Ethical Concerns Assignment Discussion Paper
Case Study
A 60-year-old man who was diagnosed with inclusive body myositis several years ago is experiencing a rapid decline in his condition. He prefers to be stay home with hospice relief to receive end-of-life care, but his wife wants him to be admitted to an inpatient setting.
Explain the health assessment information required for a diagnosis of your selected patient.
The patient is a 60-year-old man who is terminally ill and experiencing rapid decline in health for which he is receiving hospice care at home. For this patient, a geriatric assessment would be conducted as a multidisciplinary, multidimensional assessment that evaluates the patient’s functional ability, physical health, mental health, cognition, and soci0-environmental circumstances. In fact, the assessment includes an evaluation of the patient’s social support, psychological state, nutritional status, cognition, comorbidities (medical conditions), and functional status, as well as review of the medication being used. Applying this comprehensive approach to health assessment is anticipated to result in the implementation of a comprehensive care model that can improve the outcomes of the patient who has a terminal illness. The components examined in the health assessment can predict the patient’s morbidity and mortality, and can uncover problems relevant to hospice (end-of-life) care that would otherwise go unrecognized. This approach helps in facilitating individualization of the options for disease management, quality of life and prognosis (Stanhope & Lancaster, 2020) Ethical Concerns Assignment Discussion Paper .
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The geriatric assessment explores specific elements to include balance, urinary and fecal continence, hearing, vision, nutrition, cognition, and activities of daily living. The assessment focuses on diagnosing the medical conditions, developing treatment and follow-up plan, coordinating management of care, and evaluating long-term care needs and optimal placement. Geriatric health assessment differs from standard health assessment by including non-medical domains, and emphasizing quality of life and functional capacity. This helps in yielding a more relevant and complete list of psychosocial issues, functional problems and medical problems that affect the patient (Truglio-Londrigan & Lewenson, 2018).
The physiologic reserve, functional status, cognition, and comorbidity vary considerably among geriatric patients because of the aging process. This heterogeneity of factors calls for a geriatric health assessment that considers three fundamental concepts. First, the functional status of the patient. This is at the core of the assessment. Functional status is considered as dimension that can be evaluated, and an outcome that can be maintained and improved. Maintaining and restoring the patient’s functional status is the essential overriding objective of the geriatric care provided to this patient. Second, the prognosis as an overarching concept that guides the geriatric assessment. This looks at the life expectancy. Third, the patient’s goals that would guide the geriatric assessment. This looks ta what the patient seeks to achieve such as a pain free life (Helming, Shields & Avino, 2020) Ethical Concerns Assignment Discussion Paper .
Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations.
The scenario makes it clear that the patient is suffering from terminal illness causing a rapid decline in his health condition. The patient prefers to stay at home and receive end-of-life care from home while his wife prefers that he be admitted to an inpatient setting. The contention appears to be where the patient should receive the end-of-life care.
The goal of end-of-life care for this patient is to relieve or prevent suffering as much as possible while respecting his desired. The scenario presents ethical challenges since the decision to be made on where to receive the care concerns both the patient and his wife. Five ethical principles guide an advanced practice nurse in managing the situation. First, principle of autonomy that considers the patient’s right to self-determination. The patient has the right to decide what kind of care he should receive and to have that decision respected by others. The nurse should be able to protect the patient’s right to self-determination. This principle is limited by the understanding that the patient should not harm himself, and that the nurse should fulfil his/her duty to benefit the patient without causing harm. Second, principle of beneficence that requires the nurse to defend the most useful medical intervention for the patient. It involves the nurse advocating the approaches that encourage the delivery of the best care available to the patient (Akdeniz, Yardimci & Kavukcu, 2021)Ethical Concerns Assignment Discussion Paper .
Third, principle of non-maleficence that requires the nurse to refrain from causing unnecessary harm. This is a basic maxim of good nursing care. If there is any harm, then there should be a moral justification as to why the harm is caused. The harm can be justified if the benefits are greater than the harm to the patient, and the intervention of the intervention is not to cause harm. Fourth, principle of justice that focuses on ensuring fair distribution of health resources. It involves the nurse being impartial in delivering health services. Medical resources are limited, and therefore, should be distributed fairly and equally. Fifth, principle of fidelity that requires the nurse to be honest with the patient about the prognosis and possible consequences of each cause of action. This is fundamental to respecting the principle of autonomy as it involves telling the truth. Although the patient may not want to hear all the grim information, the nurse should be able to determine the patient’s preference for information, and sensitively and honestly provide accurate information (Akdeniz, Yardimci & Kavukcu, 2021) Ethical Concerns Assignment Discussion Paper .
References
Akdeniz, M., Yardimci, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Med., 9, 20503121211000918. https://doi.org/10.1177/20503121211000918
Helming, M., Shields, D., & Avino, K. (2020). Dossey & Keegan’s Holistic Nursing: A Handbook for Practice (8th ed.). Jones & Bartlett Learning, LLC.
Stanhope, M., & Lancaster, J. (2020). Public Health Nursing: Population-Centered Health Care in the Community. Elsevier, Inc.
Truglio-Londrigan, M., & Lewenson, S. (Eds.) (2018). Public Health Nursing: Practicing Population-Based Care (3rd ed.). Jones & Bartlett Learning, LLC.
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur? In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios. To Prepare Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios. Based on the scenarios provided: Select one scenario, and reflect on the material presented throughout this course.
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What necessary information would need to be obtained about the patient through health assessments and diagnostic tests? Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected. The Lab Assignment Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature. ***Below is the scenario to use for assignment *** CASE STUDY 7 A 60-year-old man who was diagnosed with inclusive body myositis several years ago is experiencing a rapid decline in his condition. He prefers to be stay home with hospice relief to receive end-of-life care, but his wife wants him to be admitted to an inpatient setting Ethical Concerns Assignment Discussion Paper