...The primary aim of my assignment is to look at the issue of end of life care in dialysis satellite units, as these areas tend to be nurse led units. My interest in palliative and end of life care has arisen from the growing number of poorly patients we continue to dialyse, this has proved distressing especially for the patient, who often has unmanaged symptoms and for their families, it is also upsetting for the staff involved in their care, as it is felt nobody is acting as the patients’ advocate and helping the decision to facilitate the withdrawal of what is now an ineffective and unnecessary treatment. One of the latest developments by the Government and Department of health is the concept of Advance Care Planning. I have looked at this from various perspectives and would like to be involved in introducing the process to Sheffield Kidney Institute. In 2004, the number of patients receiving renal replacement therapy in England, Scotland and Wales was 33,511, this figure is sourced from data which has been made available to them from participating renal units throughout the country, the number of patients receiving dialysis since 2000 has risen by 7% (Ansell et al 2005) with it projected to rise by a further 10 percent over the next 5 years (Ansell et al 2005). About 15-29 percent of deaths of patients with end stage renal disease results from a decision to discontinue dialysis (Davison 2006). Importantly we need to explore which patients especially those reaching...
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... Learning Team A 2 Ethical and Legal Issues Paper How can the American Nurses Association (ANA) Code of Ethics influence a final decision in each of the case studies: Case Study A: End of life, Case Study B: Nursing Negligence? In regard to Case Study A, the ANA has a clearly stated position on end of life care and initiating a Do Not Resuscitate (DNR) with end of life decision making. It states, “Nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care. This is particularly vital in the care of patients and families at the end of life to prevent and relieve the cascade of symptoms and suffering that are commonly associated with dying. Nurses are leaders and vigilant advocates for the delivery of dignified and humane care. Nurses actively participate in assessing and assuring the responsible and appropriate use of interventions in order to minimize unwarranted or unwanted treatment and patient suffering” (ANA, p.7). With this said, the code of ethics committee would expect for the nursing staff to have given all possible information regarding a DNR to the patient’s family members. Ultimately, because the patient did not have any advanced directives the final decision would be made by the husband. Had the husband been deceased then the decision would fall to the eldest living...
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...Original article | Published 3 February 2011, doi:10.4414/smw.2011.13157 Cite this as: Swiss Med Wkly. 2011;141:w13157 Do not attempt resuscitation: the importance of consensual decisions A qualitative study Lorenz Imhofa, Romy Mahrer-Imhofa, Christine Janischb, Annemarie Kesselringc, Regula Zuercher Zenklusend a b c d Zurich University of Applied Sciences ZHAW, Institute of Nursing, Winterthur, Switzerland Department of Education, Training and Professional Development, Stadtspital Waid Zurich, Switzerland Institute of Nursing Science, University of Basel, Switzerland Department of Medicine, Pourtalès Hospital, Neuchâtel, Switzerland Correspondence: Lorenz Imhof PhD RN Zurich University of Applied Sciences Institute of Nursing School of Health Professions Technikumstr. 71 CH-8401 Winterthur Switzerland lorenz.imhof@zhaw.ch pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education. Key words: decision-making; multidisciplinary collaboration; end-of-life issue; resuscitation orders Introduction Since the 1980s, “do-not-attempt-resuscitation (DNAR)” orders have become common in medical practice. DNAR orders are given for 50–60% of patients who die a non-sudden death, with wide variations among countries. DNAR orders apply to only 19% of hospitalised patients in Italy, but to as many as 83% in Sweden and 86% in Switzerland [1, 2]. The frequency of DNAR decisions in...
