Nursing Case Study - A Clinical Reflection

Running head: Nursing Case Study
Nursing Case Study
-A Clinical Reflection
Name of the Student
Name of the University
Author Note

1Nursing Case Study
Introduction:
The nursing profession entails caring for individuals, their family and even
communities in order to achieve, maintain or recover mental and physical well being and
quality of life. It also includes promoting well being, preventing illness, and caring for the ill,
disabled or dying individuals (who.int, 2018). Nursing philosophy therefore is based on
several ethical axioms that ensure respect to human rights (icn.ch, 2018). The ethical codes
include: beneficence, non-malfeasance, fidelity, autonomy, justice and integrity (Shahriari,
Bahrami, Abbaszadeh & Bahrami, 2018). Several dilemmas are caused while trying to
maintain the ethical code of conduct in nursing, and can include issues related to informed
consent, disclosure of medical conditions and incompetence among peers (Cherry & Jacob,
2016; Zahedi et al., 2013). Jie (2015) pointed out that nowadays, nurses face an increased
number of situations of moral dilemma, and this is especially while caring for terminal
patients.
Gibbs Model:
Description of scenario:
The patient Mr X (name withheld to protect patient’s privacy) is a 60 year old
gentleman suffering from aggressive prostate cancer, and was being treated in the oncology
department of a general hospital in Malaysia. The diagnosis was done 5 years ago, however
the patient chose to opt for alternative treatment, and refused medical or surgical intervention.
The patient also did not follow up with any urologist over the last five years and currently the
patient has been diagnosed of anaemia and hypoproteinemia. Subsequent diagnostics showed
the local spread of the cancer to the lymph nodes and metastasis to the bones, while the
primary tumour invaded the bladder, partially blocking the left kidney. Over the last 3
months, Mr X was admitted repeatedly to the hospital, that last admission was after a

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cystectomy that showed more extensive growth of the tumour, after which further surgical
and medical treatment was deemed inappropriate, and the patient was recommended
palliative care. After this, the patient resigned to the fact that he was about to die, and
confided in me about his wish to kill himself, and stop his suffering, and requested me not to
divulge this to anyone else. However, upon serious consideration of the request, and its
consequences, I had to report this incident to my supervisors, after which intervention was
planned for the patient, to help him overcome his emotional trauma. He was provided
palliative care, and stopped showing any signs of suicide attempt. He passed away peacefully
after 2 days of being discharged, in the midst of his family and friends.
Feelings in the scenario:
This was a difficult situation for me, since fulfilling the patient’s wish and being silent
of his plan to end his own life had a serious ethical conundrum. As per Beauchamp & Walters
(1982), ethical dilemma is a situation where an individual has to choose between mutually
exclusive alternatives, while Chally & Loriz (1998) suggested that ethical dilemmas occurs
while choosing between two or more, morally correct but mutually exclusive issues.
In the scenario described above, my moral dilemma was due to conflicting moral
principles. One that dictates respect for beneficence and autonomy of patient’s decisions, and
other that emphasizes on non beneficence, fidelity and integrity. Respecting the wish of the
patient not to divulge his plan of suicide would be in agreement to the principles of autonomy
(respecting patient’s wishes) and beneficence (as the patient feels his suffering can be
stopped only with his death). However, doing so will also jeopardize the principles of Non-
Malfeasance (ensuring no ham is done to the patient, either intentionally or unintentionally),
fidelity (maintaining the virtue of caring) and integrity (ensuring ethical practice is
maintained in nursing care). Also, divulging the wish of the patient can have judiciary