While executing their mandate, nurses face difficult ethical questions. These questions force them to turn to their professional standards and values so that they are able to make decisions that enhance the wellbeing of their patients. The four topics approach is among the frameworks which enable nursing practitioners to resolve ethical questions. This approach identifies four key questions that nurses should pose when confronted with difficult situations. While I have not used the approach directly, I find it to be a valuable tool.
The four topics approach is concerned with the questions that nurses should pose in their quest for solutions to ethical challenges (Sokol, 2010). As part of my duties, I am required to inform the authorities when I observe such things as suspicious injuries. Recently, I attended to a young lady who had bruises on her face. After establishing that she was the victim of domestic abuse, I faced the dilemma of reporting her cause to the authorities and risk violating her privacy, or contacting the authorities and securing her welfare. My role in this scenario was advocating for the patient but doing so within the confines of professional standards of nursing practice. I find that some of the questions in the four topics approach allowed me to reach a decision. Medical indications, patient preferences, quality of life, and contextual features are the main issues that the four topics approach addresses (Sokol, 2010). Regarding medical indications, practitioners need to pose such questions as the goals of treatment and the effectiveness of treatment. Using these questions, I determined that while I needed to treat the lady’s wounds, I also had an obligation to address the legal and ethical components of her case. Patient preferences are concerned with issues like the competency and willingness of the patient to participate in an intervention (Teven & Gottlieb, 2018). Thanks to these questions, I established that the patient was apprehensive about involving law enforcement officials as she feared further abuse in the hands of her partner. Whether an intervention enables the patient to resume normal life is the main question that the quality of life component examines. As I reflected on the lady’s case, I became persuaded that by contacting the police, I would allow her to find the help that she needs, thereby accelerating her resumption of her normal life. The last component of the four topics approach, contextual features, involves issues like the larger Interprofessional, legal, religious and ethical issues that surround a particular case (Teven & Gottlieb, 2018). I noted that the case of the lady was complex as I had to consider issues such as the provisions of the law regarding reporting domestic abuse while respecting my patient’s privacy and confidentiality. After considering all issues, I decided to refer her case to my supervisor who was better placed to offer the lady assistance without compromising her safety.
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There is no doubt that the four topics approach is an effective framework for resolving ethical questions. As noted in the discussion above, the questions that constitute this approach enabled me to handle the case of the lady competently and professionally. The four impact process allowed me to consider the law as well as the nursing code of ethical conduct. Moreover, this process played a critical role in challenging me to prioritize the welfare of the patient. The process enhanced my decision making process and I find that it is a valid tool that will undoubtedly enrich my practice.
References
Sokol, D. K. (2010). The “four quadrants” approach to clinical ethics case analysis; an application and review. Journal of Medical Ethics, 34, 513-6.
Teven, C. D., & Gottlieb, L. J. (2018). The four-quadrant approach to ethical issues in burn care. AMA Journal of Ethics. Retrieved January 20, 2019 from https://journalofethics.ama-assn.org/article/four-quadrant-approach-ethical-issues-burn-care/2018-06
