I feel the nurse was acting in the best interest of the patient. If information on alternative treatments is known by the nurse or any of the healthcare team, it should be presented to the patient as long as the therapies are available through legal and ethical sources. Patients have the right to informed consent and healthcare professionals are obligated to provide it. The physician does not necessarily have the final word on the information the patient receives. I have never had a physician say to me I can only provide certain information to a patient. If Michael G had not been given this information on alternatives, he would truly not be fully informed if the healthcare professionals were aware of the information and withheld it.
I agree with you the nurse only had the patients best interest in mind. The physician should had provided more information to the patient and he should had not been upset about the alternative information that was given. Also, I am with you when you stated the physician does NOT have the final word. Only the patient does when all information has been given and reviewed.
I agree as well. Nurse L was looking out for Michael G and making sure he knew all options available to him. The patient is the one to decide on what form of treatment they want.
I agree. I think sometimes physicians have a hard time with treatments that they don't perform. Go back to the Being Mortal episode when they spoke about wanting to fix everyone. What they believe is best is not always the best for their patients. They need to be able to accept that and support patients in their decisions.
I think informed consent includes how much information is needed for the patient to come to an understanding of the disease process they face and the procedure for which they are consenting. This may include minimal information and little exaggeration for one patient, but extensive explanation and additional/alternative ideas for another patient. I think Nurse L was acting morally correct when she supplied alternative information. I believe that, based on the patient's mental capability, the information given to the patient should be complete (including alternatives) if that is the level of comprehension for that particular patient. If a patient is satisfied, and has quit asking questions about their procedure, I feel informed consent has been reached. Obviously the physician has a higher level of education and knowledge about the procedure to be consented, however the nurse is also an advocate and resource for the patient. The physician should not be the ultimate source of information. I still believe he had given informed consent for the information that was presented, and the treatment that was being given. Based on his ability to be autonomous, he can give or not give consent to whatever he wants.
I totally agree that consent should be discussed based on patient's level of understanding and comprehension. These case studies do not elaborate on the conversations leading up to the actual discussion. I would be interested to see how the conversation went between the nurse and patient before she mentioned other therapies to him.
I think that all patients should be given all details on options to better their health from the healthcare team. The nurse is the educator for the patient and needs to talk with the patient and find out what is best for them in the situtaion given and work from there. I do not think that the doctor always has the final say. I feel that taking care of a patient in a hospital is a collabortive work done by the entire healthcare team. I think that informed consent for a patient is when the patient fully understands all therapies and alternatives offered for them during this process.
I agree I feel the same way all information should be given to our patients and let them talk about it. Education is a very big part of what we do to help support the patient in their health care decicion making.
I feel we must love to teach to be nurses. Like I said in another post, I have not ever had a physician tell me not to supply information that is relevant to the case. They just assume we are doing that anyway.
I agree that it is an effort from the entire healthcare team. Patients need as much information as they can absorb and process. The also need the time to formulate questions to ask the physician the next time they meet in order to make the best decision in regards to the care they are receiving.
I feel that the nurse was only doing her job. She just wanted to make sure that her patient was exposed to all of his choices and options. Even if this means he changes his mind. The MD should have not been upset with the nurse. The MD should have given all of the information and choices to the patient before handing him the consent. The consent that the pt had signed, according to the case study, was for chemo treatment so I feel the consent was legal.
I feel that consent the patient was legal for the treatment of the chemo but I do not feel like it was an informed consent because he was not given all the information necessary to treat his condition.
I do think the consent was legal. It was an explanation of the chemo therapy and its side effects it sounded like. Where the mistake was made was prior to the decision of chemo therapy. Were those alternate therapies offered? In the ED when I have a patient sign and informed consent I do not ask if other therapy optioins were offered as part of the consent. Saying this there was still a communication break down. All of that aside, what difference does it make that the patient changed his mind? He can see the MD again, clarify the treatments and if he would like chemo reschedule. We are talking about chemotherapy here, not a hair cut!
I thought the same thing...what if the nurse would have gone to the doctor and approached things differently, maybe she would not have been fired. Maybe there was a reason the doctor didn't give the option to the patient.
I agree that the doctor should have been included or consulted on the topic or conversation by the nurse. I don't agree that there is any reason that the doctor should withhold the option to the patient. That is the patient's choice. Autonomy is lost when the doctor takes that away. The doctor could have had a valid reason to not go over that option but it still needs to be discussed with the patient, including the doctor's reasons so the patient has all the information to make his consent informed.
