First, the nurse taking care of Marie has a duty to abide by Marie's requests. The decision was made before Marie became unable to make rational decisions. The nurse could perhaps have a sit down discussion with Marie's brother and explain what Marie is going through. She should also ask Marie's brother to explain his religious beliefs as well. Perhaps some rituals could be carried out. This will hopefully place the nurse and brother on some sort of common ground. Marie's brother has a right to entertain his cultural practices and beliefs, but Marie's decision trumps all. If the brother cannot be persuaded, then the nurse may have to involve the facility ethics committee. Continuing to administer pain medication is adhering to the patients wishes. In this case, the patient was in charge of her own treatment and decisions.
Patient always comes first. I think that maybe Marie didn't practice in the religious beliefs as much as her brother did and maybe he was pushing his culture/beliefs on to her. It's hard sometimes when dealing with religious beliefs when it says they can't do something that can save their life.
In this case about Marie F. talking about her pain control and what her brother thinks can be a little tricky because as the nurse you must do what is best for her while educating her brother. When someone has a different culture then the one you have it is hard to see their side of things. So, addressing the brother about the disease process and what his sister is going though is the key. Allowing him to be put of the care plan and teaching him about pain control will be helpful to all involved. Letting the brother express his concerns and culture beliefs will help him feel a little more in control but he also needs to know what his sisters wished are as well. If she says to stop treating with pain medicine then that is what will be done, but until then open commination with the brother about his sister’s care is the key. Nurse’s always puts the patient first and guides the family throughout the care.
It is hard to communicate our culture to other cultures and see their side of things. I like what you said about teaching the brother and allowing him to have some sort of control in regards to the care his sister is receiving. Ultimately I do believe he wanted what was best for his sister and did not want her hurting, he just had a lack of understanding about healthcare and what was happening to her.
It is very difficult indeed dealing with cultures that are not only different, but ones with which seem to be in contrast to our own. I do think the nurse's first and primary responsibility is to Marie F. I am going to assume that there are no advance directives or POA giving her brother the 'legal' right to make decisions on her behalf. In the case it states that Marie F. was able to make coherent requests for pain medicine. During a time when she is coherent, that would be a prime time for a discussion with both Marie F. and her brother Jean. Prior to that discussion, there does need to be some education for Jean, but if his culture has had that belief, I doubt the education would have a significant impact. I think more of an impact could occur if he could see Marie F. when she is more coherent and verbalize her experience. In the end, if Marie F. decides she needs the medication, it would not be disrespectful to Jean's religious beliefs. Jean is not the patient. That is not to say that Jean will not try to sway his sister into declining medication. In the end, I believe it is the wishes of Marie F. that need to be met.
The case does not state whether or not Marie becomes a/o once the medication wears off. If Marie does then it wouldn't matter if Jean is the POA or not because Marie would still be able to make her own decisions. Families don't always like the outcomes of things, but they do need to be more accepting of the patient's wishes.
If I was the nurse taking care of Marie, I would respect her wishes to receive pain medication. With that being said, I would not administer another dose of pain medication to her unless she is oriented and able to consent to receiving it. I do feel that if I proceeded to give Marie pain medications, then it would be going against Jean's religious beliefs. But my duty as a nurse is to respect the wishes of my patient.
I agree with you, I would also administer pain medications at Marie's request. Jean may benefit by hearing Marie's wishes once she is oriented after the previous dose of pain medication wears off.
I feel the same way. I would have given the medication that she requested initially. Once she awakens and becomes more oriented, if she refuses or requests more medication at that point, I would honor what she wishes at that time as well. I believe in always being respectful to families, but if the patient can competently make their own decisions then that it was is carried out.
I feel the same way. I would have given the medication that she requested initially. Once she awakens and becomes more oriented, if she refuses or requests more medication at that point, I would honor what she wishes at that time as well. I believe in always being respectful to families, but if the patient can competently make their own decisions then that it was is carried out.
