In clinical ethics, respecting the choices of a patient is an important part of the nurse-patient relationship (Boylan, 2015). As a result, there are skills required in addressing ethical issues in nursing. In the case study under discussion, the nurse practitioner requires various ethical examination skills in order to identify, address and assess the clinical ethical issue. One of the necessary skills is the ability to identify and discuss the moral issues related to Jim’s refusal to accept treatment. The NP should also be able to understand each moral view presented by each party involved in the case of Jim.
The nurse practitioner in the case study should also be able to elaborate the ethical direction of Jim’s case to all the parties involved and to other people. Besides, the NP should also be able to develop and justify interventions that can be morally accepted (Herring, 2018). Another important skill is ability of the nurse practitioner to study implemented practices which have resulted into moral questions or issues to establish if there is need for a change ( Vogelstein & Colbert, 2019) .
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Operational skills are also crucial in the case study. The skills are important in the process of solving the conflict, minimize uncertainty and establish an agreement (Daly et.al, 2014). One of the necessary operational skills in the case study is facilitation skills. The skills are required in order to conduct a smooth session in attempt to solve the ethical issue. In addition, interpersonal and active listening skills are necessary in the case study. The NP should be able to establish and maintain a smooth relationship with the patient throughout the session. In addition, communication skills and the ability to listen actively are necessary in the case study.
The nurse practitioner in the case study has various obligations towards Jim who disclosed that he would not accept treatment for hypertension and elevated creatinine and BUN. If not treated, the patient could develop kidney failure. He fears that if he takes the medication, his sex life would be affected. In this case the NP has the duty of educating the patient on an all the possible benefits of accepting treatment and the risks involved in refusing treatment. The NP should also try as much as possible to discuss the patient’s worries related to the proposed treatment to establish if there are methods to negotiate. This can help the patient realize the importance of treatment and accept interventions that are in the patient’s best interests.
The NP also has the duty of seeking the patient’s consent in order to involve other individuals who may help the patient reconsider his decision to refuse treatment. Some of the individuals who might be helpful in assisting a patient who has refused treatment reconsider his/her decision include family members, clergy and other relevant mediators ( Shashidhara, 2016 ). A patient refusing to accept treatment can be referred to a mental health facility if he/she presents overwhelming anxiety related to accepting treatment (Bingham, 2012). However, this should be done if the patient agrees to be assessed ( Shashidhara, 2016 ). The nurse practitioner should record all the efforts made to educate and enlighten the patient, treatment plan, and the decline by the patient to accept treatment (Bingham, 2012). In addition, the NP should request the patient to sign a form to indicate refusal to accept treatment.
There are several ethical considerations in assessing a patient’s refusal to adhere to a proposed treatment. These include the issues of autonomy, beneficence, no maleficence and justice. Treatment should not be imposed on a patient who refuses it. Although it is in the best interests of the patient that he/she should receive treatment, a patient should not be forced to receive treatment. In the case study of Jim, I would terminate care after exhausting all my duties towards seeking help for the patient, educating the patient on the benefits of receiving treatment and risks of refusing it. Terminating care would worsen the patient’s condition but he/she has the final decision on whether to accept it or not.
References
Bingham, S.-L. (2012). Refusal of treatment and decision-making capacity. Nursing Ethics , 19 (1), 167–172. doi: 10.1177/0969733011431925
Boylan, M. (2015). Medical ethics . Chichester, West Sussex: Wiley-Blackwell.
Daly, J., Speedy, S., & Jackson, D. B. (2014). Contexts of nursing: an introduction . Edinburgh: Churchill Livingstone.
Herring, J. (2018). 1. Ethics and Medical Law. Medical Law and Ethics . doi: 10.1093/he/9780198810605.003.0001
Shashidhara, S. (2016). Commentary: Looking beyond Treatment Refusal. Cambridge Quarterly of Healthcare Ethics , 25 (2), 333–336. doi: 10.1017/s096318011500064x
Vogelstein, E., & Colbert, A. (2019). Normative nursing ethics: A literature review and tentative recommendations. Nursing Ethics , 096973301983614. doi: 10.1177/0969733019836148
