Essay Instructions: End of life Decision making and the role of the Advanced Practice Nurse (APN):
Be sure and remember to look at the issue from the APN role or from your graduate studies. Try and see the issues or problems from a graduate perspective rather than that of the RN. Also be sure and consider the ethical principles discussed in the module.
Second, once you have identified a topic:
Identify and research the ethical issue confronting nurses in advanced practice. This requires a description of the problem (20%) including:
1.identification of the issue or description of the problem
2.identification of the ethical dilemma including the SPECIFIC ethical principles
3.how the issue impacts stakeholders involved.
Approach the issue from the Advanced Nurse Practice or graduate studies perspective as opposed to that of Registered Nurse.
Analyze the issue using the appropriate literature (30%). Your references should be from scholarly scientific journals or reputable websites and should not be older than 10 years. Example: If the issue is the APN role in the parental requirement to approve Gardasil vaccine for adolescents enrolled in public education programs, what does the supporting research reflect? Discuss the relevant legal and regulatory statutes.
Offer a conclusion that examines the APPLICATION of the relevant ethical principles (30%).
Structure the discussion (20%) using the following headings: Description of the Ethical Issue, Analysis and Literature Review, and Application of Ethical Principles. Use APA standards, including appropriate citations, spacing, indentation, margins, etc. The following website is useful for learning how to evaluate webpages to determine if they are from a reputable website that you may use in a scholarly paper:
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Essay Instructions: End of life planning is a difficult subject for many. So difficult, that the majority of people in the United States has no living will or estate will in place at the end of their lives. What this means is that the burden of making difficult medical and legal decisions for the incapacitated person falls to the family and the state court systems, often at great psychological, emotional, and financial expense for both.
Please explain and apply how the core values of Saint Leo University are fostered and cultivated by the personal decision of each of us to take responsibility to make certain these legal instruments are in place before the necessity of them comes to be. Please apply specifically the core values of Community, Respect, Personal Development, Responsible Stewardship, and Integrity.
One of the sources must be from the text, one must be an Internet source (with hyperlink) and the third may be from any source (print, personal experience, Internet, learned treatise, journal, etc.). You shall cite each source in APA format.
PLEASE USE THIS BOOK : Furrow, B. R., Greaney, T. L., Johnson, S. H., Jost, T. S., & Schwartz, R. L. (2008). Health Law. (6th ed.).
St. Paul, MN: Thomson-West Publishing
Bouvia v. Superior Court, pp. 1425-1440
- Life and death decisions
• Guardianship of Schiavo, pp. 1488-1497
- Right to die
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Essay Instructions: Type: Essay Frame work and scholarly essay
Title : Contemporary nursing in Australia : Provision of care
Topic: End of life care and professional nursing practice.
Discuss concepts surrounding end of life care . In what ways can professional nurses ensure appropriate, competent end of life care is provided?
Length Essay 1500 words(+/-10%)
Essay frame work 500 words(+/-10%)
Reference from www.ballarat.edu.au (10 at least) (journals and books)
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Total Pages: 10 Words: 2642 Sources: 6 Citation Style: MLA Document Type: Research Paper
Essay Instructions: Hi could you please help me organize this paper.
Here are the requirements that I need.
Also the out line that I started.
Requirement #1 Paper addressing an ethical issue 30%
You may choose any topic that has created an ethical dilemma in health care. Examples may include end of life care, pain, uninsured, poverty, minority populations, organ donation, DNR, individuals with special health care needs, medicine and torture, rationing, etc
1. Select an issue. Keep it focused enough to address it thoroughly. Use the literature to support your position. Be comprehensive, clear & concise. Try to be objective. Ask questions!!
2. Paper will be approximately 12 maximum typewritten pages (double spaced), excluding the title and reference pages. It must comply with APA.
APA format: (20 pts total)
3. General guidelines: (80 pts total)
Introduce the topic in a brief paragraph. (2.5 pts)
Give the background of the key issue & its relevance to health care/and or
Nursing. (15 pts)
What does the scholarly literature say about the issue? (2.5 pts)
What is the consensus or
controversy surrounding the topic? (5 pts)
Who (groups, prominent individuals, organizations/agencies) supported
which viewpoint? (5 pts)
What suggestions would you make to try to solve the issue? What
suggestions did the above make? (10 pts)
Identify the defined pros & cons regarding the issue from both your own and the
public?s viewpoint (10 pts)
Are there positive or negative implications of the outcomes? Specify. (10 pts)
What is the impact on health care, the public, nursing? (10 pts)
Specifically, what recommendation (s) would you make and why? (10 pts)
Dilemmas in Health Care at End of Life
Today, we live in a modern society where advanced medical treatments and technology can keep patients alive longer, which would not have been possible in previous times. This has made end of life care one of the most controversial issues in health care. Medical advancements have set the stage for ethical and legal dilemmas not only about patients and family?s rights but also about the health care professionals? role. In 1991 the U. S. Congress passed Patient Self Determination Act (PSDA), the purpose of this law is to inform patients of their rights regarding their medical care including the right to accept or refuse treatment and the right to make an advance directive and ensure that these rights are communicated by the health care providers, sspecially when patient?s become incapacitated (Duke et al, 2009). The dilemma presents itself in the area of conflict between the conflicting desires of patient and family. The nurse must completely support the patient?s wishes while assisting the family to do the same. The nurse is the advocate for the patient, educator of the family, and liaison between the interdisciplinary team.
