Provide a history of the problem with falls in nursing home of patietns with Dementia? What is the ethical issue when treating Dementai patietns with numerous falls, and how can we reduce the instnaces while maintainig dignity. Are there any good case studies on reduction of falls with patietns with Dementia?
Ethical value of autonomy
According to the American Nurses Association (ANA) Social Policy Statement, a core value and assumption that undergirds the professional nurse’s contract with society is, “The interaction between nurse and patient involves participation of both in the process of care.” This value remains steadfast to a Code of Ethics for Nurses’ core principle — respect for persons, including respect for autonomy, or right to self-determination. To maximize autonomy, nurses engage in a reciprocal social relationship with patients. Our responsibility is to inform patients of choices, options for selection, and to the best of our ability, inform the patient in the consequences of the choices. Once fully informed, patients can then make a choice. In essence, nurses provide information that is evidence-based so that a patient can make an informed decision.
Four core biomedical ethics (autonomy, beneficence, nonmaleficence, and justice) can be articulated and applied to fall and fall injury prevention programs. Autonomy is essential to respecting a patient’s right to engage in conversation and education about available choices and consequences.
Making a choice
Let’s examine choice for one decision that applies to all inpatients: Use of the call light for help before getting up. Healthcare professionals view patients as partners in their care, with the right of autonomy. Patients are individuals who are cognitively intact, able to make decisions, and able to take responsibility for the consequences of their decisions.
Patients have a right to make a choice, to participate in processes of care. Nurses voice concerns and frustrations about patients who do not call for help, even after repeated instruction to do so, and then experience a fall. These patients may be labeled as “noncompliant,” but are they really? Across healthcare settings, nurses design and select fall prevention interventions by checking off a box on an electronic or paper medical record according to a fall risk score or level. This approach to fall prevention is unilateral, excludes patient participation, and ignores respect for the patient to be educated and informed about choices.
Right to choose
Here is an exercise to test your approach to patient choice: Do you inform a patient about choice when discussing “use of the call light to call for help before you get out of bed”? Two choices exist: to call for help OR not to call for help.
Without question, nurses instruct patients (and caregivers) about calling for assistance and why this is important, but discussing the choice to not call for help is rarely part of the discussion. Rarely is this option found in a patient education program, brochure, pamphlet, or medical record education checklist.
Here are some examples from this tool that you may want to integrate into your fall prevention education program for cognitively intact patients.
The answers are provided during patient and family education, with instruction that the patient will “teach back” through a knowledge test and skills test. If the patient can accurately answer the questions and demonstrate use of the call light, the nurse can evaluate the effectiveness of instruction to ensure the patient is informed and knows the consequences of their choices.
Autonomy and patient safety
Opportunities exist to better integrate ethical principles into our practice, such as autonomy. Many interventions are implemented with safety as the priority; yet, there are times when autonomy supersedes safety. This same discussion should drive decisions related to bed alarm usage, purposeful rounding programs, within arm’s reach toileting programs, and other interventions applied to all patients, such as universal fall precautions. The nurse-to-patient relationship should be individual and dynamic, with respect for patients’ values, wishes, and choices.
Provide a history of the problem with falls in nursing home of patietns with Dementia? What is the ethical issue when tr...
Describe issue of autonomy as it relates to medicine. What is it and when could it come up in medicine? Use one example of autonomy from the case studies we have read in our book. Then explain how one consequentialist ethical theory could deal with autonomy in medicine and one deontological ethical theory could deal with the issue of autonomy.
Describe issue of rule of rescue as it relates to medicine. What is it and when could it come up in medicine? Use one example of the rule of rescue from the case studies we have read in our book. Then explain how one consequentialist ethical theory could deal with the rule of rescue in medicine and one deontological ethical theory could deal with the issue of the rule of rescue.
What are the implications of a current nursing issue to society? What are the ethical concerns or questions that are implied in this issue? You can find several news sources on the web and find issues that impact society and health care. Look at the issue from the perspective of society as a whole and then think about different members of the society and how each might be affected by the issue. You should find your own issues of interest
What are the implications of a current nursing issue to society? What are the ethical concerns or questions that are implied in this issue? You can find several news sources on the web and find issues that impact society and health care. Look at the issue from the perspective of society as a whole and then think about different members of the society and how each might be affected by the issue. You should find your own issues of interest
Based on Elder Abuse in Nursing Homes and Fighting Nursing Home Abuse A. What observations can you make regarding elder abuse in nursing homes How would you address the problem What are specific issues with for profit nursing homes? Based on information provided in the articles able, how does NY fare compared to other states regarding elder/nursing home abuse? Identify specific cases and studies.
Laura Penman works in a nursing home with a specialty in dementia care. She floats from the units that provide care to patients with mild dementia to the locked floor for those with severe end stages of the disease. Today she is assigned to care for Sandra McKendrick. Sandra is an 82-year-old woman with end-stage Alzheimer's disease. Laura remembers her from when she was admitted to the facility several years ago. Last month, Sandra's daughter Kate agreed to placement of...
The patient is an 88-year-old man with an extensive cardiac history who has been a resident of a skilled nursing facility for the past 3 years. Comorbid conditions include type 2 diabetes (15 years) and severe peripheral vascular disease. For 6 months the patient has suffered from a serious left leg wound that has not responded to treatment and that has become much worse over the past 2 months. At this point, the leg is gangrenous to above the ankle,...
CASE STUDY pital or in the ph as a general benefit at the nursing home and are seen at the hos Last month you were hired with the title Specialist at an independent comm 350 beds、The hospi clinic, a rehabilitation center with bot Health Informatics ital includes a comprehensive outpatient tient services, a cardiac care center, and an emergency room. lty t an independent community care hospital with sicians' offices. This coordination is seern atients have for a number of...
Answer the questions in paragraph home, What is the issue/conflict in this case? What are the long-term consequences of these decisions? Address your thoughts on this case and what ethical issues this Case addresses. Have you seen any other ethical (or legal) issues related to pricing during the COVID-19? DANIELS FUND ETHICS INITIATIVE Case Bank COVID-19 IMPACTS THE AIRLINES CASE The COVID-19 pandemic is increasingly impacting businesses and creating a wide range of ethical issues. Attempts to slow the spread...
Case Study: Name: Ms. Jenny Long DOB: 09/02/1951 New resident of Dementia Specific Unit, Westside Aged Care Facility Single, Under the Australian Guardianship and Administration Council protection Medical Background- Ischemic heart disease (IHD) since 2005, takes Nitro-glycerine patch, daily In 2011 - diagnosed with severe dementia - able to understand simple instructions only, confused and disorientated Osteoarthritis of both knees 20 yrs. Voltaren Gel to both knees BD Muscular weakness of both upper extremities Chronic constipation, takes Laxatives PRN No...