analyzing complex situations in an emergency department or a department of surgery course prepared...
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Analyzing Complex Situationsin an Emergency Departmentor a Department of Surgery
Course prepared for training given at Coimbra Hospital in Portugal
By Margot Phaneuf, R.N., Ph.D.
Which steps of the critical thinking process
are required to analyze a complex situation?
A complex situation requires complex tought, combining one’sintuition with thinking that is: . Inductive, . Systematic, . Dialectical and critical, . Hypothetical-deductive, and . Creative.
The care process remains the best strategy for dealing
with a complex situation, since it calls on several
aspects of critical thinking.
The nursing processThe nursing processData gathering
Analysis
Planning
Intervention
Evaluation
Evaluation
Clinical judgmentNursing diagnosis
6Margot Phaneuf, RN, PhD
Hypotheses
Inductive thinking
Intuition
Systematic thinking
Hypothetical-deductive thinking
Dialectical and critical thinking
Clinical judgment
Contributions tothe formation of a clinical judgment
Choices
7Margot Phaneuf, RN, PhD
Inductive thinking:for collecting data
Intuition: for structuringa more targeted search
for data
Systematic thinking: for taking into account all
aspects of a situation
Hypothetic-deductivethinking: for identifying and analyzing hypotheses
Types of thinkingused in the overall nursing process
Dialectical and critical thinking:for selecting the hypothesis
or nursing diagnosis and evaluating the process
Creative thinking: for planning interventions
8Margot Phaneuf, RN, PhD
What to avoid in a complex situation
Simplistic reasoning that
moves directly from cause
to effect
Analysis of a complex situationAnalysis of a complex situationInductive thinking Systemic thinkingInductive thinking Systemic thinking
Critical thinking: I look at both sides.
I look for other factors.
I reconsider what I know about the subject. I consider different aspects of the person.
Deductive reasoning
I confirm my intuitions.
I validate the facts and the symptoms. I analyze and integrate my observations.
(Dialectical thinking)
Choices Hypotheses
Inductive reasoning
Clinical judgment
Deductive thinking
I observe signs and facts; I have certain perceptions.
Intuitive thinking I ask myself questions.
Various dimensions of a complex situation
11Margot Phaneuf, RN, PhD
The complexity of a situation may The complexity of a situation may result from a variety of factors.result from a variety of factors.
Factors: Physiological, Psychological (discouragement, depression,
lack of motivation, suicidal thoughts), Social (family socio-economic status), Cultural (habits, hygiene), Religious (values, taboos), Linguistic (barriers to communication), Moral and ethical, Legal
Observations and data to be gathered
Explanation of the CQAST model
Percussion
Inspection
Palpation
Auscul-tation
Ante-cedants
Currentproblems
Familyhistory
Examinationsand tests
3
Overview of data collection: Methods and types
Interview,questionnaire,
medical history1
Physicalexamination
2
Two main types Two main types of data collectionof data collection
Data related to independent role
Data relate tocooperative role
ConceptConcept ExplanationExplanation ExampleExample
CC CauseCause What causes the symptom to What causes the symptom to emerge? What makes it go emerge? What makes it go away?away?
How did the pain first appear? How did the pain first appear? Are you using an analgesic?Are you using an analgesic?
QQ Quality, Quality, quantity quantity
Description of the symptomDescription of the symptom
FrequencyFrequency
What does it feel like: a burning What does it feel like: a burning sensation, a pounding, etc.? How sensation, a pounding, etc.? How bad is it, on a scale of 1 to 10?bad is it, on a scale of 1 to 10?
AA Area affected Area affected by irradiationby irradiation
Area where the symptom is Area where the symptom is locatedlocated
Other affected areasOther affected areas
Tell me where it hurts, or point to Tell me where it hurts, or point to it with a finger. Does it hurt it with a finger. Does it hurt anywhere else? anywhere else?
SS Related Related symptomssymptoms
Other symptoms associated Other symptoms associated with the main symptomwith the main symptom
Do you have any other related Do you have any other related problems?problems?
