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The Role of Nursing in Maintaining Privacy

The Role of Nursing in Maintaining Privacy
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  Running header: MAINTAINING PRIVACY, DIGNITY AND PAIN RELIEF 1 The Role of Nursing in Maintaining Privacy, Dignity, And Pain Relief for the Terminally Ill Shelley A. Sandblom Dalhousie University  MAINTAINING PRIVACY, DIGNITY AND PAIN RELIEF 2 Abstract This paper explores the image of nursing as portrayed by the actor in the screen adaptation of the 1999 Pulitzer Prize winning play by Margaret Edson titled “Wit” (2001). In particular, three specific values (see Appendix A) as outlined in the CNA Code of Ethics (2008) will be discussed insofar as they are represented in the film. These values center on the concept of maintaining privacy, dignity and pain relief for the patient (in this case one who is terminally ill). The importance of these values will be addressed, and a selection of relevant literature will be referenced in an effort to broaden the scope of the discussion.  Keywords : dignity, end-of-life-care, patient advocacy  MAINTAINING PRIVACY, DIGNITY AND PAIN RELIEF 3 The Role of Nursing in Maintaining Privacy, Dignity, And Pain Relief for the Terminally Ill In the movie “Wit”  (2001) Emma Thompson portrays Dr. Vivian Bearing, an English professor diagnosed with stage IV ovarian cancer. After agreeing to undergo a series of experimental high-dose chemotherapy treatments, the screenplay follows Dr. Bearing’s progress from her initial treatment until her subseq uent demise. Her attending nurse, Susie Monahan (played by Audra McDonald), is compliant with many of the  positive qualities associated with the nursing profession. Three of those qualities are found in the 2008 CNA Code of Ethics and will be examined here (see Appendix A). In contrast, the attending medical resident, Jason Posner (played by Jonathan Woodward), is the antagonist and is often non-compliant with the three qualities explored here. Nurses Respect the Physical Privacy of Persons In clinical settings, patients can feel particularly vulnerable by having their  privacy invaded (for example, if they are required to disrobe). In the 5 th  part of section D in the CNA Code of Ethics (2008), it is outlined that in order to respect the physical  privacy of persons, care must be provided discreetly and with minimal intrusion. Compliance/non-compliance in the Film In the film “Wit” , Vivian must have a pelvic exam. She is alone in the examining room when the resident doctor, Jason, arrives. He demonstrates exaggerated non-compliance with minimal intrusion and discretion by hoisting Vivian’s hospital gown  up around her waist and briskly removing her shoes before placing her feet carelessly in the  MAINTAINING PRIVACY, DIGNITY AND PAIN RELIEF 4  bare stirrups on the examining table. As an afterthought, Jason remembers that he needs another female present before he begins the exam. He leaves the room to find the nurse, Susie, and neglects to close the door. Susie enters the room and instantly assesses in the situation. She closes the door to shut out the din from the hallway and to provide more physical privacy. She perceives that Vivian feels exposed, and gently tucks the gown discreetly under her legs to provide more coverage. She offers tissues, speaking softly to Vivian and reassuring her. She  places a towel under her head. Vivian immediately appears more relaxed and responsive. The nurse has demonstrated several times in this scene the respect for physical  privacy and discretion of the patient. Relevant Literature Baillie et al. (2009) conducted a study that determined both the physical care environment, as well as care activities and how they are conducted work together to ensure patient comfort. Simple things like curtains, which can easily be ignored by staff, go far in respecting privacy. Care should be taken during activities which may be routine for staff, but which represent an invasion of privacy for the patient: the retrieval of a  bedpan in a sensitive manner, without unnecessary exposure, for example. Physical  privacy is important, and helps maintain dignity, which is the second quality to be examined here. Nurses Intervene When Others Fail to Respect the Dignity of a Person If a nurse observes the failure to respect the dignity of a person receiving care, the 4 th  of part of section D in the CNA Code of Ethics (2008) outlines that the nurse should  MAINTAINING PRIVACY, DIGNITY AND PAIN RELIEF 5 intervene and report when necessary, because remaining silent is the same as condoning the behavior. Compliance/non-compliance in the Film In the film “Wit”, Vivian eve ntually becomes despondent Susie reaches out to her emotionally. The two share a Popsicle (which soothes Vivian’s painful throat) , and Susie  broaches the fact that chemotherapy treatment has failed to eradicate the metastasizing cancer. Susie asks Vivian if she wishes to be resuscitated if necessary. Vivian decides she does not want to be resuscitated (DNR), and Susie makes note of this in her chart. When Vivian’s vital signs are  plummeting, the resident doctor, Jason, automatically begins making arrangem ents to resuscitate. Susie intervenes on Vivian’s  behalf and reiterates that the patient is DNR. The other members of the health care team ignore Susie and she has to scream to be heard. Finally, one of the paramedics grabs Vivian’s chart and reads that she is in fact DNR  . Susie’s intervention has spared Vivian the indignity of being kept alive against her wishes, and as a nurse, Susie has intervened when the dignity of a patient is being compromised. Relevant Literature Sharon Valente (2011) discusses some of the challenges, concerns, and strategies involved in facilitating a dignified death that were brought up in a focus group. Nurses reported “challenges in enlightening their colleagues…about the patient’s wishes about end of life care”  (p.30). Some of the nurses found allies in social workers and  psychologists when seeking help to convince physicians to honour the patient’s wishes.  Gardner (2012) advocates that nurses must   initiate these conversations in order to ensure their care is well coordinated, especially when technology has advanced to the
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