Nvt2 Task 1

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NVT2 Task 1

The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney (DPOA). She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be vague and sometimes the issues can be in conflict with our own personal beliefs.

In California, nurses look for guidance to their professional body and to the nurse practice act, which is a set of laws that mandates the board of registered nursing to set out the scope of practice and responsibilities for Registered Nurses. The California nurse practice act recognizes the existence of overlapping functions between physicians and registered nurses but registered nurses are authorized to perform independent nursing functions related to “direct and indirect patient care services that insure the safety, comfort, personal hygiene and protection of patients.”(CA nurse practice act, 1995) In California, a registered nurse has a duty to insure safety and protection of her patients. Some of the verbiage in the act is broad and open to interpretation, and it could be argued to what extent they apply in this case. The practice act further clarifies this expectation by stating; a registered nurse ‘acts as a client’s advocate, by giving the client, the opportunity to make informed decisions about health care before it is provided’. (California code of Regulations Title 16) All of these state laws make it clear that nursing is responsible for managing itself. Nurses have a professional and legal obligation in their advocacy role to assess the care prescribed and act to ensure that the patient does not endure procedures that the patient have not authorized. To act without consent is a form of battery.

As with all ethical dilemmas that occur in modern healthcare, it can depend on the individual’s perception and perspective as to how they view the situation. The nurse, the patient, the family and the doctor view the situation differently based on their own values and life experiences and often the view is colored by their own deeply held beliefs. The nurse has a code of ethics that she can refer to The Code of Ethics for Nurses (The Code) (American Nurses Association [ANA], 2001) which assists her as she functions in progressively more complex roles and situations. Provision 1.4. ‘The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient’ (ANA, 2001, p. 12). “Patients have a right of self determination including the ‘choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision making and treatment process” (ANA, 2001, p. 8). The nurse must advocate for Mr. E, for his right to refuse treatment, his right to decide what will be done to his person even it means that he may die. Mr. E had an advance directive and also had verbalized his wishes. In this case, it is complicated by the fact that the patient has mild mental retardation which calls his competency to refuse treatment in to question. The nurse has an obligation to gage the ability of the patient to be able to process the information that is presented to them and assess if they understand the ramifications of refusing treatment. ‘The Nurse preserves, protects and supports those interests by assessing the patients comprehension of both the information and the...
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