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Ethical dilemmas in nursing often involve people outside of the nurse-patient relationship. For example, the interaction of nurses with patients’ families or next of kin can result in a variety of problems that do not have simple solutions. The article by Tønnessen, Solvoll, and Brinchmann (2016) explores two types of scenarios in which nurses fund themselves in a challenging situation. An analysis of the discussed issues is offered, including the investigation of state health law and processes of ethical decision-making. When maintaining a nurse-next of kin relationship, nurses must approach cases individually and remember the principles of patient autonomy, benevolence, and nonmaleficence.
Issues’ Summary
The chosen article discusses two distinct types of next of kin individuals whom the authors identify as “professionals” and “shadows.” According to Tønnessen et al. (2016), “professionals” are relatives or selected representatives that have healthcare education, in most cases being practicing or retired nurses and doctors. Here, the conflict arises between the next of kin who criticize nurses or demand them to perform specific procedures, using their knowledge as a point of authority and disregarding patients’ wishes and nurses’ medical experience. The second group, “shadows,” refers to parents or loved ones of drug addicts. In this situation, nurses find that such next of kin are treated poorly and neglected (Tønnessen et al., 2016). Although “shadows” rarely demand any attention, their position requires nurses to consider their opinion and participation in the decision-making process. Overall, the authors suggest several solutions to both scenarios, calling for an individual approach, empathetic communication, and clarification of nurses’ and relatives’ responsibility.
Moral and Ethical Dilemmas
The issues described in the article raise several possible dilemmas that nurses may encounter. Referring to the first problem, nurses may see themselves between two forces – a patient who may or may not have enough autonomy to make decisions and the next of kin who may have unrealistic or critical expectations for medical care. Nurses need to act in the patient’s best interest, but, in this case, the limits of patients’ and their carers’ opinions may not be evident. For example, the patient can feel the pressure from their relative or listen to their advice but express different feelings to the nurse (Tønnessen et al., 2016). Here, the nurse acting according to the patient’s wishes will come in conflict with the next of kin whose knowledge about the situation is different. The presence of a professional in the role of the next of kin also confuses the loyalties of a nurse who may be uncertain of personal responsibility to the patient and the colleagues.
In the second case, the central dilemmas include nurses’ need to prioritize certain interactions due to emergency and severity, while also expressing commitment to all patients and their loved ones. On the one hand, patients who require more attention due to the condition, treatment, and support, may spend more time with nurses. On the other hand, no patient or their next of kin should feel neglected regardless of their state or involvement in the care. Although the next of kin of people with drug addiction are described in the article as passive and quiet, they require attention and support similar to any other family of those who is in a difficult position (Tønnessen et al., 2016). Their neglect is, thus, an issue of nurses failing to care for patients adequately.
State Health Laws and Regulations
Both problems discussed in the article relate to patients’ autonomy and the foundational principles of benevolence and nonmaleficence. The interaction of nurses with relatives-professionals should not change their relationship with patients for whom they act as health care providers. Therefore, it is the professional duty of the nurse to care for patients and discuss their health with the next of kin regardless of the latter’s professional experience (Buppert, 2018). While they may possess more knowledge than other relatives, they also have personal reasons that may interfere with their judgment of the situation. As a result, the nurse needs to examine the opinions of the relative and see whether their interests align with the wishes of the patient and their evidence-based guidelines.
The conversation with “shadows” should follow the same principles – their participation in the decision-making process depends on the state of the patient and nurses’ conclusions about the treatment. It is crucial to contact these next of kin and see whether a conversation may improve their participation, while also respecting their potential choice to withdraw. If an increased level of interaction between the nurse, patient, and the next of kin is harmful to the patient or their family, then it may be better not to continue the dialogue.
The principles used in the issues’ analysis are outlined in the American Nurses Association’s (ANA) Code of Ethics for Nurses. According to ANA (2015), the nurse has to put the interests of the patient first, committing to human dignity and patient protection. This principle guides the nurse in establishing clear limits in the authority of the next of kin and prioritizing patient wishes. In turn, the nurses’ commitment “to the patient, whether an individual, family, group, community, or population,” and their duty to practice with compassion requires them to treat all next of kin with equal respect and attention (ANA, 2015, p. v). Additionally, according to the New Jersey medical record laws, clinicians have to share the information with the next of kin if the patient cannot make decisions (FindLaw, n.d.). Thus, nurses are legally required to navigate the relationship with patient representatives through information sharing and collaboration.
Process of Ethical Decision Making
To address both situations, one should start by assessing the patient’s best interest. Then, in the first case, it is essential to determine the role of the next of kin in the patient’s treatment and see which reasons guide their judgment. To achieve an understanding, the nurse should talk to the patient’s relative separately and in the presence of the patient to guarantee full transparency of the information sharing. It may also be helpful to write down the information obtained from both the patient and the next of kin to provide all sides with substantial proof of any statements. In the second case, collaboration and commitment to care can positively affect the situation and help involve the next of kin in the conversation.
Conclusion
The issue of sharing information with the next of kin and discussing patients’ health with them is challenging as it requires an individualized approach to every person. Nevertheless, nurses guided by the foundational ethical principles of their profession can balance their professional experience and relatives’ personal opinions. Overall, communication, collaboration, and commitment are the primary focuses that should provide nurses with the necessary tools to deal with the next of kin.
References
American Nurses Association. (2015). Code of ethics for nurses. Web.
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones Learning.
FindLaw. (n.d.).New Jersey medical records laws. Web.
Tønnessen, S., Solvoll, B. A., & Brinchmann, B. S. (2016). Ethical challenges related to next of kin-nursing staffs’ perspective. Nursing Ethics, 23(7), 804-814.
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