TT Time, durationTime, duration When it appears, durationWhen it appears, duration How long have you had this How long have you had this problem? Is it constant or does it problem? Is it constant or does it come and go? How often in a come and go? How often in a week or a month? week or a month?
CQAST Model
Source: Mario Brûlé et Lyne Cloutier
L’examen clinique, Erpi 2001.
Situation 1Physiological complexity
Situation 1: Serious abdominal injurySituation 1: Serious abdominal injury
Car accident, 50-year- oldsingle male
Significant bleeding,multipe fractures inthe thorax and thecervical spine
IssuesIssuesPhysiologyPhysiologyWhat signs and symptoms have I seen?(CQAST) What is the patient saying about it?Do I get the feeling that it’s serious?Does it remind me of anything that I’ve already
seen or learned about?What do I know about this subject?What should be checking or monitoring?Is there an intervention model or protocol that
would apply?What is the treatment? What do I need to plan?
IssuesIssues
General nursing planGeneral nursing planWhat are the patient’s emotional, psychological What are the patient’s emotional, psychological
and social needs?and social needs?What are the patient’s reactions, expectations, What are the patient’s reactions, expectations,
fears and complaints?fears and complaints?Are there family members who need to be Are there family members who need to be
contacted or who need support?contacted or who need support?What are my nursing diagnoses?What are my nursing diagnoses?What do I need to explain to or teach the patient?What do I need to explain to or teach the patient?What do I need to plan? What do I need to plan?
Anticipating physiological complications: hypovolemic shock
and cardiogenic shock
Situation 1. Potential complication: Situation 1. Potential complication: State of shockState of shock
Anxiety, prostration or agitation
Intense thirstcapillary refill time = 5 sec.
Blood pressure = 80mm Hg
If septic shock: shivers, fever, sharp rises in temperature or hypothermia
Skin mottling
Cold extremities, cyanosisOliguria:- 30 ml or anuria
Tachypnea Tachycardia, weak pulse
Nausea, vomiting
Cold sweats
Severed spinal chord
Obstructive shock
Drop in cardiac output, vascular trauma
Vasogenic (distributive) shock
Hypovolemic shock
Pneumothorax, cardiac tamponade
Cardiogenic shock
BleedingExternal-internal(liver, spleen, or retroperitoneal)
Cardiac failure
Circulatory distress mechanisms
Situation 1. ComplicationsSituation 1. Complications
IssuesIssuesPhysiologyPhysiologyWhat signs and symptoms have I seen?What signs and symptoms have I seen?(CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it?Do I get the feeling that it’s serious?Do I get the feeling that it’s serious?Does it remind me of anything that I’ve already Does it remind me of anything that I’ve already
seen or learned about?seen or learned about?What do I know about this subject?What do I know about this subject?What should be checking or monitoring?What should be checking or monitoring?Is there an intervention model or protocol that Is there an intervention model or protocol that
would apply?would apply?What is the treatment? What do I need to plan?What is the treatment? What do I need to plan?
IssuesIssues
General nursing planGeneral nursing planWhat are the patient’s emotional, psychological What are the patient’s emotional, psychological
and social needs?and social needs?What are the patient’s reactions, expectations, What are the patient’s reactions, expectations,
fears and complaints?fears and complaints?Are there family members who need to be Are there family members who need to be
contacted or who need support?contacted or who need support?What are my nursing diagnoses?What are my nursing diagnoses?What do I need to explain to or teach the patient?What do I need to explain to or teach the patient?What do I need to plan? What do I need to plan?
