The Patient Autonomy Assignment Paper
The Patient Autonomy Assignment Paper
In our assignment, we have to describe at least one meta-theme as well as any themes that contribute to this meta-theme.
Also, describe any patterns that may be present among themes and meta-themes. Once again, use quotes (i.e., text units) to illuminate the meaning of the meta-themes and to support your description and discussion.
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We decided to write about autonomy as a meta-theme as it is present in every critical incident. Meta-theme is based on themes. There are several themes that are present in all six critical incidents: empowerment, distress, conflict, and powerlessness. Basically, you need to write why we decided to choose autonomy as a meta-theme based on the themes. Data-based are text units that you can find in appendixes 1 and 2. Please, if you have any questions reach out. Sorry for giving you only 12 hours. I really need to finish my part tomorrow.
Various themes and meta-themes are evident the in every critical incident. Some of the most dominant themes include empowerment, distress, conflict, and powerlessness. However, this discussion illustrates why autonomy has been selected as the most significant meta-theme in the six critical incidents.
Patient autonomy is one of the five ethical principles that guide healthcare delivery. The ethical principle of patient autonomy holds that individual patients have a right to make all significant decisions concerning their treatment without being interrupted (Liang et al., 2022)The Patient Autonomy Assignment Paper. Thus, healthcare professionals should inform the patients about all potential interventions and let them make informed decisions without influencing them. The healthcare professional should respect the patient’s treatment decision even if would not give the best health outcomes.
In the six critical incidents, patient autonomy is present as the most dominant theme. Critical incident one depicts a patient with compromised autonomy. The compulsory vaccination, which was imposed on Federal employees forced Don to take the vaccine even if it was against his wish. He felt that no adequate details on the negative side effects of the vaccine had been availed. Nonetheless, Don feared that failure to take the vaccine would render him jobless, making it challenging for him to pay bills and take care of his family. Consequently, Don’s patient autonomy was compromised. Secondly, patient autonomy is evident in critical incidents involving Sarah who works as a pediatric nurse. Despite focusing on promoting good and healthy habits, which are in the patient’s best interest, Sarah considers patient autonomy. She allows the patients to make the most significant decisions concerning their treatment without interfering with their choices.
Furthermore, critical incident three, which occurred in a surgical unit during a clinical placement depicts patient autonomy. The patient, Mr. Smith wished that his wife was beside him to provide psychological and emotional support as he was undergoing the treatment. His wish was not granted since COVID-19 measures restricted the number of people allowed in the treatment rooms and wards. However, the nurse respected the patient’s autonomy since she allowed the patient to speak to his wife over the phone, providing him with psychological and emotional support during the treatment period. On the contrary, the patient’s autonomy was compromised in this scenario, since the patient was not involved in making significant decisions regarding his treatment. For instance, the healthcare provider did not consult Mr. Smith when they were making decisions to transfer his care The Patient Autonomy Assignment Paper.
Additionally, the patient was not consulted while multiple IV medications were being ordered nor during the administration of fluid boluses. Additionally, patient autonomy was compromised in critical incident four. The patient who was awaiting leg surgery was not consulted before completing neuro-vitals and assessing for other signs and symptoms of a stroke. Thus, conducting this treatment procedure could be acting against the patient’s will. In the 5th critical incident, patient autonomy was also compromised by vaccinating the minors without their parent’s consent. Even if minors cannot consent during treatment procedures, parents have a right to consent on behalf of their children (Benjamin et al., 2018). Thus, the parents were supposed to be informed about the vaccine and be allowed to make informed decisions regarding their children’s vaccination. Finally, critical incident six depicts patient autonomy. The healthcare providers resected the patient’s decision not to proceed with MAiD as she wanted to “go on her own terms” even if it would not lead to the best health outcomes.
In a nutshell, patient autonomy is the most evident ethical principle in all six critical incidents. In some incidents, the healthcare providers adhered to the patient’s autonomy by allowing individuals to make all significant decisions concerning their treatment. However, patient autonomy was compromised in other scenarios where healthcare professionals failed to consider the patient’s interest in making significant treatment decisions.
References
Benjamin, L., Ishimine, P., Joseph, M., & Mehta, S. (2018). Evaluation and treatment of minors. Annals of Emergency Medicine, 71(2), 225-232.
Liang, Z., Xu, M., Liu, G., Zhou, Y., & Howard, P. (2022). Patient-centred care and patient autonomy: doctors’ views in Chinese hospitals. BMC medical ethics, 23(1), 1-12.
Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence The Patient Autonomy Assignment Paper
CI #1 Don is a 45-year-old healthy male. He is a 23-year veteran of the Canadian Armed Forces, and he now works for the Federal Government as a contractor for the military. He comes from a large family and has a father who is skeptical of government motives and from the beginning of the pandemic, Don and his father were both fairly skeptical of various governmentimposed mandates, such as lockdowns or mask mandates. As a healthy male who has already recovered from a COVID-19 infection, he elected to not get the vaccine because he already had natural immunity. Up until recently, he really did not have any major impacts to his life due to the vaccination mandates. Once a deadline for vaccination was imposed on Federal employees, he became frustrated and conflicted as to how he wanted to proceed. He looked for different jobs in similar industries, he spoke with his supervisors, and he even considered not getting vaccinated with the risk of losing his job and his pension. He felt like he was forced into having to get the vaccine because he still had to feed his family and pay his bills. During my interview, I heard Don speak of the speed at which the vaccine has been produced, that the data of negative vaccine side effects is being suppressed, that these mandates are an attack on peoples’ freedoms, that there is fearmongering from the media, that there is a lack of long-term efficacy of the vaccine, and that the robustness of natural immunity is greater when compared to vaccine mediated immunity. For him, the waning effect of the vaccine, the possibility of needing endless boosters, and the fact that the vaccine appears to be more of a therapeutic than an actual vaccine, are all problems that he has had with the vaccine mandates. For Don, he feels as though his right to consent and his right for self-determination and autonomy has been taken away for “his own good and the good of society.” For him, the medical ethic of beneficence is being put ahead of his right to choose what types of medications go into Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence his body. Furthermore, he does not believe the current death rate and dangers of COVID-19 warrant this amount of control over his personal medical decisions. He also does not feel like we are getting enough information as to how and why public health policies are being made and on what evidence. To put things simply, he does not feel like the information he is getting is clear from governing bodies and he feels like people should be given more options. For him, if this was all about “following the science,” then natural immunity should be equally as acceptable as vaccination status. Don also points to Florida as an example of how this pandemic has been managed in a way that preserves the rights and dignity of individuals. He claims that Florida has the least number of restrictions and has done better than New York or New Jersey in terms of COVID-19 deaths after adjusting for age. New York and New Jersey have imposed very restrictive COVID19 measures, whereas Florida has allowed individuals to make their own medical calculations and risk mitigation strategies. Florida also allows doctors to use alternative types of therapies such as monoclonal antibodies to treat COVID-19 early and aggressively. Although Don and I disagree on some points, especially when considering the Canadian Governments motivations for their current approach to dealing with COVID-19, he does make some valid points and issues to consider. The fact is he feels like his freedoms are being stripped away. He points out that some of the biggest people at risk are those who are obese or have multiple comorbidities, yet very little is being done to encourage those people to get healthy. The only messages Don hears is to “wear a mask,” “socially distance,” and “get vaccinated.” Why can I not be regularly tested? Why is my natural immunity not good enough? Ultimately, he is not happy with how Canada is handling COVID-19 and he does not believe that beneficence should be placed ahead of autonomy in regards to personal medical decisions.
