Ethical Decision Making In Nursing Scholarly Nursing Essay

Ethical Decision Making In Nursing Scholarly Nursing Essay Nurses are constantly confronting various ethical issues in their everyday clinical practice. An ethical dilemma is complex situation emerging from the conflict between moral obligations in which complying with one would result in contravening another (College of Nurses of Ontario [CNO], 2009). Nurses using CNOs ethical conducts and decision-making framework will help in directing their ethical course of action. This framework involves the use of moral component such as claim, evidence, warrant, basis, rebuttal and ethical decision to guide in resolving the conflict (Arnold Boggs, 2011). Thus, the aim of this paper is to use ethical decision-making framework step by step in exploring an ethical issue by analyzing a pediatric case study to make significant decisions. Claim is the first moral component of the framework. It emphasizes on various dilemmas arising from the case study such as pediatric advance directive, consent to treatment by being competent minor and decision-making capacity. The ethical dilemma arises from this case study is whether to choose wishes of adolescent patient considering his treatment or should the wishes of his parents outweigh his request. The case study describes Kyle 14 years old male who has stake in outcome of the decision, and suffering from lymphocytic leukemia cancer. The case study involves Kyle as patient with physicians and his parents to determine the care in best interest of patient. The involved Physicians in care stated Kyles health is deteriorating and not responding to the chemotherapy treatment. Hence, the value of Kyles parents is to continue with the chemotherapy treatment in hope to work and prolong his life. However, Kyle having different point of view, refused to take any heroic measure and aske d for DNR order to be placed in his chart. This way, his parents value would be violated if nurse chooses to accept the decision of Kyle. According to article by Tabak and zvi (2008), patient being mature minor competent has right to refuse treatment and is allowed to choose decisions regarding all the aspects of his treatment. Hence, nurse is caught in conflict between parents and Kyle. Thus, Kyle being in client center care, whichever decision nurse chooses from patient and parents will impact the Kyles care. The evidence is next moral component of the framework. According to the scenario, physician sharing information with patient about the health status shows their mutual trust in relationship. This relationship indicates Kyles right to know as being cognitively capable to understand pros and cons of the treatment and participate in the discussion. According to Tabak and zvi (2009), the norm of informed consent is that patient has right to know truthful information about his health status from health care professionals to make informed decisions. From the case study another evidence indicates, Kyle being cognitively mature adolescent with a chronic illness (at the age of 5), knowledge to make informed decisions (DNR) and, experienced with treatments (several dose of chemotherapy). According to the article by Tabak and Zvi (2008), if the adolescent being minor is coping with long term and life threatening situation then patient is cognitively aware of the nature of the illness and has ri ght to give consent. With this fact, his parents are seizing over his autonomy by denying his choices or capacity to make decisions. According to the article by Rogers, Alex, Macdoland, Gallant and Austin (2009), states that allowing children to express and offering choices escalates their quality of life and dignity. In this case, parents emotional grief for child may prevent them understanding childs moral value or quality of life. It seems parents attachment with child making them not to understand childs perception of suffering from medications and wishes to extend his life even if it has to do with holding on to the hope of future medication to work (Macgrawth Phillip, 2008). As a result, parents are going against standards and not performing critical thinking. The evidences found in the case study are true, relevant to make decision, but lacks in sufficiency due to having inadequate in-depth reasoning behind klyes decisions. Warrant is another part of the framework. It requires using professional standard of care, and legal precedents and policies. If I were a nurse confronting ethical dilemma conflict between patient and parents decision over treatment, I would critically examine choices using professional standards. First thing I will take childs age into consideration for informed consent. As stated in pediatric Cancer Society (CPS) (2008), in Ontario there is no age of consent. However, there is mature minor right where patient not being adult in age, but cognitively able are allowed to consider the treatment choices and alternatives based on the evaluation of consequences. This explains Kyle being only 14 years old is able to give consent of refusing treatment, which is on his best interest along with knowing his nature of treatment. As well as, according