Maybe there was a reason why the Dr didn't give all the options but he still should have even if he didn't believe in all the reasoning himself. It is the responsiblity of the dr to give all options the the patients and not just the ones he believes in.
In reading this case, I had an almost uneasy feeling as I read through it. I do believe that the patient should have all the information necessary to make the best decision possible. While we are constantly educating our patients, it seems like she could have handled to situation differently by notifying the physician of the information she provided. This would give the physician the opportunity to allow sufficient time for additional questions by the patient.
I believe that Nurse L was morally correct when she provided Michael G with alternative therapies. According to the study of Ethical Problems in medicine, informed consent promotes the overall well-being of the patient and autonomy. If the patient is mentally competent the patient should have the right to be provided with information of alternate therapies from his health care team. I believe Nurse L was providing additional therapy opportunities to promote self-determination. The physician should not have the right to make the final decision for the patients’ healthcare decisions. The physician does not own the patient but to provide care that the patient and the doctor have a mutually agreed treatment plan. If the patient was not informed of alternative therapy regimes besides chemo, I feel that his right of autonomy was violated.
I agree with you in that the patient's autonomy was not considered. Instead of the doctor being upset with the nurse, he should reconsider his approach to obtaining consent to make sure he is completely informed.
1. I believe Nurse L was acting in a morally correct way in that she had the patient's best interest in mind. She felt obligated to inform him of all his choices regarding treatment. Perhaps she was offering him hope that if chemo did not work that there were other things to try as well. I don't feel the nurse was intentionally trying to contradict the doctor, but in light of the patient actively dying, she wanted to make sure he knew about other therapies available. Maybe she could have suggested he try other means after his chemo was over if it was ineffective, but it is unclear what really swayed his opinion to stop treatment immediately. 2. I do not believe the physician should have the final word about the information a patient receives. Medicine is a multi disciplinary approach where all input should be appreciated. Most of the times, doctors have the nurses get consents signed without really explaining much to the patient. I do feel consent has become more of a legal thing for doctors instead of a contract making sure they are fully aware of the consent they are signing. Even when doctors explain the treatment to families, the consent is only for that treatment. They do not typically get into a discussion of all the options available for their condition besides the current treatment being offered. As the expert in their field, I believe they arrive at the conclusion of what is best for the patient and then offer the treatment and get consent. This goes against the actual self-determination of patients, which is a component of informed consent. I think nurses have a right to talk to patients about other options they may want to investigate for themselves, but not to overstep their boundaries. Hopefully to inform them and then say, yes, I agree with your doctor that even though there are other options, I believe your doctor is steering you in the right direction. We still need to have a good working relationship with our doctors and I don't feel challenging them on every consent or options available is a good practice. 3. I do not think Michael G's consent to chemotherapy was informed consent if he was not aware of any other treatment options. I feel some doctors do explain other options, but persuade them that the one they are offering is the best option. In this case, either the doctor did not inform him at all or just glossed over it as not the most effective.
I think Nurse L did nothing wrong in educating her patient Michael G about other forms of treatment. Perhaps it was an oversight by the physician that Michael G was not informed of natural alternatives, but as nurses we are advocates for our patients and that is what Nurse L was doing. I also think that most physicians do not believe in natural alternatives. The way the oncologist acted was unprofessional and HE should have been reprimanded.
Physicians do seem to dismiss natural / homeopathic treatments as invalid, but a good physician needs to stay informed in order to address those questions that may come up as far as alternative therapies are concerned.
I agree too many times patients are offered the decision that the physician believes is the best treatment. The patient should be offered all treatments, especially those outside of the treating physicians scope of practice. Did this MD offer any referrals to holistic med, hospice, palliative care? The patient has the right to make his medical treatment decisions, even if this means no treatment or alternative medicine.
Agreed, its very rare that a doctor will educate patients on natural treatment options. A doctor should educate him/herself on all the options available to patients so they can better educate their patients.
Dr. don't often offer natural therapies, but they also avoid other sensitive conversations that need to take place. If this patient was dying from leukemia, why put him through chemotherapy unless it was really going to improve his quality of life. Being a person that has been through chemo myself, I would not agree to it unless it is curative, I'd rather enjoy the rest of the time I had left.
