Accordingto Gaylord and Grace (2014, p. 188) “facilitators of ethicalleadership in nursing practice are the same as those that supportethical nursing practice or environments that have the patient’s,group’s, perhaps or society’s good as the motivator of everyaction”. However, this is not always the case. Perhaps, majority ofethical issues in nursing occur in the end of life care (Thacker,2008). In a typical case, Mrs. K, a 78 years old female patient wasadmitted in a nursing facility with a severe pneumonia infection andan advanced case of chronic obstructive pulmonary disease. Sheexhibited signs and symptoms such as shortness of breath, severeheadache, coughing and fever. She has been diagnosed with diabetesand a recurring pneumonia infection. Four days after admission, Mrs.K’s condition worsened and was transferred to the intensive careunit. This is after the infection started spreading rapidly to otherparts of the body. The on-call resident to which she was transferredto was not adequately informed about her case. Throughout the night,she complained about severe headache and suffered shortness of breathbut the nurse could not assist her. Additionally, at night, she hadan acute case of nose breeding which resulted into aspiration ofblood into the lungs. As a result, she required endotrachealintubation to survive. As a result, a fairly health old woman was inan intensive care united living with the support of a ventilator pumpand a fast spreading infection.
However,her case did not end there. When Mrs. K daughter and brother camevisiting her the following day in the afternoon, they were shockedabout the rapid deterioration of her health status. Through a writtennote on a pad, Mrs. K expressed her pain and worried to her daughter.She specifically mentioned that she was uncomfortable with how shewas handled and her continued stay in the facility. A discussionbetween the family and the doctor did not improve the situation whichhas deteriorated to disorientation and despair. While the family wasworried about the rapid deterioration of her health and the qualityof services in the hospital, they were also concern about thefinancial implication of her long term care.
Thereare several ethical issues that are involved in Mrs. K case. Theethical concerns are as a result of lack of adequate factors thatfacilitate ethical practice. The first ethical concern is the failureof the health care professionals to adequately manage the pain andsymptoms Mrs. K experienced. For example, she experienced severeheadache and lack of sleep as well as acute nose breeding, but shewas not provided with adequate medical help. Secondly, there was noadequate communication between the family of Mrs. K and the medicalworkers. Also, different medical workers handling her did notcommunicate effectively. The clinical team did not communicate thegoals of the treatment or the health status until it was too late.This denied Mrs. K an opportunity to express herself about herdesires while she was able to communicate. The conversation wasinitiated after her health conditions have deteriorated significantlywhen she could not be able to communicate. The uncoordinated healthinterventions complicated Mrs. K health conditions and the healthcare facility was unable to meet her physical and psychologicalneeds.
Asan advanced practice nurse in a leadership position, I would haveensured that the physical and psychological needs of Mrs. K were met.The first step would have been analysis of her health care history.This could have been the basis of all clinical interventions (Kim,2011). For example, Mrs. K is terminally ill patient suffering fromchronic obstructive pulmonary disease, recurring pneumonia anddiabetes. Since her condition is terminal, but requires management, adiscussion between the patient and the family with the medical teamwould have been convened after the patient was stabilized. This willensure that there is adequate communication between medical workershandling her. Additionally, Mrs. K and her family would be adequatelyinformed about the goals of medical interventions (Van Vorst, 2006,Tucker, 2012).
Gaylord,N. & Grace, P. (2014), “Ethical leadership by advanced practicenurse”. In NursingEthics and Professional Responsibility in Advanced Practice,Jones & Bartlett Publishers, ISBN 1449667430. 175-193.
KimS. (2011). “Development and initial psychometric evaluation ofnurses` ethical decision making around end-of-life care scale inKorea”. JHosp Palliat Nurs.13(2):97–105.
ThackerK. (2008). “Nurses` advocacy behaviors in end-of-life nursingcare”. NursEthics 15(2):174–185.
Tucker,K. L. (2012). “Aid in dying: guidance for an emerging end-of-lifepractice”. Chest142:218–24.
VanVorst R. F. et al (2006). “Barriers to quality care for dyingpatients in rural communities”. RuralHealth.22(3):248-253.