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The 1991 the Patient Self-Determination Act (PSDA) was designed to give patients and their families greater autonomy over making decisions in regards to end-of-life care and minimizing the extension life beyond what would be considered a 'quality' level. It has been said that "advanced care planning increases the quality of life of dying patients, improves the experience of family members and decreases health care costs" for patients of a variety of backgrounds (Eggertson 2013). However, few patients are aware of how to go about constructing such directives even though the evidence indicates that most have clear preferences about how their end-of-life care should be managed. "A recent study in Maryland found that although 'only 34% of respondents had an AD, 61% indicated that they have preferences about medical care in the event they are unable to make such decisions', and of these '83% said it was very important…
Brown, L.D. (2012). Stealing on insensibly: End of life politics in the United States. Health Economics, Policy and Law, 7(4), 467-83. doi: http://dx.doi.org/10.1017/S1744133112000254
Eggertson, L. (2013). Doctors, patients urged to discuss advanced care plans. Canadian Medical
Association Journal, 185(13), E617-8.
Kwon, Y.C., Shin, D.W., Lee, J.H., Heo, D.S., Hong, Y.S., Kim, S., & Yun, Y.H. (2009).
Advanced directive may be one of the most important and underutilized tools in estate planning and health planning. This is partially due to the stigma that people have about advanced directives, as if, by planning how to deal with health issues, they are somehow going to cause health problems. However, the reality is that most people will encounter at least one medical emergency during their lifetime. In the event that the health event renders a person unable to communicate his or her wishes, the advanced directive is a method of ensuring that the patient is still able to communicate his or her wishes. This is specifically relevant in scenarios where third parties may have to make decisions about whether to provide or withhold life-saving treatments.
There are a number of different documents that fall under the rubric of advanced directives. The term encompasses all legally binding written documents that describe…
American Bar Association. (Unk.). Myths and facts about health care advance directives.
Retrieved November 14, 2013 from ABA website:
American Hospital Association. (2012). Put it in writing: Questions and answers on advanced directives. Retrieved November 14, 2013 from AHA website: http://www.aha.org/content/13/putitinwriting.pdf
Hartocollis, A. (2012, October 14). Daughter's right to die is weighed against family's wish to keep her alive. Retrieved November 14, 2013 from The New York Times website: http://www.nytimes.com/2012/10/05/nyregion/in-sungeun-grace-lee-case-right-to-die-is-weighed-against-a-familys-wishes.html
However, it does mean that some things will be different from the normal line of treatment. ("Advance Medical Directives.," n. d.); (Feldman, Mitchell D; Christensen, John F. (2007)
The fact that resuscitation of a patient through CP will not add significantly to the quantity and quality of life is an indication that death may not be very far off and that medicine does not have the power to turn around the dying process. CP has not only proved to be ineffective for terminally ill patients but the harsh nature of its functioning make it a technological, cruel and expensive death process. The results of many studies have indicated that the "out-of-hospital survival" rate of patients suffering from multisystem disease like renal failure and advanced cancers have not increased as a result of CP. Conflicts often crop up when the patient's family members, friends or relatives who have a vested interest…
American Academy of Orthopaedic Surgeons. (2006) "Emergency Care and Transportation
of the Sick and Injured" Jones & Bartlett Publishers.
Billings, Diane M. (2008) "Lippincott's Content Review for NCLEX-RN." Lippincott
Williams & Wilkins.
For example, Wissow and colleagues (2004) collected gender, age, ethnicity, and levels of clinic/ED use. This information may provide valuable insight into who is most likely to create an advanced directive in response to the intervention. The time frame for the study was not mentioned or how long after the intervention the survey instrument would be presented to intervention participants. This could be relevant because some individuals exposed to the intervention may decide to create an advanced directive right away, while others may wait weeks or months before finally making the decision to put into writing their care preferences.
Hunter-Johnson, L. (2014). Evaluating advanced directive promotion. University of South Alabama.
Wissow, L.S., Belote, a., Kramer, W., Compton-Phillips, a., Kritzler, ., & Weiner, J.P. (2004). Promoting advance directives among elderly primary care patients. Journal of General Internal Medicine,…
Hunter-Johnson, L. (2014). Evaluating advanced directive promotion. University of South Alabama.
Wissow, L.S., Belote, a., Kramer, W., Compton-Phillips, a., Kritzler, R., & Weiner, J.P. (2004). Promoting advance directives among elderly primary care patients. Journal of General Internal Medicine, 19(9), 944-51.
According to this second view, contemporaneous autonomy trumps precedent autonomy because honoring precedent autonomy imposes preferences and values of a different person, the formerly competent self (Buccafumi, p. 14).
The role that patient's families, doctors, health aides, pastors, chaplains and administrators, health educators and others play is crucial. Few people have executed an advanced directive, much less appointed a healthcare power of attorney by the time they enter a hospital with a debilitating condition. An informed consent form only marks the fact that a conversation has taken place in a health facility. The process that needs to or ought to take place concerning a patient's wishes and ensure one's wishes are empowered are part of the process involved as one fills out the advanced directive for themselves. In California the state has consolidated statutes for advanced directives and added some rights and included the best features of past laws. A…
REFERENCES WHICH I DID NOT USE (JUST for YOUR INFO, NOT to BE INCLUDED in THIS PAPER)
American Nurses Association. (1985). American Nurses
Association Code for Nurses with Interpretive Statements, Section 1.1. Washington, DC:ANA.
Docker, C. (1995). Deciding How We Die. The use Limits of Advance Directives. [Online]. Available: http://www.finalexit.org/wfn27.3.html .
Fishback, R. (1996). Harvard Medical School Division of Medical Ethics. Care Near the End of Life. [Online]. Available: www.logicnet.com/archives/file2001.php.
The main finding sof the study were in addition to correlate identification the development of a more clear idea of the real limitations of prevalence of existing PADs, in that 4-13% of study participants had already created PADs of one or both types and that this same study group had a very high statistical desire to create their own PADs (66-77%) but would like and subsequently lack appropriate assistance in doing so.
This article is really well organized, written and supported. The work provides substantial, timely and comprehensive information about the finer points of PADs and why they are important, as tools to ideally aide mental health consumers in both self-empowerment and to aide providers and caregivers in decision making that falls short of coercive or legal treatment demands. The work provides demonstrative insight with regard to the community need to provide adequate support to mental health consumers regarding…
Swanson, J., Swartz, M., Ferron, J., Elbogen, E., & Van Dorn, R. (2006). Psychiatric Advance Directives among Public Mental Health Consumers in Five U.S. Cities: Prevalence, Demand, and Correlates. The Journal of American Academy of Psychiatry and the Law, 34 (1), 43-57.
Cae Planning Analysis
In eality, sound healthcae-elated advanced planning is a continuous convesation, involving pioities, values, QOL (quality of life) and what one's life means. Tool kits, in this context, compise vaious self-help esouces, woksheets, and ecommendations. They aid individuals in pefoming the moe complex tasks of identifying, confiming, and shaing impotant facts with an individual faced with a seious ailment (Ameican Ba Association, 2005). Iespective of whethe the individual is teminally ill o suffeing fom an acute ailment o chonic, long-tem ailment, advanced cae planning (ACP) is capable of facilitating the alleviation of unnecessay suffeing, impoving QOL and offeing a bette gasp of decision-elated challenges faced by the ailing individual, his/he family, and othe caegives. Advanced cae plans may be implemented at any junctue in the patient's life and must be updated when changes occu in patient cicumstances. A peson who contacts a pogessive disease that leaves him/he disabled…
references? A Study of the U.S. Medicare Population. Medical care, 45(5), 386.
Centers for Disease Control. (2013). Advance care planning: ensuring your wishes are known and honored if you are unable to speak for yourself. Retrieved 16 February 2016 from http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf
Wehri, K. (2011). Living well at the end of life: a national conversation. Caring: National Association for Home Care magazine, 30(9), 38.
Supervision: When to Use Directive Control Behaviors
This paper is about many different aspects of effective supervision, training and evaluation, but the main concern here is control. It can be assumed that the supervisor has control over the supervisory situation, but this would be an oversimplification of the relationship between a line employee and their direct boss. Control is a shared entity because though the supervisor may determine the course an employee must take, the employee decides whether they will follow that direction or not. Thus, the supervisor must prove to the employee that they are competent in the job before they can expect the employee to follow direction.
This is the stance taken by directive control behaviors. A supervisor who uses directive control behaviors has to be a subject matter expert. If they cannot claim an expertise in the elements that the job entails then they are less likely…
Pistole and Fitch (2008) examined the role of attachment in supervision. The findings in this study were much like those of the cultural study. Two factors influenced the role attachment played in the supervisory relationship: a culture that valued attachment, or a person who did not feel confident in the job that they were doing. The second type of employee seems to thrive under the vertical, directive style of leadership and have productivity decreases when forced to complete a task with little direction (Pistole & Fitch, 2008). This meshes well with other research which suggests what the appropriate role of directive control behaviors are.
