Active Learning Activity Content
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Chapter 14 in our textbook
A HISTORY OF NURSING ETHICS
The Nuremberg trials at the close of WWII offered disturbing questions. How can “good” people in traditionally honor-bound professions become complicit in some of the worst violations of humanity in history? What happens when individual professionals are not held to account by their peers, professions, and society as a whole? The trials showed how moral individuals within organizations can engage in morally “wrong” functions. “I was just following orders,” complicit healthcare providers, doctors, and nurses claimed.
Morality refers to principles that help determine what is “right” and what is “wrong.” Ethics is the related field that puts these principles to work to:
apply moral principles to choose “right” actions,
conduct relationships in an ethical manner, and
manage situations where a “right” action is clear but for some reason not possible.
Using what we have learned this week- read the ethical dilemma below and explain your response and actions:
Nurse Is Instructed to Have Patient with Low Literacy Level to Sign Consent for Treatment
Scenario: Nurse Gloria is instructed by the attending physician to have Mr. Isaacs sign a consent form before a scheduled colonoscopy. As Nurse Gloria goes over the form with the patient, she notices he seems confused and is unsure where or how to sign the paperwork.
Ethical Dilemma: It is common for nurses to be the ones to get signatures on consent forms, especially for procedures like the one described in this scenario. When faced with a situation like the one here when the nurse is not sure that the patient understands what he is being told or if he can read, the decision of whether to delay a busy schedule to have the doctor come back and talk to the patient or explain to the best of her knowledge and get the patient’s signature may seem difficult to make.
Now that you have read the ethical dilemma below WHAT IS THIS PERSON FOCUSING ON EMOTIONALLY? What are the ASSOCIATED ETHICAL PRINCIPLEs AT PLAY IN THIS SCENARIO? WHAT ARE THE IMPLICATIONS OF THE NURSE’S ACTIONS? explain your responses and your current actions.
Please note the grading rubric.
Actions should incorporate EI, your actions and priorities, and the EBP behind your decisions.
This assignment is to be submitted as an essay- with an introduction, questions developed at the graduate level, and a conclusion to summarize and synthesize key points. A minimum of 4 pages not counting cover and reference pages- APA must be strictly followed.
4 references
· Learning Activity Question
50% of total result
Excellent
The learning activity questions are answered comprehensively. The word count if applicable has been met, and it is accurate, non-evaluative, coherent, readable, and concise. All the following elements are included: a. The problem or issue you are presented and clearly explained, and b. the author’s conclusions are clear and concise are explained. There is an introduction and a conclusion to the submission.
50
Satisfactory
The learning activity questions are not answered comprehensively. The word count is 50 words short of meeting the required count, and it is accurate, has some non-cohesive thoughts, readable, and is concise. All the following elements are included: a. The problem or issue you are presented and clearly explained, and b. the author’s conclusions are clear and concise are explained. There is either an introduction or a conclusion to the submission- but not both.
37.5
Unsatisfactory
The learning activity questions are not answered comprehensively. The word count is 50 words short of meeting the required count, but it is not clear and accurate, has some non-cohesive thoughts, and struggles to be coherent, readable, and concise. All the following elements are included: a. The problem or issue you is not presented and clearly explained, and b. the author’s conclusions are not clear and concise are explained. There is either an introduction or a conclusion to the submission- but not both.
25
· Reference Page
25% of total result
Excellent
Utilizes at least 4 sources and all sources are current within 5 years. Cited following APA format.
25
Satisfactory
Utilizes at least 2 sources and all sources are current within 5 years. Cited following APA format.
18.75
Unsatisfactory
Utilizes at least 1 sources and all sources are current within 5 years. Cited following APA format.
5
· Grammar, Spelling, APA, Page Requirement
25% of total result
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### Ethical Dilemma in Nursing: Informed Consent and Patient Literacy
#### Introduction
Nursing is a profession deeply rooted in ethical principles, compassion, and patient advocacy. In my practice at [Your Hospital or Healthcare Facility], I frequently encounter scenarios that challenge these core values. One such ethical dilemma involves obtaining informed consent from patients with low literacy levels. This essay examines a case where Nurse Gloria is instructed to have Mr. Isaacs, a patient with apparent low literacy, sign a consent form for a colonoscopy. The discussion will focus on the emotional aspects, associated ethical principles, implications of the nurse’s actions, and evidence-based practice (EBP) considerations to guide appropriate responses.
