Human_Growth

Case Study Nursing is a profession that is based on caring and in order to provide quality care the nurses must understand each client’s situation. This paper will focus on an 86-year-old client, and the nurses’ skills, roles, ethical issues and options available regarding his care. Summary Mr. Johndor is an 86-year-old resident of a long term care facility who was transferred to an acute care facility after having a cerebral vascular accident which left him paralyzed on his left side of the body. He also had two grown up daughters who where involved in looking after him including registered nurse who has been caring for him and has been able to talk to him about his present condition. Anyhow, after tests were done it was determined that Mr. Johndor’s ability to swallow was very poor and the Speech-Language Pathologist concluded that it was not safe for Mr. Johndor to take in oral food and suggested that other methods of feeding be discussed with Mr. Johndor. At the time of admission, Mr. Johndor was able to communicate with the nurse and it was believed that he could still make decisions for himself. Mr. Johndor’s physician discussed with him feeding options they had and a temporary tube was inserted while they were waiting to reassess him. After reassessing it was determined that there was no change and the physician suggested that Mr. Johndor might consider a permanent percutaneous endoscopic gastronomy (PEG) tube for he was at risk of aspirating, developing pneumonia and consequently dying if he continued orally taking his food. Mr. Johndor told the nurse that was working with him that he had had a good life, and was not afraid of dying, and wanted to enjoy food for it was one of the few pleasures he still had, so he was willing to take the risk and his young daughter who was looking after him all along, supported the decision. However, after Mr. Johndor spend some time with both his daughters, and the younger daughter informed the physician that her father wanted the permanent tube, but the elder daughter was against it. Therefore, Mr. Johndor informed the nurses that he was so confused about why his elder daughter was upset about his decision. Therefore, registered nurse ask herself how she could help Mr. Johndor' Ethical Issue The major ethical issue in this situation arises from the conflict between the nurse’s beliefs about what will benefit Mr. Johndor, and the eldest daughters belief against her fathers choice. Mr. Johndor is caught in the middle and he is unwilling to say publicly his own feeling. Another ethical issue is that Mr. Johndor’s autonomy is being compromised for the nurse get the impression that he is being influenced or coerced. He was clear in his decision and explained why he was refusing treatment in the form of a permanent PEG tube. After spending some time with both his daughters however, he is second-guessing his decision because his eldest daughter is upset with his decision. Anyhow, it would be helpful to know more about the youngest daughter regarding her involvement in her father’s life and how much she understands about his health and his reasons for making the decision to put his life at risk. In addition, knowing more about her relationship with her eldest sister, who also help looking after their father would also help both sisters to support their father’s decision. Ethical Principles The ethical principles involved in this case are autonomy and beneficence. As noted in Yeo, Moorhouse and Dalziel (1996), “Autonomy means self-determination, the right to make independent decisions concerning one’s own life and well-being”(p.91). When Mr. Johndor’s was admitted to the acute care facility it was felt by the nurses that he was capable of making decisions for himself. Autonomy requires relevant information, ability to understand information and freedom to act on that information. The physician provided the relevant information including the risks involved and Mr. Johndor’s understood the information. Furthermore, the health care team wanted him to be free to act on that information so the physician gave him time to discuss his options with his family. According to Yeo, Moorhouse and Dalziel (1996), “beneficence denotes promoting someone else’s good of welfare”(p.58). The health care team wanted to promote Mr. Johndor’s good as a human person for he has the capacity to make choices and it is the duty of nurses to honor this good. Skills Required On a daily basis, nursed have duty tasks that they carry out with require them to have skills that give them accurate knowledge on the client they are dealing with. Providing physical assessment skill from head to toe, gives information on the functionality of the person in nightly detailed way. Clinical skills that are accomplished at school are very imperative when admitting a patient especially in this situation. This competent includes the ability of the examine to collect pertinent clinical information, which brings a strong teamwork in the medicine area of practice. In Mr. Johndor’s situation, clinical skills work hand in hand with communication skills. The nurse is seen as a link to pass information