Advance

The Department of Human Resources received a report on Ms. Sue Salter on 9/17/14 alleging Ms. Salter a paraplegic who is paralyzed on her left side was living in a home with no water, power, and had an inadequate caregiver. During investigation, utilities were reconnected and Hospice service provided. Hospice stated Ms. Salter was losing notable weight and found lying in urine during visits. Due to this, several bedsores increased and the doctor ordered a catheter and low air mattress. Ms. Harville, the caregiver was educated on wound care numerous times and demonstrated a working knowledge but choose not to administer wound care.

Patient's decision-making is influenced by several factors. Patients may change their decisions, from accepting or refusing treatment depending on the available treatment options. The capacity of the individual to make informed medical decisions can differ as the patient's status changes cognitively, emotionally, and/or physically and as the proposed treatment interventions change. Treatment refusal is a common situation faced by clinicians. Patients do not usually refuse the medical advice if the advice is of good intention. When patients refuse an advice, it indicates some underlying reasons related to the patients or family, factors associated with the physician as well as social and organizational issues.

At today’s visit she is found in her room at Tiffany hall SNF. She is awake, alert and confuse. The facility staff reports that the patient often refused care. She is wheelchair dependent. She is assist with most ADLS. She has chronic edema in lower extremities and refuses to elevate legs. She also refused

Beneficence compounded by nurse-physician communication created ethical problems in this case. Mainly, Joanna’s assessment of Mrs. Kelly being ignored by the resident physician and the nursing supervisor. Joanna worked within the scope and standards of practice, she assessed, evaluated, and monitored her patient’s condition. She then reported her findings to the resident twice, and also sought nursing support from her shift supervisor. After Joanna’s first call to the resident, and her continued concern she needed to advocate in a proactive manner. Continuing her assessment of Mrs. Kelly to include palpation and auscultation could have offered additional clinical information enabling her to articulate the problem to the resident and nursing supervisor.

Every patient has a right to decide on their own course of treatment and freely consent to that treatment. In order to make an educated decision they must be provided with the proper information to make an informed choice (Opinion 8.08 - Informed Consent, 2006). It is the physician’s legal and ethical obligation to provide this information when making their recommendation on treatment. The choices given must be in accordance with good medical practice (Opinion 8.08 - Informed Consent, 2006). The informed consent is the legal policy, either written or verbal, that gives full disclosure of all the information including potential risks that is applicable to the patient’s condition and treatment being offered (Kazmier, 2008).

The nurse in the case study is faced with an ethical and professional, dilemma. How can she be an advocate for her patient Mr. E? Dr G. is proceeding on a course of action or plan of care that is directly contrary to the patients advance directive and his verbalized objections to the course of treatment proposed by the physician and that is concerning for her. There are multiple issues to consider. For the nurse, she needs to think about her code of ethics, her scope of practice and the legal issues regarding advance directives and Durable Power Of Attorney (DPOA). She also needs to consider the patients right to privacy and confidentiality. As with most areas and issues in modern healthcare the statues can be

Rarely any physician intends to harm patients when he or she provides treatment to them. Patients see physicians and specialists in full faith that they will get help with a condition. What complicates the patient-doctor relationship is that the outcome of each patient’s treatment is different because of individual health conditions and the course of treatment chosen by the doctor. Problems arise when a patient is not satisfied with care provided by the doctor or in extreme cases when a patient dies. Since most of the time it is hard to clearly determine whether the outcome was solely a result of the course of treatment chosen by the doctor or whether other factors played a role too, quite often patients take their

It was not long after I started my job at a long term acute care center that I had a patient who came for vent weaning to our facility. This patient was unresponsive for a while and her oldest child had the durable power of attorney (DPOA). By the time the patient came to us, she was able to communicate by mouth wording or using the alphabet board. She was alert and oriented sometimes, and confused other times. Her problems started with stroke and respiratory depression, but doctors found out that she had very progressed form of cancer and not much chance of survival as they were treating her for stroke. The problem was that DPOA still wanted the patient to be full code and would not listen to the health care members to consider her mother’s

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

Alyssa, a 56 year old patient at LA Hospice has been admitted in December with a brain tumor, following having stage 3 lung cancer. Alyssa is currently getting radiation treatment along with chemo therapy. Alyssa and her husband John both do not have medical insurance, leaving them with using Medicare. Her functional status is having to use a walker if she has enough strength that day. Alyssa is forgetful from time to time having short-term memory. She has fallen several times in the past and has broken quite a few bones. The last time she had fallen was a week before getting admitted. A nurse or physician is watching her 24/7 every day. The nurse has to write down every symptom and change in her health every day. Alyssa’s overall goal is to be able to go back home and continue her treatment. Alyssa said “I know I can be strong enough to fight this battle, I have to for my husband.” Jenna the IDT talks with her husband about her situation. Jenna asks “Here at LA Hospice we

K.K is a 43 year old male with a history of an advanced Friedreich’s ataxia and chronic pain. He is on hospice through Heartland Hospice. Staff reports that resident had a fall over the weekend from his wheel chair while he was trying to put a hot cup of coffee on his bed side table and landed on his buttocks and he spilled his coffee on his left foot and he sustained a second degree burn. Staff has been treating his burn with silvadene and gauze dressing. When I asked resident if he is has pain, he stated has pain everywhere most of the time. States that he has had pain for more than 20 years. He describes the pain as a “stabbing ” when it’s worse. When I asked K.K what his pain level was on a scale of 0-10, he would not give me a number,

According to Pozgar (2016), “The Patient Self-Determination Act of 1990 (PSDA) describes the rights of patients to make their own health care decisions” (p. 438). Indeed, health care organizations need to educate their patients about their rights and make sure that they understand and are aware of them. The PSDA requires hospitals, hospice programs,

Patients cannot always be saved, medical personnel can help patients understand their outcomes. In the listed scenario a 17 year old has Duchene Muscular Dystrophy and multi organ failure. Although the patient is alert, his health continues to decline. Medical personnel feel from a medical perspective they cannot save the patient. The patient is unaware of his declining condition, because his parents asked the medical personnel to remain optimistic and encourage the patient to work towards getting better. The nurse should help the parents understand that they are ethically obligated to be honest and forthcoming with patients. It is the patients’s right to know his medical diagnosis. When everyone is aware of the current medical state of the

An Advanced Directive is a legal, written document of specific instructions on how to conduct medical treatments should the individual become unable to communicate their wishes to doctors and specialists. The document only becomes effective once the patient is unable to make any decisions because of mental inability or incoherence; until then, the patient is fully responsible for making their health decisions. This document is legal in the United States of America, but certain terms and conditions vary amongst the different states. It is important to consult a doctor and specialist when writing the document. An Advance Directive is significantly important to have, regardless of age; it is always better to be safe and prepared because anything could happen to anyone at any time.

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to