Criminal patient ! November 23, 2014

The last blog that I’ll be writing is about a patient that I had to care for during stage. The reason why he was admitted to the hospital was because of his bipolar disorder. He had a mental problem. I had developed a good therapeutic relationship with him in the morning as I would with all my other patient. Then around 11am, two cops came in the floor and they were looking for my patient. The nurse in charge of my patient can and told me that my patient had to go to the court because he had an aggressive behavior and he was violent with his wife.  I was really shocked when I heard this because to me the patient looked totally normal and cooperative. Then they took him and he had to go to the special unit for prisoner.

I never thought I would have to take care of a criminal patient. Then after the experience with my teacher. I talked with her and she also didn't know that he was a criminal. I then realized that if I would know that he was a criminal at the beginning of the shift, I may would have felt a moral distress and maybe I would have behaved and treated this patient differently. The teacher made me realized that from this experience that is the way I have to treat every of my patients. They need to be treated equally and fairly as every other patient. He was admitted to the hospital because he had a mental illness not because he did something wrong. Therefore I treated him because of his bipolar disorder not because he was being violent. But his aggressive behavior could also have being linked to his mental illness, I don’t know. It is my duty to provide good and safe care to my patient, judging them is not correct. Now, all the patient I have, I interact with them without judging or treating them differently (Respecting the principle of justice). I say to myself that they are all patient that needs help and care. It is a good thing that this happened to me because now I have the virtue and moral courage with criminal patient (I treat them as if they are normal patient). They are our patient and we need to advocate for them because maybe they weren't aware of what they did, they have a mental illness, etc. But I may still have hard time with some extreme cases such as killing children because I didn't had to deal with it yet so I don’t know if I will be able to deal with it or not (I will still try even if it goes against my beliefs and values).

Qais Khedri

Nursing Ethics

Jehovah's Witnesses and blood transfusion November 16,2014

One of my colleague during stage had a patient from Jehovah's Witnesses, The patient was admitted because of a lack of Red blood cells in her blood. And in the hospital, the main care that needs to be provided for someone lacking blood is blood transfusion. The student nurse told me that since the patient was from that religious belief, she was refusing blood transfusion. The patient explained that in her religion blood transfusion is a violation of God's law. She was aware that if her condition is life-threatening and she absolutely needs blood, she will refuse because of her belief. After my colleague told me the story, I felt that this can create a serious ethical dilemma. Meaning that we have patient that can easily get cured but religion is a barrier for us to intervene. I would personally have a hard time dealing with this type of situation especially if we it is our job to promote beneficence. In this situation we would be prevented from doing so because of religion. I would have a moral distress because I wouldn't be able to do anything to save that person. It remind me of a story that happened this year in Europe. There was parents from Jehovah's witnesses that kidnapped their child so he wouldn't get a blood transfusion because of their belief. This is not right, the parents chose for the children based on what they thought was right. They could have killed their child for this. I would have hard time dealing with this type of surrogate because for me they didn't provide good for the child. But still as the DNR, I would have to respect their choice and not do any transfusion without their consent.

