Patient-Centered Care: Ethical Reflections on Autonomy, Disclosure, and Family Involvement

1. Identifying ethical concepts about freedom, rights, responsibilities, and the use of power in care for consideration.

Nurses are often faced with a dilemma in the course of their practice to disclose sensitive information to their patients. Nevertheless, they should protect human rights by upholding professional ethics and values in their practice. Treating patients without revealing the diagnosis to them raises several ethical concerns. It becomes more complicated when the family or those close to the patients are advising against the decision. Mrs. Wang's case is more complicated since the family is to be relied on to ensure there is an effective communication between the clinician and patient. In such a situation applying the concept of autonomy and respecting the right of a patient might not be realistic. In the era of the clinician-patient centered relationship, the physician or nurse has no final say on the treatment process and must actively engage the patient in the entire process. The nurse, as the primary healthcare provider, has an active role to play to ensure that the patient's dignity and rights are not violated by all the parties involved in this scenario. Seeking nursing dissertation help can also be valuable for understanding the complex ethical issues that arise in such situations.

Respecting the Patient's Freedom and Dignity

Shared decision-making approaches discourage paternalism and, to an extent, limit the opinion of third parties such as family members. This approach anchorage is on the principle of ethics that guarantees patient dignity, rights, freedom, and values. The patient's inability to understand English and poor prognosis cannot be taken advantage of by both the medical professionals attending to her and the family. She needs to be consulted after engaging the services of the hospital counselors. Though it is factual to comprehend that the family request to withhold information may be to the best interest of the patient and they should be informed of the ethical standards that must be upheld by the clinicians. The premises for the revelation of the diagnosis and prognosis should be in the best interest of Mrs. Wang and not other parties.

Experts Opinion on Patients Autonomy

Most of the bioethics and medical experts base their position to engage fully in the diagnosis and prognosis processes to the seminal work of Katz, 'The Silent World of Doctor and Patient.' Katz is one of the founding proponents of incorporating patients in the decision making process (Reiser, 2003). He believes that patient dignity and autonomy must be respected even in controversial situations. According to this philosophy, non-disclosing diagnosis or prognosis to the patient is unethical and violates the patient's liberty. Based on this argument, the oncologists and other clinicians attending to Mrs. Wang must ensure the patient is aware of her condition even if it is relying on an independent interpreter. However, the family being part of the caregivers to the patient should be engaged and not blatantly ignored.

Biomedical Ethics Considerations

Principles of Biomedical Ethics provide a robust framework for the clinicians to refer to when dealing with delicate situations such as the case of Mrs. Wang. These concepts ought to be integrated with the principles of beneficence and nonmaleficence. Incorporating these principles ensure that the patient's rights, autonomy, and dignity are respected without complicating their poor health condition (Beauchamp, 2016). It propagates a cautious approach of telling the truth to the patient and not truth-dumping or one-size-fits-all disclosure that might negate the patient recovery process. The approach respects the right disclosure of the information at the right time and condition. In overall, it encourages trust and meaningful relationship between all the parties by ensuring the preferences of the patient accessing information is realized. It also assimilates the patient's wish and participation in the clinical processes as well the contribution of the family as preferred by the patient in making critical decisions upon disclosure of the prognosis and diagnosis.

Cultural Ethics Consideration

The decision-making process must take into consideration the cultural dynamics. In this case, the culture of the Mandarin native speakers gives the family the primary role to make critical decisions on the health status of their members. For instance, it is the cultural responsibility of the family to protect their vulnerable members from bad news that can complicate their poor health status. It is evident that Mrs. Wang's family is duty-bound by this obligation and would not encourage the truth to be revealed unto her. Respecting these cultural practices might be controversial more in situations where the family's cultural heritage is antagonistic to the United States health systems procedures and varying family members' opinions. Conversely, if it is the interest of the patient, they should be respected since the dignity, responsibility, and the values of the patients would have adhered. The clinicians, therefore, have a delicate balancing role in enacting between adhering to bioethical standards and respecting the patients' and families' cultural values. The nurse has a lead role to play to ensure that there is no adversarial or antagonism between the medical professionals attending to the patients and the family. The authentic family concerns should be embraced positively. In the event of cultural intrusions that might violate the patient's rights, they should be informed with due diligence and respect, if need involve a professional from the same cultural background to persuade them. In all these approaches, the cultural significance should not be underrated since it provides an emotional support framework for the patient and family in the event of unfavorable news such as the inability of the patient to recover from the disease. The more these cultural preferences and traditions are respected, the more trust is developed between the clinician and family and patient exposed to the best health outcomes.

