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