Essay NURS5029 GEM Assessment 3: Bioethics case study

NURS5029 GEM Assessment 3: Bioethics case study

Length; 2,000 words +/- 10% worth: 45% of total unit mark

1.0 Assessment Requirements

            The purpose of this assessment task is to further develop your clinically applicable skills in bioethics by selecting one of the following three case scenarios and applying the Ethical Decision Making Framework (Kerridge, et al., 2013) as cited by Staunton and Chiarella (2017) to identify the legal and ethical issues arising within the case study and develop an ethically and legally sound management approach as an Australian healthcare professional (registered nurse in this case). The layout of the academic paper will consist of an introduction, body of the paper and a conclusion using the following headings incorporating the Model for Ethical Decision Making (Kerridge, et al., 2013):

1.1 Introduction:

1.1.1 Clearly state the problem

• This will form part of your introduction (suggested word count ~ 150 words). Consider the problem within its context; ethical, medical, social and legal considerations. This should be a very brief summary of the issues as you see it – extract the issues:
• What is the ethical issue-what is the decision about?
• What is the medical condition, just state this in a few lines
• What is the social situation of the patient -is the person dependent, do they have support?
• What appear (prima facie) to be the legal issues? For example is it assault; is it the application of an Advance Directive or informed consent for example?

1.2 Body: (sections 1.2.1 to 1.2.6)

1.2.1 Get the facts

Here you need to find out what are the facts of the case; what is the medical condition and history, examination, relevant tests (investigations), define the medical condition what is the pathophysiology of the condition/s (suggested maximum word count 300 words) – use scientific references –consider the following:

• What is the prognosis?
• What are the implications of the condition/s -for example is it acute, chronic, and degenerative?
• What type of progression or prognosis might be expected?
• Are there any alternative treatments?
• What social factors might have an influence – family input, social interactions?

1.2.2 Consider the fundamental ethical principles

 You need to define each principle and relate the principle to the patient (suggested word count ~ 300 words) –consider the following:

• Autonomy: what are the patient’s preferences?
• Beneficence: what benefits can be obtained for the patient?
• Non-maleficence: what are the risks and how can they be avoided?
• Justice: how are the interests of different parties to be balanced?

1.2.3 Identify the ethical conflicts

Refer to the International Council of Nursing Code of Ethics (2012) in this section – (suggested word count ~ 300 words) –consider the following:

• What are the ethical conflicts? For example to promote autonomy are we in conflict with beneficence (Autonomy vs Beneficence).
• Explain why the ethical conflicts in this patient are occurring and how they may be resolved.

1.2.4 Identify relevant legal concepts and laws and how they might guide management Suggested word count 350 words –consider the following:

• You need to use the Acts (legislation) that apply to the case study for example:
  WA Health Consent to Treatment Policy  and/or Human Tissue and Transplant Act (1982).
• Consider the National Safety and Quality Health Services Standards (Australian Commission on Safety and Quality in Health Care Australian Commission, 2017) and how they apply to the case study.
• Consider the registered nurse Standards for Practice (Nurses and Midwifery Board of Australia [NMBA] Standards, 2018) how they apply to the case study.
• How does duty of care apply to the patient?
• How does the Standards for Practice (NMBA, 2018) relate to the Act?

1.2.5 Make the ethical decision

Suggested word count ~ 250 words –consider the following:

• Clearly state the clinical ethical decision and justify.
• Specify how guiding ethical principles were balanced and why (i.e. justify the decision). Use the information that you have in the Law and Get the Facts section to support your decision (ensure it is evidenced based).
• How would you record/document this decision?

1.2.6 Evaluate the decision

Suggested word count of ~ 150 words –consider the following:

• Identify how you would evaluate your decision-what is the fundamental tool for establishing the efficacy/outcome of an action/decision? – Here you will research what the literature says about evaluation – also use the NMBA (2018) Standards for Practice.

1.3 Conclusion

Layout to be consistent with classical conclusion of any academic paper.

2.0 CASE SCENARIOS

SELECT ONE CASE SCENARIO AND APPLY THE MODEL FOR ETHICAL DECISION-MAKING

2.1 Case scenario one:

            Mary-Jane is 14 years old; her parents are newly separated and they both work. She has three younger siblings and Mary-Jane does a lot of the child minding. She has been complaining of abdominal pain, moderate now severe and has some vaginal spotting (bleeding) for the past 24 hours. She presents with her parents who are concerned about their daughter to the emergency department at a local hospital. Mary-Jane is looking pale, sweaty, light headed, nauseated and has some stomach bloating. You have taken her base line observations on admission and they are: temperature 37.8C, pulse 118bpm, BP 90/50, Respirations 28bpm, shallow breathing. A history taken from the patient reveals her last menstrual period 4 weeks ago and that she is currently sexually active with a 15 yr. old boyfriend and that minimal contraceptive precautions have been used. The attending Emergency Physician makes a provisional diagnosis of ectopic pregnancy. As the attending student registered nurse caring for Mary-Jane consider the health care team’s professional, legal and ethical issues responsibilities including consent, confidentiality and mandatory reporting of sexual abuse from an Australian healthcare setting perspective.

2.2 Case scenario two:

Michelle is a 42 yr old female with stage four breast cancer with fungating lesions to the anterior aspect of her chest wall who is currently an short stay inpatient of a hospice unit aiming for improved pain control and improved management of her fungating lesion (both cosmetically and odour) –her prognosis at present is considered to have ~ 6 to 12 months of life.. Michelle is married and has a supportive husband and has two children aged 12 and 14 yrs. As a GEM student nurse you are caring for her and as sometimes happens you establish an early and strong rapport (the GEM student is a female aged 44yrs old and has two teenage children and is a survivor of stage 1 breast cancer). Michelle confides in you that she is planning to commit suicide and certainly appears to have a well-developed plan. You are very conflicted both ethically and legally as an adult but also as a student nurse what to do with that information- Michelle pushed you emotionally to make a commitment to maintain the confidentiality of this disclosure. Using the ethical decision making framework investigate and analyze this case.

2.3 Case scenario 3:

Annabel is a 16 and half yr old student who was involved in a MVA which has left her with a fractured left femur, unstable pelvic fracture and left sided thoracic trauma. She is haemodynamically unstable and is currently being assessed at a Metropolitan Trauma centre. She has moderate anaemia (Hb 85) at present and continues to show signs of active ongoing bleeding. The ED Consultant is planning to transfuse her urgently with four units of group specific blood and two units of FFP whilst waiting for definitive operative interventions. Annabel is drowsy, however, seems to be orientated in time, person and place and makes it known clearly to the ED Consultant attending her that she refuses any blood products. Annabel’s parents are both in attendance and the ED Consultant discusses the current situation and they are dismayed at Annabel’s refusal of blood products. They explain to the ED Consultant that 12 months ago she became an active member of the local Jehovah Witness Church community and ~ 6 months ago she signed a document stating her desire of not receiving a blood transfusions. The ED Consultant has made it clear to patient and parents that without a blood transfusion the likelihood of survival is < 10% whilst with a blood transfusion and definitive treatment survival increases to ~ 80%. The parents are actively wanting a blood transfusion, the patient is emphatic about not receiving a blood transfusion and the ED Consultant is conflicted regarding the ethical and legal way forward. Using the ethical decision making framework investigate and analyze this case.

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