The argument arises within those conflicts; the ANA Code of Ethics requires nurses to respect the autonomy of each patient and their decision to choose the healthcare options they believe are correct for them based on their religious, race, social, cultural and personal desires for end-of ?life care (ANA Code of Ethics 2001). Nurses are also obligated to participate in advocating for the patient to alleviate unnecessary treatment for the patient who has designated they do not want treatments that doctors and/or families may be advocating for the patient against that patients wishes (ANA Code of Ethics 2001). The nurse must be familiar with the end-of-life wishes of their patients otherwise; the patient looses a valuable advocate to assist in achieving their goals for end-of-life care. Nurses must also be recognizing their own personal values and beliefs surrounding end-of-life care for their patients? choices to advocate adequately.
The dilemma during end-of-life issues arise when there are differing opinions between the doctor, the family and the patient about the care received during this time of life. Imagine this scenario; the patient has end stage heart failure, coronary artery diseases, peripheral artery diseases, chronic obstructive pulmonary disease, sleep apnea, and renal failure insufficiency. This patent has refused for many years any invasive treatments regardless of the consequences and the patient opted for medical management. This patient has an advance directive stating the preference of no cardiopulmonary resuscitation, no artificial hydration or nutrition and desiring only comfort measures to allow for a pain-free and natural death. This patient developed shortness of breath, leg edema, and chest pain, was rushed to the emergency room. Up on admission to the emergency room the patient was diagnosed with pulmonary edema and renal failure. Medications are administered to treat pulmonary edema but, the patient is not responding to the medications and the patient starts to decompensate. The patient mentions she does not want to have dialysis or a respirator. The family insists on multiple treatments that the doctor has recommended improving the health status of the patient. The family is informed of the critical status of the patient and the chances of survival are minimal. The family continues to insist that the patient be put on the respirator and have dialysis. Only one sibling has a copy of the advance directive, is medical durable power of attorney and informs the family of the patient?s wishes per the advance directive. The family disregards the advance directive to meet their own needs to keep the patient alive regardless of the patient?s wishes or the severe decline in quality-of-life. It obvious that the family as a group has not discussed the advance directive or the patient?s end of life wishes.
When faced with difficult ethical dilemmas, it is best to have a plan of action to assist in decision-making. A step by step approach often works best because it allows the decider to breakdown a stressful choice into workable parts. Once the ethical conflict is addressed one must not allow his her personal feelings to interfere with professional decisions. Purtillo says there six steps one can follow in resolving ethical dilemmas this steps are; assessing, exploring identifying the ethical problem, analyzing the problem, exploring the options, implementing the action, and evaluating the process outcome (Purtillo, 2005). When assessing an ethical dilemma the nurse needs to collect the medical, social, psychological, and legal facts pertaining to the case, in some case the nurse needs to take in to consideration the patients psychological state, prognosis, knowledge of treatment and quality of life. It is also important to evaluate the families understanding of patient?s illness and wishes and not forget the patient?s culture and religious beliefs, organizational policies, and other available resources that can aid at the time of a dilemma. Identifying ethical dilemma can be intense and difficult at times, nurses may need guidance and support from professional expertise such as patient advocates, risk management, palliative care, and ethic committee (Cohen & Erickson, 2006).
Step two is identifying if the problem is a true ethical issue or is the nurses letting her feelings intervene with the ethical dilemma, when in question check with other colleagues and other recourse team members. If your moral issues interfere with ethical issues ask other colleague to take care of the patient. It is also important for nurse to look at ethical theories based on the ethical dilemmas to help identify solutions to the problem (Cohen & Erickson, 2006).
After analyzing the problem and identified that the dilemma is indeed an ethical problem, step three is to study and start the resolution of the dilemma. There are multiple theoretical methods that can be used to aid nurses to analyze the dilemma. Ethical theories can be consequential, duties, individual rights, and communal or intimate relationships ( Beauchamp & Childress, 2001). When dealing with ethical issues nurse have a tendency of either looking at consequences or duty-based mythologies to accomplish the result. When using consequential theory nurse feel that is very important to tell the patients the truth about diseases so patients can make decision about their care. When using the duty-based approach health care professionals feel forced tell the truth to patients, although this can cause patients mental stress and pain. When making decisions nurse tend to use their morals and opinions to guide them in ethical issues. One thing nurses need to recognize is that the opinions and ideas of all the team members are important; the morals of the patient and family members have priority in end of life decisions ( ANA, 2001).
