Thursday, April 23, 2015
Case 10: Pain relief & cultural beliefs
Collectively, discuss case 10. Whomever posts first can answer one of the questions, the next person the next question, and so on. Once the questions have been addressed, please (gently) critique them. Make your original post, then follow up on at least 1 of your classmates' posts.
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1.) How should the nurse responsible for Marie's care handle this predicament?
ReplyDeleteI can see two possible ways to handle this situation. One, allow Marie to be taken off of the pain medicine long enough to express, clearly and without doubt, that she wishes to be kept under this pain management regime to her family and other caregivers. After this has been done, find a way to calmly and thoroughly explain to Marie's family what exactly the pain medicine is doing and what it is not doing. The downfall to this situation would be exposing Marie to what I would consider unnecessary pain and suffering.
Two, the nurse must acquire more information about the culture that she is attempting to provide care to, such as the validity of a male family member making decisions about a female family member's care. After such information has been gathered, the situation can be approached with the respect and delicacy that it deserves and may even require bring doctors and lawyers into the mix to insure that all parties were treated appropriately.
While ultimately I believe the nurse should respect the decision of the patient over the concerns of the family, I like your idea of perhaps educating the family. I realize the difficulties given the cultural differences, but attempting to explain to the family the side effects of the medical might help ease their concern. But in the end, I believe the nurse is primarily responsible for the care of her patient, and ethically should not be required to satisfy the family. Her primary duty is to her patient, who has clearly expressed her wishes.
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DeleteI agree that Jean should receive some conformation from the nurse that her mumbling is a typical symptom of the pain medication. Part of the nurse's job is to manage pain. It is a good idea that Marie could be taken off the pain medication until she is able to confirm to her brother that she requested it. However, there may be implications regarding this. Once she is woken up, she could oblige to her brother if in her culture, his opinion is more valuable than hers. Jean could also tell her that it seems like evil spirits were in her and then Marie would possibly become afraid of receiving the pain medication after.
DeleteI think that the idea of taking Marie off the pain medication long enough for her to express her thoughts wouldn't be a terrible idea. Yes she would be in some pain but she would be able to tell everyone what was going on. I am not on a scale what kind of pain she is in. This would be a decision that wouldn't necessarily be right no matter what decision was made. There may not be a right decision at all. There is a decision that has to be made though.
Delete2.) Does the principle of self-determination apply to competent adults regardless of cultural context?
ReplyDeleteYes, I think self-determination does apply to competent adults regardless of cultural context. Self-determination is more of a basic right of human nature. This means that people who are in pain, as Marie is, have the right to make an autonomous decision based between the pain medication leading to altered mental status and the belief from that evil spirits are in her body, or no pain medication avoiding this situation. If it came down to the patient wanting their pain relieved then this is what will be done, whether having to reduce the dose, or even remain with the altered mental status, the individuals choice would overcome the concerns of the family.
I think you are absolutely right that the individuals choice overcomes the concerns of the family. I believe that because we live in the United States that self-determination is a negative right. People have the right to freely control their own lives without the interference of others, including family members. Therefore, her self-determination and autonomy should be respected regardless of cultural context.
DeleteI also agree with you. The fact that the family's cultural belief's caused them to think that the medication brought these spirits into her is irrelevant to the patient's care. In our culture, patients have a right to autonomy and self-determination. While the family may have concerns based on their cultural beliefs, the patient competently made a decision to be put on pain medication, a choice which the patient has the right to make This right should be respected, as it precedes the cultural beliefs of the family.
DeletePeople have the right to be able to make decisions for themselves. This is hard when the feelings about families come into the picture. Self-determination and autonomy should be respected no matter what. This can become an issue when dealing with kids. When is the right state of mind and age that children are able to make decisions for themselves.
Delete3.) Would continuing to administer pain medication to Marie entail a failure to respect the religious beliefs expressed by Jean?
ReplyDeleteThe possibility of failing to respect the religious beliefs of this family depends upon whether or not a male family member is supposed to make the medical decisions for the female. If this belief is apart of the religion, then I do think that continuing pain medication would be disrespecting their religious beliefs. However, i believe that the patient's autonomy shoukd be put first. If the patient was properly informed of the medicine she was going to receive and the possible side effects it could have, she was then able to take in to account her religious beliefs and still wanted to receive the medicine.
I agree. I recognize the importance of taking other people's cultural beliefs into consideration, but when the patient has specifically and competently requested pain medication, the right of the patient to self-determination is put before the concerns of the family. Even if the family's culture involves men making medical decisions, she is in the United States, and here patients, whether men or women, have a right to autonomy, and therefore are able to make their own medical decisions. These decisions, such as Marie's decision to be put on pain medication, must be respected over the concerns of the family based on their cultural beliefs.
DeleteI totally agree with you Amanda. I also believe that the failure to respect the religious beliefs expressed by Jean depends on who makes the medical decisions for the family. I also believe that it should be up to the patient to make their own decisions.
DeleteAmanda,
DeleteI completely agree with you. If the patient is fully informed on what is happening and what the medication is doing for her then her wished should be granted. I know that the male might feel betrayed but upon the informed consent of the sister, wouldn't that be an issue the family has to work out together? There are plenty of people in today's society that don't believe everything their religion or beliefs tell them is the right thing. Maybe this is one of those circumstances with Marie.
I feel you answered this very appropriately, respecting the individuals religious beliefs and culture while also making the patients autonomy the primary component. Like you said if she is properly informed and she has the opportunity to reflect on it then we are not failing to respect her religion, we are simply abiding by her request and reassuring Marie and her family that it is the medication altering her mental status.
ReplyDeleteI agree with what everyone who posted an original answer to the questions. I believe that the nurse needs to figure out if the male family member makes decisions for the females of his family. That is major factor of whether the distribution of the pain medication continues. Another major thing would be to educate the family on the side effects and what the pain medication is doing to help Marie. After the family is educated and their opinion doesn’t change, it could be beneficial if they did stop the medication in order for Marie to come to and explain to her family that she chose to get the medication. Only problem would be that it would be putting Marie back into pain and after administering the medicine the pain becomes unnecessary.
ReplyDeleteI agree with previous statements and opinions. I believe the nurse responsible for her care should first look into all options for the patient. She should get to know her culture, while listening to her patients wants and making the family comfortable with the care being given. Autonomy of the patient would be the first thing I would take into consideration. With being a nursing student myself I think one of the hardest things is being open to all possibilities while trying not to give too much of your own input, even with patients in this position. In this case you have to ask yourself if respecting the wishes of Jean or Marie is more appropriate.
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