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Summarize The Difference Between Nursing And Ethical Decision Making

The purpose of this paper is to summarize an ethical dilemma and consider the principles of moral reasoning and the fundamentals of the ethical decision making involved. Also, to consider the affect of society, the institution, the profession, and stakeholders on the ethical dilemma. According to Butts and Rich (2016), moral reasoning is defined as a process in which the objective is to determine if an idea is wright or wrong. Ethical decision making is the process of choosing and evaluating among outcomes, keeping in mind the various ethical principles (Butts & Rich, 2016).

The difference between these two are, in moral reasoning one is deciding what is right or wrong based on morals where as in ethical decision making one is making a decision on what is right or wrong by evaluating ethical principles (Butts & Rich, 2016). There are four topics to approach when experiencing an ethical dilemma. Those topics are: medical indications, patient preferences, quality of life, and contextual features (Butts & Rich, 2016). For the first topic of medical indications, the approach is centered around the principles of beneficence and nonmaleficence (Butts & Rich, 2016).

One must understand the patient’s medical problem, the goals of treatment, the possibilities of success, and overall the best way the patient can benefit from medical and nursing care and avoid any harm (Butts & Rich, 2016). The second topic which involves patient preferences focuses on the principles of autonomy (Butts & Rich, 2016). These include understanding patient consent, if the patient is mentally capable to make decisions and if not who is deemed the decision maker, and lastly is the patient willing or unwilling to comply with medical treatment (Butts & Rich, 2016).

The third topic on the quality of life includes the principles of beneficence, nonmaleficence, and autonomy (Butts & Rich, 2016). One needs to consider the physical, mental, and social deficits the patient may have, quality of life assessments, any plans to forgo life-sustaining treatment, and the legal and ethical status of suicide (Butts & Rich, 2016). The fourth topic on contextual features involves the principles of fairness and justice (Butts & Rich, 2016). One must consider any conflicts of interest, financial factors, as well as legal and ethical issues (Butts & Rich, 2016).

The Ethical Dilemma This ethical dilemma takes place on the Mother-baby unit at Crouse Hospital. The ethical dilemma involves a breastfeeding mother who refuses to supplement with formula to help raise her newborns blood glucose level, since bottle feeding is “unnatural”. The infant is over 4000g therefore it is on the blood sugar protocol per Crouse Hospital policy. The mother has attempted breastfeeding two times and her infants blood sugar is still low per the hypoglycemic newborn protocol.

Therefore, the registered nurse notified the nursery charge nurse who in return notified the pediatrician of the infant’s status. In this ethical dilemma, the nurse promotes the well being of both the mother and the newborn and this is not always an easy process. By offering education to the mother and collaborating with the nursery charge nurse along with the pediatrician, the nurse advocates for the infant. For this ethical dilemma, a policy was utilized when explaining measures on feeding to the mother and the next steps to take in order to avoid crisis.

My options are as follows: • Follow policy • Advocate for infant • Educate mother that bottle feeding would not be permanent • Follow MDs orders • Introduce pumping to mother • Lactation support Medical Indications This ethical dilemma involves the elements relating to the first topic on the medical indications. The patient’s medical problem as been clearly defined in the previous paragraph. The goals medical treatment includes normalizing the infants blood sugar. The mother’s refusal to not supplement per protocol is hindering the possibilities of success.

In sum, the patient can be benefited by following the proper protocols, by the registered nurse offering education to the mother, and by the registered nurse reaching out to the charge nurse as well as the pediatrician for support. Patient Preferences The second topic of patient preferences is relevant to the ethical dilemma presented above. The registered nurse has provided the mother with education on the risk of infant hypoglycemia as well as treatment options, and so far the mother has refused all treatment options other than breastfeeding.

The infant which is the patient is not capable of making decisions for itself, therefore the mother makes the infants choices. The mother is unwilling to comply with treatment since she is against feeding her baby anything other than breast milk, since formula is unnatural. Quality of Life The third topic on quality of life applies to this ethical dilemma. If the infant does not receive the proper treatment to raise its blood glucose level, the infant may suffer and need to be transferred to the Neonatal Intensive Care Unit for extensive medical care and treatment.