If Maria's cultural actions or beliefs do not place herself or others in harm, the principle of autonomy should be honored. According to Macklin, a health care provider should respect the patient culture difference and not scrutinize them because of their beliefs.Once Maria is coherent, I would discuss with Maria and her brother(with her consent) about the side effects of the medication, other therapeutic options, cultural beliefs, and not to degrade the practice of voodooism. Discussing this information would be an example utilizing the principle of self-determination, and to embrace the understanding of ethical relativism. If her decision is to continue to take the medication to assist with pain management, I do not think my duty as a nurse would represent a failure to respect the religious beliefs expressed by Jean. The patient comes first therefore, I would respect Maria's wishes first and foremost.
The nurse caring for Marie should talk with the family so they get the information they need to make decisions regarding Marie. As well as the nurse learning the beliefs about their religion. Regardless of her family's wishes, the nurse is taking care of Marie and should respect her wishes. The nurse should explain that pain medicine can make her act delirious but she needs it to make her comfortable. Self determination does apply to competent adults regardless of cultural context. This can be hard to deal with when the patient wants one thing and the family wants something else. The patient has the right to choose what treatment they receive, so if I were the nurse caring for Marie I would carryout her requests as long as she was competent. This is a case Macklin speaks of where the nurse and the patient have different cultural backgrounds, which can cause a barrier for effective treatment.
Ascertaining information on the families religious and cultural beliefs is a great idea as the nurse can better understand how to take care of Maria in a culturally competent way.
I agree we as caregivers should try to be open about other cultures and beliefs, but we should also honor the wishes of the patient even if it goes against what the family wants since the patient has already expressed her desire. I believe we should continue to educate the family about disease process, medications and possible side effects.
It may be "easy" for a family and even the patient to say they do not wish to use mind altering pain medication. But as the disease progresses, and the pain becomes more of an issue, Marie F. may want to go against what she has grown up as a standard of care. I feel as though it is our job as nurses to help her stay as comfortable as possible while helping her also feel at ease with her decision whatever that may be.
I agree with you. We are looking at this scenario as if a decision is made and then set in stone. As nurse's we medicate patient and then observe side effects. The medication could be titrated to decrease the negative effects. This all must lie in the hands of Marie until she is unable to make this decision. It would be beneficial considering her dx that the nurse talk to her about advanced directives and what she would like done for her end of life care. A consult to Palliative care would also be helpful.
In a perfect scenario, Maria's cultural beliefs would have been addressed on admission . We do have these questions built in to the admission navigator. Also , are we considering that initially Maria came in alone and therefore had no family to assist in her decision making ? Haitian beliefs do include the designation of a family member who decides treatment for the ill , and the involvement of voodoo priests , priestesses , or simply the practice of voodoo is quite common. Assuming that it is the pain medication making her delirious and not her underlying disease, I think the nurse should wait for Maria to return to her faculties and have this discussion with Jean present. In the meantime , explanation of the side effects of pain medication should be made clear to her brother so that he understands this as an expected outcome.
We often take for granted the questions asked in the admission navigator. That is a great opportunity to ask the patient about their culture and religious preferences. I know I fail at looking back at that data. Once its filled in, its like something has been checked off our list and we don't refer to it much after that. I need to be more conscientious about reading up on my patients's preferences, especially if its a cultural difference.
Even though we ask about cultural practices and beliefs, and if someone has different cultural backgrounds they do not always practice those beliefs. I feel in this case maybe Maria didn't but her brother did and that is why he was so upset about her behavior. In a perfect world it would be nice to hold off and wait for the patient to regain her faculties, but what if her confusion was not the pain medicine but part of the disease process itself. Then she suffers in pain and agony while we as care givers try to give the family the opportunity to satisfy their belief when the patient has already said they want to be comfortable.
I agree that some of these issues in this case should have been discussed on admission and most patients present to the hospital with another person to help with questions. Knowing more about Marie's culture would be beneficial.