Directive control also calls for a leader who is charismatic enough to generate the trust necessary for the directive relationship to succeed. The worker must be able to see that the supervisor has confidence in their skill level before that leader will be accepted. Einstein and Humphreys (2001) looked at how directive leaders were perceived by their subordinates. The most important part of the relationship, according to the research, was the belief by the employees that the leader was an expert. This led to a belief that the direction that was being received was appropriate to meet the set goals. The researchers did find that a leader must be willing to move from "directive to persuasive to involving to inspirational styles of leadership" as the competency and confidence of the employees increased. If the supervisor remained in a directive role for too long then productivity of the employees would decrease.
These studies bear out two points that are important for understanding the role of directive supervisory behavior. First, there are certain groups of people that will generally feel more comfortable when the supervisor takes a more directive role. Second, directive leadership has a very specific window of success. It needs to be used in the correct situations.
We are living in times of continuous change that thrives on information. Information is the cornerstone of the financial construct of organizations. Information and access thereto drives the success of organizations in present times. The way the external world receives the statements of organizations is causal to its perception by individuals and institutions in evaluating it. As such, it is imperative that the architects and designers of this vital information need to pursue diligently highest levels of moral, ethical, and professional standards in preparing it. In providing for the financial and economical framework for such information, services of auditors are simply indispensable. The audited reports of an organization is the basis on which the organization makes its statement of intent public and helps aid the process of decision making and perception about it in the capital and investment markets (Franca & Maria, n.d.).
IMPORTANCE OF MATERIALITY IN AUDITING
Acito, A.A., J.J. Burks, and W.B. Johnson. 2009. Materiality decisions and the correction of accounting errors. The Accounting Review 84 (3): 659-688.
American Institute of Certified Public Accountants (AICPA). 2008. Clarification and Convergence. An AICPA Auditing Standards Board Project. New York: AICPA, July.
Brody, R.G., D.J. Lowe, and K. Pany. 2003. Could $51 million be immaterial when Enron reports income of $105 million? Accounting Horizons 17 (2): 153-160
Eilifsen, A. & Messier, W., 2014. Materiality guidance of the major public accounting firms. Auditing: A Journal of Practice & Theory.
Methodological consideration on the project is designed as tri-partite study of legal and popular culture on UK immigration and the new formations of labour and capital through: Phase I: Archival esearch; Phase II: Data Analysis; and Phase III: Writing. Iterative archival and internet research will be employed throughout the project in order to craft substantive dialogue into the dissemination and publication of the project.
Implications to the Study
A study on migrant workers in the UK during a radical shift in the global economy, the research promises to offer new information on the mechanistic uses of law to redirect labour where capital flows are no longer adequate to sustain them. Integral to prospectus of the project is a comparative legal perspective, meant to engage and challenge our taken for granted assumptions about the role, rights and responsibilities of foreign nationals as they attempt to participate in Britain's democracy. Outcomes…
Downturn cuts foreign worker jobs (2009). BBC News. Available at: http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/politics/8317193.stm
Employment Act, 2008 (Commencement No. 2, Transitional Provisions and Savings) Order 2009. Office of Public Sector Information (OPSI). Available at: http://www.legislation.gov.uk/uksi/2009/603/pdfs/uksi_20090603_en.pdf
Employment Rights Act 1996. Order 2009. Office of Public Sector Information (OPSI). Available at: http://www.legislation.gov.uk/ukpga/1996/18/contents
A Gillespie 'The Human Rights Act 1998 and the European Convention on Human Rights (ECHR)' Jurist. Available at: http://jurist.law.pitt.edu/World/ukcor3.htm accessed 24 June 2010
Professional oles and Values
A good number of patients visiting emergency departments are in a position to make independent decision concerning their care. Nevertheless, a significant proportion of them are extremely incapacitated either mentally or physically to the extent that they cannot solely make decisions regarding their treatment. Some of the conditions associated with this incapacitation include organic brain disorder, hypoxia, or head trauma. Jones et al. (2005) describes an emergency department as a very hostile environment where patients may lose control of the nature of care they undergo. Such is the case scenario in this current study. Mr. E is developmentally delayed and hypoxic. Dr. K considers his situation as an emergency and a ventilator must support it. The fact that Mr. E had already signed an advance directive under the supervision of a patients advocate that he did not want a ventilator or cardiopulmonary resuscitation complicates the matter…
Dickey, S.B. (2003-2004). Nurses should be concerned about the ethical implications of HIPAA regulations (pp. 1-5). Washington, DC: American Nurses Association
Fowler, D.M. (2008). Guide to the code of ethics for nurses. Silver Springs, MD: American Nurses Association
Jones S, Davies K, Jones B (2005). The adult patient, informed consent and the emergency care setting. Accident and Emergency Nursing. 13, 3, 167-170
In any case, patients can set out defined clause in the Power of Attorney telling operators how they might like them to act with respect to deathbed issues (Edge & Krieger, 2008).
Living wills and other development directives depict a patient's inclination with respect to medicine if the patient is confronted with a genuine mishap or disease. These authoritative reports represent the patient when he/she is not ready to represent himself/herself. Unforeseen end-of-life scenarios can happen at any age, so it is imperative for all grown-ups to have progress directives. Durable power of attorney for health care (POA) is an authoritative record that designates a single person to settle on restorative choices for a patient in case he/she is unable to do so (Kerridge, Lowe & Stewart, 2013).
A patient's advance directives incorporate the living will and durable power of attorney for health care. They may be the…
Cohen, M.H. (2010). Beyond complementary medicine: Legal and ethical perspectives on health care and human evolution. Ann Arbor: Univ. Of Michigan Press.
Duquenoy, P., George, C., & Kimppa, K. (2008). Ethical, legal, and social issues in medical informatics. Hershey, PA: Medical Information Science Reference.
Edge, R.S., & Krieger, J.L. (2008). Legal and ethical perspectives in health care: An integrated approach. Albany: Delmar Publishers.
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions. Upper Saddle River, N.J: Prentice Hall.
With regard to the medication administration itself, in a life saving circumstance, which this clearly is not the weight of the potential for depression of respiration and cardiac status is clearly indicated, yet it would seem unethical under these circumstances, if the review of the documentation proves its validity and clearly indicates the patients wishes, to deny at least the smallest dosage (2mg) of ordered Morphine to reduce the pain and potentially allow the patient to regain calm, which will clearly improve his status with regard to short-term treatment.
If the fear of doing harm, drives every medical decision, based on the extreme notion that all patients can be saved under all circumstances then bioethical decisions are futile. The observations and communications of others in the immediate vicinity to care, including the family, other nurses, support staff and most importantly the orders of the doctor to administer palliative care for…
Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.
Forsythe, C.D. (2005). Protecting Unconscious, Medically-Dependent Persons after Wendland & Schiavo. Constitutional Commentary, 22(3), 475.
Mantz, a. (2002). Do Not Resuscitate Decision-Making: Ohio's Do Not Resuscitate Law Should Be Amended to Include a Mature Minor's Right to Initiate a DNR Order. Journal of Law and Health, 17(2), 359.
Saunders, D.E. (2003). Removing the Mask. The Hastings Center Report, 33(2), 12.
The death of elderly individuals takes place in different circumstances and settings such as painless death at home or painful death in a healthcare facility. Social workers have an important role in planning end-of-life care as part of providing essential social support to elderly individuals. The role of social workers in this process is attributable to the significance of their professional practice in a multidisciplinary palliative care team in hospice and hospital settings (Watts, 2013). Since the death of elderly individuals occurs in a variety of conditions and settings, social workers need to plan for end-of-life care. The planning and delivery of end-of-life care helps in helping the elderly cope with serious illness, face mortality or manage the process of dying in an effective manner.
One of the major functions of social workers in their role in planning for end-of-life care is providing psychosocial and practical support to individuals who…
I do not believe that wearing glasses or make-up is wrong, even though this is an enhancement of the human body by improving one's life by being able to see, or covering blemishes and unsightly birthmarks that might make an individual self-conscious. Is selecting the best sperm donor really so much different than a man or a woman basing his or her choice of a mate upon that individual's appearance, intelligence, and lack of unpleasant 'skeletons' in the genetic closet? Svaulescu's idea that one has a moral obligation to screen for genetic defects or to personally improve the human race through reproduction makes one queasy, but the idea of leaving everything up to nature, in theory, would mean an end of folic acid for pregnant women or even birth control.