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...of how the process of do not resuscitate (DNR) results in an ethical dilemma for workers in the healthcare field. In presenting the argument, this paper will also address the following three course learning objectives: 1) explain the legal rights of individuals as they interact with health care services, 2) analyze the monitoring systems that ensure human rights, legal aspects, and quality health care, and 3) analyze selected ethical and legal case studies that have promulgated precedent setting decisions. Even though the physician may believe CPR would be the appropriate decision, “many a deserving patient loses out on the opportunity for such treatment” as a result of an DNR order (Thomas, 2002, 412). Decisions about resuscitation have become a matter of concern and highly debatable issue because the legality of a patient’s right to request DNR. The order must be approved in advance by a written statements signed by a physician upon order of the patient or surrogate in cases which the patient cannot give consent. A DNR order must not confused with giving care, whereas, do not resuscitate does not mean do not give care. “It means a different kind of care that can best be achieved through end-of-life protocols and education” (Field, 2007, 294). The process causes ethical dilemmas for health care workers in several ways. For example, in cases which surrogates can give consent to carry out an DNR order; an ethical dilemma may arise in the case which a surrogate may change...
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...As you are dying the last thing you want to do is have to make decisions of what is going to happen to you, so let’s make the decisions before we get to this point. Physicians should make it routine to talk to their adult patients about the options of end of life care and advance directives. These end of life care and advance directive involve: living will, a medical power of attorney (or healthcare proxy), palliative care and hospice care. Allowing these patients to know all the options they have, it could make the end of life care process easier for families when deciding what should be done. I believe physicians and nurses should talk about end of life care and advance directives because everybody should know their options before they get...
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... | |Flaws in Advance Directives, Living Wills, and Power of Attorney | Introduction A Living Will is a form of an advance directive that is a “legal document that describes those treatments an individual wishes or does not wish to receive should he or she becomes incapacitated and unable to make medical decisions” (Pazgar, 2007, p. 378). Normally in a Living Will an individual would also indicate another individual as his or her power of attorney in the legal document; however, it is not necessary for a living will to be created with a power of attorney or a power of attorney to be created with a living will though it is highly recommended to do so. This is due to the fact that each has its flaws and each could compensate for one another though in reality it could create more conflicts too. For a physician or any other healthcare provider to go against a patient’s autonomy means that there are many legal problems these physicians may face because they went against the patient’s desires, especially because of such allegations as criminal assault and battery. Advance directives have been created to preserve an individual’s autonomy and protect a physician from having...
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...The DNACPR Policy 4 Ethics 7 Patients Consent 9 Withholding Information 14 Informed Choice 17 Forcing Information Upon Patients 20 The Nurses Role 22 Conclusion 25 References 26 Appendix 27 Glossary of terms CPR: Cardiopulmonary Resuscitation. DNACPR: Do Not Attempt Cardiopulmonary Resuscitation. NMC: Nursing & Midwifery Council. GMC: General Medical Council. BMA: British Medical Association. GP: General Practitioner Introduction The Aim of this module is to encourage me to enhance my personal and professional skills, to increase the efficacy of patient care and interaction. Also to make me more aware of the legal, professional and ethical implications of practice. The module allowed me to further develop my knowledge of these topics: Ethics & Accountability, Legal Aspects of Practice, finally Accountability & Professional Practice. I was then asked to submit an essay of 4500 words based on the following: “Critically analyse an aspect of care from your practice setting that encompasses the ethical, professional & legal role of the nurse. Issues of accountability should be incorporated into this essay”. Aspect of care The aspect of care I have chosen to include in my essay is the “Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)” Adult Policy 2010 (please see Appendix 1). I decided to choose this topic as there was a situation on my ward recently where...
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...ETHICAL DILEMMAS FACING NURSES ON END-OF-LIFE ISSUES BASED ON CONFERENCE PROCEEDINGS HELD IN ELDORET, KENYA Author: Kamau S. Macharia: BScN (Moi), MSc (studying) Nursing Leadership & Health Care Systems Management (University of Colorado, Denver), Higher Dip. Critical Care Nursing (Nbi). Graduate Assistant, School of Nursing & Biomedical Sciences, Kabianga University College (A Constituent College of Moi University), . P 0 Box 2030 20200 Kericho, Kenya , Tel +254 722224577, Email: symomash@gmail.com ETHICAL DILEMMAS FACING NURSES ON END-OF-LIFE ISSUES BASED ON CONFERENCE PROCEEDINGS HELD IN ELDORET, KENYA ABSTRACT Problem Statement: A conference to discuss on ethical dilemmas is thought to be a good way of airing out issues. It is unfortunate that at times a patient in our care may die no matter what we do. Profound ethical questions on end of life issues confront the medical personnel as they watch and wait helplessly. This paper touches on ethics, law, social and public policy as they affect nursing practice. Setting: This is a conference proceedings report augmented with a case study of Nelly from a local setting and compares it with two others from elsewhere which were also presented during the conference. Conference was organized by Federation of African Medical Students Associations (FAMSA), Eldoret 2011. The author was a presenter...
