Unfolding Case Study
1.
The highest priority concern at this time is that the patient is requesting to discuss palliative care options. It is important for the nurse to ensure the patient has all the resources she needs to make an informed decision about her medical care.
2.
Autonomy is the most relevant ethical principle to the patient’s current condition. Autonomy refers to the patient’s right to make their own care decisions, and in this case, the patient is advocating for herself to make the decision to pursue palliative care.
3.
There are many reasons why the patient may not want her family to know about her decision to receive palliative care. She may not be close with her children or may not want them to feel sad about her condition, especially since they lost their father in a car accident only a few years ago. Ultimately, because she is of sound mind, she can make this decision for herself, and the nurse should respect her autonomy. However, the nurse could have a conversation with the patient about contacting her children to make sure that’s really what she wants. The nurse must have this conversation in a nonjudgmental way, allowing for the patient’s concerns to be expressed and then following her wishes as expressed.
4.
The nurse has three options: The first option is to leave the situation alone and respect the patient’s wishes to not contact her family. The second option is to go ahead and contact the family since the nurse knows they will want to know about her condition. The third option is to continue to discuss the situation with the patient and hope she changes her mind about contacting her family.
5.
The nurse is obligated to honor the patient’s autonomy, which means that contacting the family without the patient’s consent would be inappropriate. This action would violate boundaries and disregard the patient’s wishes, demonstrating a lack of respect for their autonomy. The nurse should maintain an open dialogue with the patient about contacting her family but should do so in a nonjudgmental way without trying to coerce the patient to do it. If the nurse is unable to have these kinds of conversations without patronizing the patient, it would be best for the nurse to proceed with option one, which is to respect the patient’s wishes and leave the situation as is.
6.
Moral distress in nurses often manifests as physical symptoms including headaches, gastrointestinal upset, and depression. If the nurse’s distress has improved, these symptoms should be improved or resolved altogether. If the nurse is experiencing these symptoms or has feelings of dread or anxiety when caring for the patient, the distress is likely still present. If that is the case, it is important for the nurse to reflect on their feelings and values and actively find ways to resolve the internal distress.