But really, the ultimate argument for allowing patients to attempt to engineer their offspring by selecting 'better sperm' may be…
For elderly patients who have no one to appoint as their proxy, completing a living will that outlines their wishes is preferable to not providing any information at all about care preferences. This is equally so for patients who want to provide their proxy with some guidance about their treatment preferences and end-of-life care wishes, including artificial nutrition, ventilator support, and pain management. A living will (LW) provides specific instructions to health care providers about particular kinds of health care treatment that an individual would or would not want to prolong life. Living wills are often used to declare a wish to refuse, limit, or withhold life-sustaining treatment when an individual is unable to communicate. All but three states (New York, Massachusetts, and Michigan) have detailed statutes recognizing living wills. The usefulness of LWs is limited, however, to those clinical circumstances that were thought of before the person became incapable…
Burnell, G.M. (1993). Final Choices: To Live or to Die in an Age of Medical Technology. New York: Insight Books.
Fisher, C.B. (2002). A Goodness-of-Fit Ethic for Informed Consent. Fordham Urban Law Journal, 30(1), 159.
Galambos, C.M. (1998). Preserving End-of-Life Autonomy: The Patient Self-Determination Act and the Uniform Health Care Decisions Act. Health and Social Work, 23(4), 275.
Hardwig, J. (2000). Spiritual Issues at the End of Life: A Call for Discussion. The Hastings Center Report, 30(2), 28.
It is also wise to have it reviewed by a doctor or attorney, the Family Doctor eb site suggests; that way you can be assured that what you wish to have done with you and to you if you become incapacitated is "understood exactly as you intended" (Family Doctor).
The advance directives are sensitive and private, and they are very important for seniors. But the advance directives can be controversial, so it is wise for older people to know the law and understand the facts. To wit, there have been rumors and falsehoods spread on the orld ide eb and elsewhere about the advance directives that are spelled out in the recent overhaul of the healthcare system. Former governor of Alaska Sarah Palin made news in the summer of 2009 by asserting that the advance directives in the healthcare overhaul created a "death panel" of bureaucrats who will "decide, based…
Binstock, Robert H., and George, Linda K. (2010). Handbook of Aging and the Social
Sciences. Maryland Heights, MO: Academic Press.
Black, Jane A. (2008). Notes: The Not-So-Golden Years: Power of Attorney, Elder Abuse, and Why Our Laws are Failing a Vulnerable Population. St. John's Law Review, 82(1), 289-314
Collier, Elizabeth. (2005). Latent age discrimination in mental health care. Mental Health
Nursing and Ethical Choices
What are the utilitarian and Kantian justifications for Advance Directives?
The health care proxy and the living will are two ways in which a patient can express advance directives relating to health care and/or end of life treatment should that person become incapacitated. The utilitarian justification for advance directives is that the end justifies the means, or in other words the greatest good for the greatest number of people. If an advanced directive is given, it covers all the people involved and lets the patient's wishes be known ahead of time in case there comes a moment when the patient can speak for him or herself. The doctors and care givers will be obliged to accept this as the greatest good, because it relieves them of any duty to give care (if the directive has in place that it should be refused) and vice-versa. The Kantian…
Edwin, A. K. (2010). Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Medical Journal, 43(1): 34-39.
Gallagher, Thomas H. "A 62-Year-old Woman with Skin Cancer Who Experienced
Wrong-Site Surgery." (CIB, 65-71)
Philipsen, N. C., Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practicioners, 7(9): 740-746.
An adult do not need to make all decisions in advance, but educating oneself is a vital first step. (Death with Dignity: Planning Ahead for End-of-Life Care) few guidelines for signing a DN order are given here. A Do Not esuscitate Order - DN is a physician's order to not to employ cardiopulmonary resuscitation - CP in case of cardiac or pulmonary arrest. Competent adult patients may relinquish CP for medical or non-medical reasons. The patient may make such requests verbally irrespective of whether or not he/she is fatally ill. An appeal to relinquish CP may also be part of an Advance Directive. When it has been determined that the patient is short of decision-making capacity, the suitable substitute decision-maker should be recognized to make treatment decisions, including decisions to relinquish CP, if no such person has been appointed by an Advance Directive. If the patient is out of action,…
Care of the Sick and Dying. Roman Catholic Bishops of Maryland. Retrieved at http://www.mdcathcon.org/Care.htm . Accessed on 17th March 2005
Collins, Tony. Dealers of Death. Retrieved at http://www.envoymagazine.com/planetenvoy/Update-TCollins-TerriS-Jan04-Full.htm . Accessed on 17th March 2005
Dealers of Death. 30 November, 2004. Retrieved at http://www.catholicexchange.com/vm/index.asp?vm_id=2&art_id=26177Accessed on 17th March 2005
Do not Resuscitate- DNR Orders. 1 January, 2001. Retrieved at http://www.healthsystem.virginia.edu/internet/housestaff/policy-manual/dnr.cfmAccessed on 17th March 2005
The hospital should always defer to the patient and family that has an advanced directive in place, and if the patient cannot speak for themselves but has an advanced directive, then a proxy must make the decision. The only case where the hospital should be allowed to make the decision on futile care is in the absence of a proxy, in the absence of an advanced directive, and only if it is in the best interest of the patient.
In this psychological-based model, the healthcare professional and hospital is put in the position of negotiating with the family and/or patient. Burns and Truog (2007) state that in these situations the healthcare professional should always follow the wishes of the patient's family in futile care efforts (Burns & Truog, 2007). However, that view places a burden on the healthcare professional to compromise medical principles when that professional deems the care to…
Burns, J., & Truog, R. (2007). Futility: A Concept in Evolution. Chest, 1987-1993.
Forde, R. (1998). Who is to define the futility of treatment -- the patient or the physician? Tidsskr nor Laegeforen (Norwegian), 2652-2654.
Jonson, a., Seigler, M., & Winslade, W. (2002). Clinical Ethics 5th ed. New York, NY: McGraw-Hill.
Lachman, V. (2009). Ethical Challenges in Health Care: Developing Your Moral Compass. New York, NY: Springer Publishing.
Internal and external consistency was tested. A pilot study showed that there was internal consistency. However, the results of the larger study indicate that more work on the KAESAD to improve the internal consistency of the scales used to measure the responses was needed. Data were statistically analyzed with an accepted value of statistical significance set at p < 0.05. Also, some data that was found to be statistically significant was determined by the authors to be clinically insignificant. How this was determined by the authors was not explained in the procedure.
The results were presented in several helpful tables and also interpreted by the authors. The authors discussed the results of each aspect of their research questions. None of the research questions were left out. The tables that were used were helpful, easy to read and agreed with the interpretations that the authors made about their results. The discussion…
Jezewski, M.A., & Feng, J.-Y. (2007). Emergency nurses' knowledge, attitudes, and experiential survey on advance directives. Applied Nursing Research, 20, 132-139. doi: 10.1016/j.apnr.2006.05.003
Jezewski, M.A., Brown, J.K., Wu, Y.-W., Meeker, M.A., Feng, J.-Y. & Bu, X. (2005). Oncology nurses' knowledge, attitudes and experiences regarding advance directives. Oncology Nursing Forum, 32(2), 1-9.
Difficult Situations as a Nurse Practitioner
The scenario for the nurse practitioner centers on Angela Smith and her family. Angela is a 55-year-old who suffered a stroke and admitted after neighbors noticed some really odd behaviors. The situation was further complicated when Angela suffered a respiratory arrest and required mechanical ventilation and after a second CT scan the team found that she bleed into the ventricles and brainstem which may have caused irreversible brain damage. Her condition is quite serious and there must be a decision made about how to proceed with the care for Angela. It is likely that she will need long-term ventilation and PEG and the neurological team suspects that the brain damage is irreversible.
The most difficult aspect to this scenario is that there is no advanced directive and the family is being indefensibly optimistic regarding the potential for recovery. In fact, the patient's…
Burchum, J. (2002). Cultural Competence: An Evolutionary Perspective. Nursing Forum, 5-15.
Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care. Journal of Transactional Nursing, 181-184.
Tervalon, M., & Murray-Garcia, J. (1998). Cultural Humility vs. Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal for Health Care for the Poor and Underserved, 117-125.
Hawaiian elde cae pofessionals impove patient eldecae sevices to Japanese nationals, taking into consideation Japanese cultual noms and expectations
Caegiving fo eldely paents in Japan
Japan has witnessed a significant gowth in its elde population. In the yea 1950, 4.9% of the Japanese population was aged 65 yeas and above. This figue inceased to 14.8% (1995). By 2025, it is estimated to gow to 25.8% (Yamamoto & Wallhagen, 1997). Japan's 'vey old' population goup (aged 85 and above) is swiftly inceasing in numbe. It has been pojected that by 2025, the nation's 'vey old' population will account fo 4.3% of its total population -- a five-fold ise in thee decades. Futhemoe, it was pojected that as many as 2.62 million Japanese would be suffeing fom senile dementia by the yea 2015; the 1990 estimate fo senile dementia was about one million individuals (11WSA 1996).