CI #2 Sarah works as a pediatric nurse at a large city hospital. She works with children of all ages and with varying acuity levels. During a clinical shift together, Sarah told me she sees a lot of mental health patients, and that she spends a lot of time trying to understand the patients’ perspective and avoiding re-traumatization. She likes to focus on healthy coping mechanisms and emphasizes empowerment and self-direction. She said it is important to her to promote good and healthy habits that are in the patients’ best interest, but to also let them decide so they feel in control and autonomous. Sarah enjoys being a pediatric nurse and says the work is incredibly rewarding and I find her work ethic to be very inspiring. Sarah and I shared a patient for several weeks who had an eating disorder (ED), whom I shall call Beth. Beth had been in the hospital for over a month and was understandably frustrated. Beth’s meals were very strict and timed, she was weighed three times a week, and Sarah had to stand outside the bathroom to make sure Beth was not purging or exercising. Beth was sad all the time and had not seen her family because of COVID-19, and she was clearly struggling. Sarah reflected that a lot of the nurses seemed to be focused on just going through the motions and perhaps only focusing on not causing harm –maleficence. Sarah suggested we act to promote the well-being of this patient, in her best interest. On an evening shift, we wrote down all the things we needed to accomplish before bedtime. Tasks such as vitals, assessment, snack, shower, bedding change, etc. Instead of telling Beth what needed to happen and when, we showed her what needed to be done and asked her how and in what order she would like to do it. Beth instantly smiled and said no one had ever asked her that. All these things needed to be done, and Beth chose a very logical order of things, but to simply be given the choice made her very happy, and we could tell that it benefited her. By Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence promoting her independence and doing something specifically for her, it really made a positive influence on her mental health and wellbeing. By making space for her to choose the order of things, she was also more open to receiving care and education. Which also adds to the beneficence piece of being in her best interest and doing something to actively promote her wellbeing The Patient Autonomy Assignment Paper.
CI #3 This incident took place on a surgical unit during a clinical placement. A post-op patient (Mr. Smith) that the nurse I was working with (Tara) was taking care of, went through an acute decline in his health status three days after surgery. He had developed a new onset of uncontrolled atrial fibrillation and chest pain accompanied with diaphoresis and shortness of breath. Tara and I worked together to contact the most responsible physician (MRP) and obtain an order for nitro. We realized that Mr. Smith was progressing well surgically and following the expected healing process after his surgical procedure but was growing increasingly unstable related to his cardiac status. Mr. Smith was in a lot of distress due to his condition and worsening anxiety about his health and wellbeing. Mr. Smith had asked Tara if he was going to be okay. It was a very high stress situation for Tara and me as a second-year nursing student caring for and monitoring Mr. Smith’s deteriorating health status while also taking care of three other patients as part of the assignment. Tara had acted very professionally, used a calm and reassuring approach and taken every step to ensure Mr. Smith was comfortable. Mr. Smith had wished for his wife to be at the bedside with him but due to strict visitor restrictions because of the COVID-19 pandemic, she was unable to visit Mr. Smith and accompany him. Tara ensured to speak to Mr. and Mrs. Smith while on the phone in Mr. Smith’s room and provide an update on his treatment trajectory. Meanwhile, multiple residents and attendings were coming from different units and specialties like internal medicine and the cardiac unit to assess Mr. Smith’s status and make decisions about transfer of care. With multiple IV medications being ordered, and fluid boluses being administered wide open, we realized that the patient needed to be cared for on a unit with a lower nurse to patient ratio. While talking with the patient to ease their nerves related to their Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence changing health status, I overheard residents and attendings arguing over where the patient should be transferred. “They’re a surgical patient, they should stay here” was used by most. It took hours to stabilize the patient and talking with different physicians for Mr. Smith to be transferred to a higher acuity unit. Tara advocated for a lower nurse patient unit due to the medications that were being administered which required close telemetry monitoring which a surgical unit was unable to provide. Even though the physicians assessing this patient believed the patient was appropriate for the surgical unit post op, Tara was concerned about the patient’s safety due to the critical care/cardiac medications that were being administered and recognized that she was unable to provide the best care for Mr. Smith. Tara also identified the need for additional support and delegated care of her other patients to her coworkers. She spoke to the clinical nurse leader (CNL) as well as Mr. Smith’s MRP about allowing his wife to visit as an essential visitor for emotional support. Being part of this morally distressing situation with Tara, I was very impressed by her approach while caring for Mr. Smith in a high stress situation and advocating for his care needs and safety. Tara promoted beneficence by upholding her concerns and constantly advocating for Mr. Smith’s care to be escalated to a higher acuity unit while also providing emotional support and reassurance to the patient and their family The Patient Autonomy Assignment Paper.
CI #4 In the summer of 2021, I had a clinical placement at Saanich Peninsula Hospital (SPH) in the central medical unit. While caring for a patient awaiting leg surgery, I noticed their pupil sizes were slightly different in diameter. Knowing that they had a history of a cerebrovascular accident (CVA), I wanted to ensure the patient was safe. Therefore, I completed neuro-vitals on the patient and assessed for other signs and symptoms of a stroke. I became insecure in my assessment skills and decided to have my nurse double check the patient. The nurse entered the patient’s room, asked them questions, and asked the patient to perform actions, all the while not explaining to the patient why or what they were assessing for. The nurse swiftly left the room and I felt compelled to provide a simple explanation to the patient as they looked very confused. In discussion with the nurse afterwards, they told me that I should not have provided an explanation to the patient because it could cause them unnecessary stress and worry. I however, felt it was also unethical to not inform the patient of what we were doing. From my perspective, I had already established a therapeutic relationship with the patient and had already had opportunities to discuss their health with them, as such I felt confident that it would have harmed our trusting relationship if I had not explained that we were assessing for a CVA. Furthermore, the patient did not appear distressed at this news and was relieved that I had been attentive to their care because I knew their history. In contrast, the nurse had not interacted with the patient enough from my perspective to make a judgement on what action would be more beneficial for the patient, I had simply asked them to ensure the patient did not have any other symptoms of a CVA. I am disappointed to admit that I was too nervous to tell this to the nurse directly as I did not know them well or feel comfortable contradicting their judgment as an experienced nurse. This scenario was an ethical dilemma on whether it was more beneficial for the patient to be Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence informed and risk unnecessary distress or inform the patient to promote autonomy and transparency within the relationship. Ultimately, I am glad that I informed the patient that we were confirming they did not have any signs and symptoms of a CVA. This is because I had established a relationship with them and knew they would be more concerned if I had not been transparent with them The Patient Autonomy Assignment Paper.
