![]() ![]() After being evaluated by a social worker and a physical therapist, the patient is recommended to be placed in a skilled nursing facility. On one of the days, when she is brought to the hospital to receive hemodialysis, the nurses discover that her state is in a rapid decline: she is malnourished and has early signs of bedsores. For example, one can consider the following situation: an elderly woman is suffering from hypertension and final-stage renal failure. Sometimes the principle of autonomy has to be the guiding principle in nursing practice. On the other hand, providers need to consider patterns of practice and defaults developed over time, medicolegal risk of decisions, and scientific evidence. (2015), with regard to patients, it is important to consider the acuity of illness, decision-making capacity, and desire to engage in the decision-making process. Researchers point out that there are both patient and provider factors that influence the way that decisions are made in fast-paced environments. (2015) provide a tentative table of factors that could be guiding workplace policies with regard to patient autonomy. Continuing education would be a logical step toward accountability and ownership in medical staff. Secondly, changes must be made at the individual level: Vanderboom, Thackeray, and Rhudy (2015) show that 47% of nurses would like to receive additional training and mentorship. Firstly, there are organizational issues such as understaffing and poor scheduling that need to be tackled to promote ethical, patient-centered care. (2015) outline several approaches to creating an environment where medical ethics do not clash with performance. There must be a middle ground between patient autonomy and hospital efficiency. ![]() The patient herself was excluded from the decision-making process while her daughter became a “surrogate decision-maker (Hess et al., 2015).” The time pressure must have put an extra strain on the department to reach out to the relative instead of trying to work through the challenges of mild dementia and communicate with the patient. ![]() The daughter agreed with the offered option, and the emergency department proceeded with surgical intervention. Her daughter was chaperoning her, and it was the daughter who received the news that the best decision for her mother would be to have surgery (Hess et al., 2015). (2015) describe a real-life case when an elderly woman with mild dementia was brought to an emergency department with a broken hip. Still, the patient was not fully involved in the decision-making process because it was a life-or-death situation, and doctors and nurses prioritized his or her survivability above all.Īnother example of an ethical dilemma arising from working in a fast-paced environment is the treatment of patients with mental impairments. While this intervention is likely to be helpful, the patient’s religious beliefs might condone such a practice. A patient brought to an emergency department after an injury may be administered a blood transfusion. In this case, there are opportunities for many ethical dilemmas that are likely to complicate the treatment process.Īn example would be the workflow at an emergency department that is often chaotic and unstructured and leaves little to no time for negotiations. For instance, the research by Vanderboom, Thackeray, and Rhudy (2015) demonstrated that as many as 64% of nurses did not have enough time to address patients’ fears and anxieties. When work is fast-paced, it often becomes nigh-on impossible to pay attention to each patient and negotiate decisions from the place of respect for autonomy. ![]() It is not unusual for nurses to work under time pressure, be it due to the necessity to deliver acute care or high workload that is not matched by an adequate number of employees. This paper discusses how a nurse can maintain efficiency while respecting patient autonomy and what situations require prioritizing autonomy over the rest of the principles. However, as an ethical principle, autonomy has many nuances that need to be taken into account before translating this value into practice. Due to negative emotions and the lack of expertise in the medical field, they can be swayed by medical paternalism and convinced to accept interventions without considering other options. Indeed, such an environment is unusual for the majority of people. The motivation for patient autonomy stems from the recognition of patients’ vulnerability in clinical settings. At that, the health worker’s role is to guide and educate them but not overtake the decision-making aspect of their treatment. Patient autonomy is defined as the patient’s right to make their own decisions (Timms, 2016). Alongside benevolence, non-malevolence, and justice, the principle of autonomy is one of the four fundamental principles in medical ethics. ![]()
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