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Introduction To Professional Practice 

Introduction to Decision-Making Framework Analysis

The study is based on a clinical scenario in a children’s Haematology/oncology ward. The nurse professional has been assigned to work in this ward at Women’s and Children’s Hospital in Adelaide, in the South-Australian region. The nurse helped a 15-year-old boy named Abdul, in recovering from his illness. The boy had developed a close relationship with staff due to his jolly and melodious nature. The boy was admitted to the clinical setting, for the treatment of his rare malignant blood condition. Over the due course of time, the boy recovered with fine treatment therapies in place and was discharged. Somehow the disease resurfaced and the patient was reported back to the hospital. He had to undergo few blood test and other diagnostic tests to evaluate for the presence of infection re-occurring. The paediatric oncologist of the patient Abdul suggested a new treatment method that can be beneficial for managing his given medical condition. Abdul invited the nurse for a conversation when his parents were not around. He notified the nurse that he heard his parents talk about the underlying risk from the treatment and were not in favour of Abdul getting treated with this new method. However, Abdul perceives that this new method of treatment might be his only option to survive and is in strong favour of taking the same. As a nurse aligned in care of Abdul, the healthcare professional is in a state of dilemma as to what next should be done.

Considerations as Per Ethical Model of Decision-Making

Nurses during their clinical practice are required to make ethical decision on a daily and regular basis (Storaker, 2019). Some of these decisions can be deemed as more complicated than others. The ethical model of decision making designed by McDonald’s is mainly divided into multiple steps that help in simplifying this process (McDonald, 2019). The step-wise and procedural approach helps the individuals to work by abiding the Code of Ethics for Registered Nurses. This provides a medium for the nurses to work in collaborative manner with the patient, their family members and other healthcare team members, when subjected to an ethically challenging situation. The methodical approach of the model helps in defining the best course of treatment plan to be implemented to obtain improved healthcare outcomes. The five-step model is a guided model framework that helps in enabling smooth facilitation of ethical decision-making process.

The first step of the model is gathering the facts pertaining to the given case scenario (Heyler, 2016). The patient is known to the nurse as he has been admitted to the clinical setting before. However, with the re-surfacing of the condition, the patient is to be viewed from a different perspective. The patient’s parents are not in the favour of the treatment. However, this has been informed by the patient himself and not his parents. This can be a matter of concern as the new treatment method can be quite helpful for the patient. The underlying factors can be reluctance of the parents due to the uncertainty of the effectiveness of the treatment to be provided to the patient (Muller, 2018). To identify and assess the gap a collaborative team approach should be required in this case. The patient Abdul in the case scenario thinks that the new method of treatment is his only chance of getting recovered from the condition. The parents however, do not have the same understanding. The model of ethical care should be used in a manner that it holistically supports Abdul and his family in care decision-making with any coercion. The main aim is to prevent the further suffering of Abdul from his condition. As per the healthcare standards, the main goal of the healthcare professionals should be safeguarding the best interest of the patient and his family as well. The policies should be crafted in a manner that is helps in resolving the underlying conflict with prompt solution, before deciding on whether or not to commence with the treatment (Rathert, 2016).

Role of multidisciplinary team can be considered as faithful in this given situation. The nurse can work along with the care physician in providing care to the patient. The situation calls for a group session with the patient that can be carried out along with his parents, with the medical team members. This will help in deeply evaluating the current situation and thus, will help in identifying the gap and short-comings to be worked on. All clinical derivatives should only be conducted after contemplating the medical facts, such as diagnosis, prognosis and best treatment options available for the patient (Fiset, 2017). All of these clinical objectives should be identified pertaining to the benefits that it can offer to the patient, post implementation of the treatment. The parents along with the child can be enlightened about the favourable forecast of the treatment which will be provided to the patient. The reluctance of the parents can also be marginalized by enumerating all of the pros and cons of the treatment modality to be used for Abdul’s remission of disease. The nurses can also help the patient and his family in letting them know about the details of the procedure to be followed. The reluctance of the patient’s family can also be due to the fear of not knowing the details of the treatment protocol. In any given medical scenario, the patient’s ability to choose relevant information decides on the possible consequences of the treatment applied. It is imperative that a sound rationality should be offered along with the treatment options provided to the patient. The decision making should also be formulated, by keeping a close consideration for the past experiences of the patient and their families (Giles, 2016). As in the given scenario, the patient can be observed to having a relapse of the condition, this might be an contributing factor for reluctant attitude of his parents, towards the new method of medical management. It should also be a decision of the patient to make sure what he desires from his treatment. It is also known that there is a sound cognitive development and moral sensitivity in the person, enough to make a personal and voluntary decision, by the age of 14 years above (Yeom, 2017). However, in a paediatric care setting, this decision making is generally carried out by the parents of the patient. Parents also know what is best for their children and they can make a good clinical decision for them. However, there is an underlying concern for considering patient’s emotional and biological concerns as well.

