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Kids room - 52672

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Transcript of Kids room - 52672

Group Activity
Group 2 Members:
Sonja Cameron, Kristie Lau,
Marc Romero, Amy Sola,
Traci Spielman Chiu, Jordan Thorpe, and Claire Truz

By the end of this 20 minute lecture students will:
Articulate the meaning of the terms "ethical dilemma" and "moral distress"
Recognize how the terms "ethical dilemma" and "moral distress" relate to the clinical topic presented
Identify 6 main elements of ethical nursing relationships
Identify main components of the Ethics Composite Model and the Framework for Ethical Decision Making
Describe additional nursing actions / resources relevant in addressing the ethical dilemma presented
1.4 - Articulates nursing sensitive goals and outcomes for client care
1.6 - Skillfully considers best practice evidence in nursing and health care; nurse expertise; client state, circumstances, preferences and values; and evaluation of health care resources in planning and delivering nursing care
2.1 - Demonstrates knowledge and behaviours to address social/health inequities for vulnerable populations as well as enacts the principles of social justice while providing safe, competent, ethical care within the systems in which health care is delivered
2.3 - Integrates purposeful communication, collaboration, consultation, and advocacy skills and relationship-centered care directed toward client understanding of and choice for care
2.5 - Displays knowledge of factors influencing client safety and vigilance in protecting client safety in the course of providing client care
4.1 - Translates knowledge of the uniqueness, developmental stage, complexity and inherent differences and values of clients as individuals, family, group, or population into holistic care practices
5.2 - Analyzes impact of complex contextual factors on client care and nursing practices, intervening when needed to address client health challenge

Introduce placement
Present our ethical dilemma
Discuss pain
Case study and group activity
Identify how to navigate through an ethical dilemma
Questions and survey
Opioids are medications that relieve moderate to severe pain. They act on opiate receptors in the CNS resulting in CNS depression and reduced pain stimuli (Arenella, 2014; Lewis et al., 2014, p. 206).
K.M. was a terminally ill 6 year old
Tumor compromised her respiratory function
Child reported severe pain, cried when touched
Parents refused use of opioids due to belief that K.M. was not in pain, fear of addictive and sedative properties
Healthcare team attempted to advocate for K.M.
Child pleaded for pain relief
Parents eventually consented
K.M. died peacefully
(Weidner & Plantz, 2014, p. 999).

What are your thoughts on this case study?
If you were the nurse faced with this ethical dilemma, how would you address the conflict of a child in severe pain and parents refusing opioids for pain management?
What resources would you access to help deal with this situation?

What are some barriers to pain management?
What is Pain?

Pain is an "unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (International Association for the Study of Pain, 2015).
Pain is "whatever and whenever the person says it is" (McCaffery & Pasero, 1979).
"Medicine has always viewed the relief of pain and suffering as a fundamental human right and a moral and ethical obligation" (Weidner & Plantz, 2014, p.998).
Please go to the following link to complete the evaluation survey.

Our Ethical Dilemma:
Parental refusal of opioid analgesics for moderate to severe pain management within the pediatric population.

Nursing Values and Ethical Responsibilities:
Promoting health and wellness
Preserving dignity
Promoting justice
Promoting and respecting informed decision making
(CNA, 2008, pp. 10-17).

Unwanted side effects
Fear of developing addiction
Fear of developing drug tolerance
Parental reluctance
Lack of knowledge

(Arenella, 2014; Chng, He, Chan, Liam, Zhu, & Cheng, 2015; Czarnecki, Simon, Thompson, Armus, Hanson, Berg, Petrie, Xiang, & Malin, 2010; Macauley, & Fritzler, 2014; Olmstead, Scott & Austin, 2010; Weidner & Plantz, 2014).
What are Opioids?

“Ethical dilemmas arise when there are equally compelling reasons for and against two or more possible courses of action, and where choosing one course of action means that something else is relinquished or let go” (CNA, 2008, p.6).
Physiological stress responses:
- Respiratory dysfunction
- Increased heart rate and cardiac workload
- Muscle spasms/contractions
- Decreased GI function
- Immunosuppression
Psychosocial/emotional distress
Sleep disturbances
Impairs recovery time
Causes general suffering
Left untreated, pain can progress to chronic pain problems

(Lewis et al., 2014, pp. 154-155).

Learner Outcomes
Ethical Dilemma
Unit 3
Short Stay Surgical Unit
Negative Effects of Pain
Common Opioids?

Case Study Discussion
Thank You!
Moral Distress

"Arises in situations where nurses know or believe they know the right thing to do, but for various reasons (including fear or circumstances beyond their control) do not or cannot take the right action or prevent a particular harm" (CNA, 2008, p.6).
Sonja add Chart and Picture and reference the textbook (Oberle?) - THIS BOX CAN BE DELETED

3 zoom ins:
1) So now what? Even if we go to the code of ethics, pulls in many directions?
2) What about the code of ethics is confusing?
3) Picture
4) Activity (Class Discussion) list what are qualities of a good nurse
5) Model


Applying to Future Practice
Class Discussion
What are qualities of a good nurse? List some...
(Oberle, & Raffin Bouchal, 2009, p. 62).
(Oberle & Raffin Bouchal, 2009, p. 46).
Code of Ethics
Relational Ethics
Institutional Values
Legal Context
Other Values
Social Context
Assessing the Ethics of the Situation
Relationships, Goals, Beliefs and Values
Reflecting On and Reviewing Potential Actions:
Recognizing Available Choices and How Those Choices are Valued
Selecting and Ethical Action:
Maximizing Good
Engaging in Ethical Action
Reflecting On and Reviewing the Ethical Action
Qualities of a good nurse:
1) Motivation
2) Compassion
3) Caring
4) Trustworthiness
5) Fidelity
6) Integrity

(Oberle & Raffin Bouchal, 2009, pp. 47-48)
Al-Noor Nenshi Nathoo
Executive Director, Clinical Ethicist
Alberta Children's Hospital / Provincial Representative
Navigating Through an
Ethical Dilemma

Barriers to Pain Management
Three Factors to Override Parental Consent

Parents lack mental capacity
Parents are acting on their own motivation and not in the best interest of their child
Parents are egregious (causing extreme harm)
One of the following three factors must be present:
Full transcript