Situation 2 Mixed complexity involving physiological risks and little
motivation to get better and live
Model for analyzing motivation
Situation 2. Suicide attempt: Situation 2. Suicide attempt: Antipsychotic poisoningAntipsychotic poisoning
30-year-old woman, mother of a young child
Difficult situation in terms of family support and living conditions
27Margot Phaneuf, RN, PhD
Model of relative motivation Model of relative motivation (McEwen)(McEwen)
Individual perceptions:
. Severity of the problem
. Subject’svulnerability
. Value of acting
Change factors:. Personal
circumstances: age, situation. Internal and
external obstacles to assistance
Prior knowledge
Motivation to change behaviour
Trigger
IssuesIssuesPhysiologyPhysiologyWhat signs and symptoms have I seen?What signs and symptoms have I seen?(CQAST)(CQAST)What is the patient saying about it? What are her What is the patient saying about it? What are her
problems?problems?What does my intuition tell me? What does my intuition tell me? Does it remind me of anything that I’ve already Does it remind me of anything that I’ve already
seen are learned about? seen are learned about? What should be checking or monitoring?What should be checking or monitoring?Is there an intervention model that would apply?Is there an intervention model that would apply?What is the treatment? What do I need to plan?What is the treatment? What do I need to plan?
IssuesIssues
General nursing planGeneral nursing planWhat are the patient’s emotional, psychological What are the patient’s emotional, psychological
and social needs?and social needs?What are the patient’s reactions, expectations, What are the patient’s reactions, expectations,
fears and complaints?fears and complaints?Are there family members who need to be Are there family members who need to be
contacted or who need support?contacted or who need support?What are my nursing diagnoses?What are my nursing diagnoses?What do I need to explain to or teach the patient?What do I need to explain to or teach the patient?What do I need to plan?What do I need to plan?
Issues Issues PhysiologyPhysiology Is the patient motivated to live, to get better?Is the patient motivated to live, to get better? Where does this motivation come from? Love Where does this motivation come from? Love
(spouse, children, family), personal interests (spouse, children, family), personal interests (nature, work, art), fear of having a serious (nature, work, art), fear of having a serious problem, fear of dying?problem, fear of dying?
What is getting in the way? Depression, problems What is getting in the way? Depression, problems in her love life, family or work, not having a job, in her love life, family or work, not having a job, other problems?other problems?
What are my nursing diagnoses?What are my nursing diagnoses? What do I need to plan? What do I need to plan?
Situation 3Mixed complexity
involving cultural issues
Transcultural analytical model
Situation 3. A miscarriage at 3 months, Situation 3. A miscarriage at 3 months, South American patientSouth American patient
Age: 38 yearsState of health: suffering from malnutrition
Support network:In-laws who are a bit hostile and very disappointed at losing the child.
Adapted from the transcultural models Adapted from the transcultural models of L. Purnell and M. Leiningerof L. Purnell and M. Leininger
Person
Family
Cultural community
Receiving society
Communication
Family
Spirituality
Maternity
Death rituals
Nutrition
Hygiene
Health-relatedhabits
Organizationof work
Authority andcommunityorganization
Biological differences
Risky behaviours
Values
Place of origin Education
LeasureReciprocal perceptions
Perceptions of the health system
34Margot Phaneuf, RN, PhD
Data collection: Data collection: A transcultural approachA transcultural approach
Cultural differences:
food, hygiene, etc.
Variations, biological
frailties
Communicationproblems:
language, mode
Concept of space
Concept of time
Socialorganization
structuresThe idea of
the family and theenvironment
Identify Identify
IssuesIssues
PhysiologyPhysiology What signs and symptoms have I seen?What signs and symptoms have I seen?(CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it?What does my intuition tell me is going on?What does my intuition tell me is going on?What do I know in this area?What do I know in this area?What should be checking or monitoring?What should be checking or monitoring?Is there an intervention model or protocol that would Is there an intervention model or protocol that would
apply?apply?What is the treatment? What is the treatment? What do I need to plan?What do I need to plan?
IssuesIssues
General nursing planGeneral nursing planWhat are the patient’s emotional, psychological What are the patient’s emotional, psychological
and social needs?and social needs?What are the patient’s reactions, expectations, What are the patient’s reactions, expectations,
fears and complaints?fears and complaints?Are there family members who need to be Are there family members who need to be
contacted or who need support?contacted or who need support?What are my nursing diagnoses?What are my nursing diagnoses?What do I need to explain to or teach the patient?What do I need to explain to or teach the patient?What do I need to plan?What do I need to plan?