to CPS (2008), when benefit of the treatment overweighs burden it should be respected. Similarly, Kyles choosing to preserve his quality of life o verweighs the option of treatment associated with pain and suffering which should be respected. Moreover, according to CNA (2008) code of ethics, under promoting and respecting informed decision-making, nurses have right to advocate for the patient if his/her rights are being influences by others decisions. In this case, by abiding this code, I would recognize the kyles right and support his capability to withdraw or withhold the consent for treatment regardless of his parents request. Furthermore, according the CNOs (2009) practice standard ethics clients well-being and client choice are relevant ethical values for nurse when parents and patients view are differentiated in what is beneficial. I as a nurse without judging would evaluate, respect and determine the rationale for the chosen option by parents and patient in terms of benefit vs. risk to assist in making decision. By abiding professional standards and policies will help me as a nurse to have evidence based rationale to de liver ethical clinical care to Kyle. Basis is the next component in the framework involves ethical principles. In this scenario, autonomy, beneficence, and veracity are ethical principles used as guide to analyze ethical issue (Arnold Boggs, 2011). Autonomy refers to patients right to make informed decision about his/her medical care without having anyones influence on it. In this case, parents desired decision takes over Kyles autonomy by contradicting his decision-making capacity (being minor) regarding his treatment and DNR options. Hence, allowing Kyle to make informed decision by allowing him to express his preference, concerns, and wishes would respect his autonomy and will preserve his dignity (Whitty-Rogers et al., 2009). Another principle, beneficence requires to prevent harm to others. In this scenario, kyles going through chemotherapy treatment shows no improvement (beneficences), yet him going through this process for prolong life will increase his pain and suffering. From parental perception, treatment hel ping to prolong lifetime indicates harm in hope of beneficences. For parents, treatment adding to survival period over side effects would appear as convenient option to accept (Mcgrath Phillip, 2008). Last ethical principle veracity refers to responsibility of telling truth. In this case scenario physician or HCP has provided truthful information to patient and family regarding health status and effectiveness of treatment. Hence, there is no other information hidden from patient to help making informed decision. Hence, it is significance for nurse to continue using this principle to support and oppose argument made by each person to solve the conflict. In addition, rebuttal is another component of framework. It focuses on costs and benefits of each choices. The benefit of the choice made by Kyle will alleviate his suffering by refusing the unresponsive treatment and DNR, which will increase his quality of life. It will strengthen the trust in nurse-patient relationship. On the other hand the risk associated with Kyles choice shortens the quantity of life due to having no treatment and DNR actions to rescue his life. Another harm associated is that it would hinder the relationship between parents-patient and nurse-family due to opposing their request. Furthermore, the benefits associated with parental choices of continuing treatment will prolong their and Kyles time of togetherness. As well as, risk associated with parents choice will escalate the pain and suffering of patient by reducing the quality of life. This violates the ethical principle of choosing non-maleficence for the hope of beneficence and reducing patients autonomy an d dignity. As denying parents preference can hinder trusting nurse-patient relationship. Especially when trust, respect and honesty are essential to meet the health care needs of patient and in facilitating end of life care decision making (RNAO, 2006). Although, alternatives could be arranging meeting with parents and patient will help to understand each others perception, as well as allowing to accommodate/negotiate any choices to reach mutual decision. This way parents might be able to see the suffering and pain that treatment brings for child in order to prolong time. Also, Kyle would be able to understand emotional side of parents where his life is more valuable and beneficial over side effect of the treatment. As a result, palliative care could be an alternative option in progressive illness to ease quality of life with quantity of life. Palliative care can benefit in relieving the suffering in holistic way of patients life. For example, chemotherapy being used can have medica tions to relieve side effects of nausea to minimize the suffering (Mcgrath phillip, 2008). As well as, choosing to continue with the unresponsive chemotherapy treatment (side effects) with palliative care may limit the patients quality of life. At last, a nurse being reasonably prudent and ethical should apply moral principles in decision-making. The primary object