Change in the pecentage of Japan's…
references, and Arrangement of End-of-life Care and Decision-Making among Japanese-American Older Adults, ProQuest LLC.
National Asian Pacific Center on Aging. (1998). Growing APA elderly population adds urgency to improving health services. Asian Pacific Affairs, 6 (Dr. 2-3.
SALDOV, M., KAKAI, H., McLAUGHLIN, L. & THOMAS, A. (1998). Cultural barriers in oncology: Issues in obtaining medical informed consent from Japanese-American elders in Hawaii, Journal of Cross-Cultural Gerontology 13: 265-279.
Sato, S. (2015). THE IMPACT OF GENDER AND CULTURAL FACTORS ON THE PATTERNS OF ELDER CARE SERVICE UTILIZATION AMONG FAMILY CAREGIVERS OF JAPANESE ANCESTRY IN THE STATE OF HAWAII, ProQuest LLC
SOROCCO, K.H. (1998). BECOMING A HEALTH ACTIVE OLDER ADULT: THE EFFECTS OF A WORKSHOP FOR JAPANESE-American OLDER ADULTS. ProQuest Information and Learning
The law recognizes the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures. In Terri's case there was a feud between Terri's husband and her parents in that there was not a clear cut answer, as to what she wanted or would have wanted. They both had conflicting views, which ended up in a feuding battle.
In conclusion, my view on the case is that I believe since there was no clear cut decision as to what Terri wanted, she should have been able to live. It is a moral, ethical, political, and legal decision that was a battle for many, but especially for Terri. God rest her soul.
Cassel, E. (2005). The Terri Schiavo case: Congress rushes in where only courts should tread. Retrieved April 24, 2005, from eb site: http://writ.news.findlaw.com
Dorf, M. (2003).…
Cassel, E. (2005). The Terri Schiavo case: Congress rushes in where only courts should tread. Retrieved April 24, 2005, from Web site: http://writ.news.findlaw.com
Dorf, M. (2003). How the Florida legislature and governor have usurped the judicial role. Retrieved April 24, 2005, from Web site:
Huntington's disease (HD) was the first autonomic dominant disorder for which genetic prediction became possible" (Harper, et al., 2000, Journal of Medical Genetics, p. 567). HD is a disease that occurs due to an inherited disorder leading to the death of brain cells. A diagnosis of HD is accomplished through genetic testing which can be implemented at any age regardless of whether the symptoms manifest or not. Although, the specific symptoms vary between people, nevertheless, symptoms can start with people between 35 and 45 years of age and can also start in some individuals at even anearlier age. The disease may affect successive generations if health interventions are not implemented (Mandel, 2016).
Additionally, "the cause of HD is due to a dominant mutation of autosomal form of the gene called Huntington. This shows that a child born by an affected person has a 50% chance of developing or inheriting the…
Causes and risk factors. (2016). Health Communities. Retrieved from http://www. healthcommunities.com/huntingtons-disease/cause.shtml.
Denbo, S. M. (2013, January 1). Balancing the rights of children, parents and the state: The legal, ethical and psychological implications of genetic testing in children. Southern Journal of Business and Ethics, 5, 188-190.
Domaradzki, J. (2015, January 1). Lay constructions of genetic risk. A case-study of the Polish Society of Huntington's Disease. Polish Sociological Review, 189, 107-111.
Draper, B. (2004). Dealing with dementia: A Guide to Alzheimer's Disease and other dementias. Crows Nest, NSW: Allen & Unwin.
Physician Assisted Suicide in Patients With Unbearable Suffering or the Terminally Ill
One of the most hotly debated issues today is physician-assisted suicide. ecently, California became the fifth state to legalize physician-assisted suicide, and there is an increasing likelihood that other states will follow suit in the foreseeable future. The purpose of this study is to determine if the factors chosen have any bearing on those who choose to end their life with physician assisted suicide. In support of this purpose, the objectives of this study were as follows: (a) to research scholarly articles regarding physician-assisted suicide and gather pertinent information into a comprehensive profile; (b) to research whether unbearable suffering is the dominant motive to request physician-assisted suicide; (c) to research whether the race and level of education of the patient are contributing factors when physician-assisted suicide is requested; and, (d) to research whether the type of terminal illness…
Bauer-Maglin, N. & Perry, D. (2010). Final acts: Death, dying, and the choices we make. New Brunswick, NJ: Rutgers University Press.
Biller-Adorno, N. (2013, April 11). Physician-assisted suicide should be permitted. The New England Journal of Medicine, 368(15), 1451.
Black's law dictionary. (1990). St. Paul, MN: West Publishing Company.
Boudreau, J. D. & Somerville, M. A. (2013,April 11). Physician-assisted suicide. The New England Journal of Medicine, 385, 15.
This has sparked many debates in social and political arenas in regards to personhood, self-determination and human autonomy.
Any time a person wants to intentionally end his or her life, it is considered suicide. Suicide, in itself is now legal (Manning, 1998), but proponents of euthanasia argue that suicide may not be an option for the terminally ill, the hospitalized or physically disabled. These people may not have the strength or the means to end their lives alone, therefore, they cannot exercise the option of suicide and consequently are being discriminated against (Gifford, 1993).
I personally agree with those on the pro-euthanasia side of the camp, who believe that suicide is not an appropriate term for this issue because suicide is often associated with desperate emotion whereas euthanasia is based on a "cogent and deliberate form of relief from a painful and hopeless disease" (Adams, 1992). As opposed to suicide,…
Adams, Robert. "Physician-Assisted Suicide and the Right to Die With Assistance." Harvard Law Review 105:2021-2040, 1992
Gifford, Edward. "Artres Moriendi: Active Euthanasia and the Art of Dying." UCLA Law Review 40:1545-1583, 1993.
Manning, Michael, MD, Euthanasia and Physician-Assisted Suicide: Killing or Caring? Paulist Press, Mahwah, NJ, 1998
Olen, Jeffery & Barry, Vincent. Applying Ethics: A Text With Readings (6th ed.) Belmont, CA: Wadsworth Publishing Company, 1999.
Revival of revoked wills. In most cases, a revoked will is not revivable unless it is reexecuted or revived by codicil; however, if a revoked will was destroyed, it cannot be revived in this fashion.
Dependent relative revocation. These are mistakes of law made by the testator concerning the disposition of property that can be disregarded in the administration of a will.
Components of a Will
Integration. This term refers to the collation of various sheets of paper into a cohesive whole which constitutes a single, entire will which is executed via a single act.
Incorporation by reference. A majority of states allow documents that were not integrated into the single, entire will to receive the same force and effect by referencing them in the will.
Facts of independent significance. This term refers to the description of intended beneficiaries or bequests in a will that…
In an acute care setting, such Veterans Affairs, this objective is executed by educating patients about how to maintain a healthy diet and lifestyle after the leave the facility, while in a long-term care setting-such as Cobble Hill-this objective is executed on a daily basis by providing nutritious meals for elderly residents. And finally, in an ambulatory, out-patient care setting-such as Atlantic -- the clinical nutritionist works to support patients in maintaining a diet that addresses their personal healthcare needs, while still living independently within a larger community. Perhaps the most significant similarity between facilities is the notion of nutrition as merely one component of a comprehensive care program; hence the necessity of a clinical nutritional to work in conjunction with a full medical, administrative, and social support staff. The apparent goal of such an approach is to promote multiple aspects of health and well-being among patients, regardless setting or…
Cite Health. (2010). Long Island College Hospital. Retrieved December 19, 2010 from http://citehealth.com/dialysis-centers/new-york/cities/brooklyn/long-island-college-hospital
Cobble Hill Health Center. (2010). Resident Services. Retrieved December 19, 2010 from http://www.cobblehill.org/services
United States Department of Veterans Affairs. (2010). Patient Information. Retrieved December,
19, 2010 from http://www.brooklyn.va.gov/patients/index.asp
But there will also be situations where clinicians are asked to discuss with a patient whether they want to or should have resuscitation if they have had a cardiac arrest or life-threatening arrhythmia. The potential likelihood for clinical benefit in accordance with the patient's preferences for intervention and its likely outcome, involves careful consideration, as with many other medical decisions, in deciding whether or not to resuscitate a patient who suffers a cardiopulmonary arrest. Therefore, decisions to forego cardiac resuscitation are often difficult.
Cardiopulmonary resuscitation (CP) is a set of specific medical procedures designed to establish circulation and breathing in a patient who's suffered an arrest of both. CP is a supportive therapy, designed to maintain perfusion to vital organs while attempts are made to restore spontaneous breathing and cardiac rhythm (Braddock 2).
The standard of care is to perform CP in the absence of a valid physician's order to…
Braddock, C.H. (1998) Termination of life-sustaining treatment. University of Washington School of Medicine. Seattle: Department of Medical History and Ethics. Retrieved 3/12/07 at http://depts.washington.edu/bioethx/topics/termlife.html .
