Nursing Practice Ethical Dilemmas Essay

Nursing Practice Ethical Dilemmas Essay Nursing Practice Ethical Dilemmas Essay I need help with a Writing question. All explanations and answers will be used to help me learn. 1. Provide a brief introduction of the selected film that includes a title, year released, genre, and main theme. (the film selected is “June”) 2. Provide a one paragraph summary of the selected film. 3. Identify and discuss the ethical issue(s) identified in the film. 4. Define each of the four ethical principles: autonomy, non-maleficence, beneficence, and justice. Provide examples from the film that relate to each relevant principle. 5. Compare the film’s portrayal of the issue to current legal and ethical issues in the practice of professional nursing. 6. Evaluate the impact of the ethical issue(s) portrayed in the film on the nursing profession. 7. The scholarly paper should be 4-5 pages excluding the title and reference page. Nursing Practice Ethical Dilemmas Essay 8. Include an introductory paragraph, purpose statement, and a conclusion. 9. Include level 1 and 2 headings to organize the paper. 10. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used. The exception to this rule is if/when you do the reflective piece as it relates to your position (values) at the end. 11. Include a minimum of (4) professional peer-reviewed scholarly journal references to support the paper (the articles ar attached at the end). 12. APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations). too_much_too_soon.pdf bundles.pdf abortion.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Nursing Practice Ethical Dilemmas Essay. 838344 APY Australasian PsychiatryGhosh et al. Australasian Psychiatry Perinatal psychiatry “Too much too soon, let me out of here!” Psychiatric and obstetric implications of a child’s pregnancy Australasian Psychiatry 2019, Vol 27(2) 129­–131 © The Royal Australian and New Zealand College of Psychiatrists 2019 Article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/1039856219838344 DOI: 10.1177/1039856219838344 journals.sagepub.com/home/apy Sunanda Ghosh Senior Staff Specialist, Redcliffe and Caboolture Child and Youth Mental Health Service, Metro-North Mental Health Service, Caboolture, QLD, Australia George Bruxner Senior Staff Specialist and Clinical Lead Consultation-Liaison Psychiatry Service, Redcliffe and Caboolture Hospitals, Metro-North Mental Health Service, Caboolture, QLD, Australia Alka Kothari Senior Staff Specialist, Obstetrics and Gynecology, Redcliffe Hospital, Caboolture, QLD, and; Conjoint Site Coordinator, Northside Clinical School, Faculty of Medicine, University of Queensland, Redcliffe, QLD, Australia Abstract Objective: Psychiatrists may become involved in circumstances where a child is seeking termination of pregnancy. Potential roles include capacity advice and advocacy, but ethical and legal uncertainties abound. This paper uses illustrative cases, in an Australian jurisdiction, to exemplify the issues. Conclusion: Termination of pregnancy at the youthful extreme raises unique challenges for all involved. Keywords: capacity, consent, teenage pregnancy, ethics, law T ermination of pregnancy is a procedure performed to discontinue a pregnancy. The risks and benefits of proceeding with a termination, as well as alternative options, should be comprehensively discussed with the patient.1,2 Termination is a very personal and difficult decision and the surrounding circumstances may be socially and legally complex, especially when striving to provide the best possible care when the patient is a minor. Despite the rate of teenage pregnancies falling in Australia, a significant number of very young women fall pregnant (0.8% under the age of 15 years).3 Obstetric risk is highest for this subgroup, and the capacity to make complex life decisions may be most uncertain. Overall, teenage mothers are nine times more likely to have a lower socioeconomic status and approximately a quarter of these are of Indigenous origin.3 To further complicate matters, laws relating to the legality of termination of pregnancy vary considerably within and between countries. Presently, a total of 57 countries permit an abortion to protect a woman’s life and health.4 On October 17, 2018, the Queensland Parliament passed the “Termination of Pregnancy Bill” decriminalising abortion.5 As clinicians working in Queensland, the authors have experienced a complex clinical and legal environment where abortion remained a potentially criminal offence. They aim to describe the additional challenges of working within this complex e­nvironment. Even in j­urisdictions where termination of pregnancy is not criminalised, similar challenges to decision-making processes will present themselves. This is especially the case in situations where medicolegal issues, such as capacity to consent, are not always clear. Although local guidelines exist to assist clinician’s decision-making with respect to minors, each situation may be unique, and frequently ethically and emotionally challenging, with no clear course of action. The following hypothetical cases (derived from actual clinical situations) are being used to illustrate some of these problems. Case 1 Patient A, a 13-year-old girl requesting termination of an 11-week-old foetus is referred to the Obstetrics clinic. She conceived