from patient to his family members and hospital team; therefore, communication skill is a greater importance in the nursing field, to provide the adequate health treatment for Mr. Johndor. Furthermore, social skills bring out the interaction that builds up the strong bond between the nurse and Mr.Johndor. Mr.Johndor open up to the nurse about his feeling about his eldest daughter being upset, and trust the nurse by telling her what was going on with him, which makes it easy for the nurse to monitor the changing conditions of him and finding caring possible to improve his behaviour and social skills. Never the less, social skills bring out the human side of an individual. Code of Ethics The Code of ethics for registered nurses help them in this case by stating the principles that should guide in their practice such as Choice and Dignity. According to the code of ethics: “ Nurses respect and promote the autonomy of persons and help them to express their health needs and values, and also to obtain desired information and services so they can make informed decisions”(CAN, 2008, P.) this helps nurses respect the informed decisions of competent persons to refuse treatment and to choose to live at risk. In addition, regarding dignity code of ethics also states that, “Nurses must seek out and honor person’s wishes regarding how they want to live remainder of their life. Decision making about life-sustaining treatments is guided by these considerations”(p.13) Options Available to The Health Care Team Based on the summary and the information available, Nurse’s options are limited. The options available to the nurse in this situation is leaving it to the family to discuss and come up with a decision or taking action to facilitate the decision making process. I believe that there are no substantial ethical arguments against leaving it to the family to discuss on their own, for Mr. Johndor is now second guessing his decision after speaking with his eldest daughter and has asked the nurse what he should do. The ethical argument against leaving it to the family is that we might be leaving him in a vulnerable position. Somehow, what is good of his well-being is not just his health, but it is also allowing him to make decisions for himself. Part of that is promoting his autonomy. Moreover, as nurses we want to ensure that Mr. Johndor has thoughtfully and rationally considered the situation and considered the impact of his decision and also that the choice of action is consistent with his values and character. I also believe that there are no good arguments against this as long as we discuss and objectively without becoming emotionally involved. Another option towards which nurse seems inclined, would be to encourage Mr.Johndor, to insists on some kind of counseling, psychological. This may be compatible with nurses understanding of client of advocacy in nursing. Therefore “encouraging” Mr.Johndor, however, nurse should be respectful of her autonomy and sensitive to the possibility of pressuring or coercing him. Telling Mr.Johndor what to do is different that advising him and different again that helping him to explore options and work through his own decisions. The most effective way to intervene could be to explore with Mr. Johndor the consequences that might follow from the options available to her and ensure that these are considered in the decision-making. Recommendations I would recommend that the health care team take action to facilitate the decision making process. The health care team can facilitate it by talking to Mr. Johndor when he is alone and inform him that we want the decision that he makes to be voluntary and genuine after he has thoughtfully and rationally considered the situation. Furthermore, the nurse can ask Mr. Johndor if he wants them to talk to his daughters and remind them that the final decision should be their father’s and that they should consider his reasons for making whatever decision he does and he needs their support. In addition, nurse can ask Mr. Johndor if he needs any other resources such as speaking to a Priest or having the Speech-Language Pathologist to promote successful communication for him, by assessing his communication and swallowing disorder, by screening, evaluating and diagnosing him before he makes his decision. A meeting can be held with both daughters and the health care team present where the options can be discussed thoughtfully and rationally to help Mr. Johndor consider the situation from different perspectives before he makes his final choice. In conclusion, this case has analyzed that nurses play an important role in facilitating and ensuring that clients make informed decisions based on having established rapport with the client and having a good nurse-client relationship. Furthermore, nurses have important role to play in Mr. Johndor’s live through providing quality service and they achieve their goal by working as a team and also improving quality care by having the proper skills. The nurses respect the client’s autonomy as well as supporter for them and work as a team with other health care professionals to ensure that the client receives good care.