I believe that Nurse L was was acting in a morally correct way when she gave Michael G the information on alternative natural therapies. She was merely providing education to her patient, which is a major role of a nurse. What the patient decided to do with that information was not the fault of Nurse L. The physician in charge does not have the final word about the information a patient receives. The nurses are with the patients for extended periods at a time and interact with the patients throughout their shifts...they are constantly educating the patients. A different approach Nurse L could have taken would be to talk to the physician and inform him that Michael G did not know alternative therapy options. Since Michael G did not know about the alternative therapies available to him, I believe that is agreement to the chemotherapy was not informed consent.
Sarah I agree, as nurses we are always education our patients. So why would it be wrong for this nurse to give her patient more options about treatments that could effect the outcome of his disease.
I agree it is our duty to given the patients as much information as possible in regards to treatment options, and I often encourage my patients to go to reputable sites to look up the options as well. an informed patient is a healthier patient as they can take control of their situations and do what is best for them. However , when a patient opts to sign the consent regarding a certain procedure - they are signing that they are well informed for THAT procedure . Take for instance an angio consent - they are signing that they understand the procedure as well as the risks and benefits. I'm not convinced that in this particular instance that the consent that was signed was not an informed one.
I do not feel the Nurse L was acting immorally. I think that she was trying to give the patient all the information to help him make the best decision possible for his treatment. I do not feel that the physician in charge has the final word about the information a patient receives. With the many options available to research information about medical treatments a patient can do research and look into other options and treatments that may be available. As nurses we are always teaching patients about treatments, options and precautions. Michael G did sign a legal consent for the treatment of chemo, but I do not believe he signed an informed consent because he was not given any other options for other possible treatments that may have been available.
The key word is informed. Having all the information to make a voluntary consent. I think a lot of doctors assume patients have done their due diligence when it comes to topics of personal illness and this is not always the case. That is why they "forget" to discuss relevant issues or concerns. I always tell my patients to ask, "is there any questions I need to ask that I don't know to ask?" Sometimes it helps.
Patients need to be aware of all their options before being made to make a decision. This patient was not informed of his options. It's very unfortunate because we all have information readily available of Mosby's on almost every diagnosis, drug, and treatment available.
1. I believe Nurse L was morally appropriate in educating Michael G. about the alternatives that were available to him. You have to have the most education available to make decisions, especially life and death decisions. As nurses it is our duty to deliver this education. I do believe this should have been a topic for discussion at the beginning of his treatment therapy, when he was diagnosed. 2. The physician in charge should not have the final say about the information a patient receives. Patients put their faith in us as professionals to make sure they have all the information they need to make an informed consent. I have been in this particular situation before and have been reprimanded verbally about information given. So when I give information on topics that I feel the patient needs education about, I always finish my education time with, "You should discuss this with the doctor if it is something you want to pursue and see what he/she thinks". That way the doctor is able to discuss the topic with the patient and then give them his/her professional opinion. Also there is so much information on the internet to further educate our patients I always encourage patients and their families to do some research on their own so they can ask other educated questions to their doctors. 3.I believe the consent was not informed as without this new information Michael G's right for self determination was not considered therefore making the consent void. Michael has to have all relevant information to make a voluntary informed consent.
I agree with you about the consent. By leaving out relevant information on treatment alternatives, the consent needs to explained again with ALL options available and re-signed. This defiantly alters Michael G's self determination.
Yes the nurse was acting morally when she chose to give information to the patient about alternative therapies. The nurse was respecting the patients self determination when she gave the information and in doing this she was allowing him to make the best decison for him at this particular time of his treatment.The Dr. wasn't giving the patient all the information about all his treatment plans and by wanting to go against the nurse and in turn disrespecting the patients choices that he was making about his own health care decisions.No the dr. shouldn't have the final say in the information that is given to the patient. By withholding information the paitent isn't really giving his informed consent. Informed consent means that the patient is given all the information that is available at the time with the choices.