CI #5 The COVID-19 pandemic has brought up new ethical issues for both healthcare workers and the general population as well. With the vaccination rollout, it was obvious there was a distinct separation between those who were thrilled at the opportunity to become protected, and those who opposed receiving the vaccine. When the vaccine became available to children ages 12 and older, the same divide occurred, this time surrounding a parent’s right to make medical decisions for their child. I was working at the vaccination clinic this summer for my final 3rd year practicum and noticed that a lot of children were coming in with their parents to get vaccinated. We were given forms to fill out for minors and were taught that we had the right to vaccinate a child without their parents present and without their consent. If we deemed the child to be a mature minor, able to make their own medical decisions around the vaccine, we could provide the vaccination and never have to inform the families of the decision. All the children that were coming in for their vaccine had their parents or guardians with them, therefore, I thought I would not have to deal with the decision to vaccinate a mature minor without consent. Near the end of my time at the clinic there was an incident in which a child, who I will call Luke, came with a friend to get the vaccine. Their friend, who I will call Tyler, had already received his first dose of the vaccine when he came in with his parents the week prior. Luke and Tyler had been talking about the vaccine, which made Luke realize that he wanted to get vaccinated. He expressed that their parents were against the vaccine and when he brought up the idea of getting vaccinated, his parents were not supportive of the decisions. The student vaccinating and I informed Luke that he had to the right to get vaccinated without parental consent and that we did not have to inform his parents of his choice either. I was not going to be vaccinating Luke, but if it were my turn to, I probably would have. With the help and support Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence from our instructor, we deemed Luke to be a mature minor and vaccinated him. Before doing so, we had him repeat all the information required to assess their ability to give informed consent. The event was significant because it involved the ethical issue of a parent’s ability to make medical decisions for their child. We felt that the need to benefit the patient and the population as a whole, outweighed the parents’ desire to know their child’s vaccination status. We were concerned with Luke’s rights first and foremost, but we were still thinking of the greater good for the rest of the population, therefore, since he was willing to get the vaccine, we felt as if it was in everyone’s best interest to do so. Legally no one needed to inform the parents because the child’s vaccination status was confidential, but as a parent it would be upsetting to know your child had a procedure done that you did not believe in. Following rules set by the clinic was important for us, however, we still would have preferred to have the parents involved in the child’s care. Our concerns at the time were focused on Luke and his ability to understand the decision he was making. Luke was very clear that he wanted the vaccine and believed that his parents were making the wrong decision about their health. Luke wanted to protect himself and others and felt like getting the vaccine was going to do so. We felt confident in our decision to provide the vaccine and encouraged Luke to continue to wear their mask and follow COVID-19 guidelines even with being vaccinated The Patient Autonomy Assignment Paper.
CI #6 As a student, I worked with a patient that had been diagnosed with “severe and enduring eating disorder.” She had been deemed mentally competent by a psychologist to proceed with Medical Assistance in Dying (MAiD) despite her diagnoses. This was quite unique as normally individuals with eating disorder are illegible for MAiD and are sectioned under the mental health act. However, she ultimately chose not to proceed with MAiD as she wanted to “go on her own terms.” On the unit, our goal was to provide supportive care and to keep her alive until she got her affairs in order and then she would be discharged to palliate at home. As a student, we are taught about the importance autonomy and beneficence when caring for patients. We are taught to act in the best interest of the patient while also respecting their freedom of choice. I found it morally distressing to work with this patient as I was unsure if I completely agreed with the psychologist’s choice of deeming her mentally competent, and her care plan of supportive care. While I could loosely relate this scenario to when people choose to smoke cigarettes despite being told it will cause lung cancer, or their choice to not wear a seat belt while driving, I still could not help to think we were breaking our code of ethics as health care professionals. Non-maleficence is the ethical obligation to prevent or do no harm. In this situation, I also felt as though we were causing the patient harm as we were not doing anything to intervene with her eating disorder. As health care professionals, we often have unconscious biases we hold about patients and are taught to reflect on our practice to avoid projecting these emotions onto our patients. In this scenario, I found it challenging to keep my opinions of what I thought was right out of the care I was providing. I found it difficult to respect my patient’s autonomy because I believed we may be causing her harm and that I was not doing what was in the best interest for her medically. I was scared I was supporting her eating disorder which Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence caused a lot of moral distress for me despite knowing that this was what the medical professionals all agreed upon. I could not help but to think they may be wrong in some way and I wanted to challenge their medical decisions regarding the patient. On the other hand, from my patient’s perspective, I could also see that it was her right to ultimately choose how she wanted to live her life. After speaking with other nurses about the matter and my patient about her choice to get a better understanding of this unique situation, I was able to feel less conflicted and support her fully in her decision to end her life. Although her choices did not align with what I would do if I were in her position, I was conscious of the opinions I had regarding her choice and ensured I kept this out of the care I was providing. Similarly to when a person who is Jehovah’s Witness chooses not to receive blood due to religious beliefs, I kept my own beliefs to myself and did not let it impact the care I was providing to respect my patient’s freedom of choice The Patient Autonomy Assignment Paper
Appendix 1
CI #1 Themes
Patient powerlessness: TU’s 10, 11, 12, 13
Patient feels uninformed/ineffective communication: TU’s 14, 15, 16, 18, 21, 22, 25
Patient with compromised autonomy: TU’s `
Paternalism: TU’s 5, 9
Covid restrictions or mandates: TU’s 5, 9
Patient moral distress: TU’s 10, 13, 16, 19
CI #2 Themes
Nurse’s and student’s roles and responsibilities: TU’s 1, 2, 3, 14, 20
Beneficence acted through trauma-informed care: TU’s 4, 5, 9, 29
Patient autonomy: TU’s 7, 9, 10, 27, 28, 29, 30, 31, 35, 36, 38
Patient empowerment: TU’s 26, 27, 28, 29, 30, 31
Beneficence promoted through patient well-being: TU’s 6, 8, 28, 37, 40
Respect: TU’s 13
Mental illness: TU’s 3, 15
Paternalism: TU’s 16, 18, 19, 20, 21, 22, 23
Covid restrictions or mandates: TU’s 16, 18, 19, 20, 21, 22, 23
Unhappy patient: TU’s 17, 21, 23
Non-maleficence: TU’s 24, 25, 33
Content patient: TU’s 32, 36
Patient education: TU’s 39
CI #3 Themes
Nurse as a patient’s advocate TU 11, 16, 17, 18, 21, 22, 23, 24
Nurse’s communication abilities TU 9, 11, 17, 22, 22
Nursing awareness TU 18, 21
Student in distress TU 8, 23
Patient’s anxiety TU 6, 7, 10
Nurse in distress TU 8
Autonomy TU 4, 17, 20, 21
Paternalism TU 14, 15
CI #4 Themes
Beneficence involves active listening: TU’s 14
Student powerlessness/inferiority: TU’s 7, 20, 22
Insecure: TU’s 7
Conflict/ineffective communication: 7, 9, 11, 12,13, 18, 19, 20, 22
Veracity/truth telling/honesty: TU’s 11, 13, 15, 24, 25, 26, 28
Therapeutic nurse-patient relationship: TU’s 2, 14, 15, 17, 25, 27
Lack of bond between nurse and nursing student: TU’s 18, 21
Patient education: TU’s 11, 26
Autonomy: TU’s 3, 6, 8, 9, 25
Moral distress: TU’s 13, 23
Paternalism: TU’s 8, 9, 12
Lack of nurse-patient interaction: TU’s 10, 18
Non-maleficence: TU’s 5, 6
CI #5 Themes
Autonomy: TU’s 10, 11, 12, 14, 19, 20, 21, 26, 27, 28, 31, 33, 40, 41, 42
Child Covid-19 vaccination: TU’s 7, 13, 16, 17, 18, 19, 27, 40
Empowerment: TU’s 19, 21, 22, 26, 27,31, 33, 40, 42, 43
Informed consent: TU’s 28, 39, 40, 41
Mature minor: TU’s 8, 9, 10, 11, 12, 14, 26, 33, 40, 41, 42
Moral distress: TU’s 9, 10, 12, 14, 22, 23, 36, 37, 38
