Nursing Advocacy: The Ethical Issues

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Description of the Clinical Issue

Wrong diagnosis and treatment is a medical scenario where a medical report does not conform to the patients actual condition. In a hypothetical case, Mss. Elizabeth Brown was admitted to St. Benedicts teaching and referral hospital, a hospital specializing in heart diseases. The physician who attended to Mss. Brown carried out a physical examination and noticed that the patient experienced shortness of breath and swelling of the legs and lower extremities. The practitioner hurriedly recommended a heart failure test because the symptoms pointed to it. It is, however, prudent to note that chronic kidney disease sometimes has symptoms similar to heart failure. The practitioner ignored the possibility of chronic kidney disease and reported heart failure. Mss. Brown was placed under heart failure treatment instead of chronic kidney disease. Before commencement of the heart failure treatment, her son, who knew about her history of kidney disease, approached a nurse advocate to stop the treatment because it could lead to further complications.

Application of the Bioethical Decision Making Model on Mss. Browns Case

Definition of the Dilemma

The dilemma in the hypothetical situation is a wrong diagnosis where Mss. Brown was diagnosed with heart failure instead of chronic kidney disease, her actual condition. The decision to stop the heart failure treatment as requested by her son has negative impacts on either the patient or the hospital. Continuation of the heart treatment may endanger Mss. Browns life as she does not suffer heart disease. Similarly, nullifying the treatment and admitting that a wrong diagnosis was performed may affect the hospitals reputation, leading to a lawsuit that may terminate the hospitals operation license.

Medical Facts Relevant to the Dilemma

A wrong diagnosis has a severe complication and may claim a persons life when it is not adjourned on time. Failure to consider a patients medical history is a prerequisite for making medical errors, as observed in Mss. Brown. The practitioner made a mistake because he was overconfident and did not do the necessary follow-up with the client for better understanding. The correct procedure for diagnosis and testing must always be followed to reduce cases of misdiagnosis.

Non-Medical Facts Relevant To the Dilemma

Family members play a significant role in the treatment process of a patient. When the family is supportive, it becomes easier for a medical practitioner to speed up the process (Gerber, 2018). Mss. Brown has a supportive family where her son follows up closely to ensure that his mother gets the best treatment. Therefore, the medical practitioners must ensure they offer high-quality care failure to which the family may file a lawsuit.

External Influences

When a patient goes to a hospital for treatment, an implied contract that an expert in the medical profession will treat them, an error in the treatment process is a breach of contract, violating regulatory and ethical standards. The Patient Safety and Quality Improvement Act (PSQIA) of 2005 protects patients from all unsafe practices, including misdiagnosis. When a patient sues the hospital for a wrong diagnosis, it may lead to penalties for both the practitioner and the hospital (Plantz, 2018). The principle of justice further ensures that a patient gets fair treatment when an error is a committed-the misdiagnosis that could have claimed Mss. Brown life should be treated with fairness.

Items That Need Clarification

Decision-making is made easy when all items surrounding the case are clarified. In the case of Mss. Brown, the misdiagnosis for heart failure instead of chronic kidney disease, the points to clarify are whether the misdiagnosis was due to a faulty test kit or whether the practitioner made a hurried decision based on the assumption. The cause of the misdiagnosis determines the punishment for the action (Gerber, 2018). If the test kits are faulty, both the hospital and the practitioner will be at fault for failing to maintain the testing kits hence jeopardizing the patients safety. If the practitioners are at fault, disciplinary action must be taken against them and ensure the standard procedure is followed during diagnosis.

Key Decision Makers

The key decision-makers in the scenario are the government regulatory authorities on medical care. The role of the regulatory authority is to ensure that the law and ethical standards are followed when carrying out a medical procedure. The hospital management has a crucial role in the decision-making since it has the mandate to ensure that patients get better treatment. The patient and her family are sole decision-makers because they can decide to file a lawsuit against the hospital or request for a repeat diagnosis and improved efficiency. The decision-makers must agree on the mode of solving the dispute for efficiency in the medical field.

Underlying Ethical Principles

The nursing profession is guided by four critical ethical concepts which must be followed to enhance better outcomes. The four fundamental ethical principles are justice, autonomy, nonmaleficence, and beneficence. Justice relates to the case because Mss. Brown requires justice to adjust her treatment based on the test results. Beneficence is an ethical principle requiring doctors to act with kindness, mercy, and moral obligation to do good deeds (Gerber, 2018). If the practitioner practiced beneficence, he would have conducted the complete procedure for efficient results and diagnosed Mss. Brown with chronic kidney disease and not heart failure.

Alternatives

The critical alternatives in the case are either to settle the issue without involving the external regulatory bodies and law courts. The advantage of the alternative is that it exempts the hospital and the practitioner from disciplinary action by the regulatory agencies, which may impact its operations. However, the out-of-court settlement will likely encourage future mistakes because disciplinary actions are not strictly against the offender. The other alternative is for Mss. Browns son sued the hospital for endangering his mothers life. The advantage of filing a lawsuit is that it will create precedence for future cases and assist in formulating strict rules to ensure patients safety. Though filing a lawsuit takes time to be determined, it is the best option for the case study.

Follow Up

The follow-up procedure is prefaced by determining the interested parties and what is at stake for both parties. Since the desired outcome is to ensure Mss. Brown undergoes a second diagnosis of kidney disease, her previous history of kidney disease must be prepared. The plaintiff must further request the court to issue an order to stop the heart treatment and ensure that a new diagnosis is made for accurate results. Additionally, the hospital must present a qualified and certified practitioner.

Nursing Advocacy and the Role of a Nurse in Nursing Advocacy

Nursing advocacy is a process through which a need is identified and acted upon in the hospital setting. A nurse advocates for a patient in a scenario where the patient has little knowledge or control. In the case of misdiagnosis like the Mss. The Brown case can only take a registered nurse to initiate intervention to ensure that the results are nullified and a new diagnosis is ordered (Gerber, 2018). The nurses role in advocacy is to represent the best interests of a patient while respecting the will of the family under the autonomy principle. The nurse further files a request to the relevant authority on behalf of the patient and attends meetings on the patients behalf. Therefore, nurse advocacy is a prerequisite to achieving quality care in the hospital setting.

References

Gerber, L. (2018). Understanding the nurses role as a patient advocate. Nursing2020, 48(4), 55-58. Web.

Plantz, D. (2018). The Patient Safety and Quality Improvement Act: A Total Eclipse. UMKC L. Rev., 87, 751. Web.

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