Patient and Family Involvement in Making Critical Decisions

Despite the enhancement of the clinician-patient relationship, the role of the family should not be undermined by the oncologist and other clinicians. It is of the essence to consider the family apprehension and views by empathetic to them. Such an approach will be more beneficial to the patients as the family will feel their effort appreciated, and their moral and financial support to the patient sustained. If the family feels left out or treated as outsiders in the decision process, they might neglect the patient or minimize their involvement. For instance, the family should be engaged in sharing vital information such as diagnostic results, prognostic propositions, and therapeutic interventions. Sharing of information enables the patient's family to familiarize and adhere to their cultural obligations without interfering with clinicians' professional engagement. It is essential to engage the family in defining moments more so when there is emerging information that should be shared that necessitate making of fundamental decisions. The nurse or physician must, however, be careful to ensure that Mrs. Wang is protected against some of the family requests that violate these radical ethical principles. All the parties must be made aware that the primary preferences in the entire decision making and clinical procedures are to lessen the patient's pain and promote her well being.

Respecting patient autonomy comes with a heavy responsibility for active engagement and seeking approvals on issues that require patient consent. Mrs. Wang has a right to make critical decisions, and she cannot delegate this role to any of the family members. It is, therefore, ethical to engage her and her family made aware of her primary obligations that ought to be respected. A well-defined approach of disclosure of diagnosis and prognosis should be applied to ensure that all the parties are satisfied with the process and the patients’ rights are protected (ANA Center for Ethics and Human Rights, 2016). The clinicians would have discharged their ethical and professional duties by preserving the dignity of their patients at the same time improving her wellbeing.

2. Maintaining effective communication and use their interpersonal skills including compassion, dignity, and respect to deliver the best care outcomes possible

The quality of nurse-patient communication is an essential element in respecting the dignity of patients more so those diagnosed with cancer. Most cancer patients are unable to communicate effectively and would avoid following physicians' instructions to uncertainties. Due to high-stress levels, fear of death, self-pity, mental distress prompted by the cancer treatment processes and fatigue, the patient requires a more empathetic communication approach that is motivational (Ercolano, 2017). These issues can result in poor communication between the clinicians, the patent, and the family. They can cause undesirable health outcomes that have a direct effect on the patient and an indirect impact on the family and healthcare providers. Based on this fact, the nurse must work closely with the family and a mental health expert. As much as the patient dignity being upheld and autonomy respected, the disclosure process must be subjected to due diligence to avoid communication breakdown between the clinicians and patient. It is essential to comprehend that an open communication system motivates the patients to develop a close relationship with the healthcare providers and benefit immensely from the health care approaches designed to improve their condition. Positive relationship results in timely diagnosis and excellent prognosis for the patient

Appropriate Communication Approaches for Cancer Patients

The nurses and other clinicians attending to cancer patients require appropriate communication skills that help make the patients be at ease and compliant to the treatment process. In this scenario, maintaining effective communication is essential in attaining the best health outcomes as well as upholding the patient's dignity. To ensure that the patient's dignity is respected and she is made aware of all the decisions, a transparent communication approach is necessary. They are several communications models that can be applied in this scenario. The SPIKE method is one of the models that have been confirmed effective in communicating complicated information to oncology patients. It is an acronym of communication tools that are set up, perception, invitation, knowledge, and empathy. It also ensures that the communication between the patient and healthcare provider is clear, summarized, and factual. Apart from the distinct communication approaches, they are other practical strategies that help deal with delicate situations such as analyzing nondisclosure requests. In the case of Mrs. Wang, it would be recommendable to hire the services of an independent professional translator to overcome language barriers that might complicate effective communication with the family and patient. Through the professional interpreter, the clinicians would be able to make meaningful decisions that are acceptable to the patient and all the parties involved. The nurse has a moral obligation to ensure that the patient is well prepared and in the right state of mind to bear information passed to her regarding test results and the treatment process. Establishing a clear information pathway is critical as it helps in respecting the dignity of the patient (Carruthers, Astin, & Munro, 2017). For instance, patient preferences in passing and obtaining information ought to be ascertained. In Mrs. Wang's case, she might opt to have one on one talk with the clinicians through the interpreter or involve the family in the discussion. Alternatively, she might prefer the family to directly engage the health professionals who attended to her and make a critical decision on her behalf.