Frequently asked questions. (2007). The World Federation of Right to Die Societies. Retrieved at http://www.worldrtd.net/faqs/qna/?id=8 .
Guru, V., Verbeek, P.R. And Morrison, L.J. (1999). Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma. CMAJ. 61 Nov; 161(10).
Hilz, L.M. (1999). Psychology Terms: Transference and countertransference. Kathy's Mental Health Review. Riverside, CA: Mental Health. Retrieved at http://www.toddlertime.com/mh/terms/countertransference-transference-3.htm .
A.J., an 82-year-old female, was admitted three weeks ago with acute on chronic congestive heart failure (CHF) after presenting to the emergency department (ED) with c/o progressive worsening SOB, leg edema, and fatigue. She has a history of severe CHF, atrial fibrillation, myocardial infarction (MI), renal insufficiency, and hypothyroidism. Since admission, A.J. has needed intubation and ventilation for acute decompensated heart failure due to a massive MI. She is alert when not sedated but has been too unstable for a cardiac catheterization and has needed vasoactive medications to support her blood pressure. Her renal function has declined and plans are being made for hemodialysis. Today when speaking with A.J.'s husband, he conveys to you her nurse that "she would not have wanted all of this." "
Discuss the pros and cons of continued therapy and what role nursing can play in helping the patient and family.
This case deals with…
Newborn pain is an example of an everyday occurrence where achieving neonates' interests are through making them comfortable and pain-free. As the neonatal intensive care nursery gives rise to many potentially painful procedures, a dilemma exists for caregivers in assessing if sick and/or premature infants are in pain (Nagy 1998). Although newborn pain affects the short-term interests there are possibilities that the lasting effects may also be harmful (Spence, 2000).
For a long time, the medical profession has given its members with the knowledge and skills that are required to treat disease and deformity. Physicians have often been the front line of technological mastery, increasingly emotional with the onerous responsibility of determining when intervention is suitable. Underlying this responsibility is a foundation of core principles, including beneficence, non-malfeasance, and compassion. Conscious use of these principles is not often supportive when the best interests of patients are diverse and apply to…
Head, David W., Head, Becky and Head, James L. (1985). Life or Death of Severely Disabled
Infants: A Counseling Issue. Journal of Counseling & Development. 63(10), p. 621.
Kopelman, Loretta M. (2005). Are the 21-Year-old Baby Doe Rules Misunderstood or Mistaken? Pediatrics. 115(3), pp. 797-802.
Morrow, Jason. (2000). Making Mortal Decisions at the Beginning of Life: The Case of Impaired and Imperiled Infants. Journal of American Medical Association. 284, p. 1146-
Merrill, in the UK. Following his experience with heart surgery using innovating surgical techniques, the physician noted the problems he experienced in understanding all of his alternatives compared to a simpler earlier procedure, and finally trusted to the advice of his cardiologist to surgically intervene. In response to the experience, Dr. Merrill emphasized that, "As a physician talking to colleagues, I had the best information possible under the circumstances. But it wasn't the same as my hernia repair. The experience brought home to me the realization that the progress of medicine has made informed consent impossible -- even for me" (Merrill 1999: 190).
ationale of Study
Taken together, the foregoing issues indicate that there is an ongoing need for an assessment of knowledge levels of informed consent among perioperative nurses and operating department practitioners. Perioperative nurses and operating department practitioners, though, are frequently subjected to an enormous amount of stress…
Calloway, S.J. (2009) 'The Effect of Culture on Beliefs Related to Autonomy and Informed
Consent.' Journal of Cultural Diversity 16(2): 68-69.
Cobb, W.G. (2005) 'Defending the Informed Consent Case.' Defense Counsel Journal 72(4):
Patient is a 69-year-Old male who is refusing treatment for cancer. The following is a description of the patient.
Primary diagnosis: Malignant Neoplasm of Head, Face and Neck (C76.0) because this is the diagnosis that brought the patient into treatment (Hogston, 1997).
Patient's past medical history: Hypertension, hyperlipidemia, stomatitis, anemia, neutropenia. Patient had right radical neck dissection in 2012.
Current Medications: Carvedilol 12.5 mg. q.d.; Furosemide 40 mg q.d.
Social History: Patient is a former smoker who quit two years ago following cancer diagnosis. He is married with children.
Current Issue: Patient is refusing to engage in further treatment regarding his cancer (chemotherapy and radiation) stating that he is tired of the untoward effects of treatment. Patient wants information regarding other options.
A. Patient's family does not agree with his decision to stop treatment.
B. Patient does not have an advanced directive or living will.
7. Possible Secondary…
Auning, E., Selnes, P., Grambaite, R., Saltyt? Benth, J., Haram, A., Lovli Stav, A., ... & Aarsland, D. (2015). Neurobiological correlates of depressive symptoms in people with subjective and mild cognitive impairment. Acta Psychiatrica Scandinavica, 131(2), 139-147.
Ellershaw, J., & Wilkinson, S. (2011). Care of the dying: A pathway to excellence. New York:
Hatfield, R. C. (2014). The everything guide to coping with panic disorder. Avon, MA: Adams.
Hogston, R. (1997). Nursing diagnosis and classification systems: a position paper. Journal of Advanced Nursing, 26(3), 496-500.
business strategy class, group assigned a case study. It a 12-20-page paper, responsibility write 4 pages, part write. Here teacher instruction: "A case study assigned group. Additionally a rubric showing material case study included.
Recently, a young woman dying of brain cancer in Queens was forced to engage in a legal struggle with her own parents to 'win' the 'right to die. "Paralyzed from the waist down, the 28-year-old woman won court approval last week to be taken off life support, a move challenged by her devout Christian parents who claimed that would be tantamount to suicide and would be a sin that would send their daughter to hell. After winning the right to die, Grace changed her mind. Her lawyer, David Smith, said she made the decision out of love for her parents and to alleviate their suffering" (Scott 2012). This case illustrates how right-to-die cases can…
Fraser, Sharon I. & James W. Walters. Death - whose decision? Euthanasia and the terminally ill. Medical Ethics 26 (2000):121-125. [21 Oct 2012]
Quill, Timothy E. "Terri Schiavo -- a tragedy compounded." The New England Journal of Medicine, 352(2005):1630-1633. [21 Oct 2012] http://www.nejm.org/doi/full/10.1056/NEJMp058062
Scott, Marvin. "Saving grace." WPIX. 2012. [21 Oct 2012]
Predict the economic impact (e.g., costs, benefits, efficiency, cost containment) on healthcare delivery at the local, state, national, or international level if the legislative bill were enacted.
This paper examines the economic impact upon the nation if the bill, the Palliative Care and Hospice Education and Training Act, were passed. Fundamentally, the economic impact of the bill would ultimately be a positive one. The bill proposes the necessity for better training and support for the clinicians who will ultimately work in palliative care. The bill represents a long-term investment: more expenditure to better train and educate these professional healthcare personnel, but with the understanding that definitive savings will be substantial. First of all, there's almost always a substantial amount of fiscal savings when the quality of care is improved; this has been demonstrated in a range of studies and is something which is experienced at the local and national level.…
Ascan.org. (n.d.). Evidence-based research: cost savings of palliative care to hospitals and the medicaid program. Retrieved from http://acscan.org/ovc_images/file/action/states/or/QoL/Cost_savings_of_Palliative_Care .
dimensions (criteria) and define them in no more than one paragraph each.
Safe: avoiding injuries to patients from the care that is intended to help them.
Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
(quoted from: Committee on Quality of Health Care in America, IOM)
Part B. Question 2b (2. In no more than one paragraph each, please evaluate the…
Committee on Quality of Health Care in America, Institute of Medicine. (2002) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press.
