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Step 1: Look back at the experience, present a brief overview of your life crisis event and identify 2 social justice principles related to your reflected event (300 words).
A little girl has been admitted for her end-stage leukemia to receive treatment. The patient's family was properly consulted about their daughter's condition. The parents were followers of the Jehovah religion. Their religion prohibits them to take any kind of infusion therapy, be it medication, fluid, or blood transfusion. The nurses took careful notice of the family's cultural values and, thus, she was treated only with the aid of oral medicine.
However, the patient's health worsened with every day that passed. The oral medications were not helping the patient in improving her health conditions. The parents were clarified the possibility of blood transfusion therapy. However, the parents never gave the consent for the same, despite that they were a believer in the witness of Jehovah. The parents were not willing to compromise on their cultural and religious beliefs despite the deteriorating condition of their daughter (Chojnowski 2016).
The emotional demands may substantially impact on nurses' and leads to mental distress. This situation of unable to help the child gave an ethical dilemma. The religious beliefs prohibited a nurse from doing what was right at that time. This uncertainty, called "social distress," caused the nurses to feel weak, nervous, and even depressed (Haghighinezhad 2019). This kind of situation affected my emotions and caused anxiety to me, so, later on, I looked at the code of ethics as I was not sure how to respond to a specific circumstance. The whole situation made me feel helpless and the emotional distress prevented me from doing the work.
The 2 social justice principles identified in this situation are Social justice of participation and Social justice of equity. In this case injustice can cause substantial harm to the ill person. The society must remove barriers to participation to increase access. Historically oppressed communities should be allowed to speak out for justice (Kankkunen 2018).
Step 2: Elaborate and describe your life crisis reflected event (500 words)
The girl having leukemia was admitted to the department of emergency care with trouble breathing and impaired vitalities. The girl was found to be seriously anemic on blood tests and this was a life-threatening condition. However, the consent of the patient or their family is necessary before implementing any interventional procedure, but in the given care scenario, the nurse was also bound by her ethical duties and doing what is best for her patient. The principle of social equity also states equal treatment so the patient was provided transfusion of blood, ignoring the cultural and religious interest of the patient.
Crisis events in health care settings are numerous. During our day-to-day work, I regularly witness traumas, crime, death, human error, and human suffering. I was very nervous and tense in the situation but at the same time, I was aware of the fact that I have to remain detached emotionally, provide competent care, and effective interventions. Being the health care provider, the principle of social equity and participation has to be followed and the family member's consent should have been taken. Helping the patients and family members to cope with their mental distress was emotionally quite difficult. Also, at the same time inside I was blaming the parents on being so rigid with their religious beliefs.
The situation was stressful for all the members of the team. All the members of the multidisciplinary were thinking about the ways to convince the parents and think about the condition of the daughter followed social justice of participation. This created a very difficult situation to deal with as there was a big ethical dilemma created with the situation. The parents were also in miserable conditions seeing the child go through so much pain. Later on, after the transfusion of blood for the patient, the parents were very furious for not taking their consent for the treatment and for informing them late regarding the same. The social justice f equity was followed giving equal care to the patient.
The condition of the patient was improved within three hours of receiving a blood transfusion. She was in better condition but the parents of the patient were angry as the nurse did not honor their religious beliefs. The whole outcome created a situation of the ethical dilemma but the nurse considered the patient health on priority. In this case, the principle social justice of participation was ignored as the child health would have deteriorated more even could have put her on life risk.
The social justice principle of equity was followed, however, in the process of prioritizing the needs of the patient, the principle of participation was overlooked significantly. The patient condition improved by the means of critical and apt thinking and decision-making process of the nurse assigned to the patient care (Rababa, 2018). However, the decision-making process was not based on the perception of the family in managing the care of patient. Australia's Nursing and Midwifery Board has set a minimum of seven standards to be met by the leading nurse and it must be maintained that all nurses and health care participating in the same care cycle to meet the same requirements for the better care of a patient (Australia's Nursing and Midwifery Board 2016).
Step 3: Analyse the outcomes of your life crisis reflected event (500 words)
The patient family is a follower of the Jehovah religion. The beliefs of the religion prohibit them to take any kind of infusion therapy, be it medication, fluid, or blood transfusion. The patient is a child of age 13 and suffering from leukemia. She needs a treatment which under the principles of social justice for equity is her right. As a healthcare professional it is a duty to treat each patient with the best possible treatment. But the child couldn't be provided the necessary treatment for her. The nurses took careful notice of the family's cultural values and, thus, she was treated only with the aid of oral medicine (Rooddehghan 2019). These medications were falling short in improving her condition because of the inability to give her intravenous drugs.