Nursing student role and responsibilities: TU’s 8, 10, 12, 22, 25, 26, 27, 28, 30, 37, 44
Paternalism: TU’s 4, 9, 12, 22, 23, 29, 32, 34, 35, 38
Vaccine hesitancy: TU’s 2, 3, 20, 21
CI #6 Themes
Moral distress: TU’s 9, 12, 14, 15, 19, 20, 22
Patient autonomy: TU’s 5, 7, 19, 20, 25, 32, 33, 34
Patient empowerment: TU’s 30, 32, 34
Vulnerable patient: TU’s 1, 2, 3
Mental illness: TU’s 1, 3
Student powerlessness: TU’s 15, 23
Personal reflection: TU’s 7, 11, 12, 16, 17, 18, 19, 24, 25, 28, 30, 31, 32
Internal conflict: TU’s 10, 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23
Beneficence involves supportive care: TU’s 6, 7, 30
Beneficence considers patient’s point of view: TU’s 24
Non-maleficence: TU’s 8, 13, 15, 18, 20, 23, 28, 30, 32, 33
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Appendix 2
Data Matrix
| Themes | C1 | C2 | C3 | C4 | C5 | C6 |
| Nurse’s and student’s roles and responsibilities | ✔ | ✔ | ||||
| Beneficence acted by trauma-informed care | ✔ | |||||
| Autonomy/Patient autonomy/Nurse autonomy/Patient with compromised autonomy | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Empowerment/Patient empowerment | ✔ | ✔ | ✔ | |||
| Beneficence promoted through patient well-being | ✔ | |||||
| Respect | ✔ | |||||
| Mental Illness | ✔ | ✔ | ||||
| Covid restrictions | ✔ | ✔ | ||||
| Paternalism | ✔ | ✔ | ✔ | ✔ | ✔ | |
| Vulnerable patient/Unhappy patient | ✔ | ✔ | ||||
| Non-maleficence | ✔ | ✔ | ✔ | |||
| Content patient | ✔ | |||||
| Patient education | ✔ | ✔ | ||||
| Distress/Moral distress/Psychological distress/Student in distress/Nurse in distress | ✔ | ✔ | ✔ | ✔ | ✔ | |
| Powerlessness/Student powerlessness/Inferiority/Patient powerlessness | ✔ | ✔ | ✔ | |||
| Personal reflection | ✔ | |||||
| Conflict/Internal conflict/Ineffective communication/Patient feels uninformed | ✔ | ✔ | ✔ | |||
| Child Covid-19 vaccination | ✔ | |||||
| Ethical Issue | ✔ | ✔ | ✔ | |||
| Informed consent | ✔ | |||||
| Mature minor | ✔ | |||||
| Vaccine hesitancy | ✔ | ✔ | ||||
| Beneficence involves listening | ✔ | |||||
| Insecure/Lack of bond between nurse and student | ✔ | |||||
| Veracity/truth telling/honesty | ✔ | |||||
| Therapeutic nurse-patient relationship | ✔ | |||||
| Beneficence involves supportive care | ✔ | |||||
| Lack of nurse-patient interaction | ✔ | |||||
| Nurse as a patient’s advocate | ✔ | |||||
| Nurse’s communication abilities | ✔ | |||||
| Nursing awareness | ✔ | |||||
| Beneficence considers patient’s point of view | ✔ |
Appendix 1
CI #1 Data and Text Units
| 1Don is a 45-year-old healthy male. 2He is a 23-year veteran of the Canadian Armed Forces, and 3he now works for the Federal Government as a contractor for the military. 4He comes from a large family and has a father who is skeptical of government motives 5and from the beginning of the pandemic, Don and his father were both fairly skeptical of various government-imposed mandates, such as lockdowns or mask mandates. 6As a healthy male who has already recovered from a COVID-19 infection, 7he elected to not get the vaccine because he already had natural immunity. 8Up until recently, he really did not have any major impacts to his life due to the vaccination mandates. 9Once a deadline for vaccination was imposed on Federal employees, 10he became frustrated and conflicted as to how he wanted to proceed. 11He looked for different jobs in similar industries, he spoke with his supervisors, and 12he even considered not getting vaccinated with the risk of losing his job and his pension. 13He felt like he was forced into having to get the vaccine because he still had to feed his family and pay his bills.
14During my interview, I heard Don speak of the speed at which the vaccine has been produced, 15that the data of negative vaccine side effects is being suppressed, that 16these mandates are an attack on peoples’ freedoms, that there is fear mongering from the media, that there is a lack of long-term efficacy of the vaccine, and that 17the robustness of natural immunity is greater when compared to vaccine mediated immunity. For him, the waning effect of the vaccine, the possibility of needing endless boosters, and the fact that 18the vaccine appears to be more of a therapeutic than an actual vaccine, are all problems that he has had with the vaccine mandates. 19For Don, he feels as though his right to consent and his right for self-determination and autonomy has been taken away for “his own good and the good of society.” For him, the medical ethic of beneficence is being put ahead of his right to choose what types of medications go into his body. Furthermore,20he does not believe the current death rate and dangers of COVID-19 warrant this amount of control over his personal medical decisions. 21He also does not feel like we are getting enough information as to how and why public health policies are being made and on what evidence. To put things simply, he does not feel like the information he is getting is clear from governing bodies and he feels like people should be given more options. 22For him, if this was all about “following the science” then natural immunity should be equally as acceptable as vaccination status. 23Don also points to Florida as an example of how this pandemic has been managed in a way that preserves the rights and dignity of individuals. 24He claims that Florida has the least number of restrictions and has done better than New York or New Jersey in terms of COVID-19 deaths after adjusting for age. New York and New Jersey have imposed very restrictive COVID-19 measures, whereas 25Florida has allowed individuals to make their own medical calculations and risk mitigation strategies. Florida also allows doctors to use alternative types of therapies such as monoclonal antibodies to treat COVID-19 early and aggressively. Although 26Don and I disagree on some points, especially when considering the Canadian Government’s motivations for their current approach to dealing with COVID-19, he does make some valid points and issues to consider.27 The fact is he feels like his freedoms are being stripped away. 28He points out that some of the biggest people at risk are those who are obese or have multiple comorbidities, yet very little is being done to encourage those people to get healthy. 29The only messages Don hears is to “wear a mask,” “socially distance, “and “get vaccinated.” Why can I not be regularly tested? Why is my natural immunity not good enough? 30Ultimately, he is not happy with how Canada is handling COVID-19 and he does not believe that 31beneficence should be placed ahead of autonomy in regard to personal medical decisions. |
1Don – 45 years old
2Don – 23 years military veteran 3Don works as a contractor for the military 4Don and his father are skeptical 5They both doubtful about government directives regarding lockdowns and mandates 6Don got COVID-19 7Don refuses vaccination as he has natural immunity 8Don’s life was not impacted by mandatory vaccination until recently 9Deadline was announced for vaccination 10Don was frustrated and conflicted about what he had to do 11Don started to search for other jobs 12Don thought about losing his job and pension 13Don was forced to be vaccinated to feed his family and pay bills 14Don concerns that the vaccine was produced very fast 15Inadequate information about long-term side effects 16Media spreading fear 17Don is sure that natural immunity is better 18Don believes COVID-19 vaccine is therapeutic 19Don thinks his right to autonomy was infringed 20Don thinks the statistics does not have to affect his autonomy 21Don does not believe the government provides real information 22 Don strongly believes natural immunity is greater 23Don uses Florida as an example of precautionary measures needed. 24Don says that COVID-19 statistics are better in New York and New Jersey 25Florida keeps people’s rights regarding COVID-19 immunization 26 Don disagrees with the Canadian Government’s motivations for COVID-19 mandates 27Don feels his freedom was stripped 28Don believes, people with multiple comorbidities and obese should be more encouraged for healthy life status 29Don hears messages such as “wear a mask,” “socially distance, “and “get vaccinated” 30Don does not like Canadian government responses to COVID-19 31Don believes that beneficence should not override autonomy |
CI #2 Data and Text Units
| 1Sarah works as a pediatric nurse at a large city hospital. 2She works with children of all ages and with varying acuity levels. During a clinical shift together, 3Sarah told me she sees a lot of mental health patients, and that 4she spends a lot of time trying to understand the patients’ perspective and 5avoiding retraumatization. 6She likes to focus on healthy coping mechanisms and 7emphasizes empowerment and self-direction. 8She said it is important to her to promote good and healthy habits that are in the patients’ best interest, 9but to also let them decide 10so they feel in control and autonomous. 11Sarah enjoys being a pediatric nurse and 12says the work is incredibly rewarding and 13I find her work ethic to be very inspiring.
