Appendicitis and its Symptoms - Essay Example

? Case Study Introduction the Problem The case study will make use of ethical decision making model of Kerridge, Lowe, & McPhee (2005) to identify and to determine the ethical dilemma as well as to reach a consolidated conclusion about Xuix’s health and the ethical perspective in relation to the use of interpreter. Xuix, a Chinese citizen has been admitted to hospital with having pain in the abdomen. Currently, he is in Australia and his English understanding is limited. Consequently, he is not able to interpret the problem efficiently as well as other useful information needed for further treatment. Furthermore, it is ascertained that he has been suffering from appendicitis and he need to undergo emergency surgery. Xuix is also unable to communicate his medical history appropriately to the medical practitioners. Eventually, the problem is that the medical practitioners are unable to communicate him the risks associated with the surgery and obtain valid consent from him in order to proceed with the surgery. Consequently, an online interpreter’s help was sought, however due to certain issues related to funding the person could not be consulted. In contrast, a cleaning staff who could communicate at a moderate capacity in Chinese as well as in English was employed as an interpreter. Unfortunately, the staff did not have proper knowledge of the medical terminologies. The basic information relating to his surgery was communicated to him and with his consent; he was taken to operation theatre for emergency surgery. The major concerning issue is that was it ethical to employ a cleaning staff as an interpreter which could be stated to be an impinge on patient confidentiality and was it legal to get obtain consent from a foreign patient with limited knowledge of a English language for surgery who might not have properly recognised the risks accompanied with the surgery. Get the Facts According to US National Library of Medicine, “Appendicitis is swelling of the appendix. The appendix is a small pouch attached to the beginning of a large intestine” (National Center for Biotechnology Information, 2011). The symptoms of appendicitis are altering. The first symptoms that may relate with appendicitis include sharp and severe abdominal pain (U.S. Department of Health and Human Services, 2008). Slowly the swelling of appendix increases and the pain gets shifted into the lower abdomen. Appendicitis is an emergency situation which might create a medical scenario that requires the appendix to be removed urgently as soon as possible to alleviate the pain felt by the patient. If it is left untreated or swelling continues to persist, appendix may get ruptured or burst. Once the appendix is burst, it may lead to peritonitis and other serious abdominal problems that can be fatal unless it is treated quickly and efficiently (WebMD, LLC, 2012). The diagnosis of appendicitis is conducted by patients’ history and examinations. In modern medical field, appendix can be removed in two ways, the traditional open surgery or the laparoscopic surgery. The surgery procedure nearly takes an hour (National Center for Biotechnology Information, 2011). However, there are certain complications relating to surgery. Complications may result from anaesthesia, breathing problem, or side effects caused by surgery (National Center for Biotechnology Information, 2011). The possible complications of the surgery may comprise excessive bleeding, or any kind of infection in incision part within the body. Notably, infection may tend to be mild or severe. Contextually, in mild infections, patient may have to suffer from mild tenderness and redness in the area of incision. At the same time, moderate infections may require patient to take antibiotics to prevent any complications while severe infections may cause patient to undergo another surgery along with antibiotics. The complications possibility is rare in terms of laparoscopic procedures. However, the surgery may also have long-term effects which may result in diagnosis of other diseases such as Crohn’s diseases (National Center for Biotechnology Information, 2011). Four Ethical Principles Any information relating to patient is considered to be confidential. Reproduction of any such information without consent of patient at any case is legally prohibited. Xuix is a Chinese patient with limited ability to communicate in English. In such a scenario, employing a cleaning staff as interpreter may place various questions in terms of confidentiality of Xuix’s medical records, information and security of patient’s vital information (State University of New York, 2011). According to Australian Nursing and Midwifery Council (ANMC) code (2006), nurses should carry out their activities in accordance with the law pertinent to the profession and practice of nursing. It is further supported by ANMC code that nurses should take care of the personal information of the patient obtained during the professional capacity in order to be private as well as confidential. Sharing of information with any others without the prior consent or understanding of the patient is considered to be unethical and may be termed as breach of confidentiality which may amount to a serious medical misconduct (Brooks, 2006). The following definitions will facilitate