I believe the nurse should handle this situation being respectful of the patient and families cultural and religious differences, but also honoring the patients wishes, which were to receive pain medicine. The nurse needs to take the time to try and explain the reasoning behind giving the pain medicine and educating the brother on the need for it and potential "normal" side effects. Ruth Macklin describes this same exact situation in her essay, and agrees we are to be respectful of patients traditions and religious practices if it poses no harm to the patient or others. However, in terms of autonomy, we can not deny the patient her rights to treatment and receive her pain medicine. I believe the principle of self-determination should apply to all competent adults, regardless of culture. If one believes so strongly otherwise in their culture then they can defer to their family for their determining answers. Her brother was not there however, and had no idea how severe her pain was. Had he talked with her and witnessed her pain, he may not be so afraid of what was happening. I do believe the nurse should continue to medicate Marie as needed, but if she is truly having delirious reactions, the nurse may want to consider talking with the doctor about switching pain medicine to find something with a lesser side effect. I'm sure Jean will feel his religious beliefs are being disrespected, but our duty is always to the patient and that does not always agree with the family, despite our best efforts at communicating this.
I feel that if there has been a discussion made with the patient and they made it clear that they want to be kept comfortable and out of pain then the nurse has the obligation to honor those wishes. Even though this patient was from a different culture that does not mean she was practicing those beliefs. When the subject of the matter was brought up by her brother the nurse should have given him and opportunity to discuss his concerns and beliefs, maybe even do some investigating about this culture to better understand what was going on and if there was anything that could be done to help with the brothers concerns. She also should have explained the disease process and what could happen as his sister continues to decline and that she may need medication to be kept comfortable. It is very difficult to provide care to someone whom does not have the same beliefs as yourself. But in this case it did not seem as if the patient was worried about the voodoo or evil spirits in her body she just wanted to be comfortable.
I think the number one rule to live by for every nurse is to be a patient advocate. Marie F. is in pain and needs pain medication. In this case it states that Marie is competent, meaning if she did not want any of the medication we were offering her then she would refuse them due to her religion. When Marie's brother arrives and thinks that because of the effects of the pain medication, she has evil spirits in her and he wants the medication reversed. Education is what needs to happen in this situation. The nurse needs to privately speak to Jean and if he still does not fully understand then the nurse needs to get an interpreter to explain the situation and that Marie was in agreeing in receiving the medicine and it is helping her. This is a great example of self determination.
I would feel that Marie made the decision to take pain medication because she was in pain. As a nurse we act as a patient advocate and we need to be there for the patient in every way possible. If when the pain medication wears off and Marie becomes oriented again then I would take whatever her wishes are and carry them out from there. If her brother was there it would be good for him to hear her wishes and I would also again ask her in private as some people don't always say exactly what they want in the presence of some of their family. I don't think it would be disrespectful to honor Marie's wishes if they didn't comply with her religious beliefs. When a person is in pain and they may change their mind and want to except treatment when at a different time in their life they may have been against.
I completely agree. I would always treat the patient as they want to be treated. If her pain medication wears off and she then wants further medication held, then I would comply with her wishes. It is completely different once a patient has requested particular treatment than when a patient is unconscious from the start.
I completely agree. I would always treat the patient as they want to be treated. If her pain medication wears off and she then wants further medication held, then I would comply with her wishes. It is completely different once a patient has requested particular treatment than when a patient is unconscious from the start.
The nurse should be respectful to Marie's family, offering her understanding of the culture, however she should not comply with their cultural requests of not supplying her with pain medication. Marie clearly was hurting and requested the pain medication prior to their arrival. She can be autonomous in her decision making and the nurses taking care of her knew her wishes before her family was involved. In Macklin's essay, an ethics committee came to the conclusion that the patient must be remain autonomous in their care when capable of doing so. I believe it is ethical to continue to supply the pain medication to Marie. When a patient is faced with challenges they may or may not adhere to what they previously had determined. It is their right to make their own decisions and change their plan at any time. I do not think the nurse owes any religious duty towards Jean, nurses should be respectful in their response, however the duty is first to the patient.
