Model for Clinical Analysis of Clinical Cases 1

Seminar presentation
DEBRE BIRHAN UNIVERSITY
ASRAT WOLDEYES HEALTH SCIENCE CAMPUS
SCHOOL OF NURSING AND MIDWIFERY
Department of Pediatric and Child Health Nursing
Course: -Ethico-Legal Issue in Nursing

Submitted to:- Instructor Kasa (Assistant Prof.)

Prepared by:- Demessie Yimer (BSC )
ID:- DBU1700155
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Outline

 Objective

 Model for Clinical Analysis of Clinical Cases

 Ethical decision making of Nursing Process

 Summary

 Reference
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Objectives

After completing this topic Participants:

 will list models and know approach of clinical analysis in clinical cases .

 list moral dimension of each model and able to ask question to address
ethical aspects.

 knows step of Ethical decision making process in nursing care.

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Model for Clinical Analysis of Clinical Cases

 Ethics is not added to a clinical case by injecting into it, but is arises out
of the facts and values imbedded in the case itself.

 Clinical decision-making involves a multi-dimensional approach that

integrates 4 models

 Medical Indications

 Patient Preferences

 Quality of life considerations.

 Contextual/related/features surrounding the case

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Cont..

 So the models outlines key components to consider during clinical

analysis.

1. Medical Indications

 Clinical reasons for providing specific treatments or interventions, driven

by the patient’s medical condition, and available evidence-based

treatments.

 Moral dimension- Beneficence and non-maleficence

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1. Medical Indications…

Question to be addressed

 What is the patient's medical problem? History? Diagnosis? Prognosis?

 What are the goals of treatment and probabilities of success?

 How can this patient be benefited by medical and nursing care, and how

can harm be avoided?

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1. Medical Indications…

Key Considerations

 Diagnosis and Prognosis:-Understanding the underlying disease or

condition and its progression.

 Treatment Options:-Consider evidence-based practices, standard

guidelines.
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1. Medical Indications…

 Risks and Benefits:-Assess the potential benefits of interventions

(e.g., symptom relief, life extension) versus possible harms (e.g., side

effects, complications).

 Expected Outcomes:-A positive response to the intervention, and

what is the goal of treatment.

2. Patient Preferences 9

 It is to the values, desires, and choices expressed by the patient

regarding their care.

 Moral dimension- Respect for Patient Autonomy

 There are also Question to be raised to address patient preferences with

respecting patient autonomy.

2. Patient Preferences 10

 Is the patient mentally capable and legally competent?

 Has the patient been informed of benefits and risks, understood this

information, and given consent?

 If incapacitated, who is the appropriate surrogate? •

 In sum, is the patient's right to choose being respected to the extent

possible in ethics and law. (Refer Dax’s case)

2. Patient Preferences 11

Key Considerations:

 Informed Consent: After the patient understands the diagnosis,

treatment options, risk/benefits of each option.

 Cultural and Religious Beliefs: Influence their preferences for care.

(preference for alternative, refusal of certain treatments).

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2. Patient Preferences..

 Capacity to Make Decisions :-Assess if the patient is cognitively

able to make informed decisions, and if not, determine if a surrogate

decision-maker or legal proxy is necessary.

 Approach must be Engaging in open, empathetic conversations with the

patient and family

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3. Quality of Life Considerations

 Overall well-being of the patient, encompassing physical, emotional,

psychological, and social element.

 Moral dimension- Beneficence, Non-maleficence, and Autonomy

 What are the prospects, with or without treatment, for a return to

normal life? And physical, mental, and social deficits the patient likely to

experience if treatment succeeds?

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3. Quality of Life Considerations
 Any injury or illness threatens persons may lead to actual or potential
reduced quality of life.

Key Considerations

 Physical Well-being:-The impact of the disease and treatments on

physical function (e.g., pain)

 Psychological Well-being:-The emotional and mental health aspects

of care, including coping abilities.

