A forty-nine-year-old lady had been admitted for investigation of indigestion, vomiting and weight loss. After barium x-rays and gastroscopy a diagnosis of advanced gastric carcinoma was made. Surgeons recommended a palliative operation to reduce stenosis and felt it unwise to disclose the prognosis of six months to the patient. They did however discuss this with her husband, who agreed his wife should not be told of the prognosis as she was very nervous and had a phobia about cancer. A new-hired new graduated staff nurse had been taking care of this patient during the week of the operation, and she had become very close to the patient who had required a lot of physical care and had asked not to be left alone when awake at nights. Three days later the staff nurse returned on day duty and was greeted warmly by the patient who was
obviously much stronger and feeling more comfortable. After chatting for about ten minutes the
patient disclosed her fears that the doctors were hiding something and that she did not want them to explain things, but that the nurse was the only person from whom she could accept the truth. Having explored the patients fears of cancer previously, the nurse realized that she might induce severe distress, if she mentioned this. although the patient had confided that she would
not be afraid of dying as long as it wasnt cancer. Despite feeling that she was being asked to disclose the limited prognosis at this time and knowing that she would be available to support the patient for the rest of the day, the nurse decided to interrupt the conversation and ask permission from sister to disclose the prognosis but not the diagnosis. Sister did not agree to the nurse taking on the responsibility but agreed to talk to the relevant doctor. However, because of some
delays by the time the patient was discharged she still had not been able to continue her talk with the nurse who was left feeling guilty and inadequate.
This example illustrates once the dilemma faced by nurses in that while they have
opportunities to give psychological care they feel they have inadequate authority to continue this through to the full extent needed by patients.
Briefly delineate the major details of the case, attributing special attention to the dilemma in question.
In the body of the essay, directly aIDress and elaborate on the following three
questions, clearly delineating each by letter or number (e.g., A, B, C, or 1, 2, 3):
1.Knowing what you now do about the complexity of healthcare ethics, how
would you have approached the dilemma differently (if at all) in the effort to uphold
categorical nursing imperatives?
2.What factors were included in your original thought process, and how have
they changed (if at all)?
3. How should the dilemma have been resolved differently (if at all), and what
specifically in your collective readings grounds this judgment?
AIDressing and elaborating on the second and third questions should be the
longest section of the essay, and include (minimally) six citations (directly quoted or
paraphrased). Again, when citing, indicate the source and page number (e.g., B&R, 10).
The use of sources extraneous to required readings is not permitted. All citations, then, must be extracted from the course textbooks. The citations should also avoid repetition; both texts must be utilized and multiple chapters (in each) must be invoked.
Butts, Janie B., and Karen L. Rich. Nursing Ethics: Across the Curriculum and Into Practice. 4th. ed.
Devettere, Raymond J. Practical Decision Making in Health Care Ethics: Cases and Concepts. 3rd. ed.