Case One:

A young woman with a communicable disease is refusing treatment, even though she self admitted to the hospital. You are her nurse and have been told by the previous shift that she is noncompliant and attention-seeking. How do you approach this situation? What are your personal ethics on noncompliant patients? What are your personal ethics on patients who may be contagious and are requiring extra attention?

Professionally, you are obligated to provide the same standard of care to each patient. This is an in-the-moment perspective. If she is going to comply at discharge is not your current concern. Your current focus should be on getting her to trust the staff and the situation enough to accept the treatment being offered. She must have had something critical enough to her comfort level to have brought her to your facility to begin with, start there. The scenario has personal judgment from the previous shift. Try not to let that cloud your professional vision. Be wary of patients who may attempt to “split staff” based on those judgments. If she continues to refuse treatment, be sure to inform the physician so that he can change his plan of care. Document your efforts and outcomes using professional, objective language.

Case Two:

An elderly man has been admitted to the unit with a GI bleed. He admits to daily alcohol consumption. He is dirty and gruff. He will need several blood transfusions. You are a faithful blood donor to the American Red Cross.
Does this set up a dilemma for you? Have you heard other nurses say that they don’t donate blood because of patients “like him”? Are you able to be empathetic and compassionate with this patient?

Professionally, you can bring in the team for this patient once he is no longer in crisis. Finding the teachable moments can make the difference. Is this patient depressed? Many elderly are depressed and have turned to alcoholism. Finding a treatment modality for this patient could change his life. Enlist the help of your social worker. Remember in nursing school when they discussed reminiscing language? This patient could benefit from reminders of past achievements and moments of his personal growth. The chaplain services would be a perfect fit for someone who needs this kind of therapeutic touch. Does this patient have self care deficits? Could this be contributing to his feelings of sadness and anger? Perhaps an occupational therapy consult could help him find alternative ways to accomplish his ADL’s. Remind yourself why you donate blood. It is to save lives. Whether you choose to improve those lives through nursing interventions is the ethical challenge.