Deontological Approach

During the transitioning process to the new hemodialysis unit, Ms. Conlon anticipated the challenges acquired by learning to set up and use new water equipment in an acute situation. In response to this, Ms. Conlon created and implemented a reverse osmosis flow sheet to assist her colleagues with the quick set-up of the portable RO in the ICU care setting. This tool resulted in a smoother transition for her colleagues, improvement in the delivery of care to the acute dialysis patient, and a decrease in the possibility of staffing overtime.

Within the case, The Carbondale Clinic, it is apparent that a scheduling problem exists which has then resulted in patients being unsatisfied with the amount of time they must wait to be seen for his or her scheduled appointment with the physician. It is also evident that physicians prefer to have a full schedule without taking into consideration the possibility of emergencies that may arise throughout the day that will contribute to patients having to wait even longer. It is pertinent that the manager sits down with the staff to determine what is the most logical solution to help resolve the scheduling problem, taking into consideration what the physicians want along with ensuring patient satisfaction.

I am a Nurse Manager in the hemodialysis unit. The unit has eleven stations with a patient population of 40. The age range of veterans that receive care in this unit is 40 – 92. Most of the hemodialysis patients have difficulty managing their chronic illness and usually receive treatment three times a week for five hours of each visit. Most of them have

Recruiting new employees is one of the biggest challenges health care organizations face today. The total population of RN's available for staffing is rising at the slowest pace of the last 20 years (Keller, Siela, Twibell, 2009). Healthcare facilities across the nation are struggling to meet the staffing requirements to stay afloat and provide adequate care to patients. The question in front of many organizations is how to stand out in a competitive workforce and recruit top hires.

Cetiner is the primary nurse for four dialysis patients. She tends to all of their complex needs as she strives to improve their outcomes. She delivers care in a manner that preserves patient autonomy, dignity and rights. This is evidenced by all four patients exceeding unit/network benchmarks in adequacy, access and anemia management. She became an advocate for a Veteran who lives in a nursing home and has no family, resulting in improvement of care. She diligently worked with one Veteran to avoid multiple hospital admission for fluid overload. She developed a treatment program along with the Medical Director to manage the patient’s fluid both during and after the hemodialysis treatment. She has provided much support to one of the Veterans with many socioeconomic issues ultimately affecting his treatment. Because of her due diligence with his non- compliance he now stays for his entire treatment on a regular basis

Deontological Viewpoint 1. Aboriginal rights versus rights of a minor: Do you worry it is a slippery slope to paternalistic western thinking? The Deontological viewpoint places views decisions as being ethical through the intrinsic nature of the action rather than on the end results of such actions (Edge & Groves, 2006, p. 38). Being a minor, the rights of the child were placed into the hands of her parents.

Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. All of her primary patients exceed recommended adequacy guidelines and maintain patent, infection free arterial venous fistulas/grafts. While participating in monthly interdisciplinary care plan meetings, she makes suggestions that have led to positive outcomes such as: changes in dry weights, reviews of patients medications with the nephrologist to facilitate warranted medication adjustments as needed, referrals/close coordination with other disciplines such as podiatry and wound care to prevent infection/amputation in patients with advanced vascular disease, and endocrinology for educational purposes for well controlled blood sugars. She is able to quickly assess subtle changes in her patients to then notify the charge nurse and physician for appropriate guidance in facilitating positive patient care outcomes. Through her acute assessment skills she prevented an access from clotting. Prevention of clotting leads to extended longevity of the access. She applies the nursing process to systems or processes at the team/unit/work group level to improve Veteran care. She worked with flow in the new unit which led to better patient care and staff satisfaction. She developed the time out policy: a requirement for

Every day, numerous people across the world stop their lives for four hours to get hooked up to a dialysis machine at a hospital nearby. This machine helps to remove harmful wastes, toxins, excess salt, and water from their body because unfortunately their body cannot do so for them. These people wait on a list until they can one day receive a kidney transplant because kidney failure has resulted in their body not being able to clean their blood properly. More than 300,000 Americans have kidney failure and use dialysis daily and the statistics are only continuing to grow. I am going to argue that the best to solve this problem is to legalize the regulated sale of organs to better society as a

