Ethical Dilemma: Gibbs Reflection Model - Essay Example

?Ethical Dilemma: Gibbs Reflection Model of event (What happened The event to be evaluated for this paper involves an incident where a delivering woman was admitted for delivery already for artificial rupture of membranes due to polyhydramnios and post dates. The admission happened just before handover and the midwife on duty was not happy about admitting a delivering mother so close to the end of her shift. I was directed to care for the patient. I noted in her chart that the patient did not want to be cared for by a student nurse. Since I was in my student’s uniform and badge, I assumed that she could see that I was a student. The patient did not comment at any time about refusing my care so I went on to care for her, carrying out the midwife’s instructions without informing the patient that I was a student nurse. At some point during the administration of care, the patient’s labour progressed fast and I carried out interventions to ease her labour. She was also showing signs of distress. I informed the midwife of the situation, but the midwife dismissed my claims as she noted that the patient was a first time mother and would likely take longer to deliver. The mother however was actually fully dilated and ready to delivery and after 15 minutes from noting progress of delivery, the baby was delivered. I assisted the midwife in delivering the infant. I never informed the mother at any time that I was a student nurse. Feelings (What were you thinking and feeling?) There were so many thoughts and concerns going through my mind during that time. I thought that it was my duty to inform the patient about my actual status in the labour room. I was thinking however that since my uniform identified me as a nursing student, she should have known that I was a student and that it was therefore up to her to say that she did not want me to assist in her delivery. I also thought that it was a good time for me to improve my skills in the delivery setting by continuing to care for the patient. All the time however, I felt bad for not being honest with the patient. I felt that I deceived her by not revealing my role in the unit. I felt that since I already read her chart and her preference in care, I should respect such preference. I also felt disappointed with the midwife for not rendering the utmost quality in care and services for the delivering mother. I felt that she was more concerned about her personal convenience that in fulfilling her duties as a healthcare professional. I also felt that her negligence is also in not checking the status of the woman’s labour in order to determine her stage at the delivery process. Although we were able to safely deliver the infant, there were so many close calls during the incident which could have led to unfortunate incidents in the infant’s delivery. I also felt that my lack of confidence as a student nurse prevented me from speaking my mind. I felt that my lack of confidence in speaking my mind was actually a highly risky quality to have because crucial care may not be delivered to the patient when they need it the most. Evaluation (What was good and what was bad about the experience?) What was good about the experience was that I was indeed able to have an actual clinical experience in delivering babies. I was able to assist the woman and support her in the labour and delivery process, applying the principles of care which were transmitted to me in school. I was able to perform my tasks accordingly, informing and referring the patient to the midwife when there were noted incidents in her labour. I was only a student nurse and could not directly carry out the nursing interventions, but I was still able to learn and carry out the necessary tasks which helped ensure the safe and successful delivery of the infant and the safety of the mother. What was bad about the incident was that I was not able to properly inform the patient about my status in the labour room, specifically, the fact that I was a student. What was also bad about the incident was that the midwife was not vigilantly carrying out her tasks in managing the patient. She was on the last hour of her shift and clearly did not want to care for a mother who was about to deliver. She also did not want to check on the mother in order to ascertain her status during the delivery process. Although the infant was safely delivered, there were some incidents which were cause for concern, including the fact that the infant may have been delivered without assistance from the medical personnel. Vaginal tearing may also be a risk in unassisted births. All in all, the neglect of the midwife may have issues in the delivery of the child and the care of the delivering mother. Analysis (What sense can you make of the situation?) In assessing my actions in this case, I take the deontological position and conclude that I did not act in the best interests of the patient. In other words, I behaved unethically. Based on deontological moral theories, the focus on patient-centred care is emphasized (Pollock, 2012). This theory is also based on the protection of rights, not the performance of duties. In this case, the patient had the right to informed consent. From the very start, at the initiation of care, I had the duty to inform the patient who I was, what my role was, and the interventions which would be carried out in her behalf. The informed consent would include a specific description of the interventions, ensuring that the patient has understood what was going to be done, who I was, and the implications of these medical interventions on her and the baby (Schenker, et.al., 2011). She had the right to self-determination and autonomy, and as such, the right to determine her care. I deprived her of that right when I did not inform her that I was only a student nurse. The fact that I later saw in her chart that she did not want any student nurse attending her should have spurred me further towards advising her of my status in the unit. The patient may change her mind about allowing me to assist during the delivery. The point would be that it is her choice to make (McWay, 2009). Although she may have been more trusting with me because she has bonded with me already as I was assisting her during her labour, I still owed her the right to make the informed choice regarding her care. The patient-centred deontological theories are based on people’s rights. This right must not be confused with other discrete rights, including the right against being killed. It is also a right against being manipulated by another to benefit others (McWay, 2009). Specifically, this theory does not include the application of another person, his work, or talent without his consent. Based on this perspective of moral duties, those referring to other people’s rights are