Professional Boundaries In Nursing

Secondly, the patient should be capable of making and communicating health care decisions for him or herself. Thirdly, the patient must be diagnosed with a terminal illness that will lead to death within six months.  Interested patients must also provide the request for termination in writing to the physician. In addition, physicians are expected to inform patients to alternative means of care including hospice care and other medications. Only after precautions evaluation, the laws then permit patients to make the ultimate life ending decision.

Healthcare professionals have an ethical obligation to respect patient’s wishes. Consequently, many legal and ethical dilemmas arise in healthcare in response to clinical decisions related to the needs, beliefs, and preferences of patients and families. Other dilemmas result over concerns about the integrity, competence, or actions of other healthcare professionals. Preserving human dignity, relieving suffering, equality, integrity, and accountability are essential nursing values (Kangasniemi, Pakkanen, & Korhonen, 2015). Nurse leaders have an

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

In addition to advance directives, there are other decisions involving end of life care that people should think about and discuss with their loved ones. These are decisions are around the ‘how’ and ‘where’ that people wish to die. These types of measures may be touched on in one’s advance directives, but may not go into great detail. If diagnosed with a terminal disease or if the end of life is imminent, one should decide on the type and amount of treatment they receive. With death as a certainty, most people turn toward either palliative care or hospice

Death is in a sense inevitable, we can’t escape from it. In today’s day in age, we are living longer than our parents and our grandparents due to medical technology. But there are so many ethical issues and complications that go hand and hand with death. There are two forms of death, cardiac and brain-oriented. Determining these two forms of death, along with the determined time of death is vital, simply because we don’t want to treat a living person as if they were dead. With so many issues concerning death, we have to protect those who are on the brink of death or terminally ill and can’t speak for themselves, but allowing them to make preparations for the future. Advanced directives makes this possible,

When you are able, you should put thought into the physical process you will go through. All of us love you and want to make sure that when the time comes, we know and can follow your wishes regarding the care you wish to receive. Having your decisions thoroughly and clearly stated in an advance directive will make this possible. (Berger, 2014, p. 590). Your advance directive document may contain a living will, a signed consent for Do Not Resuscitate (DNR), and information identifying your healthcare proxy. Understanding these things now, will help you make clear choices. A living will clarifies what care, or lack of care, you wish to have (Berger, 2014, p. 590). This is helpful for reference if you are ever unconscious or in any way incapable

Nursing surrounds the concept of patient care physically, mentally and ethically. The therapeutic relationship that is created is built on the knowledge and skills of the nurse and relies on patient and nurse trusting one another. The use of nursing skills can ensure these boundaries are maintained, it allows for safe patient care. Professional boundaries are the line that nurses cannot cross, involving aspects such as patient confidentiality and privacy, ensuring legal aspects of nursing and the boundaries put in place are not breached. However, nurses accepting financial or personal gain from patient can also cross these professional boundaries. It is only through education in this area that the rights of patients can be preserved, as

Patient self- Determination Act (PSDA) encourages people to make a decision about the extent of medical care they want to accept or refuse (American Cancer Society, 2015). It is the responsibility of ethics committee to make patients aware of their rights. Also, “committee members need to be educational and advisory in nature, they should educate themselves, other health care workers, patients and the family members regarding the ethical principles and organization’s policy relating to the ethical issues”(Alexander & Kavaler, 2014). Many people are not aware with the advance directives, they don’t know how to complete advance directives (ADs), what are the state regulation to complete ADs and only a few people discuss their preferences with doctor, which do not protect their autonomy during the time of end- of- life (House & Lach, 2014). Health care professionals must be competent to provide information on ADs so that patients will be able to make a decision. In addition, patient’s wishes and ADs need to be discussed among family members and the health care providers so ethics committee plays an integral role in protecting patients’ preferences and supporting ADs process for

At any time a person can become incapacitated and unable to speak for themselves. “Cases come before the ethics committees around the country every day because people do not have advance directives in place, even though there was plenty of time and good reasons to engage in advance care planning” (Kottkamp, 2013). In many cases, the lack of advance care planning leads to a tragedy: families dealing not only with the grief of loved ones who are suddenly unable to communicate- and often near death- but also the heart break of trying to figure out who should make healthcare decisions and what those decisions should be (Kottkamp,2013). In most of these cases, this uncertainty could have been prevented with the simple act of executing an advance

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

Mark’s friend a fellow podiatrist he studied with posted a photo on Facebook of a lunch she had with an elderly female client. This is a breach of professional boundaries. As a health professional, a clear disassociation should occur amidst professional conduct aimed at meeting the health needs of patients and a practitioner’s own personal relationships and views which are not related to the therapeutic relationship.

A professional nurse is one who puts the needs and importance of patient care above all others. While striving for professionalism, nurses need compassion, patience, empathy, strong moral and ethics, accountability and the commitment to always act in the best interest of their patients. Nurses are held accountable for providing quality, safe, and effective nursing care (Hood, 2014). A professional nurse has the responsibility to continually improve and implement nursing standards while maintaining integrity by involving themselves in various tasks. Regular involvement in reading professional literature and sharing of evidence- based research with other healthcare personal helps increase knowledge and skills. This nursing ability can be used to encourage the actions of others in the healthcare team resulting in improved patient care. Nurses should encourage each other to become involved in hospital committees, provide an environment to encourage the discussions of ethical dilemmas, promote professional growth of nurses to voice their concerns and share viewpoints to address issues. “A professional nurse should expect to commit to a life of continuous learning growth and development”. (Hood, 2014, pp. 29). Nurses choose this profession to help others. As professional nurses we must maintain our ethics, values, characteristics, and commitment to drive our profession forward (CCN, 2015). Nurses must be autonomous, accountable, and be able to delegate to unlicensed assistive personnel. Being autonomous as a nurse means having control over their practice (Hood, 2014). It allows a nurse to take risks while being held accountable for ones’ actions (Hood, 2014).

1) Patients have the right to make their own informed decisions about if and how they die. When a chronically ill patient decides life is no longer worth living because of the insurmountable pain they are in, who are we to tell them differently? There are cases where attempts to cure are doing more harm than good, not only mentally and physically to the patient, but emotionally to his family and loved ones as well.

Nightingale said, “The very first requirement in a hospital is that it should do the sick no harm”. The history of nursing initially begins with Florence Nightingale. Before her era nurses had a tarnished reputation (Glasper, 2017). They were poorly educated and incompetent people. Nurses such as Mrs. Bedford Fenwick wanted to change the image of nursing. They did this by leading a campaign for professionalism. Which led to the culminated Nurse Bill receiving is royal assent in December 1919 (Glasper, 2017). July 27, 1921 was the official opening of the nursing register, there are currently 688,927 nurses registered with the Nursing Midwifery Council (NMC) (Glasper, 2017). The NMC code has four themes of professionalism, “Prioritizing

The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that the personal identity of the author is no longer intact and therefore has no authority over the treatment of the “new” person. The debate on this topic is extremely complex, but many of today’s cases are decided on an individual basis, with the directive often being upheld.