after a single date, shortly before she moved to live with her grandmother two months ago. She has no contact with her biological parents, and has moved homes several times in the past two years. She is Corresponding author: Sunanda Ghosh, Redcliffe and Caboolture Child and Youth Mental Health Service, Metro-North Mental Health Service, 12 King Street, Caboolture, QLD 4510, Australia. Email: sunanda.ghosh@health.qld.gov.au 129 Australasian Psychiatry 27(2) keen to live with her grandmother, who cannot support another child. Patient Nova Southeastern University Nursing Practice Ethical Dilemmas Essay A hopes to get her life “back on track”. She states that if the pregnancy cannot be terminated, her life will not be worth living. Case 2 Patient B is 12 years old, and presents at 12 weeks’ gestation. She initially requests termination of pregnancy, but withdraws her request when asked to meet the hospital psychiatrist, and represents to the clinic the following week. She has experienced a previous miscarriage. Patient B was interviewed by the police after she disclosed sexual abuse by a family member. Discussion Deciding on the fate of a teenage pregnancy is a complex individual decision-making process.6 Legal constraints may limit the person’s right to autonomy – the ability to make her own choices to accept or refuse a medical intervention. The following paragraphs summarise some of the factors impinging on legal access to termination. Capacity to consent: a child with the ability to make reasoned decisions regarding his or her own healthcare is deemed to have Gillick Competence.7 An individual’s capacity to consent can be variable, due to a number of factors including the emotional and intellectual maturity of the child, as well as the child’s social environment.8 Patient B’s ambivalence about having an abortion does not confirm a lack of capacity to consent. Legal and medical standards may offer conflicting guidelines about the roles of minors in medical decision-making.8 While the law may recognise that mental capacity is a continuous quality that may be present to a greater or lesser extent, legal competence is akin to a more absolute state where a person is either entitled, or not entitled, to have their requests for medical interventions upheld by law.9 The scope of consent is always decision-specific, with a higher “bar” for decisions of most consequence – in this case, about a child’s decision to not bear a child. Capacity also requires a degree of mental soundness. The two patients, undergoing physiological and biological changes associated with pregnancy, along with their ongoing personal and social uncertainties, are vulnerable to emotional deregulation and ambivalence. Any assessment at this stage is likely to be influenced by clinically informed probabilities open to subjective interpretation. Having the ability to make decisions freely and voluntarily is another legal aspect of capacity. Several factors could impact on our patients’ decision-making ability. Patient A may be influenced by her circumstances, such as inconsistencies with her living arrangements and a desire for more stability. Patient B may be in contact with multiple people, including child safety authorities, social workers, police officers, obstetricians, psychiatrists and paediatricians. She may also undergo several assessments using various interviewing techniques over a short period of time. This may 130 have an impact on her decisions regarding pregnancy.10 Patient B’s ambivalence may imply a desire to avoid another complex, potentially traumatising assessment. The clinical setting in which a patient is examined may also lead to difficulties. Young people may resent being seen in a paediatric setting when they are taking part in a more mature decision-making process. Others may feel coerced into accepting the pregnancy due to the emotional impact of being seen in an antenatal clinic surrounded by posters on pregnancy, child birth and breastfeeding. The choice of an appropriate decision-making clinician with possible roles for obstetricians, mental health professionals, psychiatrists, social workers and paediatricians is challenging. It is feasible that the clinician attempting to determine suitability of termination of pregnancy may be less familiar with the young woman than other healthcare professionals, such as a private practitioner not attached to the hospital. One of the authors of this paper has reflected upon the emotive challenges of working with this population, specifically walking the boundary “tight-rope”, maternally identifying with and providing care for a teen or preteen girl and at the same time respecting the child’s autonomy. Nova Southeastern University Nursing Practice Ethical Dilemmas Essay Psychological, social and economic considerations: while the criteria for legal termination of pregnancy have recently been liberalised in Queensland for gestations up to 22 weeks, the criteria for late termination remain stringent, requiring consideration of “all relevant medical circumstances” and “ the woman’s current and future psychological and social circumstances” and, therefore, a second concurring opinion is required.11,12 While these considerations have greater legal importance in requests for late termination, they remain important in capacity considerations in a young woman at