of the nurse would be to identify ethical issue. The ethical issue in this case study is adolescents treatment decision conflicts with parents decision in determining authority for decision-making. Then nurse will evaluate the evident data to obtain all the relevant and sufficient information. Moreover, nurse should have understanding of CNA, CNOs code of ethics, and RNAO BPGs to have knowledge regarding law, legal action and to have evidence-based rationale in guiding the decision-making process. Nurse would evaluate the claim by recognizing moral reasoning in each persons perspective. According to CNA (2008) values, under client wellbeing and choices, nurse should respect family and patients opinion. Nurse should make parents acknowledge about the adolescents right in making decision. If patient is mature minor and competent to make informed decision then nurse should advocate for patient even if its opposes parental request. Last but not least, nurse should weigh risk and benefits of each persons choices in terms of possible long terms and short-term consequences. Hence, nurse can offer alternative options by collaborating with other HCP if necessary to balance and develop mutual goal between HCP, patient and parents. In conclusion, to achieve resolution in ethical dilemma involves critical thinking. This paper has analyzed an ethical dilemma in determining whether is it Kyle or parents, who has authority to take decision regarding treatment. It evaluated others factors such as pediatric age consent, and being cognitively competent to understand the consequences that could influence the decision-making. Paper also included three nursing journal to support the evidence, professional standards, and ethical principles to direct decision-making. At last, being ethical nurse, to determine decision in patients best interest, possible consequences from the choices were outweighed in terms of risk and benefits. Thus, the use of decision making framework facilitated in deciding what is morally and ethically acceptable in patients best interest while facing ethical dilemma. Kyle is a 14 year old male diagnosed with acute lymphocytic leukemia at age 5. He has endured multiple relapses requiring several rounds of chemotherapy with short periods of remission. He has been readmitted to the paediatric oncology unit after metastases to his lungs and brain have been found. During a family meeting to discuss treatment options, Kyles attending physician explains that the cancer is rapidly progressing and unresponsive to treatment. Kyle feels that he has endured enough and does not want any further heroic measures and has asked that a DNR (do not resuscitate order) be placed in his chart. Kyles parents do not agree with this course of action and are holding onto to hope that more treatment may prolong his life.

The Thing in the Forrest

Sometimes in life when we have an experience that deeply affects us, it can change our whole perspective. The story â€Å"The Thing in the forest† is a example of how this can happen. The two main characters Penny and Primrose meet when they are children and share a horrific experience in the forest. Then by chance meet back at the scene and briefly reassure one another that what happened really did happen. But their contact ends there once again almost as if seeing each other was too uncomfortable. Then oddly enough both women end up going back to the forest looking for some kind of resolve. In â€Å"The Thing in the Forest† the two little girls encounter a terrifying creature that profoundly affects their sense of reality; this results in similar personal traits and shared sense of searching for what’s real despite that they never talk of it. When the two girls meet not much is given about their characters, however throughout the story we find that the two ladies have quite a few things in common. This is due to their experience in the forest that they shared so long ago. Some of the similarities are within their character and some are sheer coincidence. Neither woman has married probably because of their disrupted childhood when they were exiled from their families and sent to live in the â€Å"great house† by the woods until it was safe again at home (Byatt). This is when Penny and Primrose decide to go into the woods and are followed by a younger girl who is never seen again. The girls encounter a creature that smelled of â€Å"liquid putrefaction† and looked like a mixture of â€Å"rank meat and decaying vegetation† (Byatt). The wake of the creature leaves â€Å"a trail of bloody slime and dead vegetation† in which the younger girl disappears (Byatt). Then the very next day the girls are placed with temporary families. Once home again both girls fathers die in accidents. Penny’s father died in a firefighting accident and Primroses was a causality of the war as he was soldier. The experience of being exiled, their fathers sudden deaths and and seeing this terrifying creature that possibly killed the younger girl has hanged their sense of what is real, I’m sure the concept of love and relationship is very easily questioned for the both of them. Both women also have chosen jobs that work with