Mrs. Peterson is a lively eighty-seven-year-old woman who broke her hip while walking her dog on the slippery streets after an unusual February rainfall. Following hospitalization for the repair of her hip, Mrs. Peterson refused accommodation in any of the care facilities and asked to be returned to her own home. She was discharged home with home care services arranged by case coordinator Rose Parker, RN. Mrs. Peterson is receiving home care services which include: physical therapy, weekly home-making help and daily personal care assistance from Care Services, a private agency and Meals on Wheels delivers food at noon daily. Mrs. Peterson's son and family, who live in a neighbouring town one and a half hours away, are involved in arranging her care. She has been home for two weeks and continues to have great difficulty to ambulate. She spends much of her time sitting in her chair. Her dog stays by her side, except for the daily walks provided by Nellie, the twelve-year-old girl who lives next door.
It is Friday at 7 p.m. Helen Jones, the health-care aide, visits Mrs. Peterson to assist with personal grooming, to help her into bed and to assist her with her range of motion exercises. Helen Jones, a casual employee with limited experience, has never met this client before and has been told to do only what the client agrees to.
Mrs. Peterson is watching a favourite television show and refuses to go to bed. She says she will do it by herself. Helen tries to convince Mrs. Peterson to accept care, but finally leaves with Mrs. Peterson sitting in her chair.
Helen contacts Rose Parker and informs her that after many attempts to convince Mrs. Peterson to accept care, Mrs. Peterson has been left sitting in her chair watching TV as she has refused to go to bed. Helen also tells Rose that she is no longer at Mrs. Peterson’s residence as she has moved onto her other clients to provide care.
Rose Parker recognizes she is faced with an ethical dilemma. Mrs. Peterson has refused assistance to prepare for bed and is now alone and sitting in her chair. Rose knows that Mrs. Peterson has considerable difficulty mobilizing and is concerned with Mrs. Peterson’s ability to get herself to bed as well as the potential issues if she remains in her chair all night. Rose contemplates what she should do in this situation.
Case study adapted from Ethical Decision-making for Registered Nurses in Alberta
Ethical decision-making is not an easy exercise, nor is it always black and white. As such, it should be approached with an open mind. When faced with an ethical dilemma, registered nurses (RN) can approach the situation many different ways. Some RNs may choose to reflect on the ethical values and responsibility statements listed in the 2017 Code of Ethics for Registered Nurses. Others may problem solve by applying ethical principles to explore the issues. Furthermore, others may use ethical models to address the problem or a combination of approaches. RNs may find some models more helpful or meaningful than others depending on their practice setting. There is no right or best way to approach ethical issues; rather, each RN must find the approach that works best in their circumstance, accept the struggle of developing a value system and take responsibility for their actions.
Rose reviews the Code and its seven values. She recognizes that values are related and overlap and also realizes that the values and ethical responsibility statements are universal to all domains of nursing and all practice settings. So, she takes the time to reflect on how they apply to her current dilemma. She finds that some are directly applicable to Mrs. Peterson, while others are still peripherally relevant.
Ethical principles are another way to express values and can assist in decision-making regarding ethical action in a particular situation. The principles central to ethical decision-making are listed in the CARNA’s Ethical Decision-making for Registered Nurses in Alberta document.
Rose finds that more than one of the principles are applicable to Mrs. Peterson’s case and recognizes that the consequences of the recent event may have been as a result of how other’s perceive the ethical principles.
Regardless of what method Rose chooses to explore the ethical issues presented with Mrs. Peterson, she recognizes that, as the registered nurse, she is the appropriate person to initiate dialogue with Mrs. Peterson and Helen. She approaches them and they work together to explore, question and understand all perspectives of the issues. It is through this process that the actions to move forward become clear.
Our case studies are fictional educational resources. While we strive to make the scenarios as realistic as possible, any resemblance to actual people or events is coincidental.