Making decisions about end-of-life care is a difficult and emotional experience for patients and loved ones. Terminal illness and old age present numerous medical and ethical dilemmas that caregivers must address. Honoring the person's wishes, withdrawing care, withholding care or choosing a long-term care facilities are all decisions with difficult ethical implications. Someone who is elderly or terminally ill can make these decisions easier for his or her loved ones by creating a living will that specifies what she he wants.
When giving support and advice to patients and families at end of life one needs to understand how overwhelming and emotionally this issue is. If the patient or family member is struggling with end of life decisions, have them consult someone they trust to them help think about implications of the decision. Clergy members, counselors and medical ethicists can help patients, family members, and caregivers think about end-of-life issues and answer questions about care. A grief and bereavement counselor can help them work through the emotional difficulties associated with these decisions. Ask your doctor or health care providers for resources.
To prevent dilemmas at end of life between families and health care providers, families should discuss their issues and create an advance directive also known as living will. Once the advance directive is completed the patient should discuss their wishes with the family and primary physician to let them know that the document exists. Advance directives inform family members about the kind of care the person wants, eliminating the confusion at the end of life. Everyone, regardless of circumstance or health, can make an advance directive. It can be difficult discussing advance directives with young patients as they see no need to complete an advance directive because they are young. My explanation to them is if something catastrophic is to happen they want to make sure their whishes are granted.
In addition to the advance directive, patients may elect to name another competent adult to make the decisions regarding the providing, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration on your behalf. This designation is often referred to as a health care proxy. (You have the option of giving the health care proxy full authority to make such decisions for you or you can direct your health care proxy the type of decisions to be made). The primary rule in choosing a health care proxy is to select an individual that you trust to make significant health care decisions. This trust usually stems from a relationship in which the proxy understands your values and beliefs. In addition, the proxy should be a person with whom you feel comfortable discussing issues such as life-sustaining treatment, terminal illness and mental incapacity. In choosing a proxy you should also consider the proxy's willingness to follow through on difficult medical decisions. In some situations there may be disagreements among relatives, friends and physicians as to the "proper" course of treatment for you. At these times the proxy must be able to communicate your wishes to the physician, sometimes at the risk of alienating others. A proxy should also be familiar with your spiritual values.
Disadvantage with ethical issues at end of life can be health care providers not have the knowledge to deal with the dilemma, they not understand the advance directives, or day may not understand how important advance directives are. There times when health care providers have a hard time accepting the advance directive because they have a difficult time accepting death.
Other disadvantage are; how well are is the advance directive written that is explain the patient?s wishes clearly or is confusing. Many times the advance directives are not available or the family do not know where they and in some cases some states may not recognize the advance directive, and families not acknowledge the advance directive. In some case families and patients have the fair that advance directive can interfere with the care. It is important that health care providers are well training in the understanding of advance directives so they educate the patient and family in how important this document is a end of life. (Westphal & Wavra, 2005).
The most important advantage of an advanced directive is it allows a person to express choices and wishes to health-care providers. This strongly asserts the patient's choice into what treatments or procedures will be used in an emergency. It provides peace of mind because it answers the matter of whether life support should be used. Another benefit of an advanced directive is that it can prevent unnecessary delay in administering medical treatments that require consent. Without an explicit statement, precious time could be lost determining who has the legal authority to act on behalf of a critical patient. Advance directives can protect a terminally ill patient from excruciating pain and heroic measurement that can prolong the patient?s suffering (Westphal & Wavra, 2005).
The nurses must first review the advance directive to establish the validity of the patient?s desired wishes for their end-of-life care. Then, discuss these wishes with the patient or family to clarify the nurse correctly understands the patients stated desires. According to Mauk, the nurse would further discuss options of palliative care and hospice care, and the family?s role in end-of-life decision-making if any. Another consideration is how the nurse could best facilitate a family discussion regarding the patient?s choices (Mauk 2010). With the patient?s desire the priority, the nurse must attempt to help the family understand the patient?s end-of-life decisions. Nurses must also be aware of their own personal values and beliefs surrounding end-of-life care for their patients? choices to advocate adequately.
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. American Nurse Association. Washington, D.C.: American Nurses Publishing
Beauchamp, T L., Childress, J. F. (2001) Principles of biomedical ethics 5th ed.). New York: Oxford University Press.
Cohen, J. S., Erickson, J. M. (2006) Ethical dilemmas and moral distress in oncology nursing. Clinical Jouranl of Oncology Nursing10 (6): 775-782
Duke G; Yarbrough S; Pang K; (2009) The patient self-determination act: 20 years revisited. Journal of Nursing Law, 13 (4): 114-23
Mauk, Kristen L. (2010). Gerontological Nursing Competencies for Care. Massachusetts: Jones and Bartlett
Purtillo, R. B. (2005). Ethical dimensions in the health professions (4th ed.) Philadelphia: Elsevier Saunders
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