Autonomy And Ethical Issues In Geriatric Nursing Care

This ethical scenario presents an 86 year old female with numerous health issues and chronic illnesses. Mrs. Boswell’s advancing Alzheimer’s disease makes it extremely difficult to initiate dialysis, leading her physician to conclude a poor quality of life. The ethical dilemma portrayed in this case is between nonmaleficence and autonomy. Health care workers should focus on promoting the patient’s overall wellbeing and weigh the benefits and risks of the course of action, while also considering what the family declares they want done. Since the patient is deemed unable to make decisions, the goal is to collaborate with family, assess patient quality of life, address prognosis, and establish realistic care goals.

Long-term care assists individuals who cannot adequately perform their routine activities of daily living. These activities include dressing, bathing, walking, meal preparation, and taking medications ( Batnitzk,A.,Hayes,D.,& Vinall,P.E. 2014,(c. 5.1). These services are typically for clients over the age of 65 years old and is used to promote independence and security for those who cannot take care of their needs due to illness or debility (c.6.1). The type of provider will depend on the type of care a client needs. For instance, some elderly people that need help with food preparations or everyday activities will request to stay at home and have a family member take care of them. This is one way that long-term care is rendered but is unpaid.

In a profession where others' health and well-being are priority, there leaves room for neglect of those who are delegated to care for these people. As a professional nurse, there are many obstacles that arise and affect the care provided to a patient, as well as the livelihood of the nurse. The current deteriorating and unsafe staffing conditions in hospitals and other institutions prompts workplace advocacy as the universally appropriate concept for maintaining professional nursing practice.  Common

In dementia care we often look to family, advocates other professionals and carers in order to gain consent when the individual no longer has the capacity.

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s

Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed

Seeing first-hand the neglect of patients by distracted nurses is disturbing. One day, at the beginning of my shift as a nurse’s aide at a long term care facility, call lights were going off and a patient was screaming for help as I hurried to the room. Immediately, I saw the privacy curtain pulled back, revealing a semi-dressed patient. Her adult diaper was soaked through and had leaked onto her gown and bed. I rushed to her bedside and attempted to clean up as fast as I could, but there were no gloves or linens nearby. I was forced to leave this traumatized lady to go search for much needed supplies and another set of helping hands. As we came back into the room with supplies to provide patient care, I

According to the Alzheimer's Society diagnostic rates on average in the England are just under 48%, which despite being a two percent increase from 2012, means there are still around 416,000 people in England who are living with dementia but who are not diagnosed (Alzheimer's Society, 2014). In an effort to tackle dementia diagnosis the government in 2014 announced a £90 million package to improve services, which has lead to an increase in the number of referrals from primary care to memory assessment clinics (DoH, 2014). To meet the new demands on services it has becoming increasingly incumbent that psychologists and specialist nurses take on a new and active role in giving a diagnosis to their patients (Murphy & Gair, 2013; Page et al. 2008, & Griffths et al.

Autonomy explores the idea of every person having rights in regards to healthcare and decision making. “Autonomy is an agreement to respect another’s right to self-determine a course of action and support independent decision making” (Beauchamp & Childress, 2009). In 1990, the ideas of autonomy lead to the Patient Self Determination Act which allows competent people to make their wishes known about end of life. The act includes living wills and health care power of attorneys, which deals with end of

The issue of elder abuse is clearly an ethical concern. As a caregiver, the nurse has the responsibility to ensure that the environment of the patient is safe and supportive of health and wellness. In the case of an elderly patient who is too frail to engage in effective self-care, the demands upon the nurse increase as the nurse must

Nursing is an all encompassing profession in which practitioners are not only proficient in technical medical functionality, they also have the obligation to remain compassionate and respectful of patients and as such are expected to adhere to pre established codes of ethics. Of these ethics, autonomy is of extreme importance as it offers patients a sense of personal authority during a time where they may feel as if their lives, or at the very least their health, is no longer under their control. Autonomy in the context of nursing allocates the patient and often their family with the final word on the course of treatment. The concept of patient autonomy is a highly variable subject in all fields of health care. It is a universal concept that varies widely in its meaning and interpretation. Autonomy in its simplest form can be defined as a state of independence or self governing (Atkins, 2006). Patient autonomy can also be defined as the ability to make once own decisions, based on one’s sound judgment. It is defined by the American Nurses Association (ANA, 2011) as the "agreement to respect another 's right to self determine a course of action; support of independent decision making." This seemingly straight forward ethical concept is rife with difficulties when one considers potential disagreements that may arise even when informed consent is provided, particularly among children or vulnerable people. Relevant research and

Ethical principals are the seed of which nursing flourishes from. Many ethical principals were involved and dishonored in this case such as, justice, autonomy, beneficence, non-maleficence, confidentiality and fidelity (Burkhardt et al., 2014). I believe justice was the main principal involved as the entire ethical predicament was revolved around unjust behavior and treatment of the residents. The residents were treated poorly and given unequal rights as a causation of their illnesses. Autonomy, an essential piece of human rights was also being violated in this ethical dilemma. The residents did not have any choice or independence in their care or how they were being treated. Beneficence and non-maleficence are significant dynamics of this ethical situation, as the health care providers needed to reflect on how they can have the maximum benefit while diminishing possible damage to the residents (Burkhardt et al., 2014). Our actions as nurses should always be beneficent and non maleficent, continuously being kind, compassionate and doing what is in their best interest as well a removing and preventing harm. Confidentiality is a key component of nursing and it was blatantly being violated as the health care

Autonomy applies to the profession of nursing because the patient should always be allowed to make decisions regarding their care while being treated with respect and dignity; however, autonomy can serve as a limiting agent when the patient decides to refuse care that would be of benefit to them. Autonomy is a sensitive issue because it allows the patient to choose to die and all health care can do from that point is allow the patient to do so comfortably. With healthcare always being one step ahead, it allows a surrogate to serve as a voice piece for that patient when they are unable to make decisions. However, that surrogate can end up making decisions they think is best for the patient ignoring the patients’ will. The responsibility of the nurse and interdisciplinary team is to inform and educate the patient and patient’s surrogate on all aspects of care to include medical diagnosis, treatment, and care plan so that the patient and

The autonomy of a competent patient is an issue not often debated in medical ethics. Refusal of unwanted treatment is a basic right, likened to the common law of battery, available to all people capable of a competent choice. These fundamental rules of medical ethics entered a completely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several watershed cases elucidated these emerging issues in the 1960’s and 70’s, none more effectively than that of Karen Ann Quinlan. Fundamentally, this case established that a once-competent patient without the possibility of recovery could have their autonomy exercised by a surrogate in regard to the