Describe three different ways you could respond to the child.
The question “Am I dying” remains quite challenging to answer for any given clinician or nurse practitioner. Responding to ill patients is not only uncomfortable since the responsible clinician may lack the much-needed capacity to determine what compelled the patient to ask such a question. The situation becomes even more challenging to the nurse when tasked with the responsibility of answering a child ( Chan, 2013 ). In response to this question, however, I could utilize three major approaches, including balancing truth-telling and hope, provision of support, and exploring patient’s perspective on the terminal illness.
Balancing truth-telling and hope . I could tell Bobbie that his condition is something we lack the ability to fix since he has had more complications, and it has become clearer that his body probably will not be in the best possible position to recover from the illness. At the same time, I could present Bobbie with a scenario, as a way of giving him the much-needed hope: If our facility had 50 patients in his situation, I think only 1 might recover, meaning 49 would die.
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Provision of support . In an attempt to tell Bobbie the truth, I would place great emphasis on communicating statements characterized by non-abandonment. For instance, I would inform how I wished things were different. I would acknowledge and appreciate his emotions, such as sadness. Moreover, I would reassure Bobbie that, no matter his current situation and any possible outcomes, we remain committed and optimistic when it comes to caring for him. I would further tell him that even though the facility may not provide medicine to cure his disease, we have a variety of things to ensure his well-being, including helping with anxiety and pain.
Exploring patient’s perspective on the terminal illness . Nurses do not expect children to react as adults do when presented with the truth regarding their terminal conditions. In this sense, I would first employ a compassionate approach to establishing Bobbie’s worldview on the life-limiting illness. For example, I would as ask him to tell me his thoughts about what he is feeling and going through at the moment. Another question would involve why he chose to ask me why I thought he is dying.
Discuss the advantages and disadvantages of each of the three options.
Balancing truth-telling and hope . The advantage of this approach is that it helps in shaping Bobbie’s expectations around disease course. In essence, by framing prognosis in numeric, as well as quantitative terms, I would be well positioned to avoid nonspecific language. According to Isaac, M. & Curtis, R. (2016), one of the best practices while addressing the various concerns of fatal diseases and conditions involves avoiding vague language, including bad outcomes. The advantage of this approach to answering Bobbie’s conundrum is that it best suits adult patients as opposed to children. The sick child would prefer direct answers, which do not require them to engage in the brainstorming process with the sole purpose of inferring meaning from what the nurse said.
Provision of support . The advantage of this method to answering Bobbie involves the fact that it allows him to recognize, acknowledge, and appreciate his suffering. With this acknowledgement, I would find the best possible opportunity of engaging Bobbie in further explorations, including sourcing the much-needed support from family members, counselors, and other caregivers. One of the demerits of this approach is that it tends to escape Bobbie’s question ( LaSala, 2009 ). In essence, something must have compelled the 14-year old boy to ask the rare question, meaning he least expected emotional support.
Exploring patient’s perspective on the terminal illness . The key advantage of this approach revolves around the fact that it allows the responsible nurse to address the patient’s specific concerns ( Isaac & Curtis, 2016 ). The weakness of this method is that I felt it is outside what any given physician or health practitioner could consider being their scope of practice. For example, Bobbie is young and exploring his perspectives would cause spiritual and existential distress, which I would have to manage.
Identify and discuss at least three provisions of the Code of Ethics for Nurses you will rely upon, including how nurses are guided in the virtue of truth-telling.
I will rely on provisions 3, 4, and 6. In particular, Provision 3 requires nurse practitioners to place much emphasis on promoting, advocating, and protecting the safety, health, as well as the various rights of individual patients (Olson & Stokes, 2016). While balancing truth-telling and hope, for instance, this provision will allow me to understand that my priority revolves around helping Bobbie maximize the quality of his life and partner with him when it comes to realizing a good death. Provision 4 expects the nurse to exercise their responsibility or accountability and authority over nursing practice, especially by making informed and ethical decisions and taking actions that promote optimal care. Before answering Bobbie, for instance, I would have to communicate with him over his over expressions of non-abandonment, as well as reassurance (Olson & Stokes, 2016). In this way, I would have told Bobbie the truth in addition to reassuring him that we would exploit every resource at our disposal to ensure he achieves the desired comfort. Provision 6 requires nurses to collaborate with other stakeholder in creating, maintaining, and improving the ethical environment. Each of the approaches adopted in answering Bobbie’s question has elements of this provision, as I focused on respecting his emotions, providing hope, promising the delivery of quality and safe care, and told him the truth in a satisfying and friendly way.
What other considerations will play a role in your response? And why?
The other consideration that I will make with the sole purpose of providing the best response is seeking Bobbie’s permission. By integrating the Ask-Tell-Ask criterion into our conversation, I intend to elicit his understanding before sharing frank prognostic information (Isaac & Curtis, 2016). In as much as not all patients would want this information, I firmly believe that seeking his consent to sensitive questions will go a long way in allowing him accept his situation and possible outcome of the terminal illness.
References
Chan, Z. (2013). A Systematic Review of Critical Thinking in Nursing Education. Nurse Education Today, 33 (3): 236–240.
Isaac, M. & Curtis, R. (2016). How to respond to an ICU patient asking if she/he is going to die. Intensive Care Medicine, 43 (2): 220-222.
Lachman, V. (2010). Strategies necessary for moral courage. OJIN: The Online Journal of Issues in Nursing, 15 (3).
LaSala, C. (2009). Moral accountability and integrity in nursing practice. Nursing Clinics of North America, 44 (4): 423–424.
Olson, L. & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation, 7 (2): 9-10.