Second step in the ethical model of decision making is defining the underlying ethical considerations for the given scenario. This stage is directly defined by nursing codes of ethics. This step makes the care delivery model more approachable and acceptable for the patient. The decision-making process can involve analysing multiple aspects that drive the absolute clinical decision-making process (Schmidt, 2017). The autonomy of the individual should be respected in the given scenario. For enabling so the patient should be fully aware and should understand the implications of the treatment provided to them (Molina, 2020). These implications include both positive and negative impacts on the person. In majority of the cases the children do not have the ability to be truly informed, and thus, they directly depend on the guidance from others. Therefore, it becomes the responsibility of the healthcare professional to ensure that true informed consent should be provided to the patient, along with the parents. The aspect also covers for the principle of beneficence (Lyu, 2018). The medical professional engaged in patient care has to ensure that no harm is caused to the patient. Medical practioners can often find themselves struggling between the concept of benefit and harm. This is generally observed when a clashing situation is observed such as in the given case scenario. The bias is always found to be shifted towards the factor of benefit. Therefore, there is dire need of fully informed consent to be attained before commencing with any procedural activity. This will ensure a greater chance of a reasonable benefit for the patient. The patient always comes first in the priority to deliver care for them (Conroy, 2018). Their best interest should be promoted in the first place, before extending any concern towards the physician, family or any guardian of the patient.

The main aim of medical care is to strive ultimate support to the patient. Therefore, the planning and intervention should be delivered keeping a close consideration for the patient’s medical needs and specifications. As the main target in this case is to prevent the harmful effects of the remission of the condition on the patient, keeping the patient’s desires as priority should be the main focus of the planned intervention. Informed consent is another major ethical consideration in this situation. Informed consent procedure can not necessary be simplified in order to compensate for the medicolegal requirements. However, it can be considered as a pivotal issue, ensuring that patient’s free choice of regarded and supported at all times. This method also makes sure that the active participation of the patient is ensured in the process, even if they are a minor like Abdul. The certified age for authorizing an informed consent is defined as 18 years and above (Sil, 2017), and thus, Abdul cannot provide consent for his treatment, even when he wishes to proceed with the same. Informed consent in this given scenario can also be conflicting as the patient in the case study is a competent adult. The final decision-making process should only be delivered after due acknowledgement of the concerns of both Abdul and his parents. It is imperative that nurse professional should also try and analyse any underlying cultural or religious consideration that might be limiting Abdul’s parents in giving a positive consent for the new treatment method. Truly informed consent should be provided only when the patient is sufficiently able to weigh all of the informed pros and cons pertaining to the treatment plan to be implemented for the patient’s benefit (Waldron, 2020). This decision making should be delivered without any coercion, from both healthcare professional’s side and patient’s and his parent’s side. This should also be ensured that no underlying bias is promoted during this process.

The third step of the process is identifying the parties or the stakeholders involved in the process. There are three main parties involved in this process of ethical decision-making process and can be observed to be directly affected by the same (Waldron, 2020). The first person involved in the process is the patient, Abdul. The patient has suffered with his condition before and aspires to have a sound treatment method. Despite having the condition before and having a relapse of the same, the patient can still be observed to be positive for the treatment. However, he is still a minor and cannot provide consent for his treatment. The patient fears that his parents might not be in sync with the decision of opting for the decision of considering the new treatment plan.

The second party involved in the process is the parents of the child. The parents are not in favour of getting the new treatment for the patient. Being the sole decision maker for their child the parent’s role can be deemed as the quite crucial in the process. The parent’s decision will be directly impacting on the patient’s healthcare outcomes derivatives as well. However, they might also be have reluctance for the treatment. This can be due to the relapse of the condition in their son. There might also be certain ethical and cultural consideration that might be affecting or impacting the decision-making process directly or indirectly. The third party involved in the process is the nurse professional. She might be in a constrained ethical dilemma. The patient is younger for his age to provide consent for the treatment and only parents can provide the same. The nurse acknowledges that the new treatment might benefit the relapse of the clinical condition of the patient. She might be facing a trouble in comprehending the situation as the patient is a child and understands the positive implications of the treatment for him. The nurse has an added burden to keep the parents and the patient in sync with the conversation and enable the best possible healthcare outcomes for the patient. The nurse can work as a mediator in the process to make sure that sound clinical decision should be made for the patient, ensuring his best of interest and enabling improved healthcare outcomes for the patient, through safe delivery care model (Nilsson, 2018).

