This brooding history will discourse an ethical quandary which arose during a arrangement within a community puting. To help the contemplation procedure. the Gibbs ( 1988 ) Reflective Cycle which encompasses 6 phases ; description. ideas and feelings. rating. analysis. decision and action program will be used which will better and beef up my nursing accomplishments by continuously larning from both good and bad experiences. and develop my ego assurance in relation to caring for others ( Siviter 2008 ) . To follow with the Nursing and Midwifery Code of Conduct ( NMC ) ( 2008 ) and maintain confidentiality all names have been changed and hence for the intent of this contemplation the patient will be referred to as Bob. Bob is a 40 four twelvemonth old adult male who has been having aggressive and invasive intervention for several months in the signifier of chemotherapy in an effort to bring around his Hodgkinson’s lymphoma malignant neoplastic disease.

Throughout the intervention Bob remained positive that he would be able to set the concerns behind him and populate a ‘normal’ life with his spouse and teenage girl. However. Bob was unable to command his organic structure temperature. which was a possible mark the chemotherapy had non been successful and was offered farther probes to set up his forecast. Whilst my wise man who is a Community Matron. was speaking to Bob. his spouse Sue took me to one side and asked me if the probes revealed bad intelligence would it be possible to keep back this information from Bob because she felt he would non be able to cover with a hapless forecast and would give up hope. Prior to Bob’s original admittance the possibility of degree Fahrenheit the chemotherapy weakness was discussed but he refused to see this was an option and was convinced the status could be treated successfully.

I explained to Action that this state of affairs was outside of my country of expertness but with her permission would discourse it with my wise man and inquire her to reach Sue at a reciprocally convenient clip to discourse farther. My wise man contacted Sue and advised her that she would discourse the state of affairs with Bob’s Consultant once they had received the consequences of his trials. However. my wise man diplomatically informed Sue that she has no legal right to take a firm stand that information be kept from Robert ( Dimond 2005 ) . As expected Bob’s trial consequences concluded the chemotherapy intervention was unsuccessful. Sing what he knew of Bob. the adviser agreed it would be advantageous to keep back the diagnosing from him. Therefore it was agreed to discourse Bob’s trial consequences with his spouse.

Ideas and feelings

In the first case I felt that the Consultant was ethically incorrect to keep back the consequences of the probes from Bob and non needfully moving in his best involvements. I felt that in order to guarantee Bob’s rights were protected and to give him the chance to be involved in his ain program of attention he should be informed of the result of the trials. Bob had the capacity to consent and as during my arrangement would be moving as an advocator for him. I felt that if I was in Bob’s place. I would desire to cognize what the result of any probes were and it did non seen right that the diagnosing would be documented in his records and his household and perchance friends around him would be cognizant of his diagnosing whilst he was kept in the dark. I felt that if we were to see on a regular footing that I would experience really uncomfortable cognizing something that had been kept from him and perchance hold to lie to him or avoid replying straight when asked hard inquiries. I besides felt that his household were taking off his freedom to do an informed pick about his forthcoming attention.

Analysis

Evaluation
Barbosa district attorney Silva ( 2002 ) defines an ethical quandary as:

‘A state of affairs where a individual experiences a struggle where he or she is obliged to execute two or more responsibilities. but realizes that whoever action he or she chooses will be an ethically incorrect one’ . Kuupelomaki and Lauri ( 1998 ) and Roy and MacDonald ( 1998 ) agree that wellness professionals are faced with many ethical quandary when caring for terminally sick malignant neoplastic disease patients and pass oning the diagnosing and later forecast is one of the most common quandary experienced. Alexander et Al ( 2001 ) province that it is non unusual for relations to inquire a Consultant to keep back information. Kenworthy et Al ( 2002 ) say that these petitions are made out of compassion and love. However. Rumbold ( 2002 ) disagrees and suggests it is frequently the relations who are unable to get by and hold trouble in coming to footings with the at hand forecast. Dimond ( 2005 ) agrees and adds that keep backing the truth can be harmful or lead to a confederacy of silence but may be justifiable if it is in the patient’s best involvement non to cognize. Buckman ( 1988 ) besides appears to hold indicating out having ‘bad news’ can hold a negative and drastic consequence on a patient’s position of their hereafter.