" (AAF, nd)
The Health Maintenance Organization further should "…negotiate with both public and private payers for adequate reimbursement or direct payment to cover the expenses of interpreter services so that they can establish services without burdening physicians…" and the private industry should be "…engaged by medical organizations, including the AAF, and patient advocacy groups to consider innovative ways to provide interpreter services to both employees and the medically underserved." (AAF, nd)
One example of the community healthcare organization is the CCO model is reported as a community cancer screening center model and is stated to be an effective mechanism for facilitating the linkage of investigators and their institutions with the clinical trials network. It is reported that the minority-based CCO was approved initially by the NCI, Division of Cancer revention Board of Scientific Counselors in January 1989. The implementation began in the fall of 1990 and the program was…
Principles for Improving Cultural Proficiency and Care to Minority and Medically-Underserved Communities (Position Paper) (2008) AAFP -- American Academy of Family Physicians http://www.aafp.org/online/en/home/policy/policies/p/princcultuproficcare.html
Volpp, Kevin G.M. (2004) The Effect of Increases in HMO Penetration and Changes in Payer Mix on In-Hospital Mortality and Treatment Patterns for Acute Myocardial Infarction" The American Journal of Managed Care. 30 June 2004. Issue 10 Number 7 Part 2. Onlineavaialble at: http://www.ajmc.com/issue/managed-care/2004/2004-07-vol10-n7Pt2/Jul04-1816p505-512
Darby, Roland B. (2008) Managed Care: Sacruificing Your Health Care for Insurance Industry Profits: Questions You must ask before joning an HMO. Online available at: http://www.rolanddarby.com/br_managedhealth.html
Provide sustained technical assistance (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Evaluation of the process in rural and small communities includes: (1) scope of the project; (2) goals; (3) critical success factors; and (4) technical assistance." (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003) Community grants have been focused on the provision of 'personal digital assistant (PDA) systems in assisting with the decision support role. The initiative is stated to include: (1) development of toolkits; (2) leveraging known tools; (3) developing capacity; and (4) disseminating best practices. (Expert Panel Meeting: Health Information Technology: Meeting Summary, 2003)
Ormond, Wallin, and Goldenson report in the work entitled: "Supporting the Rural Health Care Safety Net" (2000) state: "The policy - and market-driven changes in the health care sector taking place across country are not confined to metropolitan areas. Rural communities are experiencing changes impelled by many of the same forces…
Healthcare and Healthcare Insurance Country Report: India (2004) Tata Consultancy Services and Microsoft. WebHealthCentre.com. 2004 August. Online available at http://download.microsoft.com/documents/customerevidence/7144_WebHealth_CS.doc
Expert Panel Meeting: Health Information Technology (2003) Agency for Healthcare Research and Quality (AHRQ) 23-24 July 2003. Online available at http://www.ahrq.gov/data/hitmeet.htm
Silberman, P. And Slifkin, R. (nd) Innovative Primary Case Management Programs Operating in Rural Communities: Case Studies of Three States. Working Paper No. 76 North Carolina Rural Health Research and Policy Analysis Program.
Ormond, Barbara a.; Wallin, Susan Wall; and Goldenson, Susan M. (2000) Supporting the Rural Health Care Net. 15 May 2000 Urban Institute
KATHAINE KOLCABA'S COMFOT THEOY
Evaluation of K. Kolcaba's Comfort Theory
Are the concepts in the theory explicitly and/or implicitly described in the theory?
(including the four concepts of the metaparadigm of nursing; nurse/nursing; person/patient; health; environment)? The descriptions of the theoretical concepts of comfort theory are provided below:
Nurse/nursing: According to Kolcaba (2003), "The term [nursing] can mean the discipline (noun) or what nursing does (the verb)" (p. 68);
Person/patient: Likewise, Kolcaba (2003) notes that "the concept [person] has been utilized as client, patient, family, community, region, or nation" (p. 68).
Health: "Health Care Needs" include those identified by the patient/family in a particular practice setting (Kolcaba, 2016, para. 3);
Environment: Generally, Kolcaba (2003) describes this concept as "where ever nurses practice" (p. 68).
b. Are the relationships of the theory concept relationships explicitly and/or implicitly described in the theory? According to Kolaba (2003), her definition characterizes comfort "as…
Goodwin, M. & Candela, L. (2012). Outcomes of newly practicing nurses who applied principles of holistic comfort theory during the transition from school to practice: A qualitative study. Nurse Education Today, 33(6), 614-619.
Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image, 23(4), 237-240.
Kolcaba, K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19, 1178-1189.
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. New York: Springer Publishing Company.
As the narrow policy discussions regarding Physician-Assisted Suicide continue, we ought to encourage all presently existing and legal methods of reducing the painful sufferings during the last phase of life.
Drickamer, Margaret, a; Lee, Melinda. a; Ganzini, Linda. (1997, Jan 15) "Practical Issues in Physician-Assisted Suicide" Annals of Internal Medicine, vol. 126, no. 2, pp: 146-151.
Emauel, Ezekiel. (1997, Mar) "Whose right to die?" The Atlantic Monthly, vol. 17, no. 2, pp:
Hayden, Laurel a. (1999, Apr) "Ethical Issues: Helping Patients with End-of-Life Decisions"
The American Journal of Nursing, vol. 99, no. 4, pp: 2401-2403.
Kaplan, Kalman. J; Harrow, Martin; Schneiderhan, Mark. E. (2002, Spring) "Suicide, physician-assisted suicide and euthanasia in men vs. women around the world: The degree of physician control" Ethics and Medicine, vol. 21, no. 1, pp: 14-20.
Quill, Timothy E; Meier, Diane. E; Block, Susan. D; Billings, Andrew. J. (1998, Apr) "The
Debate over Physician-Assisted…
Drickamer, Margaret, a; Lee, Melinda. a; Ganzini, Linda. (1997, Jan 15) "Practical Issues in Physician-Assisted Suicide" Annals of Internal Medicine, vol. 126, no. 2, pp: 146-151.
Emauel, Ezekiel. (1997, Mar) "Whose right to die?" The Atlantic Monthly, vol. 17, no. 2, pp:
Hayden, Laurel a. (1999, Apr) "Ethical Issues: Helping Patients with End-of-Life Decisions"
The American Journal of Nursing, vol. 99, no. 4, pp: 2401-2403.
As mentioned earlier, the desired outcome of nursing care is comfort and there are many articles in which the researchers have talked about the needs of the patients and the things that alter the comfort of the patients. Kolcaba suggested that the cancer patients who are terminally ill can benefit from comfort care as it pays attention to the perspective and needs of the patients. Through such kind of care, the patient is not only provided with pain relief, but the depression of the patient is also addressed adequately. As she said that patients who are not in pain but are depressed seek comfort in the transcendental sense as well as in the psycho-spiritual sense (Kolcaba, 1992 p 4). In some of her works, she has explained the use of the instruments and their application by the nurses. Kolcaba reckons that the instruments presented by her to evaluate the comfort…
Kolcaba K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(10): 1178-1184.
Kolkaba, K. (1992). Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome..Advances in Nursing Science, 15 (1), pp. 1-10.
Kolkaba, K. (1997). The primary holisms in nursing..Journal of Advanced Nursing, 25 pp. 290-296.
Kolkaba, K. And Fisher, E. (1996). A holistic perspective on comfort care as an advance directive..Critical Care Nursing Quarterly, 18 pp. 66-76.
As palliative care specialist Dr. Gilbert puts it, "Despite this close involvement with the very patients for whom euthanasia is advocated we do not encounter any persistent rational demand" [Southern Cross ioethics Institute]. The very point of 'Advanced Directives' is in itself confounding issue as frequently it is the patient's imaginary fears about loss of body functions and pain that drives them to such conclusions.
So it is cleanly obvious that in palliative care settings it is not uncommon for patients to succumb to momentary pain and wish for euthanasia but very rarely such requests are persistent. Instead of legalizing euthanasia, efforts must therefore be concentrated on improving the palliative care. This could take the form of improving pain control measures and providing loving and caring service to patients.