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...Abstract Research into trends concerning medical futility reveal that aggressive treatment at the end of life is not equating to better outcomes (Colello 2008). In fact, not only is it providing no benefit, all too often it imposes unnecessary pain and suffering. In the case of patients who lack decision making capacity and do not have an advance directive, families are often approached by nursing staff and asked “Do you want us to do everything?” or if they would prefer a Do Not Resuscitate status (DNR), meaning CPR will not be initiated if breathing or the patient’s heart were to stop. This sends a confusing message to families, that there is something worthy of offering their loved ones; when the reality is, there is nothing worthwhile left to offer. More often than not, despite a grim prognosis for the patient and the possibility of being in a persistent vegetative state (PSV), families routinely choose this option, largely because an informative conversation has never taken place as to the implications of these decisions. This is an issue which can no longer be overlooked. It is costing our nation dearly, both ethically and fiscally. As Americans, it is high time that we come to terms with our mortality and accept the reality that death awaits us all. Denial will not make it less likely to occur. As such, in an effort to promote awareness of this issue and the detrimental impact it has on patients and society as a whole, the following will define and explain the various...
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...of their field.” To function effectively, nurses need to be aware of their contents and incorporate them as a guide for their professional decisions. “A wise nurse who is aware of deep personal values and moral standards will make decisions regarding practice setting so that the nurse’s own personal integrity remains intact, while putting patients and their needs first” (Chitty & Black, 2010, p. 101). A person’s value system is initiated by the beliefs held by his or her family, and as growing occurs the person is exposed to other cultures, belief systems, peers, and societal norms, that may be incorporated into his or her value system. A nurse is expected to make ethical decisions. Having the ability to make ethical and responsible reasoning, involves rational thinking. It is also systematic and based on ethical principles and civil law. Ethical decision making can’t be based on emotions, intuition, fixed policy, or an earlier occurrence. (Blias & Harris, 2011, p. 61). A nurse is not exempt from developing values, and belief systems that shape how they may view their patient population. Individuals must be wise when offering advice or providing assistance to a family or patient involved in a difficult decision making process. The nurse’s personal values, societal views, and personal experiences can negatively influence a patient or family decision if his or her views regarding the decision are conflicting in nature. A nurse must stay focused on the best outcome...
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...Katharine Kolcaba's Theory of Comfort Kelly Ferreira Summer, 2004. In the early part of the 20th century, comfort was the central goal of nursing and medicine. Comfort was the nurse's first consideration. A "good nurse" made patients comfortable. In the early 1900's, textbooks emphasized the role of a health care provider in assuring emotional and physical comfort and in adjusting the patient's environment. For example, in 1926, Harmer advocated that nursing care be concerned with providing an atmosphere of comfort. In the 1980's, a modern inquiry of comfort began. Comfort activities were observed. Meanings of comfort were explored. Comfort was conceptualized as multidimensional (emotional, physical, spiritual). Nurses provided comfort through environmental interventions. It was in this decade that Kolcaba began to develop a theory of comfort when she was a graduate student at Case Western Reserve in Cleveland, Ohio. She is currently a nursing professor at the University of Akron in Ohio. Kolcaba's (1992) theory was based on the work of earlier nurse theorists, including Orlando (1961), Benner, Henderson, Nightingale, Watson (1979), and Henderson and Paterson. Other non-nursing influences on Kolcaba's work included Murray (1938). The theory was developed using induction (from practice and experience), deduction (through logic), and from retroaction concepts (concepts from other theories). The basis of Kolcaba's theory is a taxonomic...