IssuesIssues CultureCulture What cultural factors are interfering with care?What cultural factors are interfering with care? What are her eating habits?What are her eating habits? Ignorance of what the treatment involves? Ignorance of what the treatment involves? What authority do her husband’s and her in-laws’ What authority do her husband’s and her in-laws’
exercise?exercise? Do they have a different approach to personal Do they have a different approach to personal
hygiene?hygiene? What role do women play in their society?What role do women play in their society? What is the importance of a child and, above all, a What is the importance of a child and, above all, a
male child, in this family?male child, in this family? What are my nursing diagnoses?What are my nursing diagnoses?
Situation 4 Mixed complexity
involving cultural, religious and family issues
Situation 4. Uterine bleeding Situation 4. Uterine bleeding in a Muslim womanin a Muslim woman
25 years old, motherof three children
Devout Muslim family, domineering husband.
IssuesIssues
PhysiologyPhysiology What signs and symptoms have I seen?What signs and symptoms have I seen? (CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it? What does my intuition tell me is going on?What does my intuition tell me is going on? What do I know in this area?What do I know in this area? What should be checking or monitoring?What should be checking or monitoring? Is there an intervention model or protocol that Is there an intervention model or protocol that would apply?would apply? What is the treatment? What is the treatment? What do I need to plan?What do I need to plan?
IssuesIssuesGeneral nursing planGeneral nursing plan
What are the patient’s emotional, psychological and What are the patient’s emotional, psychological and social needs?social needs?
What are the patient’s reactions, expectations, fears What are the patient’s reactions, expectations, fears and complaints?and complaints?
What is bothering her: sadness, despair, physical pain?What is bothering her: sadness, despair, physical pain? Are there family members who need to be contacted or Are there family members who need to be contacted or
who need support?who need support? What are my nursing diagnoses?What are my nursing diagnoses? What do I need to explain to or teach the patient?What do I need to explain to or teach the patient? What do I need to plan?What do I need to plan?
IssuesIssuesCulture and religionCulture and religion
What specific factors apply to this situation?What specific factors apply to this situation? Religious taboos?Religious taboos? Need to preserve modesty?Need to preserve modesty? Eating habits?Eating habits? Ignorance of treatment methods? Ignorance of treatment methods? Husband’s authority?Husband’s authority? Different approach to personal hygiene?Different approach to personal hygiene? The role of women in this society?The role of women in this society? What are my nursing diagnoses?What are my nursing diagnoses? What should I do?What should I do?
Situation 5 Mixed complexity with
physiological, psychological and social factors
cardiomyopathy
Individual:77-year-old man, Severe diabetes
Social background: Retired, poorFamily: Takes care of his wife, who has cancer
IssuesIssues
PhysiologyPhysiology What signs and symptoms have I seen?What signs and symptoms have I seen? (CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it? What does my intuition tell me is going on?What does my intuition tell me is going on? What do I know about the related problems?What do I know about the related problems? What should I be checking or monitoring?What should I be checking or monitoring? Is there an intervention model or protocol that Is there an intervention model or protocol that
would apply?would apply? What is the treatment? What is the treatment? What do I need to plan?What do I need to plan?
IssuesIssues
General nursing planGeneral nursing plan What are the patient’s emotional, psychological What are the patient’s emotional, psychological
or social needs?or social needs? What are the patient’s reactions, expectations, What are the patient’s reactions, expectations,
fears and complaints? What is bothering him?fears and complaints? What is bothering him? Are there family members who need to be Are there family members who need to be
contacted or who need support?contacted or who need support? What are my nursing diagnoses?What are my nursing diagnoses? What do I need to explain to or teach the What do I need to explain to or teach the
patient?patient? What do I need to plan?What do I need to plan?
IssuesIssuesPsychologyPsychology What social and family factors are interfering What social and family factors are interfering with care?with care? How has he reacted to the situation?How has he reacted to the situation? Responsibility of caring for his wife?Responsibility of caring for his wife? Economic constraints? Economic constraints? Absence of a support network?Absence of a support network? Ignorance of treatment methods? Ignorance of treatment methods? What are my nursing diagnoses?What are my nursing diagnoses? What do I need to plan?What do I need to plan?
