Description
Part 1:
Please answer the following questions:
1. The APN’s role centers on caring for clients and families suffering multiple losses. How would you adapt your plan of care for familes with different types of grief. (chapter 11)
2. Culture & religion impact every aspect of the dying process. If husband & wife belong to a culture in which the husband or eldest male relative makes all the decisions & females are expected obey should the ARN interfere if a female patient wants to have surgery & radiation for Stage 2 breast cancer, when her husband refuses to allow it? (chapter 6)
3. How does one’s culture & religion influence decisions about prolongation of futile care? What is the APN’s role, if the family’s decisions are incongruent with the palliative care team’s recommendations? (Chapter 6)
Part 2:
Please respond to the following responses:
Question 2:
1. Joanna:
Medical practice and ethical discussions highly emphasize a patient’s self-governance and welfare. The dependent situation described poses concerns regarding the patient’s autonomy and paternalistic decision-making in a cultural environment where a spouse or eldest male relative usually takes responsibility for making decisions on behalf of women’s family members. In this scenario, the APN has a complex dilemma: The lady wants to undergo both radiation and surgery, but her husband is reluctant to have his wife subjected to two different procedures. The remark emphasizes the necessity of recognizing and assisting patients’ autonomy. APN’s must create an open communication line with all parties involved to understand better the patients’ and spouses’ views, care concerns, and cultural beliefs. Promoting culturally competent care and collaborative decision-making are also of the essence.
The APN is responsible for informing and guiding the patient, prop her spouse about the benefits of suggested therapies to engage in Stage 2 breast cancer treatment, as well as addressing uncertainties and anxiety (Powell, 2021). If the patient insists on radiation or surgery despite careful consideration and education, but her husband does not want it, the APN may consult other health professionals, such as a social worker or ethicist, to promote more dialogue in resolving this matter. Promoting the patients’ rights should involve locating appropriate legal and moral authority. The APN should highlight the patient’s autonomy and health but at the same time respect their cultural perceptions. You have to use approaches like open communication, cultural competency, and cooperation with other healthcare providers in order not only to navigate this very complicated situation properly but also to provide the patient with appropriate treatment for her Stage 2 breast cancer (Copeland, 2021).
Copeland, D. (2021). A critical analysis of the American Nurses Association position statement on workplace violence: Ethical implications. Advances in Nursing Science, 44(2), E49-E64.
Powell, K. J. (2021). Shared Decision Making. Health and Wellness in People Living With Serious Mental Illness, p. 145.
2. Jben:
As a RN and future APN, it is important to respect the patient’s cultural values and beliefs. Last semester, in my Transcultural Care class, I learned that as providers, we need to evaluate our beliefs and accept that others have unique values, beliefs, and needs. If the female patient wants to have surgery and the husband refuses it, I would definitely intervene. I would educate the patient and her husband about the procedure, risks, benefits, and most importantly ask the husband why he is opposed to the surgery. If the female patient is capable of making her own decisions, I believe she has the final say over her husband from a legal perspective. However, if the patient is staying consistent with her cultural values or if she is deemed unable to make her own decisions with her husband being her healthcare proxy, I would call for the ethics committee to assist in this situation. As an APN, it is our duty to advocate for our patient’s best interest and to support their autonomy (Matzo & Sherman, 2019).
Reference:
Matzo, M., & Sherman, D. W. (Eds.). (2019). Palliative care nursing : quality care to the end of life (5th ed.). Springer Publishing Company.
Question 3:
1. Nicholas:
The APN’s role in a situation where the family’s decision may be incongruent with the palliative care team is to be supportive and an educator. In a situation like this the APN follows the ethical principle of autonomy. Autonomy has many different stages that the APN should assess and implement as stated by Matzo et al., (2019) “Depends on patient’s capacity to make decisions, Nurses have a role in assessing decision-making capability, Advance directives are used when making decisions for others”. In a situation where the family is making the decisions the APN should honor these choices to go against the palliative care team’s recommendations. The APN should also educate the patient’s family on the patient’s situation and any risks or benefits that come with their decision, this way they are able to make a decision without feeling any confusion. In certain situations, patient’s family members may disagree with treatment due to lack of understanding and fear of change, this is where it is important for the APN to discuss the situation with the family and determine their understanding. The APN can use their therapeutic communication and bedside communication to help assess the patient’s families understanding of the overall patient condition. Once determined they can help the patient’s family understand why the care team recommends the plan and discuss the purpose of that plan.
Reference:
Matzo, M., & Sherman, D. W. (Eds.). (2019). Palliative care nursing: quality care to the end of life (5th ed.). Springer Publishing Company.
2. Joanna:
Culture and religion play a complex, multifaceted role in decisions relating to prolonging futile care. The knowledge and attitudes of people toward life, death, and ethics in medicine are often driven by cultural, faith-based values. In some cultures, there may be a strong drive towards maintaining life at any cost (Ausar et al., 2021). In contrast, others might consider the quality of life and see aggressive medical interventions as futile or counter to natural processes. APN’s have an essential role in navigating these cultural and religious nuances in making decisions about prolonging futile care. They must give their utmost respect and care in these discussions, understanding the family’s cultural background and religious orientation (Phiri et al., 2023). This means active listening, considering different points of view, and providing culturally competent information.
The APN faces an ethical dilemma every time the family’s decisions do not align with those of the palliative care team. The nurse has to defend the patient’s interests and demonstrate respect for autonomy and values on behalf of family members (Phiri et al., 2023). Communication skills become crucial as the nurse enters into conversations with family and palliative care team members, helping to foster mutual understanding about what state a patient is in and how much time he has left. To remedy incoherence, the APN may participate in frank discussions scrutinizing the family’s worries. A medical ethicist or spiritual counselor occasionally provides more support and advice (Ausar et al., 2021). The objective is to promote collaboration and find a consensus that benefits the patient’s welfare while maintaining the beliefs of all stakeholders. Therefore, the role of culture and religion regarding futile care decisions cannot be overestimated; APN’s should adopt a more delicate attitude while dealing with this issue. Addressing incongruent decisions requires effective communication, cultural competence, and commitment to represent patients in their best interests when considering different beliefs and values.
Ausar, K., Lekhak, N., & Candela, L. (2021). Nurse spiritual self-care: A scoping review. Nursing Outlook, 69(4), 660-671.
Phiri, G. G., Muge-Sugutt, J., & Porock, D. (2023). Palliative and End-of-Life Care Access for Immigrants Living in High-income Countries: A Scoping Review. Gerontology and Geriatric Medicine, p. 9, 23337214231213172.
