed by the patient. Understanding these non-medical facts is essential in order to provide patient-centered care and to advocate for the patient’s values and preferences.
External influences such as organizational policies, federal and state laws, and codes of ethics are also relevant to this situation. These external influences may dictate the processes and requirements for obtaining informed consent. The nurse should be knowledgeable about these influences in order to ensure that the patient’s rights are protected and that ethical standards are upheld.
It is important to distinguish between facts and assumptions when considering the medical and non-medical facts. Assumptions can cloud judgment and may lead to biased decision-making. By separating facts from assumptions, the nurse can ensure that the decision-making process is objective and based on accurate information.
In this situation, there may be items that require clarification. The nurse should identify any facts or information that are unclear or that need further investigation. This may involve consulting with other healthcare professionals, seeking additional information from the patient or their family, or researching relevant literature or guidelines.
Next, the decision makers need to be identified. If the patient is an adult competent to make their own choices, they should be the primary decision maker. However, if the patient lacks decision-making capacity, the nurse must identify who is authorized to make decisions on behalf of the patient. This may involve consulting with the patient’s designated healthcare proxy or legal guardian.
In reviewing the underlying ethical principles, the nurse should consider the principles of beneficence, nonmaleficence, veracity, fidelity, autonomy, and justice. These principles guide ethical decision-making and should be applied to this particular case. Beneficence involves promoting the well-being and best interests of the patient, while nonmaleficence requires avoiding harm. Veracity emphasizes truth-telling, fidelity involves fulfilling obligations and maintaining trust, autonomy entails respecting the patient’s right to make decisions, and justice necessitates fairness and equal treatment.
Defining alternatives is an important step in the decision-making process. One alternative may be to educate the patient about their treatment options, risks, and benefits, and to obtain their informed consent. Another alternative may be to seek a second opinion or consult with a multidisciplinary team to explore other treatment options. The benefits and burdens of each alternative should be carefully considered in order to make an informed decision.
In conclusion, the RN should intervene and advocate for the patient when they have not been given complete informed consent. By following the steps outlined in the bioethical decision-making model, the nurse can effectively navigate this challenging situation and uphold the principles of patient-centered care and ethical practice. It is important for nurses to be knowledgeable about ethical principles, healthcare policies, and legal requirements in order to advocate for their patients and ensure that their rights are protected.