If I was the nurse taking care of Marie, I would follow her wishes. I would not withhold pain medication based on a family members request that goes against the patients' wishes. Before her family was involved the staff knew Marie's wishes and could clearly see she was in pain. Marie's pain maybe to much for her to hand and that could be the reason she is now going against her previous wishes.
The nurse has a duty to Marie to help her with her pain management, per her competent request. I think the best start for the nurse is to educate Jean about the actions and effects of Marie's pain medication. Then if he still feels adamant about discontinuing the medicine I would allow Marie to, competently discuss her decisions with Jean before her next dose of pain medicine. Ultimately we as nurses are advocates for our patients no matter what culture they come from. Whatever Marie decides, using competent self determination, is the bottom line and withholding pain medicine when she requests it is cruel and unethical. I would also include the Dr. in this scenario to further assist Jean with any needs he feels he has with regards to his voodoo religious culture and Marie's decisions. Another option would be Marie's Dr. could speak with a Dr. of Jean's choice, voodoo or Haitian, about the events that are occurring for Marie. That way Jean and Marie's needs are met. The only other alternative is giving Marie pain medication that doesn't make her delirious and mumbling incoherently.
It is cruel and unethical to withhold treatment that will relieve pain and suffering. Culture aside, the misconceptions of Hospice, death and dying, remain in all cultures. Educating and attempting to relieve anxiety for patient and love ones must happen and hopefully, one death experience at a time, we can change those negative perceptions.
I believe that a discussion had been made before hand that Marie wanted to be kept comfortable. As a patient advacate i would abide by the pt's wishes and give her the pain medicine, unless the medicine I was giving her would put her in harm's way. By doing so I am respecting the patients autonomy. Macklin discusses that we should abide by the patients wishes as long as we are taking in consideration the patients religious prefrences also. The nurse could also speak with the brother about her wishes as long as she gave consent for us to disclose this information. It sounds like maybe Marie wasn't as religious as her brother and maybe he was pushing his beliefs on to her.
The nurse taking care of Marie needs to take the time to sit with Jean and explain to him Marie's situation and her request. The pain medication should be continued to be give to Marie. The physician should be contacted to possibly order a different pain medication or something to allow Marie to relax. I wouldn't think she would be feeling very peaceful if she is delirious and mumbling.
In the beginning of the case study it states that Maria made a competent request for pain medication. It is not said what Marie would have felt regarding how the medication made her behave. That I feel is the first dilemma. I believe the pain medication should be held until Marie is able to make a competent decision regarding how she wishes to proceed regarding the effects the pain medication is having on her cognition. She may experience some pain during the withholding but this can be relieved with more pain medication after a decision is made about its effects. When Marie is able to clearly state what she wants it also can be brought up to her regarding her brother's request. The primary focus in this case should be Marie. To me the more important question would be how she wants to spend her last moments alive, rather than what her brother feels will be brought on the family. Marie may decide that she can deal with some pain and take less medicine to be more coherent. In the end my focus should be on her and what she decided. Education should be given to the family in an attempt to help with acceptance of Marie's decision.
First, the nurse taking care of Marie has a duty to abide by Marie's requests. The decision was made before Marie became unable to make rational decisions. The nurse could perhaps have a sit down discussion with Marie's brother and explain what Marie is going through. She should also ask Marie's brother to explain his religious beliefs as well. Perhaps some rituals could be carried out. This will hopefully place the nurse and brother on some sort of common ground. Marie's brother has a right to entertain his cultural practices and beliefs, but Marie's decision trumps all. If the brother cannot be persuaded, then the nurse may have to involve the facility ethics committee. Continuing to administer pain medication is adhering to the patients wishes. In this case, the patient was in charge of her own treatment and decisions.
