Discussion 3: Clinical reasoning

Is the patient's autonomy being respected by involving her in the decision-making process?

No. Patient autonomy is defined as a patient's right to decide on their own medical treatment

without interference from a healthcare professional (Olejarczyk & Young, 2022). In this

case, the patient's healthcare decisions were influenced by her family members and

healthcare professionals except her. It was probably among the reason she kept complaining,

and it only took judicial actions to give in to her pleas finally.

How could a meeting of all parties involved have been more effective and/or ethical than

piecemeal decision making?

Due to the ease of providing the doctor and hospital staff with complete and accurate data

regarding the patient's current medical conditions, previous illnesses, hospital admissions,

medications, as well as other health-related matters, the meeting of all concerned parties

could have been more appropriate and/or ethical than fragmented decision-making (Patton et

al., 2018).

What ethical principle can function as a basis for good pain management?

Bioethical theory. The model contains ideas that are missing from conventional professional

practice, such as equality of human value, autonomy, as well as respect for the person

(Fulton & Storey, 2020).

Does the nurse have a moral responsibility to be more assertive in advocating for the

patient's relief?
 No. The patient's sister phoned the state regulatory agency to report that the caregivers are

ignoring her and not trying to take care of her pain; thus, the nurse has no moral obligation to

be more proactive in pushing for the patient's comfort. The doctor also agreed to test Nalfon

(NSAID), which later caused the patient to have symptoms including a severe gastric

haemorrhage.

Given that the doctor is likely to see the resident only every two months, what role should

the doctor take in assessing and monitoring the pain and its treatment?

Measuring pain using a verbal rating scale.

Using a numerical scale to measure pain (Ayzenberg, 2017).

Providing the patient with physical therapy.

Administering a painkiller to the patient.

Explain the ANA Code of Ethics provision(s) you think is violated in the case study and

why was it violated? Describe how you could apply the ANA Code of Ethics in the case to

uphold the provisions

Provision one was violated, given that it advocates for equal patient treatment (ANA

ENTERPRISE, 2022). On the contrary, most parties involved resented the patient for being

"stubborn", thus contributing to the negligence. The second provision that mandates nurses to put

the patient's needs was also violated because they refused to give the patient the drugs she

wanted. After all, a family member instructed them. These provisions could have been upheld if

the staff had prioritized the patient's needs instead of following solely the information the family
provided. Also, she ought to have been treated with dignity, notwithstanding her persistence in

seeking help.

List one assumption pertinent to this case that you would like to check and why.

The patient is a complainer and should not be given more painkillers because she might get

"doped up." This is because the details are from observers rather than the actual patient; hence

the best approach would have been to assess the issue and learn why the patient was ever in pain.

What other issues do you think this case explores?

Decision-making through proxy.

Concerns about informed consent.

Doctors' lack of expertise.

Question to Peers: Do you think that the staff could have handled the issue better had they

considered the ANA code of ethics? Explain.

References

ANA ENTERPRISE. (2022). Code of ethics for nurses.

ANA. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-

ethics-for-nurses/

Ayzenberg, I. (2017). Detailed characterization of pain and depression in NMOSD: Prevalence,

clinical features, management and impact on quality

life. https://doi.org/10.26226/morressier.59a3e8b3d462b8028d894143
Fulton, J. S., & Storey, S. H. (2020). Clinical nurse specialist comportment: Professional

attributes, ethical conduct, and citizenship. Foundations of Clinical Nurse Specialist

Practice. https://doi.org/10.1891/9780826195449.0002

Katz, N. (2002). The impact of pain management on quality of life. Journal of Pain and

Symptom Management, 24(1), S38-S47. https://doi.org/10.1016/s0885-3924(02)00411-6

Olejarczyk, J. P., & Young, M. (2022, June 15). Patient rights and ethics - StatPearls - NCBI

bookshelf. National Center for Biotechnology

Information. https://www.ncbi.nlm.nih.gov/books/NBK538279

Patton, R. M., Zalon, M. L., & Ludwick, R. (2018). Leadership for competencies for APRN:

Challenges and opportunity. Advanced Practice Nursing

Roles. https://doi.org/10.1891/9780826161536.0007