4. Contextual/related/features 15

surrounding the case.

 Persons, institutions, financial, and social arrangements have positive or

negative influence on the patient care/interest of others.

 These decisions have psychological, emotional, legal, financial, scientific,

educational, religious impact on others.

 Moral dimension- Loyalty, Fairness ,justice and rights of various

participants.
4. Contextual/related/features
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surrounding the case.

 Are there family issues that might influence treatment decisions?

 Are there provider (physician, nurse) issues that might influence

treatment decisions?

 Are there financial and economic factors?

 Are there religious or cultural factors?

 Are there limits on confidentiality?

 How does the law affect treatment decisions?

4. Contextual/related/features
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surrounding the case.

Key consideration

 Socioeconomic Factors: Patient’s access to resources like medications,

specialists, transportation, and financial support for treatment.

 Family and Social Support: The presence or absence of supportive

caregivers and family members

 Cultural and Community Context: How the patient’s cultural background

or community settings may influence their care choices.

4. Contextual/related/features
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surrounding the case.

 Legal/Institutional Constraints: Hospital policies, insurance

limitations, or legal considerations .

 Environmental Factors: Living conditions (e.g., home environment,

proximity to healthcare facilities) and the patient’s ability to manage

treatment in their environment.

The Ethical Decision Making Process
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(Nursing Process base)

 Nurses by definition are problem solver.

 One of the important problem solving tool is the nursing process.

 The goal of ethical decision making process is to enable nurses to

determine right or wrong in situations without clear demarcation.

 There are five steps of Ethical Decision Making Process in nursing

process
The Ethical Decision Making Process
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(Nursing Process base)

1. Collect, Analyze, and Interpret the data.

 Patient and family wishes, extent of physical and emotional problems

causing the dilemma.

 Understand how mentally competent the pt. is to make a decision

2. State the dilemma. Reduce the dilemma into a statement of one or

two that resolves around the key ethical issues.

 Patient wishes is the first to be considered.

The Ethical Decision Making Process
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(Nursing Process base)

3. Consider the Choices of Action.

 List all possible courses of action that can resolve the dilemma without

considering their consequences.

 Brainstorming activity in which all possible course of action are

considered

 Avoid dealing with the situation

The Ethical Decision Making Process
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(Nursing Process base)

Options

 Report the problem to the supervisor.

 Attempting to clarify the question with the family.

 Attempting to clarify the question to the patient.

 Confronting the physician about the question.

The Ethical Decision Making Process
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(Nursing Process base)

4. Analyze the advantage and disadvantages of each course of

action.

5. Make decision - the most difficult part.

 Ethical dilemmas produce different opinions.

 The best decision is based on sound ethical decision making process.

The Ethical Decision Making Process
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(Nursing Process base)

 Patient's wishes will always supersede independent decisions.

 Collaborative decision-making is the ideal and tends to produce

fewer complications on the long-term resolution that involves patient,

physician, nurse and family.

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Summary

 The document provides a framework for clinical analysis and ethical

decision-making, by integrates four model for clinical analysis, and a

five-step ethical decision-making process:

 Medical Indications focuses on the patient's medical problem, treatment

goals, and how to avoid harm where as Patient Preferences prioritizes

patient autonomy, and informed consent, addressing the patient's values,

desires, and choices.

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Summary

 Quality of Life Considerations addresses the patient’s overall well-being,

and prospects for return to a normal life.

 Ethical Decision-Making Process: The process involves collecting

and analyzing data, considering patient and family wishes, and analyzing

possible courses of action. Patient wishes are paramount, and

collaborative decision-making is ideal.

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Reference
1. Ethical Decision Making in Medicine: Principles, Process, and
Perspectives Beauchamp, T. L., & Childress, J. F. (2019). Principles of
Biomedical Ethics (8th ed.). New York: Oxford University Press.

2. Gillon , R. (2003). Ethics Needs Principles Four Can Help. BMJ,

327(7425), 184–185.