Legalizing Euthanasia (Implications)
Very few nations in the world have legalized euthanasia. Holland was the first country to do so and…
Eric Gargett, "Changing the Law in South Australia," World Right-to-Die
Newsletter, May 2001, p. 3. (a World Federation of Right to Die Societies
Richard a. Epstein, "Voluntary Euthanasia," Accessed on November 29th 2004, http://www.lse.ac.uk/clubs/hayek/Ama - gi/Volume1/number1/voluntary_euthanasia.htm
Caring for the Old
The End of Life Care
End of life care refers to the total care of a person that has an advanced illness that is incurable and does not equate with death. This end of life care can last for a number of weeks, months or even years depending on the state an individual is.it is usually the care which helps those that have advanced, progressive and illnesses that can not be cured to live life as well as possible until they meet their death. End of life care makes it possible for the patient and their family to get supportive and palliative care needs identified and met throughout the last phase when they are living and into the bereavement period. Supportive care is care which helps a patient and the family to cope with the condition and the treatment of that condition right from the pre-diagnosis…
Boswell, Kahana & Worth-anderson, 2006). Spirituality and Healthy Lifestyle Behaviors: Stress Counter-balancing Effects on the Well-being of Older Adults. Retrieved April 30, 2014 from http://www.case.edu/artsci/soci/documents/Spiritualityandhealthylifestylebehaviors.pdf
U.S. Department of State, (2012).Legal & Financial Issues In Caregiving for Older Adults. Retrieved April 30, 2014 from http://www.state.gov/m/dghr/flo/142266.htm
American Society of Clinical Oncology (ASCO), (2014). Caregiving Considerations. Retrieved April 30, 2014 from http://www.cancer.net/navigating-cancer-care/older-adults/caregiving-considerations
The Joanna Briggs Institute, (2011). Age-friendly nursing interventions in the management of older people in emergency departments. Retrieved April 30, 2014 from http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=7127
Web Health Care
Located in Wichita, Kansas, Via Christi Health is the agency that serves the eponymous region through the site via-christi.org. Via Christi provides care through hospitals, outpatient centers, senior communities, and in-home care for individuals in Kansas. The services the agency provides a VCMA directory, which encompasses a search for physicians through Via Christi Medical Associates and the Via Christi Clinic, along with the Via Christi Hospitals. Via Christi Medical Associates is a group of fifty family practitioners, while Via Christi Clinics offer family care and immediate care. The thirteen clinics have been in place since 1948, 160 hired physicians, and encompassed 40 specialties. Via Christi agency offers a directory and location of special centers, which includes burn center, cancer care, cardiac care, and cystic fibrosis. As well, there's epileptology, neurosciences, obstetrics and gynecology, and occupational health services. Moreover, individuals are able to look up care for pediatric…
Via Christi Hospitals: VCFM Residency. (n.d.). VCFM Residency. Retrieved December 3, 2011, from http://www.vcfm.net/details/via-christi/
HMR Clinic Program Weight Loss Surgery Weight Loss Class Corporate Wellness HMR at Home Meal Replacements ~ Via Christi Weight Management Wichita Kansas. (n.d.). HMR Clinic Program Weight Loss Surgery Weight Loss Class Corporate Wellness HMR at Home Meal Replacements ~ Via Christi Weight Management Wichita Kansas. Retrieved December 3, 2011, from http://www.viachristiweightmanagement.com/
Via Christi Clinic - Multi-practice medical care in Wichita, KS . (n.d.). Via Christi Clinic - Multi-practice medical care in Wichita, KS . Retrieved December 3, 2011, from http://www.viachristiclinic.com/
Via Christi to open cancer center | Wichita Eagle. (n.d.). Local and breaking news for Wichita and Kansas | The Wichita Eagle and kansas.com. Retrieved December 3, 2011, from http://www.kansas.com/2011/06/24/1906153/via-christi-to-open-cancer-center.html
Nursing and eligion Practice
ELIGION AND NUSING PACTICE
Nursing success depends on the ability to put the patient in a state of rest and comfort as much as it is about administering the prescriptions of the doctor. To secure the rest of the patient, nurses need to understand their needs and show respect to their beliefs and values. This requires courteous and open communication with the patient and adopting a patient-centric orientation. Along with other factors, the religious background of the patient makes a lot of difference to their values and expectations. eligious doctrines and practices may differ across religions and denominations such as Jehovah's Witnesses, Muslims, Seventh Day Adventists and Scientologists and may impose restrictions on certain kinds of interaction between nurse and patient or on certain forms of treatment. Moreover, people with a different religious background are not usually aware of such differences. Therefore, it is necessary for…
Banja, J.D. (2010). Overriding the Jehovah's Witness patient's refusal of blood: A reply to Cahana, Weibel, and Hurst. Pain Medicine, 10(5), 878-882. doi: 10.1111/j.1526-4637.2009.00648.x.
Charles, C.E., & Daroszewski, E.B. (2012). Culturally competent nursing care of the Muslim patient, Issues in Mental Health Nursing. 33(1), 61-63. doi: 10.3109/01612840.2011.596613.
Cort, M., & Cort, D. (2008). Willingness to participate in organ donation among Black Seventh-Day Adventist college students. Journal of American College Health, 56(6), p. 691-697. Retrieved from EBSCO Academic Search Primer.
Effa-Heap, G. (2009). Blood transfusion: Implications of treating a Jehovah's Witness patient. British journal of nursing, 18(3), 174-177.
Morality and ethics: what are they and why do they matter?
All you need to know about ethics approaches and theories
Means, ends, principles and virtues six step process of ethical decision making for you to follow
Surviving professional life ethically
Ethical dimensions of the professional -patient relationship
Special challenges: "difficult patients" and patients in suicidal crisis
This is a time of great change in our understanding of health, illness, and health care systems. Medical researchers, practitioners, and administrators must realize that these changes are taking place and look to current, valid research for some answers to the questions which come with increasingly complicated technology and better medications. Since knowledge is the basis for effective decision making, one goal for any medical leader should be to attain as much knowledge as possible.
Ethics has been defined as "rules of conduct recognized in respect of a particular class of human actions."…
Dunn, M. (1998). "Knowledge helps health care professionals deal with ethical dilemmas."
AORN Journal. p.1-2.
Eckberg, E. (April, 1998). "The continuing ethical dilemma of t he do not resuscitate order."
AORN Journal. April, 1998.
The author of this report is to offer a fairly extensive essay about three general questions relating to utilitarianism. The first question pertains to John awls and his deconstructions of utilitarianism and what came to be known as "the analogy." The second question pertains to the views of Peter Singer as stated and enumerated in Famine, Affluence and Morality. Last up will be Bernard Williams. Like awls, he generally viewed utilitarianism poorly and offers specific examples and explanations of why he did not agree with the subject. For all three questions, there will be a critique or criticism of the overall argument. While cases can be made for both utilitarianism and its opposite, there are some rather gaping holes in the logic that justifies utilitarianism and how it works.
Of all of the ethical and moral philosophers out there, awls is certainly one of the more notorious…
Rawls, J. (1971). A theory of justice. Cambridge, MA: Belknap Press of Harvard
Singer, P. (1972). Famine, Affluence, and Morality. Philosophy and Public Affairs, 1(1).
Smart, J., & Williams, B. (1973). Utilitarianism; for and against. Cambridge [England:
careers, many social workers will encounter individuals who are veterans of active duty military service. Like other client populations, veterans may experience issues with their day-to-day living requirements that require assistance, but these individuals may also experience a wide range of problems that are unique to service in the armed forces. This paper reviews the relevant literature to determine how current social work policies in the United States address issues of inequality, oppression or social justice for military veterans, the social work staff's ability to provide quality social work services, and ethical issues that affect social work values and practice in this area. An analysis concerning alternative approaches that social work and others could advocate or organize on behalf of veterans is followed by an assessment of which models of advocacy (Jannson or Hayes & Mickelson) are currently being used with this client population. Finally, a summary of the research…
Adams, C. (2013, March 13). Millions went to war in Iraq, Afghanistan, leaving many with lifelong scars. McClatchy Newspapers. Retrieved from http://www.mcclatchydc.com/
Franklin, E. (2009, August). The emerging needs of veterans: A call to action for the social work profession. Health and Social Work, 34(3), 163-169.
Haynes, K.S. & Mickelson, J.S. (2000). The debate. In Affecting social change: Social workers in the political arena (pp. 23 -- 39). Boston: Allyn & Bacon.
Torrey and Zdanowicz (2001) identify some important aspects of outpatient commitment that would need to be present in order to ensure positive outcomes such as clear legal principles, a clear need-for-treatment standard (p. 340), available legal counsel for individuals with mental illness, and systematic processes for reviews and appeals. When determining the criteria by which a person should be deemed appropriate for outpatient commitment there should be considerable attention paid to their propensity for violence or victimization (Torrey & Zdanowicz, 2001). It should not be based upon an individual's non-dangerous behaviors such as substance abuse, relapse rate, or repeated hospitalizations.
Outpatient commitment must be coupled with a strong service delivery system that has readily available, appropriate services. It should be viewed as a commitment not just of the individual with mental illness to participate in services but of the system as a whole to ensure availability of service providers and…
RAND Corporation (2000). Does involuntary outpatient treatment work? Retrieved from:
Torrey, E.F., & Zdanowicz, M. (2001). Outpatient commitment: What, why, and for whom.
Psychiatric Services, 52, 337-341.
One of the best things about the WAP program is the flexibility that it has. Every patient has their own individual needs that need to be met by a recovery program. Most recovery programs are very rigid and to not have much give to them. The WAP program is just the opposite. It allows each patient to recover at their own rate and using the best resources available to them.
The flexibility that the WAP program allows each patient to have helps to reinforce the idea of self-management recovery. This is so important is giving each patient the responsibility for their own recovery. Empowering each patient to design and implement their own recovery helps to ensure that they will follow through and be successful in recovering.
Davidson, Laurie. (2005). ecovery, self-management and the expert patient - Changing the culture of mental health from a UK perspective. Journal of Mental…
Davidson, Laurie. (2005). Recovery, self-management and the expert patient - Changing the culture of mental health from a UK perspective. Journal of Mental Health, 14(1), 25-35.
Dewa, Carolyn S., Hoch, Jeffrey S., Carmen, Glenn, Guscott, Richard, and Anderson, Chris.