children; Penny becomes a child psychologist dealing mostly dealing in the dreams of children and Primrose among her other odd jobs becomes a children’s story time teller at the local mall. Both women are embroiled with children and their minds just on different ends of the spectrum. One lis tens and one tells. When Penny and Primrose meet by quirk of fate back at the â€Å"great house†, that has now been given to the nation and made in to a museum, they are taken aback by the unplanned visit. They become aware of each other while reading a description of a story in a book about a fabled worm like creature that supposedly lurked in the woods near by. The alarm of the story and the by chance meeting of the two women while simultaneously reading its historic description jolts the two. They feel as if they would have never recognized each other if it weren’t for the given situation. They reassure each other that they both really did see the creature that it is real. The women remark on how strange it is that the children’s presence during the exile is not depicted anywhere in the history of the house. This lack of mention about the children in exile ever being in the house reaffirms some of the question of what is real in the two women’s minds. They decide on having some tea and reminisce a little more about the time they spent in exile, on the train, in the â€Å"great house†, brief tidbits of their life and the younger girl named Alys who had disappeared. It did finish her off, that little one, didn’t it? † â€Å"I wonder if we’d made her up,† said Primrose. â€Å"Nobody ever asked where she was or looked for her,† said Penny (Byatt). The women are slightly relived at their agreement because this gives them the assurance they need not to feel as if they made the whole thing up. The assumed death of the you nger girl could be said to mirror the psychological death of Penny and Primrose, and this reassurance helps them feel as if they can finally move on. This brief conversation between the two is the last contact they will have with each other. The women both decide not to honor the dinner date they planed, I believe at this point the Penny and Primrose feel any further contact with each other is unbearable because of the underlying memories of any supplementary conversation. Yet they are still searching for what is real within them selves. Searching to the extent that both women are drawn back in to the woods and for the same reason. Primrose goes to the woods with purpose; she even follows the same path from years ago. Primrose had really been in a magic forest. She knew that the forest was a source of terror† (Byatt). While in the forest she questions what is real in her life, her home and how her mother disclosed that her father had been killed. She resolves that the forest and what happened in it to be truly real. In all of her thinking she decides she is satisfied and in turn wants to go home. The way Primrose views this experience and the woods around her in a story like fashion is very telling about why she deals in storytelling for a job. It all comes from the same place and this is why she has always careful not to scare the children she reads to. Penny on the other hand ends up in the forest even after purposely walking in the opposite direction of their original path. She is very perceptive of her surroundings in a different way than Primrose, who feels the need to almost coach herself along in a story like fashion, whereas Penny was looking for signs of the creature. She looked for all things that would be concrete evidence of the creature. It was the encounter with the thing that led her to deal professionally in dreams. Something that resembled unreality that had lumbered into reality, and she had seen it† (Byatt). Penny believed she could feel the creature and decided that it chose to recede back into the forest. She also spent some time thinking of her own father and how when he died her mother became a recluse, seeing this reaction scared her emotionally. This is the reason she threw herself in to study and possibly never married. At the end of it all this women still do not converse or sit with one another when taking the same train home. They just share an acknowledgeable stare at the train station then go their separate ways. Primrose goes home and back to work but with a new confidence, she decides to tell the story of â€Å"The Thing in the Forest† she is no longer afraid. Penny goes back to the woods with the conviction that she needs this, for this creature to come to her because it has become the most real thing she can recognize. â€Å"She was ready† and waiting for it (Byatt). Despite how different these women are, they are one in the same. Penny and Primrose shared something awful that forever changed them in very similar ways. They also shared separate experiences in the same forest and came to the same realizations that the creature is real and it had affected their person emotionally and steered their paths throughout life. It is apparent to me that that these similarities the women share cannot be a coincidence but are a direct result of that horrifying day they saw â€Å"The Thing in the Forest†.