#### Emotional Focus of the Scenario
In this scenario, Nurse Gloria is likely experiencing a mix of concern and ethical distress. Her primary emotional focus is on ensuring that Mr. Isaacs fully understands the procedure he is about to undergo and the associated risks, benefits, and alternatives. She may also feel pressured by the attending physician’s instructions and the busy clinical schedule. Additionally, Gloria might be concerned about the potential repercussions of delaying the procedure if she seeks further clarification from the physician.
#### Associated Ethical Principles
Several ethical principles are at play in this scenario:
1. **Autonomy:** Respecting the patient’s right to make informed decisions about his own healthcare. Ensuring Mr. Isaacs understands the consent form is crucial to upholding his autonomy.
2. **Beneficence:** Acting in the best interest of the patient. Nurse Gloria must ensure that Mr. Isaacs is not subjected to procedures without fully understanding them.
3. **Nonmaleficence:** Avoiding harm to the patient. Ensuring informed consent helps prevent harm that could arise from misunderstandings or uninformed decisions.
4. **Justice:** Providing equitable care and ensuring all patients, regardless of literacy level, receive the same standard of informed consent.
#### Implications of the Nurse’s Actions
The actions Nurse Gloria takes in this situation will have significant implications:
1. **Patient Understanding:** If Gloria proceeds without ensuring Mr. Isaacs fully understands the consent form, it could result in the patient undergoing a procedure he does not fully comprehend, potentially leading to anxiety, mistrust, and a breach of ethical standards.
2. **Legal and Professional Consequences:** Obtaining consent without ensuring comprehension could result in legal ramifications for both the nurse and the healthcare facility. It also violates professional ethical guidelines.
3. **Patient Safety and Trust:** Properly addressing Mr. Isaacs’ confusion fosters a trusting relationship, promoting patient safety and adherence to treatment plans.
#### Response and Actions
1. **Assess Understanding:** Nurse Gloria should use simple language and visual aids to explain the procedure, checking for understanding through teach-back methods where the patient repeats the information in his own words【9†source】 .
2. **Seek Assistance:** If Mr. Isaacs remains confused, Gloria should advocate for the patient’s right to fully understand the procedure by requesting the attending physician to provide further explanation.
3. **Document Interactions:** Gloria should meticulously document all interactions, including her attempts to ensure understanding and any clarifications sought from the physician【9†source】.
#### Incorporating Emotional Intelligence (EI)
Emotional intelligence involves recognizing and managing one’s own emotions while empathizing with others. In this scenario, Gloria should:
1. **Empathy:** Show empathy towards Mr. Isaacs’ confusion and anxiety, reassuring him and providing support throughout the explanation process.
2. **Self-Awareness:** Be aware of her own emotions, such as frustration or stress, and manage them to remain patient and clear-headed.
3. **Communication:** Use clear, compassionate communication to convey information effectively.
#### Evidence-Based Practice (EBP)
Implementing EBP involves integrating clinical expertise with the best available evidence and patient preferences. Informed consent processes should incorporate strategies to enhance understanding for all patients, especially those with low literacy levels. Research suggests that using simplified language, visual aids, and the teach-back method significantly improves patient comprehension and satisfaction【9†source】 .
#### Summary
This case highlights the importance of ethical principles in nursing, particularly when dealing with informed consent for patients with low literacy levels. The interconnected domains of autonomy, beneficence, nonmaleficence, and justice guide the nurse’s actions to ensure ethical and legal standards are upheld. By employing emotional intelligence and evidence-based practices, nurses can navigate such dilemmas effectively, promoting patient safety and trust.
### References
1. American Nurses Association. (2015). **Code of Ethics for Nurses with Interpretive Statements**. Silver Spring, MD: Nursebooks.org.
2. Schenker, Y., Fernandez, A., Kerr, D., & Schillinger, D. (2011). Improving Communication Between Doctors and Patients With Limited Health Literacy: A Systematic Review of the Interventions. **Journal of General Internal Medicine**, 26(2), 136-146.
3. Sudore, R. L., & Schillinger, D. (2009). Interventions to Improve Care for Patients with Limited Health Literacy. **Journal of Clinical Outcomes Management**, 16(1), 20-29.
4. Kripalani, S., Bengtzen, R., Henderson, L. E., & Jacobson, T. A. (2008). Clinical Research in Low Literacy Populations: Using Teach-back to Assess Comprehension of Informed Consent and Privacy Information. **IRB: Ethics & Human Research**, 30(2), 13-19.
By addressing these key elements, this essay aims to provide a comprehensive analysis of the ethical dilemma presented, emphasizing the importance of patient-centered care, effective communication, and adherence to ethical principles in nursing practice.
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