I feel that nurse L was acting in a morally correct way . It is our duty as nurses to give patients as much information as we can about their diagnosis and treatment options, Nurse L was acting as an advocate for her patient in this instance, While the physician in charge obviously has more education regarding therapies and treatments he could certainly voice his opinion in regards to the alternative therapies, however it is not ok for him to censor what information his patients receive. In the technological age that we are currently in, most patients pursue looking into alternative medicine anyway , and the doctor should be well versed in the effectiveness of those treatments, and able to give sound medical advice. Had Michael not known about the alternative therapies , I feel informed consent was still valid., so long as he understood completely the treatment he was consenting to,
The nurse was not incorrect in her decision to give the patient all of the facts if she was knowledgeable herself regarding the patients case. I believe it would have been a professional courtesy to ask the physician why he did not offer alternative means of care prior to telling the patient. A conversation could have been discussed. My concern is there is something in the patients case that the nurse did not know or over looked. The MD and nurse are a team and need to function as one. If the physician at that time could not offer a reason to the nurse as to why the patient could not have alternate therapy then she should have informed the patient. I do not believe the physician in charge should have the final decision in the information a pt receives. Most consents require the nurse sign as well. I would not sign something that I felt was not complete. His agreement to chemotherapy as long as the procedure was explained fully was informed consent. The failure was prior to the decision of chemo if all of the options were not offered.
I believe that Nurse L was acting in a morally correct way providing information to Michael. This case made me think back to accompanying my aunt to an oncologist appointment and the discussion that took place regarding a newly diagnosed cancer. I remember that the oncologist described the type of cancer and the best treatment available for that cancer. Other possible treatment considerations were discussed but to the best of my recollection it was my aunt who asked about the alternate treatments first. Patients should be given all possible treatments available so they can seek further opinions if needed and make their decision fully informed. Nurse L was providing information that the patient had not yet received. I believe that she could have spoken to the physician to let him/her know that she had provided the additional information also allowing the physician to answer any new questions.. The physician should not have the final say in the information a patient receives. This is preventing the patients autonomy. The consent was for the chemotherapy and so long as all information regarding chemotherapy was given then it is informed consent.
I also believe that Nurse L was acting in a morally correct way. One of a nurses' main jobs is to educate their patients. A patient should know all the risk and benefits, as well as any alternative treatments to an illness. I feel that the patient did not have informed consent about the chemotherapy since alternative treatments were never discussed with the patient. I do think that the nurse should of made the doctor aware that she was going to inform this patient about alternative treatment in case there was another reason why alternative means would not work for this patient that the nurse was unaware of.
Nurse L was acting morally correct. Nurses' are responsible for patient education and advocating for patients and their care. It is the patient's right to know all of their options so they can choose what is best for them. The physician who gave Michael G. the information and gained informed consent should be reprimanded, not Nurse L. It cannot be considered informed consent if the patient was not properly informed.
I believe Nurse L wasn't doing anything wrong by providing information to the patient. It is the responsibility of the nurse to education. I would however like to see where Nurse L retrieved her information. I do not think nurses should be pulling random information for the internet for education, but if she pulled in using a work sponsor website then I think there is nothing wrong with this. Michael G is dying and I don't think anyone should be forced to go through with chemotherapy before all options are discussed. This patient was not properly informed by his physician.
I do think Nurse L. likely had the best interest of the patient in mind. The case states Michael G. was dying of leukemia. Unless these alternative treatments are so new that the physician had no time to discuss with the patient, I think her actions were not in the best interest of the patient. As nurses we do not order treatments or tests or labs on patients. It is in our scope of care to follow the orders of the physicians. I think the patient may have been better served by discussing those alternative treatments with the physician and get his or her opinion as those treatments may pertain to Michael G. I can only imagine what would happen if as a nurse I approached a patient with heart failure and told that person about the availability of a bi-ventricular pacer. Just look up a disease or disease process on the internet and you will find numerous alternative treatments. It is the physician's job to inform the patient and give options, but not all treatments are appropriate. I do not think she should have her license revoked. I do not think either that the physician has the last say on treatments for the patient in most cases. I believe it their job to present appropriate therapies, explain risks and benefits and allow the patient to decide.
I feel the nurse was acting in the best interest of the patient. If information on alternative treatments is known by the nurse or any of the healthcare team, it should be presented to the patient as long as the therapies are available through legal and ethical sources. Patients have the right to informed consent and healthcare professionals are obligated to provide it. The physician does not necessarily have the final word on the information the patient receives. I have never had a physician say to me I can only provide certain information to a patient. If Michael G had not been given this information on alternatives, he would truly not be fully informed if the healthcare professionals were aware of the information and withheld it.