generally limited and do not include the use of resources in producing good which would not be seen without the efforts of others (Porsche, 2011). In this case, the informed consent of the patient is there to protect the patient against information about his care which would be relevant to his well-being and ultimate favourable health outcomes. As I am a student nurse and my health education is still lacking. I also lack the professional knowledge and license to actually render care in the same level as other licensed and experienced medical health professionals, in this case, the staff nurses and the midwives (Falagas, 2009). This detail is important to the patient in making her decision regarding her care. She may feel that my presence in the delivery room would impact negatively on the outcome of her delivery. I must respect such decision. However, if she would still allow me to assist even after knowing that I am a nursing student, then I can assist in her care. The important aspect of the situation is that I properly gave her all the details which she would need to make an informed consent (Schenker and Meisel, 2011). I allowed her to exercise her right to autonomy. The utilitarian point of view would argue for the greater good of the patient. Based on such situation, I would have not been considered unethical in administering to her needs (Freeman, 2010). The utilitarian theory supports maximum utility, and in this case, maximum utility would be the use of my skills as a student nurse in caring for the patient. Failure to secure informed consent would not be a problem in this case because we were able to secure maximum utility in her case (Kho, et.al., 2009). In the end, her infant was safely delivered, I was able to carry out my functions effectively as s student nurse, and any possible risks and issues of birth were managed. In relation to the other ethical justice, veracity, beneficence, and non-maleficence, it is important to note that the principle of justice would likely indicate that my actions were unethical because this principle is concerned about giving everyone his due. The patient in this case deserved medical care. As the midwife was being neglectful in her duties, it fell upon me to make the necessary remedies to ensure the delivery of quality patient care (Nordhaug and Nortvedt, 2011). In the end, the patient was able to get what was her due, which in this case was assistance in the delivery of her child. The principle of beneficence would also support my actions especially as I acted in the benefit of the midwife. The midwife in this case violated the principle of benefice as she did not act for the benefit of the patient (Rose, 2011). She was in a hurry to finish her shift and she did not give sufficient and immediate attention to the delivering mother. The principle of non-maleficence was also violated by the midwife because this principle declares the importance of above all causing no harm to the patient (Mertz and Mertz, 2012). Harm almost befell the patient when the midwife initially ignored my assessment of the patient’s status. Although the patient safely delivered her child, the midwife ignored me when I said that the patient was about to delivery. We were basically fortunate in the end that the mother safely delivered the infant despite some moments of negligence in the midwife’s actions. In the case of Chester v Ashfar, the patient had a discectomy for her lower back pains. The procedure was successfully carried out, however, she was suffered cauda equine syndrome due to the surgery. She sued the doctor for not warning her of the risks. She won. The courts ruled that she should have been properly informed of the risks of her surgery. Anticipating such risks, her decision would have been more informed. The midwife also had the duty to mentor me throughout the process of care. She was not supposed to leave me unsupervised with the patient (Andrews, et.al., 2010). As a mentor, she had the responsibility of guiding me throughout the process of infant delivery. She failed in this regard. She did not carry out her tasks as a mentor and if an incident would have arisen with the patient, the legal responsibility would be hers because she was directly responsible for my actions due to her negligent actions and lack of vigilance (Collington, et.al., 2011). Although I contributed significantly to the successful delivery of the infant, I was still dishonest with the patient. In considering however the principle of veracity, honesty is required. It also calls for truthfulness and straightforwardness of conduct, also the lack of cheating and insincerity (Ross, 2010). I was dishonest with the patient by not revealing my actual status in the health unit. Even when I saw in the chart that the patient did not want a student nurse to assist in her delivery, I deliberately set out to ignore her request by not being honest with her (Kress, et.al., 2013). I justified my lie of omission by contending that the midwife was not doing her job and that it would be a good learning opportunity for me. But the truth is, I did not give the delivering mother the chance to make an informed decision about her care (Ahern, 2012). The decision-making model based on Gilbert and Harmon indicates the importance of prioritising the acceptable alternatives, the developing a plan of action, implementing action, and later, evaluate the action taken (Gilbert, 2010). In this case, the acceptable alternatives may include informing the patient about my status and still giving the patient a chance to make a decision on letting me stay or letting me leave. A plan of action would then have to be based on such decision from the patient, after informed consent is implemented (Gilbert, 2010). The action can be implemented and later evaluated, especially in terms of health outcomes and the compliance with ethical principles. Action Plan I learned through this experience that in order to improve the delivery of care, I need to be honest with my patients. I also need to respect their rights, especially the rights dictated by medical ethics (Halpern, 2013). By respecting these rights, the dignity of the patient can be respected. When I comply with the rules and respect patient rights, my rights would also not be compromised. I would be able to gain the respect of other nurses, and gain more confidence in my practice. References Ahern K, 2012, Informed consent: are researchers accurately representing risks and benefits?. Scandinavian Journal of Caring Sciences, 26(4), 671-678. Andrews M., Brewer, M., Buchan, T., Denne, A., Hammond, J., Hardy, G, West, S, 2010, Implementation and sustainability of the nursing and midwifery standards for mentoring in the UK. Nurse Education in Practice, 10(5), 251-255. Chester v Afshar [2004] UKHL 41. 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