Respond 1: When working as a nurse practitioner, there may be certain instances

Respond 1: When working as a nurse practitioner, there may be certain instances in which the provider may have difficult, more ethical conversations with a patient. The purpose of this post is to review one of the two presented case studies, discuss the best course of action in response to the concern, and support the given answer.
The case study I have chosen to review is the second case study with Mrs. Jones. In this case study, Mrs. Jones is believed or assumed to have colorectal cancer based on her symptoms; however, she is declining further diagnostic studies, and she does not want her family informed of her present state of illness. As a health care provider, respecting a patient’s decision for any treatment and promoting autonomy becomes a high priority (Kaltenmeier et al., 2020). It is taught in early practice that personal biases should be identified and put aside when providing care. In this case, education would be of utmost importance when approaching the patient and her general wishes. Without compromising patient autonomy or instilling persuasion into the conversation, the nurse should educate the patient on the potential risks and benefits of perusing diagnostic studies or treatment.
Colorectal cancer is highly prevalent in the United States—being the third leading cause of cancer-related death (National Institutes of Health [NIH], 2022). There are numerous risk factors associated with colorectal cancer, but the two factors most prevalent to this case study are age and familial history (NIH, 2022). Mrs. Jones has two children older than 60 years of age. In addition to being older than 55 years of age (increasing age), her two children may be at an increased risk if a first-degree relative has colorectal cancer (NIH, 2022). Although Mrs. Jones wishes to keep her medical concerns from her children, her diagnosis may directly affect her children. It would be incredibly important for the nurse practitioner to educate Mrs. Jones about risk factors and potential concerns. If her children have not already received a colonoscopy or some type of colorectal cancer screening, and they are also at an increased risk due to familial history, they may be—unknowingly—putting themselves at a risk for a disease that could potentially be found in early stages.
Mrs. Jones is 88 years old, and depending on the stage of her colorectal cancer, she may not want to forego treatment. Even still, the nurse practitioner should provide her with all the possible treatments, and potential risks and benefits of any chemotherapy and radiation. Mrs. Jones may continue to decline any treatment. If this is the case, the provider should respect her decision and provide Mrs. Jones with information regarding palliative treatment options. Encouraging Mrs. Jones to involve her family in her decision-making process may help to ease some stress, and it may also prepare her family in the grieving process if or when the disease progresses (Denham et al., 2015). Perhaps with enough education, Mrs. Jones may change her mind on her course of action; regardless, the nurse practitioner should respect her decision.
I have come across a similar scenario in my own nursing practice. In the hospital, I was caring for a 40-year-old female that previously had colorectal cancer. Unfortunately, her cancer returned. At that point, she was married and had two teenage children. She struggled with the decision to tell her children and how to pursue treatment. While her children were not at an age to need screening, there was still an inward struggle for the patient as to when and how she would break the news. She consulted the doctor, and he told her he would be present during the discussion if she so desired. Ultimately, it was the patient’s decisions; however, the doctor provided her with treatment options and helped to develop a plan of action. Her husband brought the children to the hospital, and the physician assisted in delivering the news to her children.
In conclusion, the nurse practitioner may be placed in situations in which uncomfortable and ethical conversations may take place with patients. It is important to provide thorough patient education, but patient autonomy should be respected.
Respond 2: This discussion board post will explore the ethical issues found in case study number two. In the case study, the patient faces serious medical issues with symptoms that point to a potential hemorrhaging cancerous mass in her colon. The patient is showing signs of anemia due to blood loss as well. The patient is refusing all diagnostic tests and refuses to let the APRN notify family of the situation. The main ethical issue at hand is whether you should tell the family against the patients request. The ethical component has to do with violating the patient’s rights while also violating HIPAA. The patient’s mental status must be examined first, as cognitive impairment due to hypoxia related to anemia may be the determining factor to why the patient is refusing all tests. The patient must be alert and oriented to self, date, and the current situation to be able to make decisions for themselves. Implied consent can also be used when a patient is intoxicated, suffers from a debilitating mental illness, is very young or very old, or if there is a language barrier between the patient and provider (Wilson, 2022). I would also determine what the patients code status is and if that plays into her decision making. Ethically, if the patient is of sound mind their wishes should be respected.
In this case, after completing a cognitive screening, I would ensure that the seriousness of the situation was explained to the patient in words that they can understand. If the patient is competent, then I would respect her wishes and have her sign out against medical advice (AMA). If it is determined that the patient is not mentally competent or shows signs of intoxication or confusion, then I would notify the emergency contact or next of kin and explain the situation in full. I believe this situation can be defused with simple communication. Taking the time to explain the risk and the benefits of the recommended tests could help the patient understand the testing procedures and therefore change her mind. I believe that this is the best course of action for this case study.
Please respond to each post. Each post needs at least one source