...End-of-life care, and making medical treatment decisions is a complex and emotionally charged topic that APRNs must be knowledgeable about. It is essential that APRNs are familiar and comfortable with taking a Values History, as this form can ethically assist patients and assist them in making well-informed decisions that are in accordance with personal preferences and values. Similar to the Values History, Fischer, Min, Sauaia, & Kutner (2012) highlight the fact that advanced directives may include various documents, including a “broader more comprehensive document outlining goals, values, and preferences for care in the event of decisional incapacity” (p. 3). Questions from various areas of a patient’s life are addressed with this tool; therefore I believe this form is an excellent way to explore personal feelings and attitudes that patients may not have taken the time to think about. However, after reviewing the Values History form, my concern is that it is not a legal document. It would be...
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...Francesca Beebe, Amanda Carvalho, Ricci Cornell, Shannon King Ethical and Legal Issues 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...
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...Satisfaction with Care at the End of Life Sydney Morss Dy, MD, MSc,Ã wz Lisa R. Shugarman, PhD,§ Karl A. Lorenz, MD, MSHS,§ k Richard A. Mularski, MD, MSHS,# and Joanne Lynn, MD, MA, MS,§ for the RANDFSouthern California Evidence-Based Practice Center (See editorial comments by Dr. Jean S. Kutner, pp 160–162) The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients’ decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A metaanalysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six showed a significant effect. For heart failure coordination of care, only seven...
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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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...and Legal Issues in Nursing NUR/391 Ethical and Legal Issues in Nursing As nurses, it is our duty to advocate for our patients. At times, we are faced with personal and professional challenges that impact how and when we chose to advocate. It is imperative we have a healthy awareness of these potential challenges. Improvements in health care technology have provided patients with an array of treatment options as well as assumed or possible increased chance of survival. As a result, nurses are met with a rise in ethical decision making. This paper will discuss the legal, ethical, social, and personal factors that can impact our decision making process, with the focus on two specific case studies. American Nurses Association Code of Nursing Ethics Role in Practice The American Nursing Association (ANA) has created a set of ethical standards for the profession of nursing to abide by, which is entitled the ANA Nursing Code of Ethics. The ANA Code of Ethics states that collaboration is central to the care nurses deliver and to their ethical commitment to the patient (Garity, 2005). In the end-of-life case study, the nurse (she) has an unwritten obligation to the patient; the family appears to be in conflict with how to proceed with the patient's medical treatment. The medical team has an obligation to give the family all of their options and possible outcomes. If the family remains in conflict, it would then be appropriate for her to refer the family to the Patient’s...
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...Dying in a Hospital Setting Elizabeth Allegro Aspen University Abstract Acute hospitals play a significant role in end of life care, it is the place where most people die. Evidence suggests that end of life care in hospitals needs improvement. The purpose of this paper was to investigate patient and family experiences of hospital death, the weaknesses within the hospital setting and possible solutions to improve. A literature search identified common themes, these included: * Hospitals are seen as a place of treatment and cure; death may be viewed as a failure. * Good communication between physician and patient is vital for a patient to make an informed choice regarding their care. * Patients may not receive palliative care if end of life is diagnosed too late. * A lack of resources such as short staffing contributes to suboptimal end of life care. Dying in a Hospital Setting Most Americans die in hospitals; many suffer unnecessarily due to the lack of knowledge about end of life care. Some patients receive aggressive treatments up until the time of death. Patients often suffer in vain attempts to prolong life instead of receiving compassionate, comfort care. Death is part of life, sooner or later everyone will face death. It would be easier if one was prepared for it. Communication is important to prepare for death. There is often an expectation of a cure when a patient is hospitalized;...
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...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 the end of their lives are choosing...
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...of patient care. What can or should be done for the patient versus the wishes of the patient’s physician conflicting with the personal beliefs the nurse holds to be true. The client’s wishes may conflict with the institutional policies, physician professional opinion, the client’s family desires, or even the laws of the state. According to the nursing code of ethics, the nurse’s first allegiance is to the client (Blais & Hayes, 2011, pg. 60). The ethical ideals of each nurse must be weighed with the laws of the state along with providing the most ethical care for the patient. The advancements in medical technology make it possible to sustain a patient life where previously there was no hope of recovery. These advancements have put nurses in the forefront of decision making begging the question “just because we can, should we” to be answered. Nurses need to understand the legalities involved with these new technologies to practice safely and effectively. Scientific achievements have opened new ground for nursing exploration. In response to the need for nursing input into social and legal issues, nurses now find career opportunities as forensic nurses, legal nurse consultants, and nurse-attorneys (Blais & Hayes, 2011, pg. 75). This paper will explore the ethical and legal issues encountered by nurses in two case studies. The American Nurses Association Code of Nursing Ethics could influence a final decision in each case study that was presented. The six caps study revealed family...