Enhancing Open Communication Systems and Skills

Due to the nature of cancer disease, it seems that the family members have already panicked. It is factual that the fear of death can impede communication between the clinicians and the nurse. The impediment of communication has a high potential to weaken supportive information sharing between the oncologists, nurse, and other clinicians with the patient and family (Zaider, Hichenberg, & Latella, 2017). The patient and family should, therefore, be informed of the treatment options to help them meaningful decisions without withholding any information for the attainment of positive results. Some of the recent research studies confirm that cancer patients who have access to excellent social communication across the divide cope well with the diseases. They appreciate nursing care services given to them, making their chances of recovery and survival to be high. Essence, cancer patients such as Mrs. Wang should have adequate information about the diseases they are suffering, clinical processes, and treatment options to help in fostering effective communication. Open communication systems create an environment of trust and enable the patient to receive emotional and social support from the clinicians, family, and peers.

Desirable results are attained by engaging the family in the communication process. Since the family are the excellent contact person to the patient, it is valuable to engage them through the entire process unless in situations where the patient would want to be directly involved. Clinicians connect well with the patients by introducing themselves and making both the patients and their families aware of the roles they will play while the patients are under their care.

Designing an Effective Clinicians-Patients’ Communication Channel

The patient's inability to communicate in English should not be the reason for her being denied the right to information. All the communication approaches and systems must be modified or simplified to ensure that the patient has a clear understanding of all the clinical decisions and her progress. The nurse must ensure that there is no conflicting information passed to the clients by either the clinicians or family. The family should, therefore, be briefed and a unified position taken before any information is given to the patient. However, this is limited to information that requires the involvement of the family. For any other communication that the oncologist, physician, or nurse deem appropriate for the patient's consumption, the clinicians must ensure it is well packed and delivered without causing emotional distress to the patient.

Dignity is a core element of human rights and the foundation for enhancing the quality of nursing care delivery. The nursing care personnel should always endeavor to sustain patient dignity within the hospital set up. In ensuring the dignity of the patient is maintained, it is prudent to establish a mutual trust relationship that will make it possible to serve the patient without prejudice or bias by meeting her immediate health needs. An in-depth examination of the conflicts that arise from the patient's cultural beliefs, professional values, and family interest is vital in formulating evidence-based approaches that influences health care decisions and patient care outcomes (Ghafouri, 2017). The examination objective must be in the best interest of the patient well being and safety more so in the administration of chemotherapy or any other medical intervention.

Improving the Hospital Environment to Establish Meaningful Communication Process

Most of the patients find it challenging to adjust to the new environment and to entrust strangers with themselves. They would prefer their family members to take care of them even in very fragile conditions. The hospital offers an unfamiliar atmosphere that makes most of the patients develop a feeling of dependence and lack of control. It has, therefore, the potential to erode their dignity, makes them anxious and psychologically disturbed. Patients under such fragile conditions are more liable to be uncooperative and hostile, making it challenging to attain the best health outcomes. If the clinicians do not make an effort to make the environment amiable, the patient might opt to hind vital information on how they are feeling or report any anomaly. In communicating with the patient or the family, it is advisable that to respect the privacy of the patient. The patient should be motivated to be social, portray a positive attitude, develop a social relationship, self- confidence, and be independent.

