What are the skills necessary for the provider to identify, address, and assess this clinical ethical issue?
Professional ethics cannot be ignored in providing health or nursing care. It is hard to give some general guidelines and recommendations on how to stay ethically correct in all cases. A provider must assess a situation and identify the major problem, including internal and external factors (Dehghani, Mosalanejad, & Dehghan-Nayeri, 2015). In this case, a patient rejects taking medications to control his hypertension because of the threat of having a low sexual activity or other related problems. A nurse cannot make the patient take the drug, as well as should not leave the situation as it is due to the possibility of negative health outcomes.
Regarding the needs of this patient, the development of specific skills can be an effective solution to identify and assess the ethical issue. First, communication and collaboration skills are important as they help to find an additional expert (i.e., a psychiatrist, a psychologist, or a therapist). Second, self-control is an obligatory quality as it promotes the possibility to evaluate the whole situation and never break emotional boundaries in patient-nurse relationships.
Finally, respect for patients’ rights and decisions is a core principle of any nurse. Therefore, such skill as ethical decision-making that meets the standards of care and individual circumstances has to be underlined (Barlow, Hargreaves, & Gillibrand, 2017).
Sometimes, an unexpected idea can be found out to solve a problem during the open and free conversation or communication with family members. In this case, the task is to gather as much credible information as possible. A nurse should be ready to explain to the patient the importance of taking medications or, at least, considering some other alternatives with the help of which the same results can be obtained.
What are the provider’s obligations when a patient discloses does he not intend to follow the treatment?
In communicating with a patient, as well as providing the treatment, the task of a nurse or any other medical worker is to remember about given commitments. At the same time, patients usually underline their rights and make nurses break their commitments to meet their personal needs as clients. For example, there two crucial rights in nursing care which are hard to ignore: the right to refuse treatment and the right to informed consent (Torrey, 2018).
In this case, the patient has the freedom to decide what a provider can or cannot do. Besides, a nurse or a physician does not have the right to use physical power to make the patient continue treating. Therefore, the main obligation of a nurse is to listen to the patient and make certain conclusions to be prepared to take another step.
In this case, the nurse should clearly understand the duties that have to be followed. It is necessary to behave and make decisions in the best interests of the patient in order neither to harm nor to break the law. At the same time, there is an obligation to raise concerns if the patient puts himself at risk of harm. Therefore, the nurse should report on this situation to a chief nurse, a therapist, or another medical worker who is involved in the treatment.
Communication with a family may also be used as a means to change the patient’s mind. However, fast decision-making without any research being conducted may harm the patient. The nurse must gather enough information for the patient about the importance of the treatment, for the doctor about the reasons to reject the treatment, and for the family about the worth of health.
What are the ethical considerations in evaluating a patient’s failure to adhere to a prescribed therapy?
Regardless of numerous attempts to diminish the number of medical errors and avoid negative health outcomes, there are still many situations when patients cannot achieve the desired improvement. Poor adherence to medication remains a serious problem in medicine and health care and leads to multiple concerns in the work of the healthcare system and public health (Boddington, 2015). There is a list of specific ethical issues that have to be considered during the evaluation of treatment or the failure to follow a care plan. In this case study, the patient rejects taking medications because of the possibility to experience negative effects on his sexual life.
To be effective, the evaluation plan should be based on several ethical considerations. The main ethical issue is the necessity not to do harm that may be both psychological and physical. Therefore, a nurse should make sure that the evaluation process does not result in stress, pain, or low self-esteem. Another consideration includes voluntary participation and readiness to cooperate and withdraw a process any time the patient wants. Informed consent is an ethical consideration that plays a crucial role in evaluating a failure to follow the prescribed therapy because a participant gets the right to learn the purposes and understand the worth of findings.
In other words, an additional discussion of the situation and clarification of the details of treatment should help the nurse to underline all the concerns again and take another round to explain the importance of medications. It is also expected that all the norms and standards of nursing behavior are met because they promote a trustful environment, reduce the number of conflicts, and contribute to safety.
Will you terminate care for this patient? What are the implications?
People may have different reasons for not following the prescribed medications and therapies, and nurses or other medical workers have to be ready to work with nonadherent patients. In some cases, a patient may not appreciate the actual severity of the situation and neglect following a treatment plan (McNary, 2015). Sometimes, confusion or the lack of knowledge prevents making the right decision.
Finally, personal concerns about becoming addicted to some medications or influences an overall work of the body may be the examples of considerations for nonadherence. If communication with the patient and the involvement of a family do not work, termination of care has to be considered. To avoid legal or personal judgments, a nurse or a therapist must explain the urgency to terminate the treatment, and further cooperation with a notice of several days before (McNary, 2015).
Then, the patient should receive several referral resources and recommendations. If there are extra time and the desire of the patient, education is offered. Finally, an explanation of the termination process should be developed in a written form to provide the necessary background information for a new caregiver.
The main implications for the participants of this case study vary and depend on the patient because the nurse manages to meet all four principles of healthcare ethics to avoid this situation. For example, there can be a personal conflict or a desire to change a healthcare facility to find another professional opinion. An overall avoidance of treatment in the future is also an option if the patient does not have any complaints and feels normal.
Finally, there is a chance that the patient changes his mind and continues cooperation with this nurse and this hospital because of being afraid that termination may negatively influence his health. Nevertheless, the nurse does not make a mistake and follows all the standards of care to satisfy the health needs of the patient.
References
Barlow, N. A., Hargreaves, J., & Gillibrand, W. P. (2017). Nurses’ contributions to the resolution of ethical dilemmas in practice. Nursing Ethics, 25(2), 230–242. Web.
Boddington, P. (2015). Rethinking the problems of adherence to medications. Clinical Ethics, 10(4), 91-96. Web.
Dehghani, A., Mosalanejad, L., & Dehghan-Nayeri, N. (2015). Factors affecting professional ethics in nursing practice in Iran: A qualitative study. BMC Medical Ethics, 16(1), 61. Web.
McNary, A. (2015). Avoiding risk with nonadherent patients. Innovations in Clinical Neuroscience, 12(3-4), 37-40.
Torrey, T. (2018). Do patients have the right to refuse medical treatment? Web.