ReplyDeleteI agree the patient comes first. Allowing the brother to express his culture beliefs will be helpfull in this case.
DeletePatient always comes first. I think that maybe Marie didn't practice in the religious beliefs as much as her brother did and maybe he was pushing his culture/beliefs on to her. It's hard sometimes when dealing with religious beliefs when it says they can't do something that can save their life.
DeleteIn this case about Marie F. talking about her pain control and what her brother thinks can be a little tricky because as the nurse you must do what is best for her while educating her brother. When someone has a different culture then the one you have it is hard to see their side of things. So, addressing the brother about the disease process and what his sister is going though is the key. Allowing him to be put of the care plan and teaching him about pain control will be helpful to all involved. Letting the brother express his concerns and culture beliefs will help him feel a little more in control but he also needs to know what his sisters wished are as well. If she says to stop treating with pain medicine then that is what will be done, but until then open commination with the brother about his sister’s care is the key. Nurse’s always puts the patient first and guides the family throughout the care.
ReplyDeleteIt is hard to communicate our culture to other cultures and see their side of things. I like what you said about teaching the brother and allowing him to have some sort of control in regards to the care his sister is receiving. Ultimately I do believe he wanted what was best for his sister and did not want her hurting, he just had a lack of understanding about healthcare and what was happening to her.
DeleteIt is very difficult indeed dealing with cultures that are not only different, but ones with which seem to be in contrast to our own. I do think the nurse's first and primary responsibility is to Marie F. I am going to assume that there are no advance directives or POA giving her brother the 'legal' right to make decisions on her behalf. In the case it states that Marie F. was able to make coherent requests for pain medicine. During a time when she is coherent, that would be a prime time for a discussion with both Marie F. and her brother Jean. Prior to that discussion, there does need to be some education for Jean, but if his culture has had that belief, I doubt the education would have a significant impact. I think more of an impact could occur if he could see Marie F. when she is more coherent and verbalize her experience. In the end, if Marie F. decides she needs the medication, it would not be disrespectful to Jean's religious beliefs. Jean is not the patient. That is not to say that Jean will not try to sway his sister into declining medication. In the end, I believe it is the wishes of Marie F. that need to be met.
ReplyDeleteI agree if Jean is not the DPOA, he does not have a "legal" right to make decisions on Marie's behalf. Here wishes should be our first priority.
DeleteThe case does not state whether or not Marie becomes a/o once the medication wears off. If Marie does then it wouldn't matter if Jean is the POA or not because Marie would still be able to make her own decisions. Families don't always like the outcomes of things, but they do need to be more accepting of the patient's wishes.
DeleteIf I was the nurse taking care of Marie, I would respect her wishes to receive pain medication. With that being said, I would not administer another dose of pain medication to her unless she is oriented and able to consent to receiving it. I do feel that if I proceeded to give Marie pain medications, then it would be going against Jean's religious beliefs. But my duty as a nurse is to respect the wishes of my patient.
ReplyDeleteI agree with you, I would also administer pain medications at Marie's request. Jean may benefit by hearing Marie's wishes once she is oriented after the previous dose of pain medication wears off.
DeleteI feel the same way. I would have given the medication that she requested initially. Once she awakens and becomes more oriented, if she refuses or requests more medication at that point, I would honor what she wishes at that time as well. I believe in always being respectful to families, but if the patient can competently make their own decisions then that it was is carried out.
DeleteI feel the same way. I would have given the medication that she requested initially. Once she awakens and becomes more oriented, if she refuses or requests more medication at that point, I would honor what she wishes at that time as well. I believe in always being respectful to families, but if the patient can competently make their own decisions then that it was is carried out.
DeleteI agree that addressing the patients needs first and honor her needs.