It is the duty of health care professionals to provide patient-centered care (Lor 2016). But despite of availability of treatment, the nurses were not able to give her the required treatment. The condition made me feel bad as the girl child was suffering because of her parent’s religious beliefs. The child had a right under the principle of social justice of equity to get the treatment. Social justice and equity should remain at the forefront of measures taken by healthcare services for the right to healthcare, promoted and enjoyed by all citizens in full and equal terms. I cannot help the child and making the child's parents understand the consequences gave me moral stress and anxiety at the same time.
My colleagues were also helpless in taking out the way to help the patient in providing the health care support and services which were her right at the moment, the parents were in turmoil of emotions seeing their child suffer but they were not ready to compromise with their beliefs. The patient was suffering and showed a severe anaemic condition. The nurse without the consent of parents did a blood transfusion violating the social justice of participation (Olding 2016). The parents had a right to participate in the decision-making process in providing the health care, the social justice for participation was violated it the given situation (Hernández-Marrero 2019). The parents were not informed before the blood transfusion and the religious belief was ignored. Both the principle of social justice for equity and participation was not followed.
The outcome could have been improved by educating the parents about the consequences of not allowing the healthcare staff to do the infusions. The family could have been made to speak to a counsellor who might have convinced the parents and they could have participated in the treatment plans. Also, the attempt could have been made in making the family speak to their religious leaders who could have guided the family according to the religion in such cases. The evidence-based approach was the need in such kind of situation where the principle of social equity could have been explained to the parents in such a situation. The nurses could have educated the family about the documented cases in such kinds of ethical dilemmas which might have made the patient's parents understood the priority of the child health (Juujärvi 2019).
Step 4: Revise your approach for caring in a similar life crisis event (400 words)
I seek to concentrate on solving the immediate problem during the crisis using financial, social, and environmental tools. My professional experience has taught me about the goals of crisis intervention. In a similar scenario, my strategy would be accelerated crisis management to prevent further worsening of the patient's health condition. I will also try to prepare myself to achieve my level of functioning by understanding the beliefs of the patient if some solution can be brought out which can help the patient at the same time the religious beliefs are respected and valued. I would also like to work on my problem-solving skills, and to recognize the signs of the patients to prevent negative outcomes (Mitchell 2016).
In the caregiving process, the support is the integral characteristic required by the patient and the family members. I will try to advocate for them and provide support. I would also like to know more about the three core components of crisis intervention theory (a precipitating event, perception of the event, and the client’s usual coping methods). Such key components are central in the identification of clients in crisis. I will also be using my social skills as a caregiver to provide patient-centered care (Rozendo 2017). Interpersonal communication skills are a requirement for successful crisis management with clients that I will use in the future if a similar situation occurs. Since nurses need awareness and ongoing professional learning to incorporate best practices in crisis management (Valderama-Wallace 2017), I'll also look for the same opportunities.
A detailed holistic evaluation must also be carried out before embarking on any strategy to address these crises. I will also be attentive to all the aspects of crisis management including action, evaluation, referrals, and short-term follow-up (Whitt 2016). I will also inform patients, families, and the community about the crisis response and prevention measures which are important for health promotion (Thandi 2019). The core nursing curriculum will be used to decide my strategies that are the theory and practice of crisis intervention, sound knowledge of the therapeutic communication and their application to crisis intervention, and regular clinical supervision.
The further effectiveness of the interdisciplinary team working in crisis management can be accomplished at the organizational level by improving the continuum of crisis care, constantly striving to achieve an integrative and collaborative model of crisis intervention practices within an interdisciplinary team. The organization with the nurses should strongly promote offering multi-level (individual, family, and community) quality crisis intervention treatment (Wathen 2018).
Step 5: Confirm how your revised approach aligns with your Professional NMBA Practice standards (300 words)
A minimum of seven standards has been set up by Australia's Nursing and Midwifery Board for the leading nurse and it must be ensured that both nurses and health care involved in the same care process meet the same conditions for a patient's better treatment (Australia's Nursing and Midwifery Board 2016). My revised approach will help in better patient health outcomes as well as they will follow the NMBA standards. I am expected to respect all cultures and perspectives according to the NMBA Standard 1, which includes reacting to the role of family and community that underpins the wellbeing of people from other cultures. I should take note that the patient's cultural and religious values are not ignored, and will in all cases be valued.
Another NMBA standard states that The Registered Nurse should undertake comprehensive and systematic evaluations. My new strategy would, therefore, be to evaluate information and data and to convey findings to the patient and family members. The family members will be made aware of the health consequences if the religious beliefs are to be followed. Also, I would try to follow the evidence-based approach in making them understand that the health of patients is more important and the beliefs can be bypassed in critical situations. I will also be conducting holistic as well as culturally appropriate assessments. Planning and coordination in nursing practice is the responsibility of the RNs. I would always take the consent of the family member before doing any health interventions. An agreed health plan will be followed in partnership with the interdisciplinary team and the family members. All the detailed, relevant facts, and recorded documentation will be shared with the family and the patient. The plans must also be updated to make the negotiated results simpler.
