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    Ethical Issues in Nursing Practice

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    1. In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.

    The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.

    The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).

    1. What, if anything, did the nurse do wrong?

    2. Had she moved beyond her scope of practice?

    3. Could the nurse's conduct be justified under the patient advocate portion of her role?

    4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?

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    2. For each of the following, state whether you think the disclosure of information was appropriate. Defend your position.

    1. A young woman, who states she has just been raped, comes into the emergency room requesting a pelvic examination and a morning-after pill, but she insists that the staff not call the police. The staff reports the incident.

    2. A young woman brings her child into the emergency room for an arm injury. The family has brought the child in several times as of late for similar injuries with the excuse that the child is somewhat clumsy and is having difficulty learning to ride her bike. The child shows no fear of the parent, and upon questioning, she confirms the parent's version of the events. The staff reports the injury as a possible child abuse case.

    3. You are a medical records technician and are in the department when two men come in and flash badges indicating that they are from the FBI and need to see the Hiram Jones record as a matter of national security. You cooperate and allow them access to the files.

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    Solution Preview

    1. What, if anything, did the nurse educator do wrong? Well, this is a debatable issue, isn't it? First of all, she did not initiate the discussion of alternative therapies. The patient did that. Therefore, who is truly responsible? In my opinion, the patient is responsible. Who is responsible for your life? Do you want a physician to be responsible for your life? Do you want to hand over responsibility to someone else for those things that you should be responsible for in your life?

    The patient made a few mistakes. First of all, she never should have listened to her son in the first place. She needed to make the decision on her own with input from her son. There's a difference there. Second, she should never have listened to the physician in the first place when the physician told her that chemo was the only treatment ...

    Solution Summary

    I provide sound practical explanations for these important questions that arise in practical nursing experience. These kinds of things do happen and it is important for our nurses to have thought through the ramifications before they take place. It is easier to act properly when you have already thought through a situation. When we panic, we tend to make the wrong decision.

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