Qais Khedri

Nursing ethics

HIV secret November 8, 2014

This blog is about an ethical problem concerning a nurse and one of her friend, a man with HIV. The patient was diagnosed with HIV few months before she met him, he was not on medication (antri-retro-viral) and was taught about the precautions that he needed to take for himself and for her partner. The guy was a friend of the nurse so she knew that the guy's relationship with his girl was new. The nurse asked the patient to be honest and say if he was using condom everytime he was having a sexual intercourse. He hesitated to answer and finally admitted her that no he wasn't always using one because it wasn't providing him a lot of pleasure. And the nurse asked the guy if his girlfriend knew about him condition, he said that he did told her once but she never asked anything again.
In this case the patient's values are different from my values and I assume from the nurse's one too. I would keep all the precautions about HIV. And I think what he should have done was to ask her girlfriend if it is fine that he doesn't put condoms even if he has HIV and then he would have let the girl decide because maybe she had forgotten that info or she just wouldn't mind him having this disease.  I think I would have hard time dealing with a patient like this (MORALLY) because he is not helping himself nor helping others. I believe he has the responsibility to tell it to his girlfriend or at least reminding her in case she forgot. But at least, he was being honest with the nurse. If I would have a patient like him, I would  still need to respect his values and I would have to treat him with respect (moral imperative). Because It is part of the CNA codes that want us to promote and and respect informed decision making but there will also have to be some coercion because we don't want something bad to happen to the patient's girlfriend there we may be limiting the patient's choice and freedom but it will be done to bring the greater good for the greatest amount of people. 
From this experience that the nurse had to deal with, I learned that the patients we are providing care to are not always helping for themselves or others and teaching is crucial for this type of situation. 

Qais khedri 
Nursing ethics 

Useless November 2, 2014

This week’s blog is about an ethical dilemma that a nurse has faced very long times ago. She told me about one of her patient that had a stroke and his left side was paralyzed. And he had a urinary tract infection. The patient had no family support and wasn't positive about his life. He told her that he was tired of staying at the hospital and that he had nothing to live for now. He was in a lot of pain and wasn't moving that much. The treatments were not effective, the patient's condition was still deteriorating. The nurse knew that there wasn't a lot of choice for the patient but she still had to follow the doctor’s order and provide treatment to the patient even if he didn't want them and knew they were ineffective. So the nurse felt that she was not advocating for the patient because the doctor wouldn't listen to her and she thought she was harming the patient with no expected goals. Pain medication were not effective and the patient’s situation was deteriorating.

In this situation, the patient’s justice of human rights was not listened to. The principle of non-maleficence was not adopted because the treatment were harming the patient, he was still in pain, and he didn't want to continue the treatment but had to. Therefore the autonomy was not taken into consideration because he was lucid, he was aware of what was going on but still the doctor took a decision without seeking the patient’s consent.  

 But on one side was acting according to duty and not according to kindness or reason. I think the nurse was facing a moral distress because she wanted to advocate for the patient but couldn't because she had to listen to what the doctor and institution ask her to do. I think that things has changed from the nurse’s time, we now have code of ethics to follow that allow us to advocate and verbalize our concerns if we are in disagree with something. Therefore, if I have this kind of patient’s situation, I would talk for my patient and don’t do the treatment if the patient refuse to and would tell it to the doctor and head nurse (getting her point of view too). 

Qais Khedri

Nursing ethics

october 26,2014 Husband to the rescue

Last week in stage, my first patient was having problem with her lung and her heart. At report, the nurse told me that the patient was not cooperative with the team and she didn't want to put her O2 mask on. I went to see her, introduced her in a calm way. Tried to understand her situation at first she didn't talk but I stayed in the room and she started saying that the nurses and doctor were not helping her. I resonated her and said that if they want her to have her oxygen mask, it's because she need it otherwise she will desaturate. She knew that but was saying that she had a lot of problems and wouldn't make it. I said that the oxygen mask will make her feel better and that it's a start. She still refused to wear it.
So I told myself that this is not helping her. I knew the consequences that could happen. I thought of whether I say these potential complications to her or I keep it for myself. I chose to keep it for myself because the patient was already negative about her problem and telling her what could happen if she doesn't cooperate could worsen and bring more negativeness in her mind.
I knew that by not telling her everything I wasn't respecting the patient's right but on the other side, she didn't ask to know it and I know it wouldn't make her situation any better. I went and talked about the situation with my nurse and she agreed that it wouldn't be a good idea to talk about the complications of not wearing a mask.
When I went back to see her, she had her mask on her, I told her it was a good thing and she said that when she called her husband, he also encouraged her to put it that is why she did it.