The infant has no quality of life issues, yes the low blood glucose dose impacts the quality of life however the treatment options are not life threatening. The ethical issues that are involved in this situation are the mother’s choices and wishes which need to be respected. Contextual Features The forth and final topic on contextual features applies to this ethical dilemma. The pediatrician was notified on the infant’s condition, therefore there might be a professional conflict of interest based on the pediatrician’s view on how serious this issue is to him/her.

Financial factors may come into play since part of the reason the mother may be opposed of formula is because of the cost? And religious issues may come into play as well if the mother refuses to bottle feed because of her religion? There is an evident conflict of interest regarding the institution since the mother is refusing to comply with the neonatal hypoglycemic protocol which is relevant to her infant’s status. Options and Decisions Out of the options I have listed above, there are some I favor the most and one in particular I favor the least.

I believe that the two best options to solve this ethical dilemma are to educate the mother on the need, severity, and time frame of bottle feeding as well as to add in what the pediatrician recommends. By the registered nurse proving education the mother should understand that offering formula is a one-time thing, with the overall goal of normalizing the infants blood glucose level, and avoiding harm to the infant. In turn, once the infants blood glucose level is normalized, the mother can continue with breastfeeding.

The mother should also understand that after the infant’s blood sugar is normalized, there is a certified lactation specialist available to answer any of her questions regarding breastfeeding as well as to help her to be successful with breastfeeding. Also, the mother may consider this situation to be more of a concern once the registered nurse states she has notified the pediatrician, therefore this may increase our chances of the mother complying with the various treatment options so the protocol can be followed.

The treatment option I favor the least is to start the mother pumping at this point in time. This is because it takes a few days for a mother’s milk to officially come in, this being said the nutrients the baby gets from breastfeeding during the first days of life is colostrum. Therefore, if the mother were to pump at this time she would most likely get less than an 1ml of colostrum, which would not be enough to normalize the infants blood glucose level anyway.

I believe this option would cause more stress and anxiety for the mother and not fix the problem at hand. My favored decision of patient education, respecting the pediatricians input, and following the neonatal hypoglycemic policy has an effect on the stakeholders, the institution, the profession, and society. The stakeholders are affected since the nursery change nurse has notified the pediatrician of the infant’s condition, therefore the registered nurse will relay the suggestions the pediatrician has to the infant’s mother.

The institution is affected since Crouse Hospital has a hypoglycemic protocol in place for safety purposes, and this policy/protocol is relevant in this ethical dilemma. The profession of nursing is affected since the registered nurse is doing the best of her ability to advocate for the patient and avoid any nonmalficence. The registered nurse is also doing her job by providing the mother with education and following the institutions neonatal hypoglycemic policy.

Lastly, society is affected since the mother is a member of our society and we need to do everything we can to ensure her safety while she is a patient as well as to keep her newborn infant safe. When considering my moral principles, professional scope of practice, and the law/constitution, I believe that my professional scope of practice had a greater influence on my overall decision. I believe this because morally, if this was my newborn I would have given my newborn formula to increase the chance of normalizing blood sugars and making sure my infant was safe as well as to avoid any effects.

However, as a registered nurse is not acceptable to offer personal opinions to the patient, therefore I did not do this. Instead I followed the registered nurse professional scope of practice, by providing patient education, being a patient advocate, following hospital protocol, and notifying the pediatrician. Summary In summary, the ethical dilemma presented above displays all of the key topics and principles of an ethical issue. This ethical dilemma was processed in a professional manner and the relevant stakeholders were involved.

The registered nurse abided by her professional scope of practice and provided the mother with the education necessary to help normalize her newborns blood sugar. In conclusion, ethical dilemmas are prominent with in the nursing profession. Therefore, it is essential that each and every nurse understand what an ethical dilemma is, how to analyze an ethical dilemma, and how the proper measure to take to solve an ethical dilemma. The nurse should utilize the four topic approach, involve stakeholders, apply any relevant policies, and analyze the various options at hand.

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