Organ donation continues to be an issue around the world. People are deciding not to donate their organs to people who need them to possibly save their lives. Some individuals have chosen to not accept organs over the age of fifty. Organs in the bodies of people sixty, seventy years old can be just as strong as an individual who is eighteen or twenty. Scientist in Washington, DC have found “new research that age cut-offs for deceased organ donors prevent quality kidneys from being available to patients in need of life-saving transplants” (4). Not only do the common people just assume organs from the elders are unacceptable, but they automatically assume a ninety year old kidney is going to enter into a twenty year old's body. That may happen

Specific plans and projects. Scheduling is concerned about the implementation of activities necessary to achieve the laid down plans. The function of control is to institute a mechanism that can trigger a warning signal if actual performance is deviating (in terms of time, cost and some other measures of effectiveness) from the plan. If such a deviation is unacceptable to the concerned manager, he will be required to take corrective action to bring performance in conformity with the plans. The PERT and

An extraction from the DoH Admitted Patient Care data set of individuals with a diagnosis or procedure code for dialysis or transplantation (excluding acute dialysis) between 2000 and 2014 identified 1899 individuals of which 1241 were also present in ANZDATA. The additional patients are likely to comprise of individuals: a) receiving care for less than 90 days and therefore not registered in ANZDATA, b) visiting from interstate (“holiday patients”), and c) never registered in ANZDATA for other, unknown reasons. A possible total of 2045 individuals met the criteria for receiving renal

Available became controversial. While the question of the dialysis machine is still controversial, the health system was caught in another ethical dilemma regarding organ transplantation. Organ transplantation is closely linked to the issue of cleanliness because patients with kidney failure can get an organ transplant as an alternative to hemodialysis. The issue is complicated by the fact Medicare is financed by organ transplant, and there are those who believe that the distribution of rare transplant is not right. There are thousands of terminal patients whose lives can be saved by organ transplantation, but there are no formulas of work that can be used to determine which of the thousands of patients will be given priority. It is left to the discretion of medical officers to decide who is worth saving. The ability to keep someone alive by replacing one or more of their major organs is a splendid achievement of medicine of the 20th century.

The current system of acquiring an organ donation is through a wait-list called the allocation system, which was supposed to be resolute. However, there are a few exceptions to the wait list causing this entire system to become even more unfair. For instance, when an organ donor dies his or her organs are more likely to be given to family members on a wait-list rather than those who are actually next in line (Hanto). Wait-lists are meant to be fair because those put on the list first are supposed to get organs first, but how fair is that really? How badly one needs an organ for his or her survival should rank higher than how quickly he or she found about his or her physical defects. Another factor that should be taken into account when placing people onto a wait list is their age. It makes more sense to give younger people a chance at life than prolonging the life of someone who has already lived to a ripe old age, but most supporters of the allocation system will argue that all lives are worth the same, even though there are clear lines between who will benefit more from organ donations.

Dialysis is a machine that has capabilities corresponding to a kidney . This would help the person to live longer til their transplant. According to “ Priceonomics” the dialysis is slower than a regular operating kidney. Particularly, dialysis can processes through the blood combined with toxins around 48 hours at a time. While a kidney can undertake the blood that is incorporated with toxins constantly, separating them apart. However, the cost of dialysis to sustain each person, every year cost 75k. About over a 20 million citizens have a disease called “ Chronic Kidney Disease” or can be referred as (CKD). Roughly about, 871,000 people have the disease and half are on dialysis during 2013. Which is 29,850,000,000 U.S dollars a year spent on dialysis. Despite, including those diseases such as kidney failure where dialysis is especially crucial. But, dialysis is not that affected due to the survival rates for those patients on dialysis is declining. Additionally, the U.S provides a service for those who donate a kidney, that they will be more prior to the U.S waiting list. If the person needs a kidney in the future. Most important, the U.S frequent donations of kidney come from a cadaver or living donors . A cadaver is a human that recently died and still has some living organs inside he or she. Eventually, studies show that with the growth of kidney related illnesses,

As a dialysis nurse I am tasked with providing pre and post treatment assessments for each patient and through these assessments I identify if there are any patient problems that must be managed. These problems can include access issues, such as clotting or infection, fluid related problems and many others. If a patient is short of breath or complains of chest pain prior to