14Sarah and I shared a patient for several weeks 15who had an eating disorder (ED), whom I shall call Beth. 16Beth had been in the hospital for over a month and 17was understandably frustrated. 18Beth’s meals were very strict and timed, 19she was weighed three times a week, and 20Sarah had to stand outside the bathroom to make sure Beth was not purging or exercising. 21Beth was sad all the time and 22had not seen her family because of COVID-19, and 23she was clearly struggling. 24Sarah reflected that a lot of the nurses seemed to be focused on just going through the motions and 25perhaps only focusing on not causing harm –maleficence. 26Sarah suggested we act to promote the well-being of this patient, in her best interest. On an evening shift, 27we wrote down all the things we needed to accomplish before bedtime. 28Tasks such as vitals, assessment, snack, shower, bedding change, etc. 29Instead of telling Beth what needed to happen and when, 30we showed her what needed to be done and 31asked her how and in what order she would like to do it. 32Beth instantly smiled and 33said no one had ever asked her that. 34All these things needed to be done, and 35Beth chose a very logical order of things, but to 36simply be given the choice made her very happy, and we could tell that it benefited her. 37By promoting her independence and doing something specifically for her, it really made a positive influence on her mental health and wellbeing. 38By making space for her to choose the order of things, 39she was also more open to receiving care and education. 40Which also adds to the beneficence piece of being in her best interest and doing something to actively promote her wellbeing. |
1Sarah – Pediatric nurse in hospital
2Sarah works with children across lifespan and differing acuity levels 3Sarah encounters numerous patients with mental illness 4Sarah attempts to understand patients’ outlooks 5Sarah prevents re-traumatization 6Sarah concentrates on healthy coping 7Sarah promotes empowerment and self-direction 8Sarah encourages good and healthy habits beneficial to patients 9Sarah supports patient decision-making 10Patient have autonomy 11Sarah enjoys her occupation 12Sarah has gratifying job 13Student inspired by nurse’s work ethic 14Sarah and student worked with patient – Beth 15Beth had eating disorder 16Beth confined in hospital for months 17Beth was frustrated 18Beth has strict and timely meals 19Beth was weighed weekly 20Beth was closely observed for purging or exercising 21Beth was unhappy regularly 22Beth had not seen her family due to pandemic 23Beth struggled 24Several nurses focus on completing tasks 25Nurses focus on preventing harm – maleficence 26Sarah wanted to promote patient well-being 27Created task list to complete before bedtime 28Tasks include vitals, assessment, snack, shower, bedding change 29Decreased dictation on tasks 30Displayed a task list to patient 31Beth was urged to choose the orders of tasks 32Beth smiled 33Previously, no nurses asked 34Tasks needed to be completed 35Beth determined the order of tasks 36Beth was happy and benefited from her own choice 37Promotion of independence and patient-centered approach positively influenced mental health and well-being 38Nurses provided space for decision-making 39Beth receptive to healthcare and education 40Autonomy and empowerment contribute to beneficence and well-being |
CI #3 Data and Text Units
| 1This incident took place on a surgical unit during a clinical placement. 2A post-op patient (Mr. Smith) that the nurse I was working with (Tara) was taking care of, went through an acute decline in his health status three days after surgery. 3He had developed a new onset of uncontrolled atrial fibrillation and chest pain accompanied with diaphoresis and shortness of breath. 4Tara and I worked together to contact the most responsible physician (MRP) and obtain an order for nitro. 5We realized that Mr. Smith was progressing well surgically and following the expected healing process after his surgical procedure but was growing increasingly unstable related to his cardiac status.
6Mr. Smith was in a lot of distress due to his condition and worsening anxiety about his health and wellbeing. 7Mr. Smith had asked Tara if he was going to be okay. 8It was a very high stress situation for Tara and me as a second-year nursing student caring for and monitoring Mr. Smith’s deteriorating health status while also taking care of three other patients as part of the assignment. 9Tara had acted very professionally, used a calm and reassuring approach and taken every step to ensure Mr. Smith was comfortable. 10Mr. Smith had wished for his wife to be at the bedside with him but due to strict visitor restrictions because of the COVID-19 pandemic, she was unable to visit Mr. Smith and accompany him. 11Tara ensured to speak to Mr. and Mrs. Smith while on the phone in Mr. Smith’s room and provide an update on his treatment trajectory. 12 Meanwhile, multiple residents and attendings were coming from different units and specialties like internal medicine and the cardiac unit to assess Mr. Smith’s status and make decisions about transfer of care. 13With multiple IV medications being ordered, and fluid boluses being administered wide open, we realized that the patient needed to be cared for on a unit with a lower nurse to patient ratio. 14 While talking with the patient to ease their nerves related to their changing health status, I overheard residents and attendings arguing over where the patient should be transferred. 15“They’re a surgical patient, they should stay here” was used by most. 16It took hours to stabilize the patient and talking with different physicians for Mr. Smith to be transferred to a higher acuity unit. 17Tara advocated for a lower nurse patient unit due to the medications that were being administered which required close telemetry monitoring which a surgical unit was unable to provide. 18Even though the physicians assessing this patient believed the patient was appropriate for the surgical unit post op, 19Tara was concerned about the patient’s safety due to the critical care/cardiac medications that were being administered and 20recognized that she was unable to provide the best care for Mr. Smith. 21Tara also identified the need for additional support and delegated care of her other patients to her coworkers. 22She spoke to the clinical nurse leader (CNL) as well as Mr. Smith’s MRP about allowing his wife to visit as an essential visitor for emotional support. 23Being part of this morally distressing situation with Tara, I was very impressed by her approach while caring for Mr. Smith in a high stress situation and advocating for his care needs and safety. 24Tara promoted beneficence by upholding her concerns and constantly advocating for Mr. Smith’s care to be escalated to a higher acuity unit while also providing emotional support and reassurance to the patient and their family. |
1 Surgical unit during student’s clinical placement