DeleteIf Maria's cultural actions or beliefs do not place herself or others in harm, the principle of autonomy should be honored. According to Macklin, a health care provider should respect the patient culture difference and not scrutinize them because of their beliefs.Once Maria is coherent, I would discuss with Maria and her brother(with her consent) about the side effects of the medication, other therapeutic options, cultural beliefs, and not to degrade the practice of voodooism. Discussing this information would be an example utilizing the principle of self-determination, and to embrace the understanding of ethical relativism. If her decision is to continue to take the medication to assist with pain management, I do not think my duty as a nurse would represent a failure to respect the religious beliefs expressed by Jean. The patient comes first therefore, I would respect Maria's wishes first and foremost.
ReplyDeleteThe nurse caring for Marie should talk with the family so they get the information they need to make decisions regarding Marie. As well as the nurse learning the beliefs about their religion. Regardless of her family's wishes, the nurse is taking care of Marie and should respect her wishes. The nurse should explain that pain medicine can make her act delirious but she needs it to make her comfortable. Self determination does apply to competent adults regardless of cultural context. This can be hard to deal with when the patient wants one thing and the family wants something else. The patient has the right to choose what treatment they receive, so if I were the nurse caring for Marie I would carryout her requests as long as she was competent. This is a case Macklin speaks of where the nurse and the patient have different cultural backgrounds, which can cause a barrier for effective treatment.
ReplyDeleteAscertaining information on the families religious and cultural beliefs is a great idea as the nurse can better understand how to take care of Maria in a culturally competent way.
DeleteI agree we as caregivers should try to be open about other cultures and beliefs, but we should also honor the wishes of the patient even if it goes against what the family wants since the patient has already expressed her desire. I believe we should continue to educate the family about disease process, medications and possible side effects.
DeleteIt may be "easy" for a family and even the patient to say they do not wish to use mind altering pain medication. But as the disease progresses, and the pain becomes more of an issue, Marie F. may want to go against what she has grown up as a standard of care. I feel as though it is our job as nurses to help her stay as comfortable as possible while helping her also feel at ease with her decision whatever that may be.
DeleteI agree with you. We are looking at this scenario as if a decision is made and then set in stone. As nurse's we medicate patient and then observe side effects. The medication could be titrated to decrease the negative effects. This all must lie in the hands of Marie until she is unable to make this decision. It would be beneficial considering her dx that the nurse talk to her about advanced directives and what she would like done for her end of life care. A consult to Palliative care would also be helpful.
DeleteIf a nurse takes the time to explain what she or he is doing, it becomes an invaluable tool. Communication breakdown causes many misconceptions
DeleteIn a perfect scenario, Maria's cultural beliefs would have been addressed on admission . We do have these questions built in to the admission navigator. Also , are we considering that initially Maria came in alone and therefore had no family to assist in her decision making ? Haitian beliefs do include the designation of a family member who decides treatment for the ill , and the involvement of voodoo priests , priestesses , or simply the practice of voodoo is quite common. Assuming that it is the pain medication making her delirious and not her underlying disease, I think the nurse should wait for Maria to return to her faculties and have this discussion with Jean present. In the meantime , explanation of the side effects of pain medication should be made clear to her brother so that he understands this as an expected outcome.
ReplyDeleteWe often take for granted the questions asked in the admission navigator. That is a great opportunity to ask the patient about their culture and religious preferences. I know I fail at looking back at that data. Once its filled in, its like something has been checked off our list and we don't refer to it much after that. I need to be more conscientious about reading up on my patients's preferences, especially if its a cultural difference.
DeleteEven though we ask about cultural practices and beliefs, and if someone has different cultural backgrounds they do not always practice those beliefs. I feel in this case maybe Maria didn't but her brother did and that is why he was so upset about her behavior. In a perfect world it would be nice to hold off and wait for the patient to regain her faculties, but what if her confusion was not the pain medicine but part of the disease process itself. Then she suffers in pain and agony while we as care givers try to give the family the opportunity to satisfy their belief when the patient has already said they want to be comfortable.
DeleteI agree that some of these issues in this case should have been discussed on admission and most patients present to the hospital with another person to help with questions. Knowing more about Marie's culture would be beneficial.