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...Debate on Health Care Ethical Issues SHARON COLES University of Phoenix JANUARY 30, 2012 To Intubate or Not To Intubate: Families vs. Physicians The top healthcare ethical issue in the United States is the disagreement between patients/families and health care professionals about treatment decisions. It is not uncommon for health care professionals to clash with the family of the patients for whom they care for over treatment decisions. Some patients will inevitably suffer the consequences of an error made during their care or hospitalization. Many people in need of diagnostic tests or surgical procedures are forced to wait months, and perhaps even years, to receive these services. These are just some examples of the kinds of ethical challenges that patients and their families may confront in the health care setting. Disagreements typically take one of two forms. Either the health care professional might push a treatment option for more or less treatment that patients and families deem unacceptable, or conversely patients/families may push a treatment option, whether it is more or less treatment, or different treatment, as an alternative, or complementary treatment that health care professionals deem unacceptable (Breslin, MacRae, Bell, & Singer, 2005). Ethical Issue According to research studies, it is the end-of-life critical care cases that tend to be the most emotionally charged, and the most intractable, because these are the cases in which the...
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...Mortality, February 2005; 10(1): 69 – 81 Tube feeding: Prolonging life or death in vulnerable populations? ELAINE J. AMELLA, 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...
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...euthanasia should not be banned. Morality, as defined by the Oxford Dictionary, is “principles concerning the distinction between right and wrong or good and bad behaviour”1. Hinde states that the principles are influenced and changed by one’s society and culture but also “based in human nature”2. As morality is influenced by society, public opinion is important when it comes to controversial issues. Morality differs from place to place and evolves over time. To compound this diversity, changes in medical treatment, and discoveries which enhance medical knowledge evolves rapidly and what was not even conceivable in some cultures or at certain points in history are now commonly accepted. Developments in end of life care fall within this category. With our increased ability to prolong life, arguments can now be made in favour of moral killings. Similarly, since morality is intuitive in nature, it exists outside of law. However, “many laws are formalizations of moral values”3. Hinde compares the two, stating that “morality prescribes how people should behave”4 while “laws are concerned with how "morality" Oxford Dictionaries. April 2010. Oxford Dictionaries. April 2010., Oxford University Press,...
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...DIGNITY IN END OF LIFE: THE ROLE OF NURSES BY (Student’s Name) Course Instructor Institution City, State Date Dignity in End of Life: The Role of Nurses LITERATURE REVIEW INTRODUCTION A literature review is a critical appraisal of researches that provides a comprehensive and up to date knowledge on a specific topic (Coughlan, Ryan and Cronin 2013). The purpose of literature review in nursing includes evaluating current practice and making recommendations for policy development and change. Thus, the purpose of this literature review is to establish the current perspectives of patients, family and nurses on the factors that improve dignity in the end of life. Resultantly, this literature review will explore the role of nurses’ based on the findings of the perspectives that patients, family and health professionals have concerning the issue of dignity in the end of life care. In that regard, the paper follows a systematic approach which involves an introduction that explains the concept of end of life and the types of end of life care available. The paper then proceeds to explore the concept of dignity as viewed from several perspectives through the use of literature on the models of dignity means of measuring dignity and the themes associated with this conception. Consequently, the factors that improve dignity are laid out and discussed at length. Eventually, the paper will achieve its secondary goal which is to determine and expound on the topic of the roles that a nurse...
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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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...Palliative and Supportive Care ~2006!, 4, 399–406. Printed in the USA. Copyright © 2006 Cambridge University Press 1478-9515006 $16.00 DOI: 10.10170S1478951506060494 Requests for euthanasia and physician-assisted suicide and the availability and application of palliative options MARIJKE C. JANSEN-VAN DER WEIDE, M.SC., BREGJE D. ONWUTEAKA-PHILIPSEN, PH.D., AND GERRIT VAN DER WAL, PH.D., M.D. Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands ~RECEIVED June 5, 2006; ACCEPTED August 27, 2006! ABSTRACT Objective: This study investigated the palliative options available when a patient requested euthanasia or physician-assisted suicide ~EAS!, the extent to which the options were applied, and changes in the patient’s wishes. Methods: In an observational study, 3614 general practitioners ~GPs! filled in a questionnaire and described their most recent request for EAS ~if any! ~n 1,681!. Results: Palliative options were still available in 25% of cases. In these cases options were applied in 63%; in 46% of these cases patients withdrew their request. Medication other than antibiotics, which was most frequently mentioned as a palliative option ~67%!, and applied most frequently ~79%!, together with radiotherapy, most frequently resulted in patients withdrawing their request. Significance of results: GPs include the availability of palliative options in their decision making when...
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...religious values? How will you support a patient’s death and dying rituals and practices, and still honor your own? HLT 324V Week 4 Case Study: Through the Eyes of the Patient and the Health Care Professional Topic: Spiritual and Cultural Emphases on Death and Dying Allied health professionals are confronted with different death and dying practices. An effective allied health professional recognizes the importance of understanding different cultural practices, and learns how to evaluate the death, dying, and spiritual beliefs and practices across the cultures. Read the two specified case histories and choose one for this assignment. Chapter 4, “Stories of Abby: An Ojibwa Journey” and Chapter 14, “Stories of Shanti: Culture and Karma,” by Gelfland, Raspa, and Sherylyn, from End-of-Life Stories: Crossing Disciplinary Boundaries (2005), available in the GCU Library: http://library.gcu.edu:2048/login?url=http://site.ebrary.com/lib/grandcanyon/Doc?id=10265487 Identify your role as a health care professional in supporting Abby or Shanti’s dying rituals, and in creating strategies for displaying respect while still providing quality care. Integrate your strategies as you develop a care plan describing how you would approach the situation and care for the patient. Review the “Care Plan” template prior to beginning. Include the following in your care plan: 1. Communication: family and patient 2. Treatment...
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