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Critical Thinking Caps

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Questions for Critical Thinking Caps Worksheet

Read the description of the six caps and the “Case Study for Six Caps” on p. 175 of Professional Nursing. Answer the following questions individually. Then, discuss your answers in your Learning Team forum online. After you have discussed each question and achieved a consensus, compile a group response, which will be submitted as a Learning Team assignment.

White cap:
What pieces of information are needed to assist the family in making a decision regarding Marianne’s care?
In this situation the family is at odds on what to do about Marianne. The husband wants to do everything possible to keep her alive, whereas the children think that surgery shouldn’t be an option because even if she was to make it through the surgery, there is no guarantee that she will be functional. Since Marianne doesn’t have an advanced directive, the family needs to know what all of their options are and the outcomes of each option. For example, the types of surgeries that can be done and the probability of Marianne being once again functional, maybe the types of non-surgical interventions such as medications or just not doing anything at all and just letting Marianne pass. It already seems that Marianne is far gone since her pupils are dilated and non-reactive. A more conducive testing of her brain activity could help them make the decision on whether or not to proceed with the surgery or not. The family as a whole need to know the best option for Marianne, which doesn’t seem there is more left that can be done but to remove the clot and see what happens.

Red cap:
How might family members’ values and morals affect their decision-making process when faced with potential end-of-life decisions for a loved one?

This is obviously a tough choice for the family, especially since they are divided in what they think would be best. I definitely would have been easier had Marianne had an advanced directive. Since she doesn’t the decision would obviously have to be made by the husband who wants the physician to do everything he can to save her. The husband obviously loves his wife and wants her to continue to be with him. He isn’t ready for her to die. It seems the children have accepted the reality that this is it for their mother and they are thinking about quality of life. If the quality of life isn’t there then what is the sense of keeping her alive, which is probably what they are thinking. It would be like she were dead anyway.

Black cap:
Discuss ways in which nurses can integrate concepts found within the American Nurses Association’s Code of Nursing Ethics and the Nursing Practice Act when caring for patients and their families.

In the Nursing Code of Ethics Provisions 1-3 are important. According to "Code Of Ethics For Nurses" (2014), Provision 1 discusses how the nurse should practice with compassion and respect for their patients regardless of the economic status or the nature of their health problem. We as nurse must empathize with the family in Marianne’s situation. They are lost and don’t know what to do to cohesively come together and make a decision so it is up to the nurse to be there and do as much teaching as possible to help them to make this decision collectively. Provision 2 discusses how the nurses’ primary commitment is to the patient and family. Even though the physician has recommended surgery, our obligation is not to what the surgeon thinks but to how the patient’s family feels. Provision 3 discusses how the nurse strives to protect the health, safety and rights of the patient. This is one of our main goals in nursing, to make sure that the patient is protected in every way.

Code of Ethics for Nurses. (2014). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurs es

Yellow cap:
How might the family benefit from conversations with their loved ones’ health care providers and spiritual advisor during their periods of stress?

First what’s important in this situation is to find out what are the family’s beliefs to understand how they want to proceed with this situation. The family’s spiritual beliefs may help them be able to decide what to do with Marianne. For example, if they have Christian beliefs, then a spiritual advisor may help the husband come to terms with letting go of his wife so that whatever decision he makes, she does not have a poor quality of life. The advisor may give the family peace is whatever decision they make regarding Marianne’s care. On the other hand, the spiritual advisor could convince the children to try the surgery and be optimistic that the outcome may be good.

Green cap:
Describe how ethics committees can provide support to patients’ families during their difficult decision-making process.

According to "Ethics Committees, Programs And Consultation" (2013), “the goals of an ethics committee is to promote the rights of patients, to promote shared decision making between patients and their clinicians, to promote fair policies and procedures that maximize the likelihood of achieving good, patient centered outcomes and to enhance the ethical environment for health care professionals in health care institutions.” The ethics committee can help the family understand what their rights are and inform them who would be the one to make the final decision and give them all the different options available to them. They can also help explain the different outcomes of each decision and help the family weigh the pros and cons of each option.

Ethics Committees, Programs and Consultation. (2013). Retrieved from http://www.depts.washington.edu/bioethx/topics.html

Blue cap:
How do you see your own morals and values affecting your feelings regarding difficult decisions for end of life care?

I believe we all as nurses have our own beliefs and opinions on how things should happen when we encounter our patient’s situations. And we all know there are some tough decisions some families have to make. We often think of, “What would I do in this situation if it were my family member?” However, we have to sometimes put our personal feelings aside. If we don’t, it can cloud our better judgment and possibly offend the family members of the patient which may make their decision even harder. We must remember to think of what is best for the patient, which includes the family as well.

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