Brief Article Teaches You the Ins and Outs of Argumentative Essay Topics on Education and What You Should Do Today

Brief Article Teaches You the Ins and Outs of Argumentative Essay Topics on Education and What You Should Do Today The Lost Secret of Argumentative Essay Topics on Education You will discover a range of argumentative essay topics but picking the perfect one might be the basic and the very first step to compose an influential essay. You have to have skills to compose a very good essay. You should communicate a comprehensive analysis as you compose the essay and not simply giving a very simple description. The ideas provided above are extremely different. An outline is a significant part of essay writing. When writing a crucial composition, it's a good idea to pick contradictive topics. Normally, it doesn't include references and quotes in it. Corruption topics aren't only common among essay writersthey're likewise an important subject for speeches. Utilizing archaic words isn't permitted. If you're clueless as to the best way to begin an essay or whether you need suggestions regarding topics, our sample essay education can be of some assistance to you. Education is an extensive subject and there might be hundreds of such topics that students may choose for an essay in education. If so, Harvard format is the thing to do. All About Argumentative Essay Topics on Education If you choose to compose an essay on political corruption, you need to know its definition. Political issues are the ideal example. Political corruption is a severe problem that has to be solved. In a few words, it refers to practices used by government officials to take advantage of their power for personal gain. Argumentative Essay Topics on Education: the Ultimate Convenience! When it has to do with writing an argumentative essay, the most crucial point to do is to select a topic and an argument you may really get behind. It's simple to miss something important and earn a mess of your topic . The topic has to be interesting, the topic has to be essential and finally the topic has to be informative. Quite frequently, the ideal topic is one which you truly care about, but you also will need to get well prepared to research it. Finding a topic all on your own is quite mind-torturing. A student should realize that the topic isn't self-explanatory. Last, you most likely want to choose a topic that's interesting to you and that you care about. You will likely find a different and fantastic topic you will love to write about. Our parents always say that in the event you desire to delight in a stable and happy life, you definitely have to get educated. Education is among the significant foundations of the society which promotes realization of financial objectives and at precisely the same time making certain that different individuals wind up living better lives. Indeed, it is regarded as a rope that carries a person to greatness. In some countries with different races, it is provided in a manner which is unequal. Some people don't believe in the thought of mandatory music education classes. Don't forget that politics can be challenging for many individuals to comprehend. Individuals who are living in poverty stricken nations can prosper if they had the chance to learn, so don't waste your time every chance you become. They need education so that they can be provided with valuable tools and skills to aid them better provide for themselves and for their loved ones. Education should relate to the outside Earth, and technology is a vital portion of it. The education process is fluid. Positive Impact though technology has many negative consequences on teenagers and youth, it's been helpful in a variety of ways. The effect of morals from technology also features an impact on other factors like physical and societal facets of a young adolescent's life. Argumentative Essay Topics on Education - What Is It? You ought to pick a topic that you agree with and the one which fulfills your preferences. Topics might be associated with the array of contradictory issues which depend on the topic and field of interest. You may pick one of them or search for different topics on the net. Contradictive Your topic should stir a selection of opinions among the general public.

The Shape Of A Girl Essay - 1608 Words

Being on the verge of adulthood and having just left the simplicity of childhood, teenagers have always been particularly complex and enigmatic individuals. While most people struggle to see things from an adolescent perspective, Canadian playwright Joan MacLeod is well-known for her accurate portrayal of teenagers. In 2002, she published The Shape of a Girl, a play related to the dramatic story of a young girl named Reena Virk who was tragically affected by bullying, a characteristic behavior of adolescent development. Throughout The Shape of a Girl, MacLeod effectively exploits the Aristotelian dramatic elements and she uses Reena Virk’s story as well as the thoughts that it produces in the antagonist’s mind to portray both adolescent character traits and behavioral patterns. First of all, with the use of plot and character as dramatic elements, MacLeod is able to depict the main characteristics of the nature of adolescence, mainly the search for identity and the quest for independence. Among the scientific community, adolescence is believed to be the most crucial period in human development. It is a period of â€Å"rapid biological, social and psychological change† (Soto, et al. 330). There are the transformations that define puberty, there are changes in the relationships and attitudes towards adults and peers, and many teenagers struggle to form a coherent identity (331). In the process of discovering their identities, most adolescents become self-centered. Having not yetShow MoreRelatedThe Disney Princess Phenomenon And How It Shapes A Young Girls1757 Words   |  8 Pageslines, multiple resorts, over five hundred films, and over thirty academy award, it’s hard to not heard of Disney. Every boy or girl has at least seen or heard of Dis ney movies. 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