2A post-op patient went through an acute decline in his cardiac health status three days post-surgery 3Patient developed Afib, chest pain, diaphoresis, and shortness of breath 2Tara – MRN with whom the student was working 4Tara and student contacted MRP to get an order for nitro 5No other post-surgical concerns for the patient 6Patient was in a lot of distress in relation to their condition and worsening anxiety about health and wellbeing 7Patient inquired if he will be okay 8Stressful situation for the MRN and student who had three other patients in the assignment 9MRN acted professionally using a calm and reassuring approach 10Patient wished his wife could be with him, but it was impossible due to COVID-19 restrictions 11Tara ensured that the wife was updated through a phone call 12Patient was assessed by the specialists from internal and cardiac medicine 13Patient’s therapy included multiple IV medications; therefore, he was needed to be cared for on the unit with a lower nurse-to-patient ratio 14Attendings and residents argued whether patient should be transferred 15The doctors claimed “they’re a surgical patient, they should stay here” 16After a long-time, patient was transferred to high acuity unit 17Tara advocated for the patient 18Tara disagreed with the physicians 19 Tara was concerned about patient’s safety 20 Tara was unable to deliver best patient care 21Tara identified the need for the support and delegated care of the other patients to coworkers 22Tara advocated for patient’s wife to be an essential visitor 23Student took part in the morally distressing situation. Student was impressed by MRN’s approach 24Tara promoted beneficence when upholding concerns and advocating for patient’s best care
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CI #4 Data and Text Units
| 1In the summer of 2021, I had a clinical placement at Saanich Peninsula Hospital (SPH) in the central medical unit. 2While caring for a patient awaiting leg surgery, 3I noticed their pupil sizes were slightly different in diameter. 4Knowing that they had a history of a cerebrovascular accident (CVA), 5I wanted to ensure the patient was safe. 6Therefore, I completed neuro-vitals on the patient and assessed for other signs and symptoms of a stroke. 7I became insecure in my assessment skills and decided to have my nurse double check the patient. 8The nurse entered the patient’s room, asked them questions, and asked the patient to perform actions, 9all the while not explaining to the patient why or what they were assessing for. 10The nurse swiftly left the room and 11I felt compelled to provide a simple explanation to the patient as they looked very confused. 12In discussion with the nurse afterwards, they told me that I should not have provided an explanation to the patient because it could cause them unnecessary stress and worry. 13I however, felt it was also unethical to not inform the patient of what we were doing. 14From my perspective, I had already established a therapeutic relationship with the patient and had already had opportunities to discuss their health with them, 15as such I felt confident that it would have harmed our trusting relationship if I had not explained that we were assessing for a CVA. 16Furthermore, the patient did not appear distressed at this news and 17was relieved that I had been attentive to their care because I knew their history. 18In contrast, the nurse had not interacted with the patient enough from my perspective to make a judgment on what action would be more beneficial for the patient, 19I had simply asked them to ensure the patient did not have any other symptoms of a CVA. 20I am disappointed to admit that I was too nervous to tell this to the nurse directly as 21I did not know them well 22or feel comfortable contradicting their judgment as an experienced nurse. 23This scenario was an ethical dilemma on 24whether it was more beneficial for the patient to be informed and risk unnecessary distress 25or inform the patient to promote autonomy and transparency within the relationship. 26Ultimately, I am glad that I informed the patient that we were confirming they did not have any signs and symptoms of a CVA. 27This is because I had established a relationship with them and 28knew they would be more concerned if I had not been transparent with them. | 1Clinical placement at Saanich Peninsula Hospital (SPH) in the central medical unit
2Caring for a preoperative patient 3Narrator observed patient’s pupil sizes were slightly different in diameter 4Patient history of a cerebrovascular accident (CVA) 5Narrator wanted to ensure the patient was safe 6Narrator completed neuro-vitals on the patient and assessed for other signs and symptoms of a stroke 7Narrator was insecure with their assessment skills and decided to have the nurse double-check the patient 8Nurse entered the patient’s room and performed own assessment 9Nurse did not explain the reason for doing the assessment to the patient 10Nurse swiftly left the room 11Narrator felt compelled to provide an explanation to the patient as they looked very confused 12Nurse told narrator that they should not have provided an explanation to the patient because it could cause them unnecessary stress and worry 13Narrator felt it was unethical to not inform the patient of what they were doing 14Narrator established a therapeutic relationship with the patient and had opportunities to discuss their health with them 15Narrator felt confident that it would have harmed their trusting relationship if they had not explained that they were assessing for a CVA 16Patient did not appear distressed at this news 17Patient was relieved that the narrator had been attentive to their care because they knew their history 18Nurse had not interacted with the patient enough to make a judgment on what action would be more beneficial for the patient 19Narrator asked the nurse to ensure the patient did not have any other symptoms of a CVA. 20Narrator was disappointed to admit that they were nervous to tell this to the nurse directly. 21Narrator did not know nurse well 22Narrator did not feel comfortable contradicting the experienced nurse’s judgment. 23Narrator found that the scenario was an ethical dilemma. 24Beneficial for the patient to be informed and risk unnecessary distress. 25Beneficial to inform the patient to promote autonomy and transparency within the relationship. 26Narrator was glad that they informed the patient that we were confirming they did not have any signs and symptoms of a CVA. 27Narrator had established a relationship with the patient 28Narrator knew the patient would be more concerned if they had not been transparent with them. |
CI #5 Data and Text Units
| 1The COVID-19 pandemic has brought up new ethical issues for both healthcare workers and the general population as well. 2With the vaccination rollout, it was obvious there was a distinct separation between those who were thrilled at the opportunity to become protected, and those who opposed receiving the vaccine. 3When the vaccine became available to children ages 12 and older, the same divide occurred, 4this time surrounding a parent’s right to make medical decisions for their child. 5I was working at the vaccination clinic this summer for my final 63rd year practicum and noticed that a 7lot of children were coming in with their parents to get vaccinated. 8We were given forms to fill out for minors and were taught that we had the 9right to vaccinate a child without their parents present and without their consent. 10If we deemed the child to be a mature minor, able to 11make their own medical decisions around the vaccine, we could 12provide the vaccination and never have to inform the families of the decision. 13All the children that were coming in for their vaccine had their parents or guardians with them, therefore, I thought 14I would not have to deal with the decision to vaccinate a mature minor without consent.