ReplyDeleteI agree with you the nurse only had the patients best interest in mind. The physician should had provided more information to the patient and he should had not been upset about the alternative information that was given. Also, I am with you when you stated the physician does NOT have the final word. Only the patient does when all information has been given and reviewed.
DeleteI agree. The patient is entitled to know all options available so they are able to make the best decisions for themselves.
DeleteI agree as well. Nurse L was looking out for Michael G and making sure he knew all options available to him. The patient is the one to decide on what form of treatment they want.
DeleteI agree. I think sometimes physicians have a hard time with treatments that they don't perform. Go back to the Being Mortal episode when they spoke about wanting to fix everyone. What they believe is best is not always the best for their patients. They need to be able to accept that and support patients in their decisions.
DeleteI think informed consent includes how much information is needed for the patient to come to an understanding of the disease process they face and the procedure for which they are consenting. This may include minimal information and little exaggeration for one patient, but extensive explanation and additional/alternative ideas for another patient. I think Nurse L was acting morally correct when she supplied alternative information. I believe that, based on the patient's mental capability, the information given to the patient should be complete (including alternatives) if that is the level of comprehension for that particular patient. If a patient is satisfied, and has quit asking questions about their procedure, I feel informed consent has been reached. Obviously the physician has a higher level of education and knowledge about the procedure to be consented, however the nurse is also an advocate and resource for the patient. The physician should not be the ultimate source of information. I still believe he had given informed consent for the information that was presented, and the treatment that was being given. Based on his ability to be autonomous, he can give or not give consent to whatever he wants.
ReplyDeleteI totally agree that consent should be discussed based on patient's level of understanding and comprehension. These case studies do not elaborate on the conversations leading up to the actual discussion. I would be interested to see how the conversation went between the nurse and patient before she mentioned other therapies to him.
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ReplyDeleteI think that all patients should be given all details on options to better their health from the healthcare team. The nurse is the educator for the patient and needs to talk with the patient and find out what is best for them in the situtaion given and work from there. I do not think that the doctor always has the final say. I feel that taking care of a patient in a hospital is a collabortive work done by the entire healthcare team. I think that informed consent for a patient is when the patient fully understands all therapies and alternatives offered for them during this process.
ReplyDeleteI agree I feel the same way all information should be given to our patients and let them talk about it. Education is a very big part of what we do to help support the patient in their health care decicion making.
DeleteI feel we must love to teach to be nurses. Like I said in another post, I have not ever had a physician tell me not to supply information that is relevant to the case. They just assume we are doing that anyway.
DeleteI agree that it is an effort from the entire healthcare team. Patients need as much information as they can absorb and process. The also need the time to formulate questions to ask the physician the next time they meet in order to make the best decision in regards to the care they are receiving.
DeleteI feel that the nurse was only doing her job. She just wanted to make sure that her patient was exposed to all of his choices and options. Even if this means he changes his mind. The MD should have not been upset with the nurse. The MD should have given all of the information and choices to the patient before handing him the consent. The consent that the pt had signed, according to the case study, was for chemo treatment so I feel the consent was legal.
ReplyDeleteI feel that consent the patient was legal for the treatment of the chemo but I do not feel like it was an informed consent because he was not given all the information necessary to treat his condition.
DeleteI do think the consent was legal. It was an explanation of the chemo therapy and its side effects it sounded like. Where the mistake was made was prior to the decision of chemo therapy. Were those alternate therapies offered? In the ED when I have a patient sign and informed consent I do not ask if other therapy optioins were offered as part of the consent. Saying this there was still a communication break down. All of that aside, what difference does it make that the patient changed his mind? He can see the MD again, clarify the treatments and if he would like chemo reschedule. We are talking about chemotherapy here, not a hair cut!
DeleteI also feel the nurse should express her concerns with the MD. Maybe there is an underlying medical reason the MD did not mention other therapies.
ReplyDeleteI thought the same thing...what if the nurse would have gone to the doctor and approached things differently, maybe she would not have been fired. Maybe there was a reason the doctor didn't give the option to the patient.
DeleteI agree that the doctor should have been included or consulted on the topic or conversation by the nurse. I don't agree that there is any reason that the doctor should withhold the option to the patient. That is the patient's choice. Autonomy is lost when the doctor takes that away. The doctor could have had a valid reason to not go over that option but it still needs to be discussed with the patient, including the doctor's reasons so the patient has all the information to make his consent informed.