Qais Khedri
Nursing Ethics

Smoking breaks October 15, 2014

During my stage in the mental health unit, I experienced a situation where I had to advocate for my patient. I was on the evening shift, and as I got the report, the nurse that that my schizophrenic patient has had a bad behavior the day and that he was no longer allowed to have his cigarette break. I went and talked with him, he explained me the situation calmly  so I told him that on this floor, being allowed to go out and smoke is a privilege and the reason why he could not have this privilege was because he didn't behave appropriately with the staff. He continued saying bad words about the staff and I told him that I would let him have his smoke only if he stay calm,behave correctly and don't say bad words. He said that he would try. Then the smoking break time was starting and my patient did what I told him to do. At first, the nurse was not letting him go out because she taught he still was agitated and was aggressive, then I came and told him (the nurse) that I made a deal with the patient that if he would nice, then he would be allowed to have his privilege, The nurse still wasn't sure of letting the patient but I told him that I made a deal with my patient and it would be nice because I will have the patient's trust and that if he would not let him, the patient would get even more agitated. He accepted and let the patient go. After the break, the patient thanked me and continued being calm for the rest of my shift.

I believe I did the right thing because I thought of the potential problems that could happen if we would not let him have his cigarette. For them, going out for 5-10 min is a relief because they spend all their day in the unit and having the permission of going out make them feel better. One the negative side, we know that letting the patient smoke isn't good for their health but many of them were smoker before being admitted to the psychiatric unit. I think I approached the issue in the right way because at the end I got positive outcome. If he would still be agitated or aggressive then I would first not try to make a deal and it could have had bad outcomes because the patient would think that even if he misbehave, he is allowed to have his ''moment of freedom''. I learned that we can develop good relationship and having the patient's trust is important because otherwise, he might not belief what you tell him after (but this can also happen).

Qais Khedri

Nursing ethics

Patient in pain October 8,2014

I remember a patient that was in moderate pain. I was assessing his pain and I could see that it was unbearable. The patient had his medication an hour ago and on his prescription it was ordered to give the medication 1 dose every 4 hours. The patient really wanted me to give his pain medication even if I tried to resonate him that it was dangerous to give it now because of the effects it could have on the body (respiratory depression,death). I could see that the patient was suffering so I tried non-therapeutic management, I suggested him to think of something else (reading) he said no, Then a warm compress and put it on the area where the pain was. He said that it was helpful and relieving, 
I used beneficence and non-maleficence because giving him his medication could potentially harm him so finding other ways of doing thins was the best to do for my patient. The warm compress was helpful so I kept doing this until he felt asleep. Then when the time can to give him his medication, he took it and thanked me for what I did to him. 


I told him that I did what we is our duty to do. I felt happy bout myself because the outcome of my intervention was successful. I found it interesting because we can find alternatives and not only have the patient think that the only way to treat pain is medication. Showing the patient that you can control a situation like that is helpful because the patient has more a sense of trust afterwards.
Continuing learning more non-pharmacological techniques will be useful because if the one I did would not work, then I could try other alternatives.

Qais Khedri
Nursing Ethics

October 4th,2014 Who has the priority ?

This week in stage one of my patient was 70 years old. He was there because of he had pneumonia. Before meeting my patient I looked at the report to see if there was something to his profile. I saw in his profile that he could eat, mobilize, and go to bathroom independently. Then as usual, I went and met him, I took his vital signs and then observed him eating his breakfast. He actually could eat by his own but it was taking him time between each bite(he ate all his breakfast). Then during dinner, I entered in my pt's room and saw the PAB feeding him. I asked her if it was the patient that asked to  be fed, she said no. Then I told her that he can eat by his own, She said that ''yes but he's taking too much time and we need to send the tray soon,’’. I didn't say much in  front of the patient but really wanted to make her stop feeding him.  I was really surprised that she would prioritize ''her time'' instead of helping the patient's autonomy.