Situation 6Mixed complexity with physiological,
cultural, social and religious factors
Aggression curve and hallucination-related behaviour
Complication: Respiratory problems Complication: Respiratory problems Obstructed airwaysInhalation of foreign object
Contusion to the brainstem
Intracranial hypertensionCervical trauma
Thoracic pneumothorax
Quadriplegia
Hypoventilation
Respiratory arrest
Car accident,multiple fractures
17-year-old man,Hindu, delinquent, schizophrenic,aggressive and hallucinating
50Margot Phaneuf, RN, PhD
Trigger event
Refusal to
cooperate
Panic reaction
Attempt at
intimi-dation
Actingout:
agitation,aggression,
violenceRecovery
phaseStabili-zation
Curve of growing anxietyand aggression
Structure of an outburst
Signs of an attack
Disjointed speech
Raised voice
Refusal to cooperate
Mistrustful look
Rising anxiety
Agitation, excitement
Arrogant comments
Hostility, threats
Clenched teeth or fists
Hyperactivity
Rigid posture
Hallucination, disorientation
Delirious remarks
Pale or flushed face
IssuesIssuesPhysiologyPhysiology
What signs and symptoms have I seen?What signs and symptoms have I seen? (CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it? What does my intuition tell me is going on?What does my intuition tell me is going on? What do I know about the related problems?What do I know about the related problems? What should I be checking or monitoring?What should I be checking or monitoring? Is there an intervention model or protocol that would apply?Is there an intervention model or protocol that would apply? What is the treatment? What is the treatment? What do I need to plan?What do I need to plan?
IssuesIssuesGeneral nursing planGeneral nursing plan
What are the patient’s emotional, psychological or What are the patient’s emotional, psychological or social needs?social needs?
What are the patient’s reactions, expectations, fears What are the patient’s reactions, expectations, fears and complaints? What is bothering him?and complaints? What is bothering him?
Are there family members who need to be contacted or Are there family members who need to be contacted or who need support?who need support?
What are my nursing diagnoses?What are my nursing diagnoses? What do I need to explain to or teach the patient?What do I need to explain to or teach the patient? Do I have reason to fear in his behaviour?Do I have reason to fear in his behaviour? What do I need to plan?What do I need to plan?
IssuesIssuesPsychologyPsychology What factors stemming from his psychiatric problem What factors stemming from his psychiatric problem
and his culture are interfering with care?and his culture are interfering with care? His personality and his reaction to the situation?His personality and his reaction to the situation? Religious prescriptions or taboos?Religious prescriptions or taboos? Eating habits?Eating habits? Ignorance of treatment methods? Ignorance of treatment methods? Different approach to personal hygiene?Different approach to personal hygiene? What are my nursing diagnoses?What are my nursing diagnoses? What do I need to plan?What do I need to plan?
Situation 7Mixed complexity
with physiological, cultural and legal factors
Gypsy woman injured in a criminal fire that she set
Family context:Single mother with 2 young children
Burns over 40% of her body
Pale, clammy skinTachycardia, tachypnea
State of
shock Loss of plasma
Cultural context: gypsy woman, Legal context: procedures foract of pyromania
Pressure when seated
Hypovolemic shock
Weakness, weak pulse
Anxiety,
Thirst
Urinary output
Symptoms
Otherfactors
Serious burn victim,30 years old
IssuesIssuesPhysiologyPhysiology What signs and symptoms have I seen?What signs and symptoms have I seen? (CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it? What does my intuition tell me is going on?What does my intuition tell me is going on? What do I know about the related problems?What do I know about the related problems? What should I be checking or monitoring?What should I be checking or monitoring? Is there an intervention model or protocol that Is there an intervention model or protocol that
would apply?would apply? What is the treatment? What is the treatment? What do I need to plan?What do I need to plan?
IssuesIssuesThe nursing planThe nursing plan What are the patient’s emotional, psychological What are the patient’s emotional, psychological
or social needs?or social needs? What are the patient’s reactions, expectations, What are the patient’s reactions, expectations,
fears and complaints? What is bothering her?fears and complaints? What is bothering her? Are there family members who need to be Are there family members who need to be
contacted or who need support?contacted or who need support? How will the legal issues affect the situation?How will the legal issues affect the situation? What are my nursing diagnoses?What are my nursing diagnoses? What do I need to explain to or teach the What do I need to explain to or teach the
patient?patient? What do I need to plan?What do I need to plan?