DeleteMaybe there was a reason why the Dr didn't give all the options but he still should have even if he didn't believe in all the reasoning himself. It is the responsiblity of the dr to give all options the the patients and not just the ones he believes in.
DeleteIn reading this case, I had an almost uneasy feeling as I read through it. I do believe that the patient should have all the information necessary to make the best decision possible. While we are constantly educating our patients, it seems like she could have handled to situation differently by notifying the physician of the information she provided. This would give the physician the opportunity to allow sufficient time for additional questions by the patient.
DeleteI believe that Nurse L was morally correct when she provided Michael G with alternative therapies. According to the study of Ethical Problems in medicine, informed consent promotes the overall well-being of the patient and autonomy. If the patient is mentally competent the patient should have the right to be provided with information of alternate therapies from his health care team. I believe Nurse L was providing additional therapy opportunities to promote self-determination. The physician should not have the right to make the final decision for the patients’ healthcare decisions. The physician does not own the patient but to provide care that the patient and the doctor have a mutually agreed treatment plan. If the patient was not informed of alternative therapy regimes besides chemo, I feel that his right of autonomy was violated.
ReplyDeleteI agree with you in that the patient's autonomy was not considered. Instead of the doctor being upset with the nurse, he should reconsider his approach to obtaining consent to make sure he is completely informed.
DeleteJodi i said basically the same thing. Without the patient being given all his opitons how was he able to make an infomred decision.
Delete1. I believe Nurse L was acting in a morally correct way in that she had the patient's best interest in mind. She felt obligated to inform him of all his choices regarding treatment. Perhaps she was offering him hope that if chemo did not work that there were other things to try as well. I don't feel the nurse was intentionally trying to contradict the doctor, but in light of the patient actively dying, she wanted to make sure he knew about other therapies available. Maybe she could have suggested he try other means after his chemo was over if it was ineffective, but it is unclear what really swayed his opinion to stop treatment immediately. 2. I do not believe the physician should have the final word about the information a patient receives. Medicine is a multi disciplinary approach where all input should be appreciated. Most of the times, doctors have the nurses get consents signed without really explaining much to the patient. I do feel consent has become more of a legal thing for doctors instead of a contract making sure they are fully aware of the consent they are signing. Even when doctors explain the treatment to families, the consent is only for that treatment. They do not typically get into a discussion of all the options available for their condition besides the current treatment being offered. As the expert in their field, I believe they arrive at the conclusion of what is best for the patient and then offer the treatment and get consent. This goes against the actual self-determination of patients, which is a component of informed consent. I think nurses have a right to talk to patients about other options they may want to investigate for themselves, but not to overstep their boundaries. Hopefully to inform them and then say, yes, I agree with your doctor that even though there are other options, I believe your doctor is steering you in the right direction. We still need to have a good working relationship with our doctors and I don't feel challenging them on every consent or options available is a good practice.
ReplyDelete3. I do not think Michael G's consent to chemotherapy was informed consent if he was not aware of any other treatment options. I feel some doctors do explain other options, but persuade them that the one they are offering is the best option. In this case, either the doctor did not inform him at all or just glossed over it as not the most effective.
I think Nurse L did nothing wrong in educating her patient Michael G about other forms of treatment. Perhaps it was an oversight by the physician that Michael G was not informed of natural alternatives, but as nurses we are advocates for our patients and that is what Nurse L was doing. I also think that most physicians do not believe in natural alternatives. The way the oncologist acted was unprofessional and HE should have been reprimanded.
ReplyDeletePhysicians do seem to dismiss natural / homeopathic treatments as invalid, but a good physician needs to stay informed in order to address those questions that may come up as far as alternative therapies are concerned.
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DeleteI agree too many times patients are offered the decision that the physician believes is the best treatment. The patient should be offered all treatments, especially those outside of the treating physicians scope of practice. Did this MD offer any referrals to holistic med, hospice, palliative care? The patient has the right to make his medical treatment decisions, even if this means no treatment or alternative medicine.
Agreed, its very rare that a doctor will educate patients on natural treatment options. A doctor should educate him/herself on all the options available to patients so they can better educate their patients.
DeleteDr. don't often offer natural therapies, but they also avoid other sensitive conversations that need to take place. If this patient was dying from leukemia, why put him through chemotherapy unless it was really going to improve his quality of life. Being a person that has been through chemo myself, I would not agree to it unless it is curative, I'd rather enjoy the rest of the time I had left.