The wise man acted in the right mode talking to Bob’s adviser and holding with him to keep back the diagnosing from the patient. Dimond ( 2005 ) states that Nurses have a responsibility to adhere to the Consultants determination even when they are in dissension. The Consultant made a professional determination to discourse the diagnosing and forecast with Bob’s spouse. Rumbold ( 2002 ) identifies it is the right determination to give information to household members when it is deemed that it is non medically advisable to inform the patient. Although patients may take a firm stand on being told of their diagnosing Advisers have the power to keep back information. there is no clear right in jurisprudence even if the patient is exerting their right under the Data Protection Act 1998 ( Dimond 2005 ) . However. Harris ( 1994 ) argues that for Consultants to move in such a manner is paternalistic.

Paternalism is when others believe they are moving in the persons ain best involvements. whilst non affording them single control over their ain life. although concern for the persons public assistance is paramount. it omits regard for the persons autonomy ( Harris. 1994 ) . However. Tingle and Cribb ( 2005 ) . argue that there are two types of paternalism. Difficult paternalism is moving on an individual’s behalf because they feel qualified to make so. whereas soft paternalism is about doing determinations on behalf of the single whilst they are unable to exert their ain liberty and feel they are making so in the best involvements of the patient. My feelings were that Robert had a right to cognize the truth about his diagnosing. this is identified by Tingle and Cribb ( 2005 ) as a deontological place. whereby duties and responsibilities to state the truth overrides the justification of behaviour. even when that action can be justified to be in the best involvements of the patient’s.

The rules of beneficence ( advance goodness ) and non-malifience ( do no injury ) are cardinal ethical rules environing the determination to state or non to state a patient the truth sing their diagnosing ( Alexander. Fawcett. & A ; Runciman. 2001 ) . Rumbold ( 2002 ) identifies that wellness professionals should move harmonizing to the rules of beneficence and non-malifience. and states that keep backing information or stating a prevarication is unethical and denies the single liberty. Rumbold ( 2002 ) argues that liberty enables the person to believe. make up one’s mind. and do determinations freely and independently based on information given. Nevertheless I felt that Bob could non be independent when he did non cognize the truth sing his diagnosing and therefore denying him the right to do informed determinations environing his decease. Although my values and beliefs differed from the Consultants. I was cognizant that I had to continue his determination.

Basically. the adviser has clinical duty for patients Rumbold ( 2002 ) . However. Kenworthy. Snowley and Gilling ( 2002 ) province that professionals who override an individual’s liberty for ‘doing good’ a quandary exists. A quandary can be described as a discrepancy between personal beliefs. feelings and rules where different replies to a state of affairs exists. although several classs of action may be taken each can be morally justified ( Royal College of Nursing. 2000 ) . Basically the classs of action that could hold been taken for Bob were to state the truth or non. both places could be morally justified. to state the truth would enable Robert to be independent. nevertheless keep backing the truth prevents Robert losing hope. Saunders ( 1991 ) nevertheless argues that health care professionals need to oppugn whose demands they are seeking to run into. This is supported by McCarthy ( 1996 ) who states that health care professionals have a inclination to presume they know what there patients demands are.

This made me experience that the Consultant and my wise man were conspiring with Robert’s married woman and later they were run intoing her demands by keep backing information therefore disregarding Roberts’s right to be independent. I therefore found that I was involved in a personal ethical quandary related to veracity ( truth stating ) honestness and keep backing information ( Begley and Blackwood. 2000 ) . Fry and Johnstone ( 2002 ) believe the rule of veracity lies with the person non to lead on or state a prevarication hence tell the truth to others. Research in to truth stating and patient diagnosing carried out by Sullivan ( 2001 ) suggests that 99 per cent of patients want to be informed of their diagnosing and felt that Doctors had an duty to state them the truth. However. 10s Have and Clark ( 2002 ) argue that when diagnosing is imparted suddenly it can arouse denial. impair version and psychologically harm the patient. McGuigan ( 1999 ) states that it is hard to foretell how patients will respond to ‘bad news’ . she suggests that the process for intelligence should be slow. this so enables the patient clip to absorb information given.

I believed that Robert had a right to cognize and felt that we would non be unduly harming him by informing him of his diagnosing. Anxiety. fright of decease are all obvious marks when patients face life endangering illness Mason ( 2002 ) . This is supported by Golds ( 2004 ) research who identifies that patients seldom suffer greater anxiousness. depression. unhappiness. or desperation on being informed of their diagnosing. Open honestness is encouraged by McGuigan ( 1999 ) who believes that as a consequence of being informed patients have a greater trust in the health care professionals handling them and are able to pass on more efficaciously with relations and health care professionals as a consequence. This is agreed by Seale ( 1997 ) who advocates that an unfastened consciousness of diagnosing affords the person to hold control over fortunes environing their decease. I had been reflecting over the state of affairs and realised it was excessively complex for me to manage hence I sought counsel from my wise man.