15Near the end of my time at the clinic there was 16an incident in which a child, who I will call Luke, came with a friend to get the vaccine. 17Their friend, who I will call Tyler, had already received his first dose of the vaccine when he came in with his parents the week prior. 18Luke and Tyler had been talking about the vaccine, which made 19Luke realize that he wanted to get vaccinated. 20He expressed that his parents were against the vaccine and when 21he brought up the idea of getting vaccinated, his parents were not supportive of the decisions. 22The student vaccinating and I informed Luke that he had the right to get vaccinated without parental consent and that 23we did not have to inform his parents of his choice either. 24I was not going to be vaccinating Luke, but 25if it were my turn to, I probably would have. With the help and support Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence from our instructor, 26we deemed Luke to be a mature minor and 27vaccinated him. 28Before doing so, we had him repeat all the information required to assess his ability to give informed consent. 29The event was significant because it involved the ethical issue of a parent’s ability to make medical decisions for their child. 30We felt that the need to benefit the patient and the population as a whole, outweighed the parents’ desire to know their child’s vaccination status. 31We were concerned with Luke’s rights first and foremost, but 32we were still thinking of the greater good for the rest of the population, therefore, since 33he was willing to get the vaccine, 34we felt as if it was in everyone’s best interest to do so. 35Legally no one needed to inform the parents because the child’s vaccination status was confidential, but as a 36parent it would be upsetting to know your child had a procedure done that you did not believe in. 37Following rules set by the clinic was important for us, however, 38we still would have preferred to have the parents involved in the child’s care. 39Our concerns at the time were focused on Luke and his ability to understand the decision he was making. 40Luke was very clear that he wanted the vaccine and 41believed that his parents were making the wrong decision about their health. 42Luke wanted to protect himself and others and felt like getting the vaccine was going to do so. 43We felt confident in our decision to provide the vaccine and 44encouraged Luke to continue to wear their mask and follow COVID-19 guidelines even with being vaccinated. |
1Pandemic brought new ethical issues
2Distinct separation with receiving vaccine 3Divide occurred with vaccine availability to children 12 and older 4Parent’s medical decisions for child 5Working at vaccination clinic 63rd year practicum 7Children coming with parents to get vaccinated 8Forms for minors 9Right to vaccinate without parents present and consent 10Mature minor 11Make medical decisions 12Provide vaccination and never inform family 13Children coming with parents or guardians for vaccine 14Decision to vaccinate 15End of time at clinic 16Incident with Luke at clinic 17Tyler received vaccine with parents the week prior 18Luke and Tyler talk about vaccine 19Luke wanted to get vaccinated 20Luke’s parents against vaccine 21Luke’s parents not supportive of getting vaccinated 22Student nurses informed Luke of the right to get vaccinated without parental consent. 23Student nurses did not inform parents 24Narrator was not vaccinating Luke 25Narrator would vaccinate Luke 26Nursing students deemed Luke a mature minor 27Nursing students vaccinated Luke 28Nursing students assessed Luke’s ability to give informed consent. 29Ethical issue of parent’s ability to make medical decisions for child 30Nursing students felt the benefit of patient and population outweighed parents’ knowledge of child’s vaccination status. 31Nursing students concerned about Luke’s rights 32Nursing students think of greater good for population 33Luke willing to get vaccine 34Nursing students felt vaccinating was in everyone’s best interest 35Legally, no need to inform parents of child’s confidential vaccination status 36Upsetting to know child had procedure parent did not believe in 37Following clinic rules was important to nursing students 38Nursing students preferred parents involved in child’s care 39Nursing students’ concerns focused on Luke’s ability to understand his decision 40Luke was clear he wanted vaccine 41Luke believed parents were making wrong decision 42Luke felt vaccine would protect himself and others 43Nursing students felt confident in their vaccine decision 44Nursing students encouraged Luke to follow COVID-19 guidelines |
CI #6 Data and Text Units
| 1As a student, I worked with a patient that had been diagnosed with “severe and enduring eating disorder”. 2She had been deemed mentally competent by a psychologist to proceed with Medical Assistance in Dying (MAiD) despite her diagnoses. 3This was quite unique as normally individuals with eating disorders are eligible for MAiD and are sectioned under the mental health act. 4However, she ultimately chose not to proceed with MAiD as 5she wanted to “go on her own
terms”. 6On the unit, our goal was to provide supportive care and to keep her alive until she got her affairs in order and then she would be discharged to palliate at home. 7As a student, we are taught about the importance of autonomy and beneficence when caring for patients. 8We are taught to act in the best interest of the patient while also respecting their freedom of choice. 9I found it morally distressing to work with this patient as I was 10unsure if I completely agreed with the psychologist’s choice of deeming her mentally competent, and her care plan of supportive care. 11While I could loosely relate this scenario to when people choose to The Patient Autonomy Assignment Paper smoke cigarettes despite being told it will cause lung cancer, or their choice to not wear a seat belt while driving, 12I still could not help to think we were breaking our code of ethics as health care professionals. 13Non – maleficence is the ethical obligation to prevent or do no harm. 14In this situation, I also felt as though we were causing the patient harm as we were 15not doing anything to intervene with her eating disorder. 16As health care professionals, we often have unconscious biases we hold about patients and are 17taught to reflect on our practice to avoid projecting these emotions onto our patients. 18In this scenario, I found it challenging to keep my opinions of what I thought was right out of the care I was providing. 19I found it difficult to respect my patient’s autonomy because 20I believed we may be causing her harm and that I was not doing what was in the best interest for her medically. 21I was scared I was supporting her eating disorder which 22caused a lot of moral distress for me despite knowing that this was what the medical professionals all agreed upon. 23I could not help but to think they may be wrong in some way and I wanted to challenge their medical decisions regarding the patient. 24On the other hand, from my patient’s perspective, 25I could also see that it was her right to ultimately choose how she wanted to live her life. 26After speaking with other nurses about the matter 27and my patient about her choice to get a 28better understanding of this unique situation, 29I was able to feel less conflicted and 30support her fully in her decision to end her life. 31Although her choices did not align with what I would do if I were in her position, 32I was conscious of the opinions I had regarding her choice and ensured I kept this out of the care I was providing. Similarly to when a person who is Jehovah’s Witness chooses not to receive blood due to religious beliefs, 33I kept my own beliefs to myself and did not let it impact the care I was providing to 34respect my patient’s freedom of choice. |
1Student working with patient diagnosed with eating disorder
2Patient deemed mentally competent to complete Medical Assistance in Dying 3Eating disorder – typically sectioned under Mental Health Act 4Patient did not choose MAiD 5Patient wanted to die on own terms 6Provide supportive care – discharge to palliate at home 7Student recognized importance of autonomy and beneficence 8Act in best interest of patient and respect freedom of choice 9Student experienced moral distress 10Student disagree that patient was mentally competent 11Student compared scenario to another example 12Student believed they were breaking the code of ethics. 13Non-maleficence – obligation to prevent or do no harm 14Student believed they were causing harm 15Student wanted to intervene with eating disorder 16Student recognizes unconscious biases that can exist 17Student recognized the importance of reflecting on practice. 18Personal values and beliefs can interfere in providing patient care. 19Difficult to respect patient autonomy 20Student believed patient autonomy could lead to harm 21Student believed they were supporting eating disorder 22Student experienced moral distress 23Student wanted to challenge medical decision 24Student considers patient point of view 25Student recognizes patient right to choose 26Student consulted with coworkers 27Student discussed situation with patient 28Conversation led to a better understanding of situation 29Student felt less conflicted 30Student could support patient with decision 31Student and patient choice did not align 32Student did not allow personal opinion to intervene with patient care. 33Student did not mention personal beliefs 34Student respected freedom of choice
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| 1In the summer of 2021, I had a clinical placement at Saanich Peninsula Hospital (SPH) in the central medical unit. 2While caring for a patient awaiting leg surgery, 3I noticed their pupil sizes were slightly different in diameter. 4Knowing that they had a history of a cerebrovascular accident (CVA), 5I wanted to ensure the patient was safe. 6Therefore, I completed neuro-vitals on the patient and assessed for other signs and symptoms of a stroke. 7I became insecure in my assessment skills and decided to have my nurse double check the patient. 8The nurse entered the patient’s room, asked them questions, and asked the patient to perform actions, 9all the while not explaining to the patient why or what they were assessing for. 10The nurse swiftly left the room and 11I felt compelled to provide a simple explanation to the patient as they looked very confused. 12In discussion with the nurse afterwards, they told me that I should not have provided an explanation to the patient because it could cause them unnecessary stress and worry. 13I however, felt it was also unethical to not inform the patient of what we were doing. 14From my perspective, I had already established a therapeutic relationship with the patient and had already had opportunities to discuss their health with them, 15as such I felt confident that it would have harmed our trusting relationship if I had not explained that we were assessing for a CVA. 16Furthermore, the patient did not appear distressed at this news and 17was relieved that I had been attentive to their care because I knew their history. 18In contrast, the nurse had not interacted with the patient enough from my perspective to make a judgement on what action would be more beneficial for the patient, 19I had simply asked them to ensure the patient did not have any other symptoms of a CVA. 20I am disappointed to admit that I was too nervous to tell this to the nurse directly as 21I did not know them well 22or feel comfortable contradicting their judgment as an experienced nurse. 23This scenario was an ethical dilemma on 24whether it was more beneficial for the patient to be informed and risk unnecessary distress 25or inform the patient to promote autonomy and transparency within the relationship. 26Ultimately, I am glad that I informed the patient that we were confirming they did not have any signs and symptoms of a CVA. 27This is because I had established a relationship with them and 28knew they would be more concerned if I had not been transparent with them.
