The Allen family presented in the simulation has several health issues they deal with individually that contribute to the family unit. Clifford struggles with depression that he does not want to have documented or take medications for out of fear. Pam is the glue of the family; she keeps the home functioning and has not worked outside the family because their son was born with Down’s syndrome. Her time is spent caring for him and the home. She has a history of endometrial cancer and has gone 14 months without a check-up.
Gary is an active special needs young man, he holds a job, participates in Special Olympics and Scouting. The family has strong ties to their church that provides support when they need it. In the simulation, Clifford has a transurethral resection of his prostate and Pam has a recurrence of cancer. Two potential dilemmas they face are Clifford’s depression and Pam’s cancer prognosis and the impact on the family, particularly caring for Gary. The Allen family have right to decide what course of treatment they want as it applies to both Clifford’s and Pam’s health.
Autonomy, the right to choose what will happen (Guido, 2010, p. 11), is a basic patient right. Clifford experienced discomfort with his benign prostatic hypertrophy (BPH) particularly after bowling with Gary. He did not find relief from the medication and did not want to wait six months as the doctor asked for the medication to relieve symptoms. A follow up visit determined the medication was not working and surgical intervention was necessary, Clifford was anxious about possible complications from surgery particularly impotence and incontinence.
The documentation did not indicate nursing interaction prior to surgery. The video interaction between Clifford and the nurse post operatively showed the nurse determining his level of consciousness, acknowledging Clifford’s pain, checking his pain score, evaluating his continuous bladder irrigation (CBI), and appeared very thorough in assessment. The medical record did raise some questions about the nursing documentation because it falls under the ethical principle of veracity, truth telling (Guido, 2010, p. 8). The 1945 entry does not include the amount of morphine given.
The 0030 entry does not give a description of the CBI color when this has been assessed and documented on previous shifts, how would a change be reflected. The 0500 entry indicates pain was assessed, does not indicate a pain score and also states the patient was asleep and this is contradictory. The documentation for Wednesday does not indicate a pain score but pain medication documentation indicates it was given. The documentation of CBI does not appear and no mention of the CBI as discontinued status was indicated.
The lack of documentation indicates a violation of fidelity, duty to keep promises or commitments because correct documentation is a duty of nursing when providing accurate care (Guido, 2010, p. 5, 8-9). The family experiences more dilemmas when Pam is diagnosed with colon cancer. She does not want to worry Clifford, so she does not elaborate when she does not feel well. The necessity of surgery and the resultant colostomy are difficult for both Pam and Clifford to deal with. They also must decide to accept treatment with Chemotherapy and Radiation Therapy.
In this situation using an ethical decision making model would assist them in arriving at a decision. During the Be Attentive phase all the priorities would be listed including treatment options, care of the family, Gary’s needs, perhaps a solution for Clifford’s depression tendencies. The Be Intelligent phase provides an opportunity to list all the stakeholders; Pam, Clifford, Gary, surgeon, nurses, and church members. The Be Reasonable phase flushes out all the duties of the stakeholders giving clarity to decision impact.
The Be Responsible phase gathers information to handle the ethical dilemma and ends with the creation of a statement about the decision. The last phase is the Be Reflective phase where Pam and Clifford write the decision down, how the decision was made and how it will be carried out (EthicsGame. com, 2013). Clifford and Pam did arrive at the decision of treatment by chemotherapy and radiation for her cancer. They had previous experience with chemotherapy when Pam had it during her endometrial cancer.
The nursing staff provided pamphlets about chemotherapy, radiation therapy, and ostomy care, however, the interaction between nursing staff and family was not documented as in-depth so it is difficult to determine if all their questions and concerns were addressed. Clifford’s difficulty with Pam’s colostomy was not addressed and remains a problem for their intimate relationship even after her recovery from the effects of her treatment. The ethical dilemmas facing the Allen family remain caring for Gary and Clifford if Pam’s cancer has not been cured. Pam and Clifford have not made a plan even in the event of both their deaths.
Pam and Clifford have not addressed issues with their intimate relationship after Pam’s surgery. Both of these issues are areas that nursing could assist them in naming the issues, listing options, creating a plan, and writing it down. The decision making model would be helpful in addressing any ethical dilemma this family faces. EthicsGame. com. (2013). Ethics Simulation . Retrieved February 04, 2013, from University of Phoenix: http://www. ethicsgame. com/Exec/CorpGame Guido, G. W. (2010). Legal & Ethical Issues in Nursing. Upper Saddle River: Prentice Hall.