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...Physician Assisted Suicide Jason July 9, 2012 Most states in the United States make euthanasia, also known as physician-assisted suicide, a felony crime, punishable by years of imprisonment. Euthanasia is a very notorious issue within the medical and legal systems; which has been in debate for almost two million years. The word ‘euthanasia’ comes from the Greek origin and means “good death, or easy death.” (Pozgar, 2010) When considering a physician acting in the best interest of the patient, the “legal system must ensure that the constitutional rights of the patient are maintained, while protecting society’s interests in preserving life, preventing suicide, and maintaining the integrity of the medical profession.” (Pozgar, 2010)Euthanasia is a highly controversial issue, especially when patients and their families recognize the quality of life being greatly decreased, with no end to the pain and suffering, the real problem occurs for both the patient and family, but for the health care professionals as well. Surely we all remember Dr. Jack Kevorkian, one of the most controversial and most publically followed physicians held liable for his actions in physician-assisted suicide. The medical staff is trained to save lives, preserve life, treat illness, and bandage wounds, so it would be considered very unethical for any medical profession to aid in euthanasia. “The prohibition against killing patients ... stands as the first promise of self-restraint sworn to in the...
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...Running head: FIGHTING FOR DEAR LIFE: AN ETHICAL CASE STUDY ON Fighting for Dear Life: An Ethical Case Study on Terri Schiavo Catherine Grace Bautista Adventist University of Health Sciences Ethical and Legal Issues in Healthcare HTCA543 Dr. Stanley Dobias February 24, 2015 1 FIGHTING FOR DEAR LIFE: AN ETHICAL CASE STUDY ON 2 Introduction Death is inevitable. However, for some of us, we fail to express our final wishes to our loved ones and this more often than not ends in conflict. In the United States, it is necessary for an individual to have a living will since this provides answers to end of life issues that would be in question. The story of Terri Schiavo was a case study worthy of note given that concerns or conflicts about end of life care have never been a source of familial dispute in my native country, the Philippines. Her 15-year saga brought about several questions that correspond to moral, ethical, and legal issues. Terri Schiavo’s end of life issue has now set a treacherous precedent for all vulnerable Americans, especially those who are in the marginalized sector: the disabled, those who have terminal illnesses, those who can no longer speak for themselves, and perhaps one day even to those who are indigent and unable to pay for costly health care. These individuals may become gradually compelled to make the choice to die and “get out of the way” notwithstanding their true wishes. Early Years Therese Marie Schindler was born...
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...JAMES F. LAWRENCE, & SUZANNE O. GRESLE Medical University of South Carolina, Charleston, SC, USA Abstract Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia...
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...Knowledge Area Module VI Contemporary Issues and the Ethical Delivery of Health Services Student: Harold Taitt, harold.taitt@waldenu.edu Student ID # A00293212 Program: Ph.D. Health Services Specialization: Health Management and Policy Faculty Mentor: Dr. Robert Hoye, robert.hoye@waldenu.edu Faculty Assessor: Dr. Jim Goes, jim.goes@waldenu.edu Walden University May 10, 2013 Abstract Breadth Component In this age of rapidly evolving technological advances, many of the legal and ethical issues that are challenging the delivery of health care and the health care profession are new. As we confront the legal, moral, and ethical aspects of health care, we are seldom faced with decisions that require or are resolved by simple right or wrong answers (Edge & Kreiger, 1998). In the Breadth component of KAM VI, I focus on several ethical theories and how those theories influence the way ethical issues and concerns are addressed and managed in the allocation and delivery of health care services. I critically assess and evaluate those theories, concepts, and derivative principles as they impact important decisions and the implications of those decisions within the context of social change and with special emphasis on health care management and policy. In addition, I discuss the key assumptions on which the selected theories are constructed, compare and contrast the writers’ interpretations across theories, and conclude by providing a critical commentary on the merits of the selected...
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