Conclusion on Decision-Making Framework Analysis

In any given clinical set ups the nurses help the patient with all of their underlying concerns. These nursing professionals have a duty to make sound and precise clinical decision making, for ensuring the protection of the best interest of the patients. This has also to be followed in consent with the personal and professional ethical principles of the nursing profession. The importance of ethical considerations can be deemed as one of the most crucial one. These principles not only help in accurate and informed decision making but also help in analysing the underlying consequences of the actions taken by them. Healthcare facilities are mainly are provided to the patients based on keenly examining the patient and subjecting them to effective diagnostic testing methods. The treatment methods to be delivered might sometime tend to overlap with an individual’s cultural and religious viewpoints. These situations can give rise to certain un-called-for scenarios which might give rise to conflicting issues. It is however, the duty of the healthcare professional to ensure that utter respect and dignity for the student is maintained in the process. They should work along with the team members to find an optimal solution for the patient. The ethical decision-model is helpful in decision-making process for the patient, to enable smooth facilitation of the healthcare delivery to the patients. This process is beneficial in sound decision-making through the means of brainstorming sessions between interdisciplinary team members. This approach can also be deemed as one of the innovative and creative method to resolve any ethical dilemma arising from any clinical scenario.

References for Decision-Making Framework Analysis

Conroy, T. (2018). Factors influencing the delivery of the fundamentals of care: Perceptions of nurses, nursing leaders and healthcare consumers. Journal of Clinical Nursing27(11-12), 2373-2386. https://doi.org/10.1111/jocn.14183

Fiset, V. J., Graham, I. D., & Davies, B. L. (2017). Evidence-based practice in clinical nursing education: A scoping review. Journal of Nursing Education56(9), 534-541. https://doi.org/10.3928/01484834-20170817-04

Giles, T., de Lacey, S., & Muir‐Cochrane, E. (2016). Factors influencing decision‐making around family presence during resuscitation: A grounded theory study. Journal of Advanced Nursing72(11), 2706-2717. https://doi.org/10.1111/jan.13046

Heyler, S. G., Armenakis, A. A., Walker, A. G., & Collier, D. Y. (2016). A qualitative study investigating the ethical decision making process: A proposed model. The Leadership Quarterly27(5), 788-801. https://doi.org/10.1016/j.leaqua.2016.05.003

Lyu, C., & Zhang, L. (2018). Who decides in withdrawal of treatment in a critical care setting? A case study on ethical dilemma. International Journal of Nursing Sciences5(3), 310-314. https://doi.org/10.1016/j.ijnss.2018.06.004

McDonald, F. & Then, S.-N. (2019). Ethics, law & health care: A guide for nurses and midwives (2nd ed.). Macmillan International; Red Globe Press p. 239.

Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health17(3), 835. https://doi.org/10.3390/ijerph17030835

Muller, P. C. H., Yildiz, B., Allaart, C. F., Brinkman, D. M., van Rossum, M., van Suijlekom-Smit, L. W., ... & De Vries, M. C. (2018). Participation in a single-blinded pediatric therapeutic strategy study for juvenile idiopathic arthritis: Are parents and patient-participants in equipoise?. BMC Medical Ethics19(1), 96. https://doi.org/10.1186/s12910-018-0336-8

Nilsson, L., & Fagerström, C. (2018). Decision-makers and mediators in a home healthcare digitisation process: Nurses’ experiences of implementation and use of a decision support system. Contemporary Nurse54(4-5), 511-521. https://doi.org/10.1080/10376178.2018.1507676

Rathert, C., May, D. R., & Chung, H. S. (2016). Nurse moral distress: A survey identifying predictors and potential interventions. International Journal of Nursing Studies53, 39-49. https://doi.org/10.1016/j.ijnurstu.2015.10.007

Schmidt, B. J., MacWilliams, B. R., & Neal-Boylan, L. (2017). Becoming inclusive: A code of conduct for inclusion and diversity. Journal of Professional Nursing33(2), 102-107. https://doi.org/10.1016/j.profnurs.2016.08.014

Sil, A., & Das, N. K. (2017). Informed consent process: Foundation of the researcher-participant bond. Indian Journal of Dermatology62(4), 380. https://dx.doi.org/10.4103%2Fijd.IJD_272_17

Storaker, A., Nåden, D., & Sæteren, B. (2019). Hindrances to achieve professional confidence: The nurse’s participation in ethical decision-making. Nursing Ethics26(3), 715-727. https://doi.org/10.1177%2F0969733017720827

Waldron, T., Carr, T., McMullen, L., Westhorp, G., Duncan, V., Neufeld, S. M., ... & Groot, G. (2020). Development of a program theory for shared decision-making: A realist synthesis. BMC Health Services Research20(1), 59. https://doi.org/10.1186/s12913-019-4649-1

Yeom, H. A., Ahn, S. H., & Kim, S. J. (2017). Effects of ethics education on moral sensitivity of nursing students. Nursing Ethics24(6), 644-652. https://doi.org/10.1177%2F0969733015622060

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