DeleteI believe the nurse should handle this situation being respectful of the patient and families cultural and religious differences, but also honoring the patients wishes, which were to receive pain medicine. The nurse needs to take the time to try and explain the reasoning behind giving the pain medicine and educating the brother on the need for it and potential "normal" side effects. Ruth Macklin describes this same exact situation in her essay, and agrees we are to be respectful of patients traditions and religious practices if it poses no harm to the patient or others. However, in terms of autonomy, we can not deny the patient her rights to treatment and receive her pain medicine. I believe the principle of self-determination should apply to all competent adults, regardless of culture. If one believes so strongly otherwise in their culture then they can defer to their family for their determining answers. Her brother was not there however, and had no idea how severe her pain was. Had he talked with her and witnessed her pain, he may not be so afraid of what was happening. I do believe the nurse should continue to medicate Marie as needed, but if she is truly having delirious reactions, the nurse may want to consider talking with the doctor about switching pain medicine to find something with a lesser side effect. I'm sure Jean will feel his religious beliefs are being disrespected, but our duty is always to the patient and that does not always agree with the family, despite our best efforts at communicating this.
ReplyDeleteI feel that if there has been a discussion made with the patient and they made it clear that they want to be kept comfortable and out of pain then the nurse has the obligation to honor those wishes. Even though this patient was from a different culture that does not mean she was practicing those beliefs. When the subject of the matter was brought up by her brother the nurse should have given him and opportunity to discuss his concerns and beliefs, maybe even do some investigating about this culture to better understand what was going on and if there was anything that could be done to help with the brothers concerns. She also should have explained the disease process and what could happen as his sister continues to decline and that she may need medication to be kept comfortable. It is very difficult to provide care to someone whom does not have the same beliefs as yourself. But in this case it did not seem as if the patient was worried about the voodoo or evil spirits in her body she just wanted to be comfortable.
ReplyDeleteI think the number one rule to live by for every nurse is to be a patient advocate. Marie F. is in pain and needs pain medication. In this case it states that Marie is competent, meaning if she did not want any of the medication we were offering her then she would refuse them due to her religion. When Marie's brother arrives and thinks that because of the effects of the pain medication, she has evil spirits in her and he wants the medication reversed. Education is what needs to happen in this situation. The nurse needs to privately speak to Jean and if he still does not fully understand then the nurse needs to get an interpreter to explain the situation and that Marie was in agreeing in receiving the medicine and it is helping her. This is a great example of self determination.
ReplyDeleteI also agree Andrea. Family education is a very key point in this case.
DeleteI would feel that Marie made the decision to take pain medication because she was in pain. As a nurse we act as a patient advocate and we need to be there for the patient in every way possible. If when the pain medication wears off and Marie becomes oriented again then I would take whatever her wishes are and carry them out from there. If her brother was there it would be good for him to hear her wishes and I would also again ask her in private as some people don't always say exactly what they want in the presence of some of their family. I don't think it would be disrespectful to honor Marie's wishes if they didn't comply with her religious beliefs. When a person is in pain and they may change their mind and want to except treatment when at a different time in their life they may have been against.
ReplyDeleteI completely agree. I would always treat the patient as they want to be treated. If her pain medication wears off and she then wants further medication held, then I would comply with her wishes. It is completely different once a patient has requested particular treatment than when a patient is unconscious from the start.
DeleteI completely agree. I would always treat the patient as they want to be treated. If her pain medication wears off and she then wants further medication held, then I would comply with her wishes. It is completely different once a patient has requested particular treatment than when a patient is unconscious from the start.
DeleteI also agree. If the patient did want any farther pain medication, I would not give it to her and try to find other forms of pain relief.