Produce a reference list for 15 resources using the Harvard reference style (this can include resources used in your annotated bibliography)
Chojnowski, K, Janus, A, Bliźniewska, K, Robak, M & Treliński, J 2016, ‘Long-lasting extreme anemia during the therapy of acute lymphoblastic leukemia in a Jehovah's Witness patient’, Transfusion, vol.56, no.10, pp.2438-2442, doi: doi/abs/10.1111/trf.13703
Haghighinezhad, G., Atashzadeh-Shoorideh, F., Ashktorab, T., Mohtashami, J., & Barkhordari-Sharifabad, M. 2019. Relationship between perceived organizational justice and moral distress in intensive care unit nurses. Nursing Ethics, vol.26, no.2, pp.460–470. https://doi.org/10.1177/0969733017712082
Hernández-Marrero, P, Fradique, E & Pereira, S.M 2019, ‘Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis’, Nursing Ethics, vol.26, no.6, pp.1680-1695, doi: https://doi.org/10.1177%2F0969733018774610
Juujärvi, S, Ronkainen, K & Silvennoinen, P 2019, ‘The ethics of care and justice in primary nursing of older patients’, Clinical Ethics, vol.14, no.4, pp.187-194, doi: https://doi.org/10.1177%2F1477750919876250
Kankkunen, P, Kreuter, M & Pietila, A.M 2018, ‘Participation in primary healthcare–using a finnish version of the patient participation in rehabilitation questionnaire’, International Journal of Caring Sciences, vol.11, no.3, pp.1423-1437.
Lor, M., Crooks, N & Tluczek, A 2016, ‘A proposed model of person-, family-, and culture-centered nursing care’, Nursing Outlook, vol.64, no.4, pp.352-366, doi: https://doi.org/10.1016/j.outlook.2016.02.006.
Mitchell P. H. 2016. Nursing ethics and social justice. International Nursing Review, vol.63, no.1, pp.1–2. https://doi.org/10.1111/inr.12251
Nursing and Midwifery Board of Australia 2016, Registered nurses Standards For Practice, Australian Health Practitioners Regulation Agency, viewed 15 June 2020, https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Olding, M, McMillan, S.E, Reeves, S, Schmitt, M.H, Puntillo, K & Kitto, S 2016, ‘Patient and family involvement in adult critical and intensive care settings: a scoping review’, Health Expectations, vol. 19, no.6, pp.1183-1202, doi: https://doi.org/10.1111/hex.12402.
Rababa M. (2018). The role of nurses' uncertainty in decision-making process of pain management in people with dementia. Pain Research and Treatment, 2018, 7281657. https://doi.org/10.1155/2018/7281657
Rooddehghan, Z, ParsaYekta, Z & Nasrabadi, A.N 2019, ‘Equity in nursing care: A grounded theory study’, Nursing Ethics, vol.26, no.2, pp.598-610, doi: https://doi.org/10.1177%2F0969733017712079.
Rozendo, C.A, Salas, A.S & Cameron, B 2017, ‘A critical review of social and health inequalities in the nursing curriculum’, Nurse Education Today, vol.50, pp.62-71, doi: https://doi.org/10.1016/j.nedt.2016.12.006.
Thandi, M.K.G & Browne, A.J 2019, ‘The social context of substance use among older adults: Implications for nursing practice’, Nursing Open, vol.6, no.4, pp.1299-1306, doi: https://doi.org/10.1002/nop2.339.
Valderama-Wallace, C.P 2017, ‘Critical discourse analysis of social justice in nursing's foundational documents’, Public Health Nursing, vol.34, no.4, pp.363-369, doi: https://doi.org/10.1111/phn.12327.
Wathen, C.N, Varcoe, C, Herbert, C, Jackson, B.E, Lavoie, J.G, Pauly, B, Perrin, N.A, Smye, V, Wallace, B & Wong, S.T 2018, ‘How equity-oriented health care affects health: key mechanisms and implications for primary health care practice and policy’, The Milbank Quarterly, vol.96, no.4, pp.635-671, doi: https://doi.org/10.1111/1468-0009.12349.
Whitt, K. J., Hughes, M., Hopkins, E. B., & Maradiegue, A. 2016. The gene pool: The ethics of genetics in primary care. Annual Review of Nursing Research, vol.34, pp.119–154. https://doi.org/10.1891/0739-6686.34.119
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