July 2019

What would you do?

The following scenario demonstrates your accountabilities when your personal beliefs conflict with a patient’s beliefs.

Carmella, a nurse, recently started working in an intensive care unit. George, her patient, has been in a coma for several months. George’s family is requesting his breathing and feeding tubes be withdrawn and George be allowed to die. They feel he would not want to continue living like this. Carmella is very upset about this. This decision does not align with her personal beliefs. She feels uncomfortable with her role in this care plan, and wonders if she is required to provide care when the patient’s care plan conflicts strongly with her beliefs.

What should Carmella do?

Carmella realizes she needs to determine what her nursing accountabilities to George and his family are. Since the Code of Conduct is an overarching practice standard, she checks the Code first. Carmella sees that the Code states nurses show respect to patients’ culture, identity, beliefs, values and goals (statement 1.2). It also states that nurses do not impose their personal beliefs, including political, religious and cultural, on patients (statement 1.7). She also reads that when a nurse’s beliefs conflict with a patient’s care plan, the nurse provides safe, compassionate and timely care to those patients, until other arrangements are in place (statement 1.8).

Carmella understands that although she disagrees with George’s family’s decision, patients are always entitled to nonjudgmental nursing care. She spends time reflecting on her personal values and whether or not she will be able to provide nonjudgmental care to George and his family. Carmella soon realizes her beliefs will prevent her from meeting her accountabilities as a nurse.

Carmella consults with her charge nurse and her manager and explains that her beliefs conflict with George’s care plan. She tells them she is concerned she is unable to provide the compassionate nursing care George is entitled to. She asks if another nurse can be assigned to his care.

Carmella then consults with George’s health care team, including his physician and social worker, and informs them she can no longer care for George.

During her shift, while deciding what to do and consulting the health care team, Carmella continues to treat George’s family with care and compassion. She spends time actively listening and giving them the opportunity to describe their feelings about the situation.

Later in the shift, the charge nurse assigns George’s care to another nurse who is better able to provide the care George needs. Carmella respectfully informs the family that she will no longer be caring for George and that her colleague will be taking over his care. Carmella then transfers accountability to the other nurse by giving them a report about George’s status and needs.

Carmella spends time reflecting on the situation, her practice and values. She realizes that she will likely encounter similar situations again while working in intensive care. She wonders if working in this setting long term will allow her to be true to her values while still providing compassionate and nonjudgmental care. Carmella reviews the Ethics practice standard and reflects on the section about maintaining commitments to herself, her team and her patients. After reflecting, she realizes this practice setting is not for her, and she makes the decision to find a new place of work.

You can learn more about the Code at www.cno.org/codeofconduct.

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