NUR 544 Module 6 Cultural Advocacy, Ethical and Bioethical Paper Example

Whose Timeline? Cultural Advocacy and Bioethics When a Patient Delays Chemotherapy for a Healing Ceremony

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 544: Theoretical Foundations for Nursing

Instructor Name

Month Day, Year

Whose Timeline? Cultural Advocacy and Bioethics When a Patient Delays Chemotherapy for a Healing Ceremony

Introduction

Nurses bring their own culture to every encounter, often without noticing it. This paper reflects on the cultural practices that shaped my beliefs as an oncology nurse, applies ethical and bioethical principles to a case that challenged those beliefs, and describes cultural advocacy in practice.

My Cultural Lens

I grew up in a family that treated illness as something to fight. When my grandmother had cancer, we spoke of battles, bravery and never giving up, and stopping treatment felt like losing. Nursing school reinforced this in subtle ways: adherence was good, missed appointments were problems, and the treatment schedule was nearly sacred. In the infusion center, I absorbed the same values. I praised patients who never missed a cycle and worried about those who did.

Reflecting on this, I can see that the language of fighting is cultural, not universal. It assumes that more treatment is always better and that the patient's main task is to endure. It can make patients feel they have failed if they choose differently, and it can make nurses impatient with beliefs that place healing in a wider frame than the body.

The Case

Mr. T. is a composite 58-year-old Diné man receiving adjuvant chemotherapy after surgery for colon cancer. Before his fourth cycle, he told me he wanted to delay treatment by two weeks to attend a healing ceremony on the Navajo Nation with his family. He said the ceremony would restore balance and that he wanted both the ceremony and the chemotherapy. My first reaction was concern about delaying adjuvant treatment. My second was to recognize that my concern came partly from my own cultural lens.

Cultural Humility and Advocacy

Cultural humility asks nurses to approach patients as experts in their own lives and to examine their own assumptions, and our theory text places cultural competence among the frameworks advanced practice nurses borrow to guide care (McEwen & Wills, 2023). Our readings on cultural competency describe advocacy as helping patients have their values and preferences respected within the health care system (Friberg & Saewert, 2023). Research on the Navajo Nation has described the value placed on positive thought and speech and the harm some traditional patients see in discussing negative outcomes (Carrese & Rhodes, 1995). That research reminded me to ask Mr. T. how he wanted to discuss the risks of delay, rather than reciting them.

Applying Ethical Principles

Autonomy: Mr. T. has decision-making capacity and a clear reason for his request. Respecting autonomy means supporting his choice, provided it is informed.

Beneficence: Chemotherapy is intended to benefit him by reducing recurrence risk, and the ceremony is intended to benefit him by restoring balance in his life. Both serve his good as he understands it.

Nonmaleficence: A short delay may carry some risk, and I have a duty to make sure he understands it. Dismissing his request could also cause harm by damaging trust and leading him to stop treatment altogether.

Justice: Fair treatment means that his traditional practices are given the same respect as other patients' requests, such as rescheduling around a family wedding.

What I Did

I asked Mr. T. how he preferred to talk about his treatment plan, and he asked that I speak about what helps people do well rather than what might go wrong. I then spoke with his oncologist, who agreed that a two-week delay at that point in his regimen was acceptable and adjusted the schedule. We arranged his labs on his return and gave him a contact number while he was away. Mr. T. completed his ceremony and his chemotherapy. My advocacy consisted of making space for his request, translating it to the team, and ensuring it was informed.

What the Case Taught Me About Advocacy

Advocacy in this case was quiet. It did not involve confronting anyone; it involved noticing my own reaction, asking a question instead of giving a warning, and carrying the patient's request to the person who could change the schedule. I also learned that advocacy needs knowledge: I could only support the delay responsibly because I could explain the risks accurately to the oncologist and to Mr. T. Without that, cultural respect could have turned into silence about real danger. The experience also changed how I talk with other patients. I now ask everyone, not only patients from cultures different from mine, what matters most to them as they plan treatment around their lives, because families, work and faith shape every patient's choices.

Limits of My Analysis

This case went well partly because the delay was short and medically acceptable. A harder case would involve a request to stop treatment entirely or to use a remedy that interacts with chemotherapy. In those situations, the same principles apply, but the balance between autonomy and nonmaleficence becomes more difficult, and an ethics consultation may be needed.

Conclusion

Reflecting on my own culture showed me that my instinct to protect the treatment schedule was a value, not a fact. Ethical principles and cultural humility helped me see Mr. T.'s request as part of his healing. Advocacy, in this case, meant helping the health care system bend to fit the patient rather than asking the patient to bend to fit the system.

References

Carrese, J. A., & Rhodes, L. A. (1995). Western bioethics on the Navajo reservation: Benefit or harm? JAMA, 274(10), 826-829. https://doi.org/10.1001/jama.1995.03530100066036

Friberg, E. E., & Saewert, K. J. (Eds.). (2023). Conceptual foundations: The bridge to professional nursing practice (8th ed.). Elsevier.

McEwen, M., & Wills, E. M. (2023). Theoretical basis for nursing (6th ed.). Wolters Kluwer.