Following this, I asked myself that how can we keep the patient's autonomy if we do things that they are able to do. And in that case, the patient wasn't allowed to make his own decision. It was a form of coercion where she was forcing the patient to eat at her speed, thereby limiting his choice and freedom. The promotion of patient's autonomy was not met and the principle of beneficence by the PAB was not respected. I should have advocated more for the patient. She could have putted the pt’s interest before her own interest.

Qais Khedri 

Nursing Ethics 

Refusal September 28, 2014

During my stage, I had a patient with dementia. When I first went to see him to introduce myself, he wasn't happy because he didn't sleep well. I told him that I understand and I would let him rest, then I explained him what procedures needed to be done and then he got mad. He said that he didn't want to do anything. I let him calm down and told him I would come back in few minutes.
When I returned in his room with the machine to take his vital signs, he started yelling that me and said that he didn't wanted us to touch him. So I went to see my teacher, and she also tried to take the patient's blood pressure but same reaction, he refused.
I tried to resonate him by telling him that what we were doing was for his good. As nurse, I knew the consequences that would happen to him if he would refuse to take his medications,refuse to eat,etc.
So I tried to keep him pushing but it was unsuccessful so the teacher said that we should accept his choices and did not disturb him.
After this experience, I felt like I couldn't bring good to this patient. I was also thinking that we are trying our best to improve our patient's condition, but when they don't want to we have to accept it even if we don't want to. This is in a way forcing them to get better.

       

Nursing ethics
Qais Khedri

Different opinion

Today's blog will about a personal experience I had where my values were different from others.  The situation happened this summer when I went to Calgary to see my family. I didn't have that much of news about them before seeing them. So I met one of my cousin, she is my age. We were talking and I saw a ring on her hand. I asked her why she has it, I thought that maybe she was engaged to someone but she told me that she was married to a men since a year. It was an arranged marriage.

 She was telling me that her mother chose the guy and she had to accept this marriage without arguing. I tried to reason her by telling that she can refuse to be with the guy but she said no (looking anxious). The next day, I and my cousins were about to go out but my married cousin said that she could not come. She told me that her husband doesn't let her go out. Again, I felt very upset inside of me but didn't show it physically. I talked to her big sister and she told me that Samira (married cousin) couldn't go out, her husband was calling her twice a day and she would have to be there to answer, her husband told her to stop school and stop working (because he doesn't trust her). And then the subject of abortion can in. My cousin told me that if she would get pregnant by her husband then she would have to keep to baby even if inside of her she doesn't want to. She feels obliged to stay with him so she doesn't dishonor the family.

  I kept telling her that she is being controlled by this men, but no reaction from her. She was saying that her mother's decision is important for her, she has to accept this man and listen to what he says. At this point, our values were completely different. I told her that she has the right to choose, take decisions, and leave him if she wants to. I think that she doesn't consider freedom as of her main values, she doesn't accept and respect herself as a women that has human right, I think that she is unable to develop her own values because others control them. For me it is different because I think that everyone has the right of living without being controlled.

Today, my reactions are the same as that time. I still feel mad knowing that this kind of problems happens in a country where freedom has a lot of importance. In a professional manner, if I would have to deal with a patient having the same type of problem. I might see patients that are not talking about their issues because they are scared of their husband, controlled by them, I would probably keep my feelings with me but I would also try to resonate that person and maybe I would involve a social worker to the situation. Same reaction with a women talking about abortion. If she doesn't want the child but keep him, then maybe there can be neglection so the life of the baby scan be a threat.

