Ethical and Cultural Considerations in Nursing: A Case Study Analysis

This case study presents a scenario involving a registered nurse caring for a 20-year-old Aboriginal Torres Strait Islander patient with end-stage renal disease (ESRD) undergoing dialysis. The patient, with a prognosis of approximately three months, expresses a desire to return home, leading to ...Read More

Running head: CASE STUDY
CASE STUDY
Name of the Student
Name of the University
Author Note

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CASE STUDY
As I am a registered nurse, I take care of the patients who are under my charge. A new
patient by the name John was admitted in the hospital under my charge. He is a 20 year old
boy from Aboriginal Torres Strait Islander community, which is one of the indigenous
community of Australia. His home is about 500 km away from the hospital he has been
admitted to. He is suffering from end stage renal disease (ESRD) and is currently undergoing
dialysis. The doctors on identifying his disease and the stage it is in, have concluded that he
can survive up to three months approximately because of the severity of the disease.
However, John established that he would be at home rather than the hospital if has only three
more months to live. The doctors have informed him that avoiding the dialysis and other
treatments would shorten the time of three months drastically. In this essay, I will be
discussing about the decisions I took based on the legal and ethical expectations, the way I
provided cultural competent care and my overall reflection of the scenario in details.
Being a registered nurse, it was my duty to provide care for everyone without any fail
and I maintained this objective ever since I started my career. The case of John was declared
to a severe one by the doctors and I took utmost care of him to make him feel comfortable
and continued with the necessary proceedings. When the doctors declared that he would not
live more than three months, John expressed the wish of staying in home for the rest of his
days. Therefore, it made me face a conflict, which was continuously fought between my brain
and my heart. I also faced an ethical and legal dilemma. The health policies that were
designed by various reputed organizations in Australia such as the Nursing and midwifery
Board of Australia (NMBA) and the Australian Charter of Healthcare Rights states with
clearly that the patients has the liberty to choose whether he would avail treatment for a
particular disease or not (Nursing and Midwifery Board of Australia, 2020). The nursing
facility and health care professionals can not force their decisions on the patient (Australian
Commission on Safety and Quality in Health Care, 2020). Keeping this guideline in mind I

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will acknowledge John’s decision. However, knowing the fact from before that John would
not survive even three months if he avoids the treatment, I will present the whole scenario in
front of him again to make him aware of all the reality.
To present the whole scenario, I will choose a moment when his discomforts are at the
lowest point and his mind is in a proper state. I will explain the whole situation and the
current status of his body from the beginning in detail to educate himself of his conditions, as
per the guidelines (Nurse Journal, 2020). Once John can understand and comprehend the
whole situation I will tell him about the advantages of continuing the treatment such as living
for a few more days, doing whatever he has wishes to do and live the moments with utmost
happiness. Then I will explain him the consequences he would face if he decides to withdraw
the treatment. In the process of this discussion, I will evaluate his mental status and the
cultural beliefs he has to act accordingly. I along with the interdisciplinary will also interact
on the grass root level to understand their views. After understanding and confirming their
decision, if they still opt for taking discharge from the hospital, I will take steps to initiate the
discharge procedure. I will also enlighten John and his family about the care that they should
ensure to help John live the last few days comfortably and happily. The decision John took is
nothing unique as most of the articles available in the internet showed that individuals who
have only a few days to live have the tendency to live with the family and rightly so. Though
I do not adhere to the same notion however, I feel the patients definitely have the right to
decide about their future.
I will also maintain the principles of palliative care in providing care to John. One of
the most important principles of palliative care states that quality care and comfort should be
provided to the patient in abundance. I will ensure that he receives the best treatment by
providing training to his family members so that his life at home becomes much more
comfortable than he himself would be expecting. Another crucial principle guideline of the

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CASE STUDY
palliative care is to understand the cultural and traditional beliefs the patients uphold and
respect it (Kelley & Morrison, 2015). Therefore, I will try to understand the cultural,
traditional and social beliefs John has and his family supports. I would also perform some
research on the beliefs the aboriginal Australian upholds and bring the interdisciplinary team
into the picture so that they can also help in understanding the patient’s beliefs and
traditions.. After researching, I will merge the information I received from the internet and
the values I got to know about while taking to John. The most common belief among the
aboriginal Australian community regarding death is the people who talk about death the most
are the ones who die the soonest. Keeping this belief in mind, I will avoid talking much about
death with John as there is a higher chance he also has the same belief. Another popular
belief among the aboriginals is naming the disease increases the duration of the disease, so I
will also avoid calling the disease by name and suggest the team to do the same as well.
Other popular beliefs about death among the aboriginal Australian community include
believing that the soul just leaves the body for few days and would also take another body as
it’s residence; soul never dies and other related traditional beliefs (Department of Health | 11
Older Aboriginal and Torres Strait Islander people, 2020). I will respect all these beliefs John
and his family upholds so that their pain decreases and they get hopes to live the life
(Duggleby et al., 2015). Until he is discharged from the hospital following the rules and
regulations he will be looked after a culturally and medically competent team under myself
including myself, which will also keep John accompanied for basic needs.
As already mentioned in the above paragraph, being a student of pure science and a
practising nurse I do not believe in any of the beliefs that John and his family have. However,
as it is my duty to support and acknowledge beliefs and faiths everyone has I would support
John. I also understand that staying at such a great distance of 500 km from the hospital he
can not stay quite well without the presence of his parents. I will also keep the beliefs I learnt

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about in the my mind to become more efficient in dealing with future similar cases and also
exhibit a varied cultural competency.
Thus, to conclude the paper it can be stated that one of the most important quality
every nurses should exhibit is acknowledging the beliefs the patients have and act
accordingly. It gives me a huge level of discomfort thinking that John will not receive proper
medical treatments during his last days however; it gave me immense happiness that he will
be staying with his family living every moment to the fullest.

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REFERENCES
Australian Commission on Safety and Quality in Health Care. (2020). Australian Charter of
Healthcare Rights | Australian Commission on Safety and Quality in Health Care.
Retrieved 29 March 2020, from https://www.safetyandquality.gov.au/australian-
charter-healthcare-rights
Department of Health | 11 Older Aboriginal and Torres Strait Islander people. (2020).
Retrieved 29 March 2020, from
https://www1.health.gov.au/internet/publications/publishing.nsf/Content/palliative-
agedcare-comm-workerbkt-toc~palliative-agedcare-comm-workerbkt-11
Duggleby, W., Kuchera, S., MacLeod, R., Holyoke, P., Scott, T., Holtslander, L., ... &
Chambers, T. (2015). Indigenous people's experiences at the end of life. Palliative &
supportive care, 13(6), 1721-1733.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England
Journal of Medicine, 373(8), 747-755.
Nurse Journal. (2020). Tips to Improve Patient Education - 2019 NurseJournal.org. Retrieved
29 March 2020, from https://nursejournal.org/community/tips-to-improve-patient-
education/
Nursing and Midwifery Board of Australia. (2020). Code of Ethics for Nurses in
Australia [Ebook]. Nursing and Midwifery Board of Australia. Retrieved from
http://file:///C:/Users/LAPTOP_MP358/Downloads/5_New-Code-of-Ethics-for-Nurses-August-
2008.PDF