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1Clinical placement at Saanich Peninsula Hospital (SPH) in the central medical unit.
2Caring for a pre-op patient 3Narrator observes patient pupil sizes were slightly different in diameter 4Patient history of a cerebrovascular accident (CVA) 5Narrator wanted to ensure the patient was safe 6Narrator completed neuro-vitals on the patient and assessed for other signs and symptoms of a stroke. 7Narrator is insecure with their assessment skills and decided to have the nurse double-check the patient. 8The nurse entered the patient’s room and did own assessment 9Nurse did not explain the reason for doing the assessment to the patient 10The nurse swiftly left the room 11Narrator felt compelled to provide an explanation to the patient as they looked very confused 12Nurse told narrator that they should not have provided an explanation to the patient because it could cause them unnecessary stress and worry 13Narrator felt it was unethical to not inform the patient of what they were doing 14Narrator established a therapeutic relationship with the patient and had opportunities to discuss their health with them 15Narrator felt confident that it would have harmed their trusting relationship if they had not explained that they were assessing for a CVA. 16The patient did not appear distressed at this news 17The patient was relieved that narrator had been attentive to their care because they knew their history 18Nurse had not interacted with the patient enough to make a judgement on what action would be more beneficial for the patient 19Narrator asked the nurse to ensure the patient did not have any other symptoms of a CVA 20Narrator is disappointed to admit that they were nervous to tell this to the nurse directly 21Narrator did not know nurse well 22Narrator did not feel comfortable contradicting the experienced nurse’s judgment 23Narrator found that the scenario was an ethical dilemma 24 Beneficial for the patient to be informed and risk unnecessary distress 25or beneficial to inform the patient to promote autonomy and transparency within the relationship 26Narrator is glad that they informed the patient that we were confirming they did not have any signs and symptoms of a CVA 27Narrator had established a relationship with the patient 28Narrator knew the patient would be more concerned if they had not been transparent with them |
CI #5 Data and Text Units (Holly)
| 1The COVID-19 pandemic has brought up new ethical issues for both healthcare workers and the general population as well. 2With the vaccination rollout, it was obvious there was a distinct separation between those who were thrilled at the opportunity to become protected, and those who opposed receiving the vaccine. 3When the vaccine became available to children ages 12 and older, the same divide occurred, 4this time surrounding a parent’s right to make medical decisions for their child. 5I was working at the vaccination clinic this summer for my final 63rd year practicum and noticed that a 7lot of children were coming in with their parents to get vaccinated. 8We were given forms to fill out for minors and were taught that we had the 9right to vaccinate a child without their parents present and without their consent. 10If we deemed the child to be a mature minor, able to 11make their own medical decisions around the vaccine, we could 12provide the vaccination and never have to inform the families of the decision. 13All the children that were coming in for their vaccine had their parents or guardians with them, therefore, I thought 14I would not have to deal with the decision to vaccinate a mature minor without consent.
15Near the end of my time at the clinic there was 16an incident in which a child, who I will call Luke, came with a friend to get the vaccine. 17Their friend, who I will call Tyler, had already received his first dose of the vaccine when he came in with his parents the week prior. 18Luke and Tyler had been talking about the vaccine, which made 19Luke realize that he wanted to get vaccinated. 20He expressed that his parents were against the vaccine and when 21he brought up the idea of getting vaccinated, his parents were not supportive of the decisions. 22The student vaccinating and I informed Luke that he had the right to get vaccinated without parental consent and that 23we did not have to inform his parents of his choice either. 24I was not going to be vaccinating Luke, but 25if it were my turn to, I probably would have. With the help and support Critical Incidents (CIs) on Nursing Students’ Experiences of Beneficence from our instructor, 26we deemed Luke to be a mature minor and 27vaccinated him. 28Before doing so, we had him repeat all the information required to assess his ability to give informed consent. 29The event was significant because it involved the ethical issue of a parent’s ability to make medical decisions for their child. 30We felt that the need to benefit the patient and the population as a whole, outweighed the parents’ desire to know their child’s vaccination status. 31We were concerned with Luke’s rights first and foremost, but 32we were still thinking of the greater good for the rest of the population, therefore, since 33he was willing to get the vaccine, 34we felt as if it was in everyone’s best interest to do so. 35Legally no one needed to inform the parents because the child’s vaccination status was confidential, but as a 36parent it would be upsetting to know your child had a procedure done that you did not believe in. 37Following rules set by the clinic was important for us, however, 38we still would have preferred to have the parents involved in the child’s care. 39Our concerns at the time were focused on Luke and his ability to understand the decision he was making. 40Luke was very clear that he wanted the vaccine and 41believed that his parents were making the wrong decision about their health. 42Luke wanted to protect himself and others and felt like getting the vaccine was going to do so. 43We felt confident in our decision to provide the vaccine and 44encouraged Luke to continue to wear their mask and follow COVID-19 guidelines even with being vaccinated. |
1Pandemic brought new ethical issues
2Distinct separation with receiving vaccine
3Divide occurred with vaccine availability to children 12 and older
4Parent’s medical decisions for child 5Working at vaccination clinic
63rd year practicum 7Children coming with parents to get vaccinated 8Forms for minors 9Right to vaccinate without parents present and consent 10Mature minor 11Make medical decisions
12Provide vaccination and never inform family 13Children coming with parents or guardians for vaccine
14Decision to vaccinate
15End of time at clinic 16Incident with Luke at clinic
17Tyler received vaccine with parents the week prior 18Luke and Tyler talk about vaccine
19Luke wanted to get vaccinated 20Luke’s parents against vaccine 21Luke’s parents not supportive of getting vaccinated 22Student nurses informed Luke of right to get vaccinated without parental consent
23Student nurses did not inform parents 24Narrator was not vaccinating Luke 25Narrator would vaccinate Luke
26Nursing students deemed Luke a mature minor 27Nursing students vaccinated Luke 28Nursing students assessed Luke’s ability to give informed consent 29Ethical issue of parent’s ability to make medical decisions for child 30Nursing students felt benefit of patient and population outweighed parents’ knowledge of child’s vaccination status 31Nursing students concerned about Luke’s rights 32Nursing students think of greater good for population 33Luke willing to get vaccine 34Nursing students felt vaccinating was in everyone’s best interest 35Legally no need to inform parents of child’s confidential vaccination status 36Upsetting to know child had procedure parent did not believe in 37Following clinic rules was important to nursing students 38Nursing students preferred parents involved in child’s care 39Nursing students’ concerns focused on Luke’s ability to understand his decision 40Luke was clear he wanted vaccine 41Luke believed parents were making wrong decision 42Luke felt vaccine would protect himself and others 43Nursing students felt confident in their vaccine decision 44Nursing students encouraged Luke to follow Covid-19 guidelines |