3. Reflective or learning model contributing to the personal learning experience on self-development and practice in understanding dignity and respect

The case of Mrs. Wang has made me realize the importance of human dignity and freedom of choice. Through a reflective learning practice, I have learned the role of engaging family participation in enhancing nursing care services. Nurses must have full awareness and appreciate the rights of the patients regardless of their age, gender, status in the society, or developmental capabilities. They have an essential role in advocating for the respect of their patients' dignity and collaborating with other healthcare providers and patients' families in identifying practical solutions that do not degrade professional ethics.

Most of the decisions that are made in most healthcare facilities daily threaten the patients' dignity. In several instances, nurses, as well as clinicians, rely mostly on the family wishes and neglect the patients' needs. Nurses must always ensure that their behavior, hospital environment, and communication favor the patient. Respecting the patient culture, an amiable atmosphere, and well-defined interface and supports systems enhances dignity. Healthcare personnel ought always to ensure they promote the dignity of their patients by affording them privacy and engaging them in a friendly manner that makes them feel valued and well taken care of by the clinicians. The patients should be motivated to interact with nurses. Besides, they should take advantage of their benevolence and interrelate with them without any biasness. Effective utilization of exceptional interpersonal skills creates an atmosphere for trust to thrive between the health care providers, patients, and family. Lack of well-established communication channels makes it difficult for clinicians to identify, analyze, and understand their patients' needs and expectations.

The quality of nurse-patient communication is critical in enhancing nursing care delivery for cancer patients that, most of the time believe that healthcare professionals and their families do not respect their dignity. This position is supported by a recent study in an oncology department of a hospital where 87% felt that they are not treated with dignity and respect (Rahmani, Avestan, Pakpour, Mohammadian, & Soheili, 2019). The clinicians must, therefore, be careful and ensure that they engage the patients meaningfully. The patients should be encouraged to ask questions and all their concerns addressed. In a situation where the family should be involved, the patient consents should be sought to avoid conflicting ideologies that might make the patient more vulnerable. However, the patients should be made aware of the significant role of the family and cultural integration in their progress. A prior briefing of the patients' families before admission to the hospital is vital in making them aware of their boundaries, patients' rights, professional ethics, and values to avoid conflicts in the course of the treatment. Both the practicing nurses and nursing students should be trained on how to establish and promote practical communication skills that are beneficial to cancer patients for the best health outcomes. They should be trained on human rights that cannot be violated even in a hospital setting. The case study provides a premise to conduct more studies on the need to respect and protect and the patient dignity without compromising professional ethics, ignoring family, and maintain a robust social and cultural support system.

References

Beauchamp, T. L. (2016). The Principles of Biomedical Ethics as Universal Principles. Islamic Perspectives on the Principles of Biomedical Ethics, 91–119. doi: 10.1142/9781786340481_0004

Carruthers, H., Astin, F., & Munro, W. (2017). Which alternative communication methods are effective for voiceless patients in Intensive Care Units? A systematic review. Intensive and Critical Care Nursing, 42, 88–96. doi: 10.1016/j.iccn.2017.03.003

Ercolano, E. (2017). Psychosocial Concerns in the Postoperative Oncology Patient. Seminars in Oncology Nursing, 33(1), 74–79. doi: 10.1016/j.soncn.2016.11.007

Ghafouri, R. (2017). Dignity-centered Care Model: an Attempt to Maintain Mutual Dignity Between the Patient and the Health System. Ambient Science, 04(Sp1, & 02). doi: 10.21276/ambi.2017.04.sp1.ga03

Rahmani, A., Avestan, Z., Pakpour, V., Mohammadian, R., & Soheili, A. (2019). The correlation between respecting the dignity of cancer patients and the quality of nurse-patient communication. Indian Journal of Palliative Care, 25(2), 190. doi: 10.4103/ijpc.ijpc_46_18

Reiser, S. J. (2003). The Silent World of Doctor and Patient. JAMA: The Journal of the American Medical Association, 290(10), 1387–1387. doi: 10.1001/jama.290.10.1387-a

Zaider, T., Hichenberg, S., & Latella, L. (2017). Advancing family communication skills in oncology nursing. Oxford Medicine Online. doi: 10.1093/med/9780198736134.003.0028

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