IssuesIssuesPsychologyPsychology What factors stemming from her problem and her What factors stemming from her problem and her
culture interfere with her care?culture interfere with her care? Her personality and her reaction to the situation?Her personality and her reaction to the situation? Religious and social beliefs, understanding of rules Religious and social beliefs, understanding of rules
and the law?and the law? Eating habits?Eating habits? Ignorance of treatment methods? Ignorance of treatment methods? Different approach to personal hygiene?Different approach to personal hygiene? What are my nursing diagnoses?What are my nursing diagnoses? What do I need to plan?What do I need to plan?
Situation 8Mixed complexity with
physiological, cultural, legal and ethical issues: a young man who has had an industrial accident and is in
a deep coma
Suggestions for analyzing the ethical issues
Neurological distress: Cerebral anoxiaNeurological distress: Cerebral anoxia
Young man, 22 years old,industrial accidentFather of 2 childrenVery devout catholic family
Very poor prognosis,coma
Intracranial bleedingor hematomaRespiratory distress
Circulatory arrest Increase in central
venous pressure Edema
Intracranial pressure
Cerebral anoxia
Neurological distress
Cranial fracture, significant compression
IssuesIssues
What signs and symptoms have I seen?What signs and symptoms have I seen? (CQAST) What is the patient saying about it?(CQAST) What is the patient saying about it? What does my intuition tell me is going on?What does my intuition tell me is going on? What do I know about the related problems?What do I know about the related problems? What should I be checking or monitoring?What should I be checking or monitoring? Is there an intervention model or protocol that Is there an intervention model or protocol that
would apply?would apply? What is the treatment? What is the treatment? What do I need to plan?What do I need to plan?
IssuesIssues
What decision will need to be made if What decision will need to be made if there is respiratory arrest? there is respiratory arrest?
What line of reasoning or principles can What line of reasoning or principles can be used for this decision and its be used for this decision and its supporting arguments?supporting arguments?
What does the family say?What does the family say? What does the medical team think?What does the medical team think?
Suggestions for analyzing situations with ethical issues
66Margot Phaneuf, RN, PhD
ANALYZING A SITUATIONANALYZING A SITUATIONTHAT RAISES ETHICAL ISSUESTHAT RAISES ETHICAL ISSUES
What are the facts? What are the facts? In physical, psychological and mental In physical, psychological and mental
terms and in terms of the person’s terms and in terms of the person’s future opportunities and quality of future opportunities and quality of life?life?
67Margot Phaneuf, RN, PhD
ANALYZING A SITUATION THAT ANALYZING A SITUATION THAT RAISES ETHICAL ISSUES RAISES ETHICAL ISSUES
(page 2)(page 2)
What values are at play?What values are at play? What are the values of:What are the values of:
The patient (moral, cultural values)?The patient (moral, cultural values)? The family values?The family values? The professionals (personal andThe professionals (personal and
professional values)?professional values)?
68Margot Phaneuf, RN, PhD
ANALYZING A SITUATIONANALYZING A SITUATIONTHAT RAISES ETHICAL ISSUES THAT RAISES ETHICAL ISSUES
(page 3)(page 3)
How has this problem come up?How has this problem come up? Is there a conflict of values (a dilemma)? Is there a conflict of values (a dilemma)? What are the possible solutions?What are the possible solutions? What legal issues may be involved?What legal issues may be involved? What would be the consequences? What would be the consequences?
69Margot Phaneuf, RN, PhD
ANALYZING A SITUATION THAT ANALYZING A SITUATION THAT RAISES ETHICAL ISSUES RAISES ETHICAL ISSUES
(page 4)(page 4)
For each alternative solution, what is the For each alternative solution, what is the most important value? most important value? How can priorities be determined?How can priorities be determined? What decision should be made?What decision should be made? What recommendations and justificationsWhat recommendations and justifications
can be made?can be made?
