Effective communication is one of the most critical skills nursing professionals can apply in their line of work. Understanding key communication concepts, such as genuineness and confirmation, can help mediate conflict and provide for more optimal patient care. Using effective communication skills is particularly important when dealing with ethical conundrums and conflicts, as these situations arise often, and can significantly impact the outcome of a patient's treatment. Therefore, the purpose of this paper is to review a case scenario from professional practice in which communication was an issue. A summary of this care is first provided, including the key ethical factors that apply to the situation. The theoretical implications of this case are then described. Finally, an analysis of the specific communication concepts that apply to this care is then described. This paper concludes with a brief summary and outline of key points.
The current case pertains to a remote prescribing service used to recommend Botox therapy for a patient seeking cosmetic surgery or enhancement. Remote prescribing services already carry a range of ethical considerations, and the current case epitomizes some of the underlying communication issues that can confound such services. In the current scenario, a prescribing nurse took a call from the patient and conducted a thorough evaluation of her past medical history and current need for Botox therapy. All relevant information was supposedly recorded, and the prescribing nurse then recommended an in-patient meeting with the physician. Upon arriving at this meeting, it became clear that the patient had failed to mention many important issues regarding her health during the telephone meeting. For example, the patient had been on antibiotics for several weeks due to an infection. According to Majid (2010), the administration of Botox is contraindicated for patients on antibiotics because of potential bacterial infections in the bloodstream. Additionally, the patient had been taking aspirin for chronic headaches, which is also contraindicated for Botox because of the drug's impact on blood clotting (Majid, 2010). As a result of this additional information, the patient was denied treatment. Unfortunately, the patient became angry and threatened to take legal action.
The current case elicits many ethical considerations pertaining to remote prescribing services and communication within the nursing profession. Perhaps most importantly, this case highlights the necessity to provide beneficent care, even against the patient's wishes. Beneficence refers to providing care that will provide the most benefit to the patient while minimizing any undue harm (Arnold & Boggs, 2011). According to the American Nurses Association (ANA, 2010), beneficence must remain a central goal of all treatment.
Similarly, nurses must seek to ensure that care is provided in a non-maleficent manner and that the patient is not exposed to unnecessary risk (ANA, 2010). Conversely, the ANA (2010) also advocates for autonomy with respect to treatment decisions. Autonomy refers to the necessity to allow patients to be involved in their own care-related decisions and ultimately opt for one that best meets their individual needs and desires (ANA, 2010). This advocacy for autonomy presents an ethical conflict in the current case and highlights the dilemmas nursing professionals often face in their daily work.
Numerous theoretical approaches might be applied to the current case scenario, although the utilitarian perspective holds perhaps the most relevance. Utilitarian theory is an ethical approach that seeks to maximize the potential gain for the greatest number of people involved (Garbutt & Davies, 2011). In healthcare, utilitarian theory suggests providing medical care in a way that is likely to have the most longitudinal and widespread benefit (Garbutt & Davies, 2011). This theory serves as the overlying approach to Western medical ethics and is believed to have the most advantageous economic impact on major healthcare systems (Garbutt & Davies, 2011).
In the current case study, the prescribing nurse and physician can utilize utilitarian theory to make a decision that most aptly suits all involved parties, including the patient. Specifically, a utilitarian approach to this case would confirm the prescribing nurse and physician's decision to decline Botox therapy due to the increased economic and health-related risks on the part of the patient. Prescribing Botox despite two major contraindications may place the patient at risk of cardiovascular disease, as well as induce potential litigation that would prove costly to the clinic (Majid, 2010). Despite ethical principles such as autonomy, respect for human dignity, and protecting the patient's basic rights as an individual, utilitarian medical ethics would override these principles in order to maximize the gain for the greatest number of individuals involved in the case (Garbutt & Davies, 2011).
During the remote prescription evaluation, the nurse relied on multiple communication techniques, outlined by Arnold and Boggs (2011), to ensure that accurate information was received. For example, the prescribing nurse attempted to establish rapport in order to encourage the patient to provide as much information as possible about her previous medical history. Additionally, the prescribing nurse sought to express empathy by ensuring the patient's needs were heard. In addition to these skills, the prescribing nurse also listened to the patient's concerns and reinforced that the patient was being heard by providing verbal feedback. Unfortunately, as this prescribing service was conducted remotely, the nurse was unable to use eye contact or nonverbal feedback to further enhance the communication process. This may have led to the misinformation that was provided on the part of the patient.
During the in-patient evaluation, the prescribing nurse and physician both attempted to, once again, establish empathy and rapport by listening to the client's concerns. In this setting, both professionals were able to use both verbal and nonverbal feedback. Through establishing eye contact and using nonverbal communication gestures, the prescribing nurse and physician were then able to determine that the patient gave inaccurate information over the phone and ultimately decline a potentially harmful medical treatment. This case highlights some of the ethical confounds of remote prescribing services, as well as the necessity to consider theoretical approaches to medical care when resolving such conflicts.
The purpose of this paper was to analyze an ethical case in which communication played a critical role. This case, involving a remote prescription service for Botox, elicited key ethical principles like beneficence, non-maleficence, and autonym. Due to the conflicts existing between the principles of non-maleficence and autonomy, a utilitarian approach was used to help reach an appropriate decision. Additionally, communication factors were considered, such as the role verbal and non-verbal communication played in generating accurate information, as well as the need to establish empathy and rapport. This case illustrates the need to continually analyze one's own understanding of core nursing ethics and theoretical approaches to medical care, as well as the importance of effective communication skills. A treatment decision was ultimately reached based on the considerate of all of these contributing factors and the desire to maximize the utility for the prescribing nurse, physician, patient, and healthcare facility.
American Nurses Association (2010). Code of Ethics for Nurses With Interpretive Statements. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf. Accessed 2 October 2013.
Arnold, E. C., & Boggs, K. U. (2011). Interpersonal Relationships: Professional Communication Skills for Nurses (6th ed.). St. Louis, MO: Elsevier.
Garbutt, G., & Davies, P. (2011). Should the practice of medicine be a deontological or utilitarianenterprise? Journal of Medical Ethics, 37, 267-270.
Majid, O. W. (2010). Clinical use of botulinum toxins in oral and maxillofacial surgery. International Journal of Oral and Maxillofacial Surgery, 39(3), 197-207.