Although she would usually take a deontological place. she informed me that she was taking a useful place in this instance hence moving within the rule of beneficience ( make good ) and moving in the best involvements of Robert. Tingle and Cribb ( 2005 ) province that persons who act on the rule of utilitarianism are moving in a manner which yields the greatest felicity to all parties concerned irrespective of the motivations for taking these actions. My wise man and I besides reflected on the conversation she had with Robert’s married woman prior to his trial consequences. It was felt that Robert was presently in denial and stating him of his diagnosing could potentially harm him. he may lose all hope therefore she was adhering to the rule of non-malificence ( prevent injury ) .

Research carried out by Kubler-Ross ( 1969 ) ( although an old mention it is still used today in Kenworthy. Snowley. & A ; Gilling. 2002 ) . identified denial as being the first phase of accommodation to the chance of decease by patients. she believes that persons deny the world of the state of affairs and are unable to confront up to the chance of decease. She besides argues that it is the retreat in to denial that isolates the person and as a effect. communicating is compromised between patients and healthcare professionals. Kubler-Ross’s research has been endorsed by Buckman ( 1988 ) research nevertheless he suggests that patients go done reactions as opposed to phases. However. Evans and Walsh ( 2002 ) place that it is frequently the health care professional’s feelings of weakness with the state of affairs that leads them to believe that patients who hope for a remedy are in denial of their disease.

However. Kenworthy. Snowley. & A ; Gilling ( 2002 ) argue that it would be unethical and damaging to coerce a patient in to confronting the truth about their diagnosing. I therefore realised that it would be unethical and be damaging to coerce Robert to confront the truth about his diagnosing. if we took away his hope of a remedy we would merely go forth him with fright. Mason ( 2002 ) believes that in terminal unwellness hope and fright are synonymous to each other if hope is taken away patients are merely left with fright. She besides states that a patient’s hope is cardinal and something to be protected. This is supported by Buckley and Herth ( 2004 ) who identify that hope of a remedy in terminal unwellness is unmeasurable. In add-on. Mason ( 2002 ) argues that hope is an individual’s right and even in the concluding phases of decease patients hold on to trust.

Decision

Reflecting back we had non really lied to Robert as I had one time presumed. although he was cognizant that farther trials had been carried out he had ne’er enquired about the consequences. I believe that if I were of all time faced with this type of state of affairs once more I would be more witting of my patient feelings. hearing and hearing what they are stating. thereby my attack would be more holistic instead than clinical. By analyzing my determinations I realise that I was blinkered and had stuck stiffly to the NMC ( 2004 ) . non to the full appreciating that the NMC ( 2004 ) has policies and parametric quantities for which a registered nurse can work within. which enables a nurse to be proactive and utilize their professional opinion ( Seedhouse. 1998 ) . Following clip I would non be judgemental but look at the environing issues related to determination devising. I had condemned the Consultant and my wise man for their determination and believed they were moving paternalistic. nevertheless I realise their determinations were based on their cognition of Robert in add-on to their experience and expertness.

Benner ( 1984 ) suggests that an expert has the expertness and rules from which to do informed determinations based on their experience. preparation and pattern which enables the expert to be holistic in their attack to patient attention of which the novitiate has yet to derive and develop. Reflecting over my determinations and feelings made me gain that I was a complete novitiate. This is supported by Benner ( 1984 ) ( in Baillie 2001 ) . who states that novitiates have no footing from which to use their rules it is merely in a clinical scene that experience can be gained. nevertheless novitiate can besides be applied to nurses working in unfamiliar milieus. I now believe that I was guilty of paternalism believing my ain beliefs and values were right. I had assumed that Robert needed to cognize of his diagnosing if he was to be independent.

To reason I now realise that in terminal unwellness it can be inquiry of when to inform the patient of ‘bad news’ . I believe that Robert was clearly non ready to accept the truth at that clip hence keep backing information had been the right determination. Arguably Robert was independent. it was his determination to trust for a remedy therefore it would hold been unethical and morally incorrect to take that off. However. the fortunes environing this determination could merely be applied to Robert’s state of affairs.

I believe that as a Nurse I will be involved in ethical quandary once more nevertheless I feel that now I my determinations will be based on each alone patient recognizing their ain single demands and wants. By utilizing the Gibbs ( 1988 ) reflective model rhythm it has enabled me to analyze. inquiry. travel frontward. learn and do sense of my actions. I am now cognizant that contemplation is a continual acquisition procedure in nursing. Rather than reprobate myself where I think I have failed I have been able to turn it in to a positive acquisition experience and use this freshly gained cognition in to my hereafter patterns

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