to identify the legal and ethical issues concerning hiring of cleaning staff as interpreter and confidentiality of patient’s vital information as well the ethical practice of the healthcare providers in terms of obtaining Xuix’s consent. Autonomy: Autonomy is the “the personal rule” confining within an individual that is free from any influence from others. An autonomous client acts intentionally with utmost understanding and without the influence of others (ANMC, 2007). Xuix is able to make any decisions but currently, due to his limited English speaking and understandability makes him unable to communicate his medical and other relevant information. However, hiring of interpreter will help Xuix to understand the complications and risks associated with surgery. Contextually, Xuix will be able to take autonomous decisions based on the interpreted information conveyed to him through the cleaning staff. Beneficence: Beneficence means “to do good” and positively help a person (An Bord Altranais, 2007). It is important that nurses should intend to benefit patients and contribute to their welfare. According to AMNC, a nurse should display the role of a family member and friend as well as the responsibility of the nurse is to alleviate pain suffered by the patient (ANMC, 2005). Xuix will be able to overcome his illness if he undergoes emergency surgery otherwise the complication relating to his health may increase that may have fatal consequences. Non-maleficence: Non- maleficence means ‘to do no harm’. It is the ethical duty of the participants to balance the probable benefits against the probable risks and at the same time to minimize the intensity of the risks to the greatest extent possible. Thus, safeguarding and protecting the participants’ health and right without causing any harm to any of the participants can be considered as one of the vital ethical principles in the field of nursing (American Nurses Association, 2012). If Xuix undergoes emergency surgery, it will lead to reduced risks associated with his health. Delay in Xuix’s treatment may result in several fatal health complications. According to White & Duncan (2002) non-maleficence can be regarded as a fundamental responsibility of medical practitioners. According to ethical principles of nursing, it is the prime objectives of the nurses to remove any hazardous circumstance that may drag the patient to serious health complications. Medical practitioners intend to remove future complications of Xuix by advising him for emergency surgery. Justice: The principle of justice is synonymous with fairness and equity and it is the prime obligation of nurses to treat the patients fairly and equitably before, during and after the surgery. Nurses should not only focus on legal aspects of justice but justice encompasses humanity and moral aspects as well (An Bord Altranais, 2007). ANMC also stresses on promoting social justice in the best interests of the patients. In relation to Xuix, it is the prime responsibility of the interpreter and medical practitioner to provide fair information without discriminating him to be a Chinese. Ethical Conflicts Autonomy v Justice: Xuix possesses the autonomy and competency to make decisions related to his welfare and beliefs but due to his limited ability to communicate in English it makes him unable to communicate with the medical practitioners. At the same time, his health condition does not permit the medical practitioners to make any delay otherwise his appendix may get ruptured which may have life threatening effect. While justice incorporates that every individual should be treated equally. However, autonomy and justice cannot be treated as competitors rather the two ethical aspects are interdependent on each other. As far as Xuix’s case is concerned, there was no other alternative available to Xuix other than proceeding with the advised surgery. Therefore, justice was overlapped and in order to prevent any fatal consequences a cleaning staff member was used as the interpreter to get his consent in his best health interest. In addition to this, nurses should integrate truthful and complete knowledge of ethical principals and code of professional conduct within the extent of professional practice in discharge of nursing care relating to medicinal products and providing patient care (An Bord Altranais, 2010). Consider the Law According to ANMC code (2005), Nurses should be aware of and must comply with the conditions under which the information about a patient, who does not speak or read English adequately, may not be shared with others. The nurses should respect each person’s privacy and confidentiality to the extent that does not compromise with the health or the safety of the patient. It is the responsibility of the nurses to comply with privacy policy of the patient’s vital information and other legislation (ANMC, 2006). While considering Xuix’s ability to consent there are several issues that need to be cautiously determined including limited ability to understand and interpret English, foreign resident and health status. Xuix is a Chinese person, and contextually he did not have any available option of relatives, friends and any other person to help him understand the scenario as an interpreter. In this context, it can be said that the hospital should employ only those staffs