DeleteI believe that Nurse L was was acting in a morally correct way when she gave Michael G the information on alternative natural therapies. She was merely providing education to her patient, which is a major role of a nurse. What the patient decided to do with that information was not the fault of Nurse L. The physician in charge does not have the final word about the information a patient receives. The nurses are with the patients for extended periods at a time and interact with the patients throughout their shifts...they are constantly educating the patients. A different approach Nurse L could have taken would be to talk to the physician and inform him that Michael G did not know alternative therapy options. Since Michael G did not know about the alternative therapies available to him, I believe that is agreement to the chemotherapy was not informed consent.
ReplyDeleteSarah I agree, as nurses we are always education our patients. So why would it be wrong for this nurse to give her patient more options about treatments that could effect the outcome of his disease.
DeleteI agree it is our duty to given the patients as much information as possible in regards to treatment options, and I often encourage my patients to go to reputable sites to look up the options as well. an informed patient is a healthier patient as they can take control of their situations and do what is best for them. However , when a patient opts to sign the consent regarding a certain procedure - they are signing that they are well informed for THAT procedure . Take for instance an angio consent - they are signing that they understand the procedure as well as the risks and benefits. I'm not convinced that in this particular instance that the consent that was signed was not an informed one.
DeleteI do not feel the Nurse L was acting immorally. I think that she was trying to give the patient all the information to help him make the best decision possible for his treatment. I do not feel that the physician in charge has the final word about the information a patient receives. With the many options available to research information about medical treatments a patient can do research and look into other options and treatments that may be available. As nurses we are always teaching patients about treatments, options and precautions. Michael G did sign a legal consent for the treatment of chemo, but I do not believe he signed an informed consent because he was not given any other options for other possible treatments that may have been available.
ReplyDeleteThe key word is informed. Having all the information to make a voluntary consent. I think a lot of doctors assume patients have done their due diligence when it comes to topics of personal illness and this is not always the case. That is why they "forget" to discuss relevant issues or concerns. I always tell my patients to ask, "is there any questions I need to ask that I don't know to ask?" Sometimes it helps.
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DeletePatients need to be aware of all their options before being made to make a decision. This patient was not informed of his options. It's very unfortunate because we all have information readily available of Mosby's on almost every diagnosis, drug, and treatment available.
Delete1. I believe Nurse L was morally appropriate in educating Michael G. about the alternatives that were available to him. You have to have the most education available to make decisions, especially life and death decisions. As nurses it is our duty to deliver this education. I do believe this should have been a topic for discussion at the beginning of his treatment therapy, when he was diagnosed.
ReplyDelete2. The physician in charge should not have the final say about the information a patient receives. Patients put their faith in us as professionals to make sure they have all the information they need to make an informed consent. I have been in this particular situation before and have been reprimanded verbally about information given. So when I give information on topics that I feel the patient needs education about, I always finish my education time with, "You should discuss this with the doctor if it is something you want to pursue and see what he/she thinks". That way the doctor is able to discuss the topic with the patient and then give them his/her professional opinion. Also there is so much information on the internet to further educate our patients I always encourage patients and their families to do some research on their own so they can ask other educated questions to their doctors.
3.I believe the consent was not informed as without this new information Michael G's right for self determination was not considered therefore making the consent void. Michael has to have all relevant information to make a voluntary informed consent.
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ReplyDeleteI agree with you about the consent. By leaving out relevant information on treatment alternatives, the consent needs to explained again with ALL options available and re-signed. This defiantly alters Michael G's self determination.
ReplyDeleteI also feel that it alters Mr G's self determination. He can not make an informed discussion if he does not know all the information.
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ReplyDeleteYes the nurse was acting morally when she chose to give information to the patient about alternative therapies. The nurse was respecting the patients self determination when she gave the information and in doing this she was allowing him to make the best decison for him at this particular time of his treatment.The Dr. wasn't giving the patient all the information about all his treatment plans and by wanting to go against the nurse and in turn disrespecting the patients choices that he was making about his own health care decisions.No the dr. shouldn't have the final say in the information that is given to the patient. By withholding information the paitent isn't really giving his informed consent. Informed consent means that the patient is given all the information that is available at the time with the choices.
ReplyDeleteI agree. The physician has no justification on why the nurse's license should be revoked.
