Evidence-Based Practice Report – Ethical Dilemma

Running head: EVIDENCE-BASED PRACTICE REPORT 1
Evidence-Based Practice Report – Ethical Dilemma
Student’s Name
Institutional Affiliation

EVIDENCE-BASED PRACTICE REPORT 2
Evidence-Based Practice Report – Ethical Dilemma
Outline of the Clinical Issue
Nurses are at the heart of health care provision for patients and act as a link between
doctors and patients with most spending more time with a patient than the average doctor. As a
result, organizations that observe and govern nursing practice have set some rules and
regulations that nurses should uphold. Additionally, there are ethical standards that they should
uphold as well to guide them in making morally accepted decisions regarding patient care
(Jabson, Mitchell, & Doty, 2016). However, in some cases these ethical standards and
regulations one is expected to observe while providing patient health care collide and put a nurse
in a difficult position in terms of decision making. In some cases, the decisions made by doctors
may conflict with what nurses might prefer to be suitable care for patients (Lee, Phan, Dorman,
Weaver, & Pronovost, 2016). As a consequence, the need for them to observe professionalism
and provide the best care for patients by availing them information to make informed decisions
regarding their treatment becomes a dilemma.
A recent incidence regarding this dilemma occurred in our hospital confirming this
problem (Obermeyer, Powers, Makar, Keating, & Cutler, 2015). In this case, a certain old lady
was diagnosed with a cancerous lump in her breast. The doctor's recommendation regarding her
treatment was to perform a mastectomy to remove the malignant lump. Since there wasn’t any
other information provided to her, she chose to go with this treatment and she was scheduled to
undergo surgery the following morning at around 8:00 am. We could all hear her cries and
groans throughout the night before her surgery. I was assigned to attend to her during the night
and I tried my best to comfort her. As I did so, a conversation regarding her treatment came up
and she was inquisitive on the existence of alternative treatment for the same illness.

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Professionally, I was required to ask her (the old lady) to discuss this issue with her doctor.
However, it was ethical and also professional to avail all the information regarding alternative
treatment which put me in a dilemma (Rathert, Williams, McCaughey, & Ishqaidef, 2015). I got
into a problem with the doctor and my supervisor the following morning after giving the patient
information that led her (the old lady) to doubt the chosen course of action that the doctor had
recommended the previous night. Nevertheless, the information I provided was correct.
The above case is one in several such cases that take place in health facilities. As such,
this is a problem that needs addressing to alleviate such problems in the future while providing
the best health care for patients (Ruberton, Huynh, Miller, Kruse, Chancellor, & Lyubomirsky,
2016). For this reason, I seek to use an evidence-based approach to interrogate this problem and
recommend the best course of action that takes care of the three parties, the patient, the doctor
and I (nurse), in the above scenario.
Clinical Question
Nurses are at the core of the provision of health care to patients in any health care facility
anywhere in the world. However, in most cases their input regarding the final decision on the
best treatment for a patient is not taken into consideration, their obligation to provide information
to patients may make them go against regulations to provide information that may seem to
contradict the doctors diagnosis and recommended treatment for the said reason (Sarto, &
Veronesi, 2016). As a consequence, this puts us in an awkward position/ dilemma in terms of
professionalism and ethics (Seiders, Flynn, Berry, & Haws, 2015). Therefore, should the final
decision regarding a patient’s health care be made by both the doctor and other parties involved
in that patient’s health care e.g. nurses such that our role is more complimentary?

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Evidence Search – Search Strategy
The current problem was investigated primarily using secondary data where individuals
of dilemma existed. Cases where a nurse and the doctor came at loggerheads as a result of the
nurse influencing a patient to change his/her preferred treatment or casting doubts on the
recommended treatment method were investigated. In addition to the above scenario, other
similar cases were considered and investigated as well.
To investigate recent cases, a period of 30 years was selected. This meant that only cases
reported between the years 1989 and 2019 were considered in this report. This was done to
ensure the recency of information and account for changes that have occurred in medical practice
over the years to address similar cases (Shay, & Lafata, 2015). The search for such cases was
narrowed down by concentrating on issues involving ethical concerns and professionalism
between doctors and nurses. As a result, issues touching other stakeholders majorly were avoided
to fine-tune the search and avail as much data as possible. The data with the highest rank was
taken as the cases that resulted in a complete change in the final decision that had been made by
the doctor regarding the patient's treatment. On the other hand, data with the lowest rank was
taken to be the cases that only resulted in a minor argument between the two parties without
affecting the decision initially made and was not escalated to a third party such as a supervisor.
Interviews, reports, and publications were used to provide the necessary data. Both
qualitative and quantitative approaches were used in the analysis of the collected data. The main
search terms applied in this research were: Nurses, doctors, ethics, code of conduct and dilemma.
Boolean operators were also applied in this search as the key search strategies with ethical
standards and professional codes of conduct being used as the main publications.