Qais Khedri

Nursing Ethics

September 13th 2014 TRANSITION TO A NEW HOME

Yesterday was my first day in stage and I heard a discussion about something I never really paid attention to. I was in a room where there were two patients. The teacher was setting up to show a technique on my patient. At that time, there was a health professional that came to see the other patient in the room and her family members. That person came to tell the patient and her family that because the patient's heart was not functioning properly, so she would have to move in a nursing home. When she said these words, I realized how hard it can be hard for someone to know that he/she won't be able to go back at home again. And how this decision affects the family members too because they are worried that she might die far from them. The patient's daughter was asking a lot of questions as if there were other possibilities, if she will be safe, etc. I am aware that I shouldn't have had listened to the conversation but it was impossible not to hear them talking. After the experience, I thought of it and noticed how confidentiality should be respected. We have to provide privacy to our patients and respect their confidentiality as much as possible. Even though, the confidentiality was an issue, the health professional was very good in communicating with the patients and family. She was sitting beside the patient, was answering the questions with understandable words, and explained the pros and cons of why it would be better for the patient to try Nursing home. I found her way of communicating very interesting and professional and I can learn from this.

 

Usually when we go on stage in a long-term care centers. We see the patients already in their room, and not really paying attention to since when they are here. This experience will be very beneficial for me because now when I'll go at Nursing home, I will be aware that patients have had their own house, they had a life before coming here and some might not be happy about moving. And this will help in my nursing practice because I will understand the patients in long-term care centers better and reflect more on their past life, family support...

Nursing Ethics                                                             
Qais Khedri

First entry September 6th, 2014

The purpose of this article is to explain my point of view on why I think this journal reflecting will help me through this semester.

By reflecting about events that happened to me, I want to be able to think of my actions (were they good or bad actions, why did I do so). I want to learn about myself because sometimes in life I do something, then I think of it and regret it. Writing down about the decision I took based on the pros and cons of my actions can I think help reduce the feeling of regretting. Expressing my feelings can make me aware of them and then to possibly work on them (if they are negative). I think this will help  me identify the positive aspects of my actions because often when an incident happen, we tend to only think about the negative side. By doing this reflection, I want to see if the situations increase my strengths, affects my self-esteem, my character, my relations with others, etc. There are many situations that are still uncomfortable to me and that I want to work on. Some of them are death (dead body and seeing a family going through the grieving process), patients being abused, patient of my age, etc.. I want to be able to face these new situations and see if my ways of dealing with them has improved. I will often relate the experiences to my nursing knowledge, by trying to incorporate what we learned in class. An example of question to integrate is : how my nursing thinking process has helped me do the right action in the experienced situation. To conclude this first entry, I believe this journal reflecting will help me learn a lot about myself and that it will be very grateful in my future because I will be aware of the reasons and the thinking process that I chose behind my actions.

Nursing Ethics
Qais Khedri

Homework Assignment #1

Nursing Ethics                                                              Homework assignment 1
Qais Khedri
August 31, 2014


Answers found from the article: A three-step method of self-reflection using reflective journal writing.

-How does reflective journaling change the role of the student?  Or the role of the instructor?

The reflective journal writing helps the student to personally learn about his/her clinical experiences, needs and finding ways to deal with the experiences with or without the teacher's help. The educator's role is to be a risk-taker and a mentor by letting the student have a sense of control over his/her clinical learning experiences. Writing about their clinical experiences help the students promote the self-directed learning process. 

-Beyond an entry in a journal, how is reflective journaling best used? What other steps must take place so as to benefit from this process?

 The three-step method used for the reflective journal are the critical appraisal, peer group discussion and self-awareness to self-evaluation. It is best used when the student knows that this is done to help him improve during his clinical, that way he will be able to promote self-awareness and self-evaluation to develop a sense of autonomy. From his perspective, he can reflect his thinking and analyzing process in the situation. Peer group discussion ( post clinical discussions) is helpful because all students are involved in sharing their clinical experiences with their ways of dealing and having the teacher present for feedback will help in this process. 

-What criteria should be used for evaluating a reflective journal?

To evaluate a reflective journal, the teacher should see if the student has used the three-step method of  self-reflection because it shows the student's ability to consider the events that occurred during the clinical. Seeing the student's improvement (in clinical, about them, with peer & teacher), progress to  gain  independence and to being able to give a feedback. Finally, the final self-evaluation will help the student give him/herself a feedback on his experiences (strengths, weakness, points to improve).