Exploring Courses of Action in a Complex Care Scenario: Balancing Ethical Principles and Nursing Guidelines

QUESTION

Patient D in the community is receiving complex wound care, IV medications, and monitoring intake and output- patient is on indwelling catheter. Patient has a diagnosis of CVA and Lung CA. Spouse is the primary caregiver and expresses burnout feeling and demanding home care to have 24 hours care to the patient as the patient is bedridden and total care. Spouse is not happy with the nurse and personal support worker as she reported that they rush to provide care to the patient, and they leave right away. Family members recommended moving patient to a smaller place like retirement home or long-term care placement or short stay respite care. Family found out through their neighbour that spouse goes out all the time and attends social activities with friends and has been neglecting to take care of patient. Family member confronted spouse and denied going out with friends and accuses all the workers that are taking care of the patient of neglecting patient. Patient is not well.

Consider possible courses of action

1. Explore options based on client’s values and context of the situation

2. List the possible actions you can take (List all actions you can think of, whether you will take the action or not.)

3. Identify nursing guidelines or values (e.i. CNO/CNA) and ethical principles that apply in each possible action?

4. Which ethical principle/nursing guidelines is the action conflicting with?

ANSWER

Exploring Courses of Action in a Complex Care Scenario: Balancing Ethical Principles and Nursing Guidelines

Introduction

In the case of Patient D, who requires complex care due to multiple health conditions, the spouse acting as the primary caregiver expresses burnout and demands 24-hour care for the bedridden patient. The spouse has expressed dissatisfaction with the nurse and personal support worker, claiming rushed care and neglect. Additionally, the family has discovered that the spouse has been attending social activities, raising concerns about the patient’s well-being. In this essay, we will consider possible courses of action, examining the ethical principles and nursing guidelines that apply to each scenario.

Possible Courses of Action

Explore Options Based on Client’s Values and Context

Engage in a family meeting to discuss the spouse’s burnout and explore the possibility of involving additional family members or friends in the caregiving process.
Consider respite care services that provide temporary relief to the spouse while ensuring the patient’s needs are met.
Collaborate with healthcare professionals to assess the patient’s suitability for a retirement home, long-term care placement, or short-stay respite care, taking into account the patient’s preferences and the level of care required.

List Possible Actions

Increase support from community resources, such as home care services or volunteer programs, to alleviate the spouse’s burden and ensure adequate care for the patient.
Conduct a thorough assessment of the spouse’s capabilities, including physical and mental health, to determine if they are capable of providing appropriate care.
Communicate with the nurse and personal support worker to address concerns about rushed care and neglect, exploring ways to improve their provision of care and addressing any misunderstandings.

Identify Nursing Guidelines or Values

The College of Nurses of Ontario (CNO) provides guidelines that emphasize the importance of client-centered care, professional accountability, and collaboration with other healthcare providers.
Ethical principles such as beneficence (acting in the patient’s best interest), autonomy (respecting the patient’s choices), and non-maleficence (avoiding harm) are crucial in guiding nursing practice.

Ethical Conflicts

The potential neglect of the patient due to the spouse’s engagement in social activities conflicts with the principle of beneficence and the nursing value of client-centered care.
Rushed care and possible neglect by the healthcare professionals conflict with the principles of beneficence, non-maleficence, and professional accountability.

Conclusion

In the complex care scenario presented, it is essential to carefully consider the available courses of action, aligning them with the client’s values and context while adhering to nursing guidelines and ethical principles. Exploring options that address the spouse’s burnout, ensure adequate care for the patient, and promote collaboration among healthcare professionals and family members is crucial. By striving to maintain the balance between the well-being of the caregiver and the patient’s needs, nurses can uphold ethical principles and provide high-quality, patient-centered care.