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ReplyDeleteI feel that nurse L was acting in a morally correct way . It is our duty as nurses to give patients as much information as we can about their diagnosis and treatment options, Nurse L was acting as an advocate for her patient in this instance,
ReplyDeleteWhile the physician in charge obviously has more education regarding therapies and treatments he could certainly voice his opinion in regards to the alternative therapies, however it is not ok for him to censor what information his patients receive. In the technological age that we are currently in, most patients pursue looking into alternative medicine anyway , and the doctor should be well versed in the effectiveness of those treatments, and able to give sound medical advice.
Had Michael not known about the alternative therapies , I feel informed consent was still valid., so long as he understood completely the treatment he was consenting to,
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DeleteThe nurse was not incorrect in her decision to give the patient all of the facts if she was knowledgeable herself regarding the patients case. I believe it would have been a professional courtesy to ask the physician why he did not offer alternative means of care prior to telling the patient. A conversation could have been discussed. My concern is there is something in the patients case that the nurse did not know or over looked. The MD and nurse are a team and need to function as one. If the physician at that time could not offer a reason to the nurse as to why the patient could not have alternate therapy then she should have informed the patient. I do not believe the physician in charge should have the final decision in the information a pt receives. Most consents require the nurse sign as well. I would not sign something that I felt was not complete. His agreement to chemotherapy as long as the procedure was explained fully was informed consent. The failure was prior to the decision of chemo if all of the options were not offered.
ReplyDeleteI believe that Nurse L was acting in a morally correct way providing information to Michael. This case made me think back to accompanying my aunt to an oncologist appointment and the discussion that took place regarding a newly diagnosed cancer. I remember that the oncologist described the type of cancer and the best treatment available for that cancer. Other possible treatment considerations were discussed but to the best of my recollection it was my aunt who asked about the alternate treatments first. Patients should be given all possible treatments available so they can seek further opinions if needed and make their decision fully informed. Nurse L was providing information that the patient had not yet received. I believe that she could have spoken to the physician to let him/her know that she had provided the additional information also allowing the physician to answer any new questions.. The physician should not have the final say in the information a patient receives. This is preventing the patients autonomy. The consent was for the chemotherapy and so long as all information regarding chemotherapy was given then it is informed consent.
ReplyDeleteI also believe that Nurse L was acting in a morally correct way. One of a nurses' main jobs is to educate their patients. A patient should know all the risk and benefits, as well as any alternative treatments to an illness. I feel that the patient did not have informed consent about the chemotherapy since alternative treatments were never discussed with the patient. I do think that the nurse should of made the doctor aware that she was going to inform this patient about alternative treatment in case there was another reason why alternative means would not work for this patient that the nurse was unaware of.
ReplyDeleteNurse L was acting morally correct. Nurses' are responsible for patient education and advocating for patients and their care. It is the patient's right to know all of their options so they can choose what is best for them. The physician who gave Michael G. the information and gained informed consent should be reprimanded, not Nurse L. It cannot be considered informed consent if the patient was not properly informed.
ReplyDeleteI believe Nurse L wasn't doing anything wrong by providing information to the patient. It is the responsibility of the nurse to education. I would however like to see where Nurse L retrieved her information. I do not think nurses should be pulling random information for the internet for education, but if she pulled in using a work sponsor website then I think there is nothing wrong with this. Michael G is dying and I don't think anyone should be forced to go through with chemotherapy before all options are discussed. This patient was not properly informed by his physician.
ReplyDeleteI do think Nurse L. likely had the best interest of the patient in mind. The case states Michael G. was dying of leukemia. Unless these alternative treatments are so new that the physician had no time to discuss with the patient, I think her actions were not in the best interest of the patient. As nurses we do not order treatments or tests or labs on patients. It is in our scope of care to follow the orders of the physicians. I think the patient may have been better served by discussing those alternative treatments with the physician and get his or her opinion as those treatments may pertain to Michael G. I can only imagine what would happen if as a nurse I approached a patient with heart failure and told that person about the availability of a bi-ventricular pacer. Just look up a disease or disease process on the internet and you will find numerous alternative treatments. It is the physician's job to inform the patient and give options, but not all treatments are appropriate. I do not think she should have her license revoked. I do not think either that the physician has the last say on treatments for the patient in most cases. I believe it their job to present appropriate therapies, explain risks and benefits and allow the patient to decide.
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