Assignment: Ethical Concerns Research

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 Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

Scenario 1:

The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines. Assignment: Ethical Concerns Research

Scenario 2:

A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.

Scenario 3:

A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment.

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Scenario 4:

A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled.

Scenario 5:

A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days.

Scenario 6:

A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity.

Scenario 7:

A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home.

To prepare:

Select one scenario, and reflect on the material presented throughout this course.

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.

To complete:

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 3 different references from current evidence-based literature.

Reminder: Please make sure the paper includes a title page, introduction (including a purpose statement), summary, and references. Lastly, please follow uploaded rubric. It is very important that the rubric is being followed

Healthcare professionals offering end of life care will encounter several ethical challenges and dilemmas. Offering quality care to a dying patient needs physicians to have knowledge of the potential ethical dilemmas and be conscious of interventions and strategies that can be used to avoid conflict. It is vital for the healthcare professional to be practical with regard to making decisions and possess exceptional communication skills. This paper looks at an ethical dilemma that healthcare professionals encounter when the wish of a patient about is health conflict with the wishes of the family. The paper also looks at how an advanced practice nurse to respond to such a dilemma. Assignment: Ethical Concerns Research

Health assessment information required for the patient with motor neuron disease

Scenario 7: A 57-year old man who has been living with motor neuron disease is experiencing a fast decline in his illness. The man wishes to be admitted to the inpatient unit at an hospice to receive the end of life care. However, the wife wants him to stay at home. Health assessment information required for the patient is an assessment of the patient’s present state of health to establish if hospice is suitable and whether he needs inpatient or outpatient hospice care. Additionally, I would assess if the patient’s family is in a position to care for him at home

Correct assessments of survival would enhance health care professionals to develop and provide more effective care and management plans and access services at a period when its most suitable a close monitoring of the physiological status and progression of the disease, and patient counseling on ways of managing the available options is essential. Due to its swiftly progressive nature motor neuron disease is regarded suitable for palliative care by healthcare professionals (National Clinical Guideline Centre, 2016).

I will also assess whether there is a probable risk of physical injury relating to the manual handling of the patient. Wheatley and Baker, (2013) notes that majority of patients receiving palliative care at home have mobility difficulties. As a result of the swift progressive nature of motor neuron disease, a patient who is mobile at the time of assessment will remain mobile only for a short period. It is hard to predict the survival of a patient with motor neuron disease. Symptoms like muscle wasting, elevated weakness, fasciculation and eventual loss of function, lead to social, emotional and physical challenges culminating to early death.

How I would respond to the scenario as an advanced practice nurse

If the patient is oriented and alert, as an advanced practice nurse, I should allow the patient to make choices and decide on his medical treatment and health. I will also look at the concern of the patient’s wife, but I will ensure the wishes of the patient are respected and adhered to. According to Karnik and Kanekar (2016), the right of a patient to autonomously express their treatment and care at end of life must be respected, putting into consideration the availability of advanced treatments along with their prognosis. The right of autonomy has its own limitations, and thus healthcare professionals are faced with an ethical dilemma. They must respect the autonomy of the patient at while thinking through its limitation and perform their roles in benefitting the patient without causing harm.

According to Wheatley and Baker, (2013) the moral principle in patient’s right to autonomy is that healthcare professionals must respect patients’ characteristics; respect their choices on their bodies and lives. This isn’t because a person’s choice essentially tends to be a good one, rather, the significances lies in an individual exercising the right to make these choices, whether bad or good. A patient’s choice is regarded ethically desirable and supporting his choice on where he receives health care is necessary to respect the autonomy of the patient. (Wheatley, & Baker, 2013).Supporting choices about where and how a patient receives health care enhances his quality of life, partly by maintaining an aspect of authority over his life which is usually compromised by the motor neurone disease.

All patients requiring palliative care usually experience mobility problem at some point, and the manner in which and rate at which they develop this difficulty is hard to predict. In contrast to majority of other patients, the mobility difficulties of majority of patients requiring palliative care is not likely to improve, and inpatient admission for rehabilitation is the most appropriate option (Wheatley and Baker, 2013)Assignment: Ethical Concerns Research .According to Karnik and Kanekar (2016), healthcare professionals play a crucial in provision of detailed information of an advanced medical treatment which might be applied at end of life care. Therefore, as an advanced practice nurse, I will perform my duty rightfully and offer the patient in depth information on the benefits, drawbacks and limitations of placing the patient in an inpatient unit at hospice. I will work in accordance to the deontological principle and perform my duty to attain the utmost good for the patient and take action that will benefit the patient.

McCartney et al (2016) argue that although a patient has the right to autonomously choose how and where to receive care and treatment, the healthcare provider can offer an explanation on the implications of his treatment choices and attempt to highlight its consequences. I will be required to make an assessment and establish if the intervention is futile. Karnik and Kanekar (2016) note that it is the duty of healthcare professionals to preserve the life of a patient. Nevertheless, they should not confuse this duty with the unnecessary utilization of resources and causing the patient more damage than good by continuing inpatient treatments that are medically futile and financially burdening to the patient and his family.

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Conclusion

Respecting the autonomy of the patient is important to ethical care for a dying patient. Therefore, the function of advance care planning is vital for a patient who is receiving end of life care. An advanced practice nurse needs to understand ethical issues and principles like the right of the patient to autonomously make decisions and act in the best interest of the patient.

References

Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-of-Life Care: A narrative Review. Healthcare, 4(2): 24.

McCartney, M., Treadwell, J., Maskrey, N., & Lehman, R. (2016). Making evidence based medicine work for individual patients. British Journal of Medicine353: i2452.

National Clinical Guideline Centre.(2016). Motor Neurone Disease: Assessment and Management. London: National Clinical Guideline Centre.

Wheatley, V., & Baker, J. (2013). “Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care. Postgraduate Medical Journal, 83(984):634-648 Assignment: Ethical Concerns Research.

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