possessing competency of National Accreditation Authority for Translation and Interpreters (NAATI) or equivalent to NAATI experience to be used as medical interpreters. Medical practitioners are not allowed to use any other bi-lingual staff (Legal Aid New South Wales, 2009). Ethical Decision Xuix is a foreign patient and he has limited understanding of the English language. Also, he is suffering from appendicitis. If he is not provided with immediate treatment, his appendix may get ruptured or burst. In such circumstances, it may lead peritonitis which may be life threatening to Xuix. Hence, Xuix urgently required undergoing emergency surgery before his condition got worse. The complications related to his illness may get more adverse due to serious infections. It is recommended that Xuix should undergo emergency surgery in order to prevent any future complication associated with his illness. ANMC code (2005) claimed that nurses should value, respect and depict kindness for self and others. The context emphasizes that nurses provide the patients with utmost care, comfort and put their efforts to alleviate pain suffered by the patient. Addressing the problem of Xuix, his limited understandability of English can be overcome with the hiring of an interpreter. Though Xuix is competent enough to understand the adversity associated with appendicitis, it will be in the best interest of Xuix to undergo emergency surgery to avoid fatal outcome. Therefore, the use of a cleaning staff as an interpreter cannot be termed as an unethical practice in the above scenario. It is more important to save the life of Xuix than adhering to legal or ethical issues. Conclusion Xuix a Chinese man was admitted to a hospital due to abdominal pain. Moreover, he is currently in Australia and has limited understanding of English language which has created a major difficulty in communicating to him about the severity of his illness as well as to properly recognise his medical history. Later it was diagnosed that he was suffering from appendicitis. The medical practitioners felt that he needed an emergency surgery but they could not communicate the risks associated with the surgery satisfactorily. Simultaneously, a cleaning staff who could communicate both in Chinese as well as English was hired. Contextually, even he did not possess proper knowledge for understanding medical terminologies, which resulted in an uncertain scenario. At the same time, ethical and legal issues regarding the use of cleaning staff as an interpreter must be considered and justified. Several issues like the degree of confidentiality of Xuix’s private and medical information, the decisions determined by medical practitioners and their adherence to ethical principles and legal obligation have been assessed. Analyzing the four ethical principles i.e. autonomy, beneficence, Non- maleficence and justice, there can be observed a conflict between Xuix’s autonomy and justice. Addressing the problem of Xuix, it could be concluded that medical practitioner consented Xuix with the help of cleaning staff; otherwise there was no option available with them. If they had not gone ahead with the emergency surgery, Xuix’s health condition could have got more serious which may have led to fatal consequences. Finally, the decision of emergency surgery was in the best interest of Xuix and his health. References An Bord Altranais. (2007). Guidance to nurses and midwives regarding ethical conduct of nursing and midwifery research. Ethical Principles, pp. 5-18 An Bord Altranais. (2010). Practice standards. Practice Standards and Guidelines for Nurses and Midwives with Prescriptive Authority pp. 3-22 ANMC. (2005). Code of Ethics. Code of ethics for nurses in Australia, pp. 1-15. ANMC. (2006).Code of Professional Conduct for Nurses. Code of professional conduct for nurses in Australia, pp. 1-10 ANMC. (2007). Guide for nursing practice decisions. A National Framework For the Development of Decision-Making Tools for Nursing and Midwifery, Practice, pp. 1-19 ANMC. (2006). Practices within a professional and ethical nursing framework. National competency standards for the registered Nurse, pp. 1-14 American Nurses Association. (2012). Short definitions of ethical principles and theories familiar words, what do they mean. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf Brooks, K. (2006). Medical ethics and law: confidentiality. Retrieved from http://www.qub.ac.uk/methics/BrooksK.pdf Kerridge, I. Lowe, M. & McPhee, J. (2005). Ethics and law for the health professions. Australia: Federation Press. Legal Aid New South Wales. (2009). Approach to using interpreters. Policy and guidelines on the use of interpreters and translators, pp. 2-14 National Center for Biotechnology Information. (2011). Appendicitis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001302/ State University of New York. (2011). Our privacy practices. Protecting patient confidentiality and security, pp. 1-21 U.S. Department Of Health And Human Services. (2008). Appendicitis. National Digestive Diseases Information Clearing House, pp. 2-5 WebMD, LLC. (2012). Appendicitis. Retrieved from http://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis White, L. & Duncan, G. (2002). Medical-surgical nursing: an integrated approach. United States of America: Cengage Learning. Read More