any gestation, specifically the evaluation of whether she has a reasonable understanding of the ramifications of her decision.13 In jurisdictions, where the legal status of termination remains unclear, delays are possible as wary clinicians are likely to defer decision-making to the courts.13 Non-maleficence: compared to cosmetic surgery, which might be deemed lawful based on an underage girl’s consent,7 abortion is more likely to be viewed as grievous assault, particularly in jurisdictions where abortion has not been decriminalised. Research on the effect on women who were declined a request for abortion indicates that women who receive a wanted abortion are better able to aspire for the future than those who are denied an abortion.14 Denial of request for termination may also be associated with a greater risk of initially experiencing adverse psychological outcomes.15 Given the dynamic nature of risk, clinicians may not be in a position to positively determine that declining Patient A or B’s request will not increase the risk of harm to either the patient, the unborn child or the wider community. An underage pregnant woman may also want to avoid loss of moral standing, social exclusion and bullying, which might be prevalent in some communities. In capacity considerations, the clinician needs to carefully view personal perspectives of the young woman faced with a difficult life decision. Ghosh et al. Beneficence: clinicians are sometimes placed in an invidious position. Their ethical obligation is to act in the interests of the patient, recognising the potential loss in moral standing and the risk to the young woman’s health and safety. This may be even more evident if her justifiable request for a termination is denied. Patients A and B’s individual preference for requesting abortion may conflict with the interests of a particular community in relation to prevailing religious and family values. This conflict may trigger protests and, in some jurisdictions, even legal action from certain community groups. These factors are likely to weigh heavily on the clinical decision-making process. Disclosure Justice: this raises the concept of fairness and equality. While changes to the Queensland criminal code should avoid the need for young women to travel interstate to seek terminations, laws in other states, such as New South Wales, are still likely to lead to medical tourism.16 A survey of women of reproductive age in Australia suggests that over half of them (51%) have an unplanned pregnancy.17 For adolescents, the birth rates are considerably higher in poor, uneducated and rural communities.18 Women under the age of 30, as well as those from a lower socioeconomic background, perhaps including Patients A and B, are less likely to access long-term contraception.1 Such patients are also less likely to travel to other states at great cost to undergo a termination of pregnancy. In jurisdictions restrictive of terminations, illegal and unsupervised importation and ingestion of abortion-inducing medication is also more likely.1 Alka Kothari Later regret: patients A and B may eventually regret their decision to have an abortion. Doctors providing termination of pregnancy bear the risk of litigation and, therefore, prefer to follow guidelines and evidence-based practices in such situations. Clinicians may be somewhat reassured by a small number of studies suggesting a lack of evidence of a link between termination and adverse mental health outcomes.19 Teenage pregnancy increases the risk of adverse birth outcomes independent of confounders such as socioeconomic status, inadequate prenatal care and insufficient weight gain during pregnancy. Nova Southeastern University Nursing Practice Ethical Dilemmas Essay 3 Recommendations The involvement of the clinician in the decision-making process relating to a minor’s request for termination of pregnancy can be ethically, legally and emotionally fraught. While there may be some guidelines to assist, it is likely there will not always be a clear course of action. As always, a multidisciplinary approach and the advice of experienced colleagues should be sought. While not providing any solutions, the authors have endeavoured to outline principles and pitfalls that may be of some a ­ ssistance to the clinicians involved in this potentially challenging situation. Acknowledgements The authors would like to acknowledge and thank Anoushka Kothari (medical student, James Cook University, Queensland, Australia) for editing the manuscript and Jane Orbell-Smith (Health librarian, Redcliffe and Caboolture Hospitals, Queensland, Australia) for assistance with the literature search and data management. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. Funding The authors received no financial support for the research, authorship, and/or publication of this article. ORCID iDs Sunanda Ghosh https://orcid.org/0000-0002-0290-8501 George Bruxner https://orcid.org/0000-0002-6961-0902 https://orcid.org/0000-0002-9816-3734 References 1. World Health Organization. Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2008. 6th ed. Geneva: World Health Organization, 2011, p.66. 2. World Health Organization. Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: World Health Organization, 2012. 3. Australian Institute of Health and Welfare. Teenage mothers in Australia 2015. Cat. no. PER 93. Canberra: AIHW, 2018. 