Essay on Community Health Nursing Case Review

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.

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

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

Any hospitalization is a stressful situation for all parties, the patient and family. In this scenario it is even more stressful because it is a life and death decision. Mr. Y’s brother is diabetic with a history of high blood pressure. Mr. Y has to face the ethical issues of quality of life versus quantity of life in deciding to follow his brother’s wishes or not. Mr. Y most likely did not understand a lot of what was happening and may have felt that it was too heavy a decision to let his brother die if no heroic measures were taken. Mt. Y asked for his niece’s opinion, indicating Mr. Y’s inability to make a decision.

The main symptoms and signs of Parkinson’s are bradykinesia, rigidity and rest tremor. Parkinson’s is mainly seen as a movement disorder, but other areas of health problems are associated with it. These include depression and dementia along with autonomic disturbances and pain, although considered to be rare they can present at a later stage of the condition. These rarer symptoms, as they progress, can lead to substantial disability and handicap which harms quality of life for the person living with Parkinson’s, this also has an impact on families and carer’s.

Imagine a frail elderly woman laying in the nursing home in pain. This woman is 80 years old and has been diagnosed with terminal lung cancer and her heart cannot withstand treatment via radiation or chemotherapy. She has less than six months to live. Day in and day out you pass her room and hear her crying out from the immense pain. The pain medications are no longer working. She’s tired of fighting, tired of hurting, and tired of waiting to die. After consideration and discussions with her family she has decided to ask the doctor to help and end her life. The doctor feels remorse for the elderly lady and wants to help but cannot decide if it is the ethical thing to do because he knows that what he’s

The spouse explained to us that up to two day ago, that patient was able to sit in a wheelchair, ate pureed foods and was awake and alert. What was presented the day in the ER was a patient with multiple fractures, nonverbal and very lethargic. The husband was not aware of any falls, or medical conditions that would cause her symptoms. He also chose not to follow up with exams looking for a reason, such as a stroke. We accepted his wishes and returned his wife back to the nursing home with no treatment. The decision was made as a team effort between the spouse, medical staff, and the patient, with her advance directives.

The authors friend Bruce, would be a clear advocate of being uninformed and making a decision without extensive inquiries. A patient being at the age of 82, having gone through numerous procedures such as an aortic-aneurysm repair, pacemaker, dialysis, now facing fainting episodes, left the decision making to his son, possibly assuming he would understand what to make of the situation. But Bruce did not research the surgery and its risk but only the best hospital for his father to undergo the surgery. The team did inform him of risks, but further expressed how the procedure was now very routine and they were sure of successful results. The definition of successful deferred for the doctors as opposed to Bruce. Their success was a procedure performed that would reduce the future risk of a stroke, not better was what causing the fainting episodes. For Bruce, success would have been his father being able to interact again, but instead his description of his father is “no life in his eyes….He’s like the living dead”, few months later his father dies. Doctors insisted on the procedures, despite having risks that outweighed the benefit, though I cannot say he would have lived longer otherwise, but suffering from a stroke while having surgery may just have contributed to a short lived recovery period. For a patient, or person making decisions for a patient, would this case not suggest that Bruce

Parkinson disease (PD), also referred to as Parkinson’s disease and paralysis agitans, is a progressive neurodegenerative disease that is the third most common neurologic disorder of older adults. It is a debilitating disease affecting motor ability and is characterized by four cardinal symptoms: tremor rigidity, bradykinesia or kinesis (slow movement/no movement), and postural instability. Most people have primary, or idiopathic, disease. A few patients have secondary parkinsonian symptoms from conditions such as brain tumors and certain anti-psychotic drugs.

As I was about to round off my shift 7am to 3:15pm, on 7/31/2015, I received a call from the admission office that I should prepare for a 75year old end stage cancer patient As I was preparing for the admission the patient was brought in on a stretcher with her family. The patient was admitted for back pain and loss of weight. It was diagnosed that “Miriam” had been diagnosed with pancreatic cancer and was given three months to live. She has two siblings who live far apart, one in New York and the other in Georgia. She used to live with her daughter in Georgia until she began complaining of back pain and losing weight. Upon admission to the facility her daughter was convinced that Miriam had less than ninety days to live.

To begin with, the client whose name is Mr. Sam Pilsudski has an obstructed airway secondary to cancer of the larynx. He is a 67-year-old widower, and a father of one son and two daughters, who is unconscious and terminally ill, if not for a much-needed operation to remove both his cancer and larynx to save his life. However, one of Mr. Pilsudski’s daughters has adamantly refused to consent to the surgical procedure despite the physician explaining that although the operation would unfortunately render his patient disabled without a voice consequentially, but ultimately surviving the procedure to live and recover. Moreover, the physician attempted with rational and clear communication to express the gravity of the rather poor prognosis of his illness to his daughter that in the event of foregoing the surgery, his patient would surely die (Ralph Dolgoff, Donna Harrington, and Frank M. Loewenberg (2012), Ethical Decisions for Social Work Practice. 9th Ed; p. 279).

Parkinson’s Disease is known as one of the most common progressive and chronic neurodegenerative disorders. It belongs to a group of conditions known as movement disorders. Parkinson disease is a component of hypokinetic disorder because it causes a decreased in bodily movement. It affects people who are usually over the age of 50. It can impair an individual motor as well as non-motor function. Some of the primary symptoms of Parkinson’s disease are characterized by tremors or trembling in hands, legs and arms. In early symptoms the tremor can be unilateral, appearing in one side of body but progression in the disease can cause it to spread to both sides; rigidity or a resistant to movement affects most people with Parkinson’s disease,

The principle of autonomy states; “individuals have the right to make choices about their own lives” (Kozier et al, 2010.p.79). In health care, this means health care providers must honour the person’s right to choose methods or approaches to diagnosis or treatment (Kozier et al, 2010). Moreover, by not giving the client, the right to make her own decision this could cause anxiety and physiological effect to both parties. Which disregard the World Health Organization (WHO), definition of quality end of life care as the "active total care of patients whose disease is not responsive to curative treatment" (Sepúlveda, Marlin, Yoshida, & Ullrich, 2002). This definition includes meeting the psychological, social, and spiritual needs for both patients and families (Sepúlveda et al, 2002). In addition, the nurse did not put the beneficence principle in action, which “is the obligation to do good” (Kozier et al, 2010, p.80). Nurses have a duty to implement actions that benefit their client’s best interest (Kozier et al, 2010). It lays the groundwork for trust that society places in nursing professional, and provides nursing’s context and justification (Burkhardt & Nathaniel, 2002). This principle seems straight forward, but it is actually very complex. Should we determine what is good- by subjective, or by objective, means? So, when people disagree about what is good, whose opinion counts? In this case, the client, and not the family because she has the

Parkinson’s Disease is a very common disorder these days. Over 10 million people live daily with Parkinson worldwide. Parkinson’s Disease was named after an English surgeon James Parkinson who wrote a detailed description essay called Shaking Palsy in 1817. The average age for Parkinson’s Disease is between 45 to 70 years old but you can also have juvenile or young onset as well. Most common symptoms of Parkinson are tremors, bradykinesia or akinesia, or rigidity or stiffness, and balance disorder. Parkinson’s Disease doesn’t have a cure and the cause is unknown it could be a number of things genetics, environmental triggers, age, or gender. Parkinson’s Disease happens because the dopaminergic neuron dies and

The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.