DeleteThe nurse should be respectful to Marie's family, offering her understanding of the culture, however she should not comply with their cultural requests of not supplying her with pain medication. Marie clearly was hurting and requested the pain medication prior to their arrival. She can be autonomous in her decision making and the nurses taking care of her knew her wishes before her family was involved. In Macklin's essay, an ethics committee came to the conclusion that the patient must be remain autonomous in their care when capable of doing so. I believe it is ethical to continue to supply the pain medication to Marie. When a patient is faced with challenges they may or may not adhere to what they previously had determined. It is their right to make their own decisions and change their plan at any time. I do not think the nurse owes any religious duty towards Jean, nurses should be respectful in their response, however the duty is first to the patient.
ReplyDeleteI agree that respect is a key element when discussing a plan of care with someone from another culture.
DeleteIf I was the nurse taking care of Marie, I would follow her wishes. I would not withhold pain medication based on a family members request that goes against the patients' wishes. Before her family was involved the staff knew Marie's wishes and could clearly see she was in pain. Marie's pain maybe to much for her to hand and that could be the reason she is now going against her previous wishes.
ReplyDeleteThe nurse has a duty to Marie to help her with her pain management, per her competent request. I think the best start for the nurse is to educate Jean about the actions and effects of Marie's pain medication. Then if he still feels adamant about discontinuing the medicine I would allow Marie to, competently discuss her decisions with Jean before her next dose of pain medicine. Ultimately we as nurses are advocates for our patients no matter what culture they come from. Whatever Marie decides, using competent self determination, is the bottom line and withholding pain medicine when she requests it is cruel and unethical. I would also include the Dr. in this scenario to further assist Jean with any needs he feels he has with regards to his voodoo religious culture and Marie's decisions. Another option would be Marie's Dr. could speak with a Dr. of Jean's choice, voodoo or Haitian, about the events that are occurring for Marie. That way Jean and Marie's needs are met. The only other alternative is giving Marie pain medication that doesn't make her delirious and mumbling incoherently.
ReplyDeleteIt is cruel and unethical to withhold treatment that will relieve pain and suffering. Culture aside, the misconceptions of Hospice, death and dying, remain in all cultures. Educating and attempting to relieve anxiety for patient and love ones must happen and hopefully, one death experience at a time, we can change those negative perceptions.
DeleteI believe that a discussion had been made before hand that Marie wanted to be kept comfortable. As a patient advacate i would abide by the pt's wishes and give her the pain medicine, unless the medicine I was giving her would put her in harm's way. By doing so I am respecting the patients autonomy. Macklin discusses that we should abide by the patients wishes as long as we are taking in consideration the patients religious prefrences also. The nurse could also speak with the brother about her wishes as long as she gave consent for us to disclose this information. It sounds like maybe Marie wasn't as religious as her brother and maybe he was pushing his beliefs on to her.
ReplyDeleteI like your observance of HIPPA! Nurses think that is such a pain in the rump but I feel it has gotten me out of many sticky situations!
DeleteThe nurse taking care of Marie needs to take the time to sit with Jean and explain to him Marie's situation and her request. The pain medication should be continued to be give to Marie. The physician should be contacted to possibly order a different pain medication or something to allow Marie to relax. I wouldn't think she would be feeling very peaceful if she is delirious and mumbling.
ReplyDeleteIn the beginning of the case study it states that Maria made a competent request for pain medication. It is not said what Marie would have felt regarding how the medication made her behave. That I feel is the first dilemma. I believe the pain medication should be held until Marie is able to make a competent decision regarding how she wishes to proceed regarding the effects the pain medication is having on her cognition. She may experience some pain during the withholding but this can be relieved with more pain medication after a decision is made about its effects. When Marie is able to clearly state what she wants it also can be brought up to her regarding her brother's request.
ReplyDeleteThe primary focus in this case should be Marie. To me the more important question would be how she wants to spend her last moments alive, rather than what her brother feels will be brought on the family. Marie may decide that she can deal with some pain and take less medicine to be more coherent. In the end my focus should be on her and what she decided.
Education should be given to the family in an attempt to help with acceptance of Marie's decision.