4. Finer L and Fine JB. Abortion law around the world: progress and pushback. Am J Public Health 2013; 103: 585–589. 5. Children by Choice Assoc. Queensland Abortion Law, https://www.childrenbychoice.org. au/factsandfigures/queenslandabortionlaw (2018, accessed 20 November 2018). 6. Hoggart L. ‘I’m pregnant … what am I going to do? ’ An examination of value ­judgements and moral frameworks in teenage pregnancy decision making. Health Risk Soc 2012; 14: 533–549. 7. Skene L. Citizen child: Australian law and children’s rights. Australian Institute of Family Studies. Melbourne: Australian Institute of Family Studies, 1996. 8. Kuther TL. Medical decision-making and minors: issues of consent and assent. Adolescence 2003; 38: 343–358. 9. Buchanan A. Mental capacity, legal competence and consent to treatment. J R Soc Med 2004; 97: 415–420. 10. Krähenbühl S and Blades M. The effect of interviewing techniques on young children’s responses to questions. Child Care Health Dev 2006; 32: 321–331. 11. Queensland Clinical Guidelines Queensland Government, Maternity and Neonatal Clinical Guidelines: Therapeutic termination of pregnancy. Brisbane: Queensland Health, 2018, p.30. 12. Queensland Government and Clinical Excellence Division. Termination of pregnancy in Queensland information for health practitioners. Brisbane: Queensland Health, 2018. 13. Douglas H and de Costa CM. Time to repeal outdated abortion laws in New South Wales and Queensland. Med J Aust 2016; 205: 353–354. 14. Upadhyay UD, Biggs MA and Foster DG. The effect of abortion on having and achieving aspirational one-year plans. BMC Womens Health 2015; 15: 102. 15. Biggs M, Upadhyay UD, McCulloch CE, et al. Women’s mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study. JAMA Psychiatry 2017; 74: 169–178. 16. de Costa CM and Douglas H. Abortion law in Australia: it’s time for national consistency and decriminalisation. Med J Aust 2015; 203: 349–350. 17. Marie Stopes International. Real choices: women, contraception and unplanned pregnancy. Melbourne: Marie Stopes International, 2008, p.15. 18. Loaiza E and Liang M. Adolescent pregnancy: a review of the evidence. New York: UNFPA, 2013, p.58. 19. Foster DG, Steinberg JR, Roberts SC, et al. A comparison of depression and anxiety symptom trajectories between women who had an abortion and women denied one. Psychol Med 2015; 45: 2073-2082. 131 557086 research-article2014 QHRXXX10.1177/1049732314557086Qualitative Health ResearchMollborn and Sennott General: Article Bundles of Norms About Teen Sex and Pregnancy Qualitative Health Research 2015, Vol. 25(9) 1283­–1299 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732314557086 qhr.sagepub.com Stefanie Mollborn1 and Christie Sennott2 Abstract Teen pregnancy is a cultural battleground in struggles over morality, education, and family. At its heart are norms about teen sex, contraception, pregnancy, and abortion. Analyzing 57 interviews with college students, we found that “bundles” of related norms shaped the messages teens hear. Nova Southeastern University Nursing Practice Ethical Dilemmas Essay Teens did not think their communities encouraged teen sex or pregnancy, but normative messages differed greatly, with either moral or practical rationalizations. Teens readily identified multiple norms intended to regulate teen sex, contraception, abortion, childbearing, and the sanctioning of teen parents. Beyond influencing teens’ behavior, norms shaped teenagers’ public portrayals and post hoc justifications of their behavior. Although norm bundles are complex to measure, participants could summarize them succinctly. These bundles and their conflicting behavioral prescriptions create space for human agency in negotiating normative pressures. The norm bundles concept has implications for teen pregnancy prevention policies and can help revitalize social norms for understanding health behaviors. Keywords adolescents, pregnancy / parenting; sexuality / sexual health; sociology; young adults Teen pregnancy receives widespread attention as a social problem in the United States. It is an object of fascination in the media and represents a cultural battleground in power struggles over morality, sex education, abortion, and the traditional family (Fields, 2008; Luker, 1996; Schalet, 2011). At the heart of these debates, and of adults’ struggles for control over teenagers’ bodies and sexual behaviors, are social norms about the acceptability of teen sex, contraception, pregnancy, and abortion. We conceptualize social norms as group-level expectations for appropriate behavior that result in negative sanctions for people who violate them (Settersten, 2004). Norms against teen pregnancy are prevalent among U.S. adults (Cherlin, Cross-Barnet, Burton, & Garrett-Peters, 2008; Mollborn, 2009). Similarly, many teenagers strongly believe that a pregnancy would be a bad idea and would be embarrassing (Bruckner, Martin, & Bearman, 2004; Mollborn, 2010). However, despite recent declines, more than 1 in 7 girls are projected to have a teenage birth (Martin, Hamilton, Osterman, Curtin, & Mathews, 2013). Teen pregnancy is thus an interesting empirical case for studying social norms. The loose link between norms and behavior has driven many sociologists of culture to abandon the … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10