#1. Yes, in a case like this we all draw away some. It is the way we defend ourselves. Personally in a case like this, we all have our secret worries and it is easy for them to slide to the surface as we care for this type of patient. This however, helps us empathize with the patients and the family. It brings some of the knowing that we have from dealing with other patients to this patient. This kind of case has a way of immersing the nurse in the patients care. There is also empowerment here as the nurse becomes empowered to care for this patient on several levels. The nurse must use emancipatory caring in allowing this patient to take some of this power for herself (Chitty & Black, 2002).. A middleground must be found for both the patient and the nurse as certainly neither will feel that there is justice in this case at all.
#2. Dealing with a physician that is not forthcoming with a patient is truly difficult. Only experience can help you deal with this. It happens more often than most would believe. Empirical knowing is important here as it allows one to use the knowledge gained from experience with previous issues like this to solve this one. Certainly a short discussion with the physician is important before approaching the patient and family but it is important to advocate for the patient. While doing that though the nurse must remember that the physician may have a very good reason for what he has done.
#3. The aesthetic way of knowing should help in understanding the patients situation no matter where they are. In seeing a patient as a whole person one should be able to separate the equipment or the environment from the patient and that patients needs. Aesthetic ways of knowing allows one to understand that there is a difference between the technical acts and procedures and the patient themselves. (Zander, 2007).
#4 Emancipatory. What can be done to assure that the patient meets his needs of work as well as his needs for dialysis? This posting was very interesting in the fact that this nurse was able to understand the needs of the charge nurse as well as the needs of the patient. Did this happen because she was in some ways separated from the everyday demands of this unit or was this because she had a good understanding of emancipatory knowing? In my opinion, the patient can still not be late to his dialysis appointments as it affects far more people than himself. There definitely needs to be a schedule change of some kind so everyone that needs it can be accommodated. As a casemanager there have been many times when it would have been easier on my conscious if I could have set one single patient up for treatment when it was best for him but one has to consider all of the needs of everyone.
Ethics. Is it the charge nurses responsibility to try to figure out why someone is not showing up for treatment? It is important to know that this man had a good reason at least in his own right he did. However, is this something that can be allowed to impact everyone. Ethically, the right decision is the one that is right for the most not the least. We cannot choose to do what we think is right for one over the others (Childress & Beauchamp, 2002). I can think of a time when I had a patient that was in need of having medications that he could not pay for. He was 35 and smoked regularly, in fact, he went outside the hospital quite a bit to smoke. Another patient on the floor also needed help and did not smoke. I could only help one with the funds and I chose the one who did not smoke, not because of the smoking but because of the funds he spent on them.
Personal Knowing. Are his personal needs for praise and personal help greater than the needs of the patients that must wait for him because he is late? I understand what you are saying but somehow we must come up with a compromise. The patient cannot come to that time slot on time so a different time slot must be used both for his health and the health of others. If he does not want to change, even though he is doing a good thing in having a job, the good thing is for him and you must consider everyone. I think under these circumstances and what I have dealt with in the past that this patient does need extra support but it probably needs to happen outside the dialysis unit. He must be compliant with dialysis for everyone's need but it is within our need to help the patient to also see that he has someone to support him.
Childress, K., Beauchamp, J. (2002). Principles of Biomedical Ethics 5th ed. Cavalier:
Chinn, PL & Kramer, L. (2008). Integrated theory and knowledge development in nursing (7th
ed.). St. Louis, MO. Mosby.
Chitty, K & Black, B. (2007). Professional Nursing, Concepts & Challenges 5th ed. Saunders &
Elsevier: St Louis.
Zander, P. (2007). Ways of knowing in nursing: the historical evolution of a concept. Journal of
Theory Construction and Testing. 11(1). 7-11.