A dilemma?
71Margot Phaneuf, RN, PhD
DilemmaDilemma: : QualityQuality of life of life sacrednesssacredness of lifeof life
A A difficultdifficult situation situation wherewhere the the principleprincipleof of qualityquality of life (of life (sufferingsuffering, , discomfortdiscomfort, , immobilityimmobility, limitations of , limitations of manymany kindskinds, , worriesworries) ) confrontsconfronts the the principleprinciple thatthat life life isis an an absoluteabsolute value, value, sacredsacred and and untouchableuntouchable for for anyany reasonreason. .
The ethical dilemma: Some food for thought
73Margot Phaneuf, RN, PhD
QUESTIONS FOR QUESTIONS FOR
ETHICAL REASONINGETHICAL REASONING
There are times when caregivers face ethical There are times when caregivers face ethical dilemmas and must respond by making a dilemmas and must respond by making a decision to act, to express an opinion or to decision to act, to express an opinion or to voice their disagreement. Asking the following voice their disagreement. Asking the following questions can help you reach that decision. questions can help you reach that decision.
What is the goal of this action or of not acting? What is the goal of this action or of not acting? Is it to bring an end to the person’s suffering? Is it to bring an end to the person’s suffering? To hasten their death and end a life considered To hasten their death and end a life considered impossible? impossible?
74Margot Phaneuf, RN, PhD
QUESTIONS FOR ETHICAL QUESTIONS FOR ETHICAL REASONINGREASONING (page 1)(page 1)
Is it for the greater good of theIs it for the greater good of the
patient? patient? Is the underlying motive: Is the underlying motive:
An economic motive (such as the An economic motive (such as the
cost of care)? cost of care)? One of compassion? One of compassion? A social motive (for example, becauseA social motive (for example, because
organizational or family problems are organizational or family problems are
standing in the way of care delivery)?standing in the way of care delivery)? Does the patient suffer as a result?Does the patient suffer as a result?
75Margot Phaneuf, RN, PhD
QUESTIONS FOR ETHICAL QUESTIONS FOR ETHICAL
REASONING REASONING (page 2)(page 2) Is the pain or the situation intolerable? Is the pain or the situation intolerable?
Intolerable for whom?Intolerable for whom? For the patient?For the patient? For family and friends?For family and friends? For the caregivers? For the caregivers?
Who lacks courage? Who lacks courage? The patient?The patient? Family and friends? Family and friends? The caregivers?The caregivers?
76Margot Phaneuf, RN, PhD
QUESTIONS FOR ETHICAL QUESTIONS FOR ETHICAL REASONING REASONING (page 3)(page 3)
What rights do health professionals have over What rights do health professionals have over
patients? Parents over their children? patients? Parents over their children? Children over their parents (in terms of Children over their parents (in terms of making decisions for them)? making decisions for them)? Does this act represent being faithful and loyal to Does this act represent being faithful and loyal to
the person?the person? Is respect being shown for the patient’s Is respect being shown for the patient’s
independence, right to self-determination, independence, right to self-determination, integrity, privacy and dignity? integrity, privacy and dignity?
Illustrations of physiology inspired by: Illustrations of physiology inspired by:
Jean-Pierre Carpentier (2002), Jean-Pierre Carpentier (2002),
Soins infirmiers aux urgences et en Soins infirmiers aux urgences et en réanimation,réanimation,
4th Ed., No 21, Paris, Masson.4th Ed., No 21, Paris, Masson.
78Margot Phaneuf, RN, PhD
BibliographyBibliography
Bandman, Elsie and Bertram Bandman (1988), Critical Thinking Bandman, Elsie and Bertram Bandman (1988), Critical Thinking in Nursing. Norwalk, Appleton &Lang.in Nursing. Norwalk, Appleton &Lang.
Brûlé. Mario and Lyne Cloutier (2002), L’examen clinique dans la Brûlé. Mario and Lyne Cloutier (2002), L’examen clinique dans la pratique infirmière. Erpi.pratique infirmière. Erpi.
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