Ethical decision making in the healthcare setting is a derivation of the ICN Code of Ethics for Nurses (2012, p. 2) which states “The nurse’s primary professional responsibility if to people requiring nursing care.” It is the duty of any nurse to offer the best feasible options for the patient’s healthcare decision making based upon their wants, needs, likes, dislikes, and financial abilities. To this end, the Shared Decision Making Model (SDM) allows for better patient understanding of their medical issues, treatment options, outcome scenarios, and monetary expenses (Stiggelbout, Pieterse, De Haes, 2015, p. 1172). The SDM model allows for a distinct and ongoing dialogue between the patient and the medical professionals in charge of their care.
The SDM process outlines a nine-step process for decision making: 1) define the problem; 2) present options; 3) discuss benefits/risks/costs; 4) assess patient’s preferences; 5) discuss patient self-efficacy; 6) provide doctor recommendations; 7) clarify patient understanding; 8) make decision; and 9) follow-up (p. 1173). The SDM model affords more interaction with the patient and medical professionals during the decision-making process thus all parties offer their recommendations while everyone understands the needs of the patient and how that will affect the treatment decisions.
I chose the Shared Decision Making model as I believe it offers the most information, communication, and better patient understanding of their medical issues and how each option may affect their prognosis and eventual outcome. Psychologically speaking, the interaction between nurse, doctor, and patient should offer a level of comfort to the patient in the final decision. Additionally, medical professionals have more knowledge as to possible monetary sources (grants, prescription costs help, rehabilitation centers) that can lower the patient’s financial responsibilities. These and other financial options for the patient will alleviate the burden of payment which could affect their decision. The better informed the patient, the better the decision-making process becomes.
A few years ago, a patient was brought to the emergency room of the hospital where I volunteered. The man was indigent and had suffered a severe and debilitating stroke while living at a local SAMS Shelter. His sister oversaw his medical treatments but she lived several hours away. The doctors and nurses in charge of his medical care had erroneously determined that the patient had not suffered any physical damage from the stroke. He could walk, talk, take care of himself, and so on. However, the sister spoke with her brother several times a day. He would call her 20 to 50 times a day asking what happened, where was he, why was he there, and where was his family. These questions were repeated over and over from call to call and even minute to minute during their conversations. After a few days in the hospital, the doctor informed the sister that her brother would be released from the hospital that afternoon. The sister questioned this decision and inquired as to whether the doctor had thoroughly evaluated her brother and his disabled state from the stroke. The doctor reiterated there was no physical disability but the sister negated that claim and explained that she believed her brother has suffered a Traumatic Brain Injury (TBI) due to the stroke which was manifested by his inability to retain short-term memories.
The sister requested a neurological evaluation of her brother. The next day, the doctor called the sister and concurred her assessment of her brother’s mental state and he had indeed suffered irreversible TBI due to the stroke. Because of this, the patient lives in a skilled nursing facility and is monitored 24 hours a day. He cannot live on his own due to the damage sustained to his brain from the stroke. Although protocol called for the patient to be released due to know “physical” damage from the stroke, due to the diligence of the sister, the doctor assessed the mental faculties of the patient and determined there was sufficient physical damage to the brain. The doctor made an ethical decision based on extenuating circumstances rather than medical protocol for stroke patients covered under Medicaid.