(2009). Cost, Effectiveness, and Cost-Effectiveness of a Collaborative Mental Health
Care Program for People Receiving Short-Term Disability Benefits for Psychiatric
Japanese: Cultural Interview and Nursing Assessment
Presentation of client and scenario
This interview was conducted with a Ms. X, a Japanese national visiting friends in another country. She was, over the course of the interview, asked about a number of personal and culturally sensitive factors about her native culture that might affect a nursing intervention.
It is important for a nursing practitioner to keep this in mind as, in the 2000 census, 796,700 residents of the U.S. identified their "race" as Japanese,
Thus it is useful for all nursing practitioners, particularly those residing on the est Coast to keep abreast of Japanese cultural traditions. (Tanabo, 2001) Also, even when residing in Japan, Japanese first-generation immigrants have traditionally seemed less eager than other immigrant groups to assimilate into the hegemonic culture. One measure of this is that compared to other Americans of Asian background, a lower percentage of Japanese elders speak…
Tanabo, Marianne. (2001) "Health and Health Care: Japanese." Stanford Ethnography e-Books. Retrieved 10 Mar 2005 at http://www.stanford.edu/group/ethnoger/ebooks/japanese_american.pdf
One of the arguments against assisted suicide as outlined in balancedpolitics.org, is that patients may give up on medical procedures too soon, and that there is always hope that a procedure or medicine might come along that can cure the illness (Messerli). Perhaps, then, we should require a doctor to be involved in a patient's decision for assisted suicide as a measure to prevent unnecessary death. In that case, however, a physician should be expected to contribute only a medical prognosis to the decision, allowing the patient to decide upon the time and means of his death.
The New England Journal of Medicine states that "more than one-fifth of doctors would be willing to assist patients' suicides if it were legal to do so" (cnn.com). If a patient is terminally ill, what is the point of draining his financial assets and placing further pressure on his family and loved ones?…
CNN. ww.cnn.com/HEALTH/9804/22/assisted.suicide/index.html. April 22, 1998.
Hess, Amy. Conservative Politics: U.S.. http://usconservatives.about.com/b/a/236307.htm
Mersserli, Joe balancedpolitics.org/assisted_suicide.html
GBMC Healthcare Hospital. The main issue relates to privacy and confidentiality issues considered essential components of fostering trust between healthcare consumers and providers. The issue arose the GBMC hospital did not strictly follow the rules of privacy and confidentiality. Because of its lack of complete control on the privacy issues, many pieces of private information of patients were stolen and compromised.
Although GBMC hospital has been committed for 75 years to ensuring patient healthcare information is used to fulfill appropriate needs as provided by consent or law, but with the advent of the electronic health record and the transfer of an individual's health information through electronic media, including the Internet, the need for privacy and confidentiality protection takes on new meanings and challenges for the GBMC.
As medical science and technology continue to mature, and new data is being created that, when accessed, could be used to discriminate against an…
Courtney S. Campbell, The Crumbling Foundations of Medical Ethics, Theoretical Medicine and Bioethics, Volume 19, Issue 2, April 1998, Pages 143-152
Roberto, M. And Flynn, E.P., Issues in Medical Ethics, Medicine, Health Care and Philosophy, Volume 1, Issue 2, 1997, Pages 188-189
Among the most important aspects to the health promotion plan will be the benefits associated with a care manager, who can ensure that all six core elements of CCM are implemented fully. If this is accomplished, there should be a significant reduction in health disparities for patient and caregiver outcomes across generations.
AHQ. (2012). National Healthcare Disparities eport, 2011. No. 12-0006. ockville, MD: Agency for Healthcare esearch and Quality. etrieved 16 Apr. 2014 from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf.
Braveman, P.A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L.N., Manderscheid, . et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl. 1), S149-55.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217-28.
Castro, A. & uiz, E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Journal of the American Academy of Nurse…
AHRQ. (2012). National Healthcare Disparities Report, 2011. No. 12-0006. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved 16 Apr. 2014 from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf .
Braveman, P.A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L.N., Manderscheid, R. et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl. 1), S149-55.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217-28.
Castro, A. & Ruiz, E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Journal of the American Academy of Nurse Practitioners, 21(5), 278-86.
Brophy Case Study
The unfortunate case of Paul Brophy should immediately remind people of the very similar case of Terry Schiavo and how that case ended up. Indeed, Mr. Brophy is in a persistent vegetative state due to an artery bursting in his brain. His life can technically be maintained through a feeding tube and other medical equipment but he is not "terminal" in the usually used sense of the word in that he is not near death so long as he is fed. However, his chances of every regaining normal brain function, which he has lost, are zero according to medical professionals. As such, the family wanted to let him go but the medical professionals resisted. While this decision may seem like an easy one to make, it is not remotely easy and for a number of reasons.
One important piece of information regarding this case is that…
Baker, D. (2013, April 25). Right to die or wrong to kill?. Christian Today. Retrieved October 9, 2014, from http://www.christiantoday.com/article/right.to.die.or.wrong
Beauchamp, T.L., & Childress, J.F. (2013). Principles of biomedical ethics (7th ed.).
New York: Oxford University Press.
North Mountain Medical is a super sniff facility as they specialized in high acuity level patient. The patient structure is respiratory, with staff trained in tracheostomy care and ventilator management. In house hemodialysis, in house physical therapy. This facility has been in operation since 2004. Patients in this facility do not self-diagnose. Patient diagnoses are from Medical doctors and Nurse Practitioners that work on site. Patient in the facility are cared for by interdisciplinary team. Certified nursing assistants that care for patient will normally report a Change in patient’s condition to the nurse. Nurse completes an assessment and report changes immediately to the doctor. In the event of an emergency patients are send to emergency room for further evaluation and treatment. Health is a right in this facility. Yes, most of the patient’s life style has impacted the health of the patient. Noncompliance with medication regimen and diet changes. Patients…
According to Toronto Star reporter Stephan Handelman in an article printed in 2005, the U.S. senior intelligence analysts consider China to be the greatest long-term threat to U.S. stability. China's military force and computer intelligence has reached its peak. Both the Europeans and the U.S. agree that the expansion of the Chinese military is more than "worrisome."
Another article posted on November 16, 2007 by the Washington Post claims that spying by China in the United States is the biggest threat keeping American technologies secret. Advances by the Chinese military are catching U.S. intelligence officials by surprise. It has also been suggested that the U.S. Department of Defense could inadvertently outsource the manufacturing of key weapons and military equipment to China. China is attempting to reverse its move into free markets by setting up state-owned enterprises and control over the 12 major industries, which include oil, telecommunications, shipping, automobiles, steel…
1. Article: online
Kim Zetter (February 3, 2010). Threat Level: Privacy, Crime and Security Online
Report Details Hacks Targeting Google, Others, (1), 1. http://www.wired.com/threatlevel/2010/02/apt-hacks/
2. Article Publication: online and hardcopy
Operation of the Homeland Security Council
Creates the Homeland Security Council and sets down is functions.
This directive creates the Homeland Security Council (HSC) and lists its functions. The purpose of the HSC is to synchronize homeland security-related efforts across executive departments and agencies of all levels all through the country, and to put into practice the Department's policies by way of eleven Policy Coordination Committees.
Homeland Security Presidential Directive 3: Homeland Security Advisory System
Creates a Homeland Security Advisory Board to issue security threat levels. There are five threat levels, each identified by a description and corresponding color. From lowest to highest, the levels and colors are: Low = Green; Guarded = Blue; Elevated = Yellow; High = Orange; Severe = ed. The higher the threat level is, the greater the risk of a terrorist attack. isk includes both the likelihood of an attack taking place and its potential…
Homeland Security Presidential Directives. (2011). Retrieved from http://www.dhs.gov/xabout/laws/editorial_0607.shtm
Life and Death: The Life Support Dilemma by Kenneth E. Schemmer M.D
Kenneth Schemmer in his thorough, thought provoking book brings to life the controversial subject of the life support issue. For years, many all over the country have pondered, "What if a person were in some kind of an accident and the physicians told them that they were not going to make it?" And all that he or she could do is just lie there in extreme pain waiting for their life to the end. Or even worse case scenario what if they happened to end up completely brain dead? These debated questions are taken on by Dr. Schemmer in making his point that life support decisions may not necessarily be the decision of the family, the doctor or the patient but by a higher being that gives life and takes life. Schemmer uses these controversial questions in his…
Court backs right to die | terminally ill have right to refuse medical life support. (1984, Dec 28). The San Diego Union, pp. A.1-1.
Ackerman, T. (2005, Mar 27). Life support battle shifts / A decade ago, patients families had to press for 'right to die. Houston Chronicle, pp. 1-B.1.
Allen, P. (2000, Oct 07). Right to die upheld despite new euro law, doctors can end life support rules judge. Daily Mail, pp. 33-33.
Dolan, M. (2001, Aug 10). Justices deal setback to right-to-die movement; health: State court bans removal of life support from conscious patients whose wishes are not clear. Los Angeles Times, pp. A.1-A.1.