A Philosophy of Nursing Forum
Monday, April 03, 2006

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My name is Karen Amos. I am currently pursing my Master’s in Nursing and one of my assignments required me to read a Chapter from Nursing Ethics and Professional Responsibility and post my views about it. I chose chapter 11 “Psychiatry and Mental Illness”, which relates most to my current field of nursing.
First of all, most of my work experience consisted of working in the medical surgical environment. My latest adventure in nursing involves me working with adults with mental retardation or intellectual disabilities. By far working with mentally retarded individuals have been my most challenging ethically and most rewarding personally and professionally. I have four year old son with autism. So, I have a better understanding of persons with disabilities and the struggles they face in the community and in healthcare.
Often, mental retarded clients suffer from mental illness. The challenges I face are not much different than those discussed in one of chapter 11’s a case study. The case study involved a client who is concern about her medication and questions the side effects and the effectiveness of the medication. Additionally, the client feels her psychiatrist does not spend enough time with her to accurately assess her condition. The client discussed her concerns with a graduate student and his preceptor. The graduated student offers his opinion of changing the client’s medication to one with fewer side effects. The preceptor informed the student he will continue the client current medication and will discuss the client’s concerns later with the psychiatrist.
The above case study gave different scenarios the student could take to advocate for the patient. However, from my experience clients with mental illness and mental retardation require a great amount of collaboration with psychiatrists, their families, case workers, the community and other nurses. Frequently, the primary nurse may know more about the client pass history and may know how the client reacts to medication adjustments. The preceptor should listen to the graduate student, but should also base his decisions on the client’s previous medical history.
As an Advanced Practice Nurse (APN) we must collaborate with others for the collective good of the patient. Often, the mental ill and mental retarded are treated on an outpatient basis. Therefore, APN’s who work in psychiatry has an ethical obligation to try to ensure that their client can function safely within the community. Additionally, they have an obligation to try to make sure the clients do not harm themselves or others. Most importantly APN’s and other care collaborator must determine the ability of the patient to make decisions in their care. The patient comes first. My ethical dilemma usually involves the client’s right to autonomy in their decision making. Also setting limits to their autonomy maybe required, when it is not conducive to their care. Collaboration with other professional seems to alleviate some problems with autonomy. I would like know if others have experienced situation where autonomy is questioned and what other suggestions do you think can help the mental ill in their decision making?
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This Blog is devoted to philosophical inquiry into nursing. If you would like to POST a paper, contact: philprofbob@care2.com. To comment on a post, 1) go to the bottom of the posting you wish to comment on and click on the word "comments;" 2) type in, or paste in, your comments; 3) beneath the words "choose an identity," at the bottom of the field, select "other" (NOT "Blogger!"); 4) type in your name, perform the "word verification" if required, and preview and publish your comments.

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