end of Life Care[1695]

Nur 421 Nursing Issues: Ethical DilemmasMielany CharleryUniversity of the Virgin Islands A current nursing issue that I have noticed is decision making by health care professionals in ethical dilemmas. According to Your Dictionary (2018), an ethical dilemma is a choice between two options, both of which will bring a negative result based on society and personal guidelines. For example, murder is considered to be unethical but if done for the protection of loved ones or self-defence some may consider it the right thing to do. When health care professionals are faced with ethical dilemmas it may be hard to determine what is the best option, leading to a clashing mental struggle. This essay will be discussing the main ethical dilemma that I usually encounter during clinical, which is end of life care. There are many root causes of ethical dilemmas encompassing end of life care. Some of them are family vs. patient wishes, withholding vs. withdrawing life support, cost of sustaining life vs. cost of ending life, and longevity of life vs. quality of life to name a few. Basically, the root cause all boils down to the question of what would be the right decision to make between the health care professionals, the patient and the family and why. There is also a worriment of morals. For example, in a case where the quality of life isn’t the best and the prognosis for the patient is poor a patient may be presented the option of physician assisted suicide. However, when the nurse has made an oath to take care of a patient, how can he/she murder them. Hospital doctors, nurses, general practitioners, community nurses, hospice staff, counsellors, social care staff, chaplains, physiotherapists, occupational therapists, complementary therapists and a palliative care team are all involved in end of life care (nhs.uk, 2020). These are the people who provide care and play a part in determining what may be best for the patient. On the other hand, there is the family which is equally important. All though they do not provide care, an individual out of the family may be appointed to be a proxy which allows them to make healthcare choices for the patient in case they are not able to (Karnik & Kanekar, 2016). Lastly, the patient is involved in their own care. They are allowed to make decisions about and refuse their treatment. The consequences of end of life care depend on the dilemma that is being faced. In one of my experiences there was an older male in the ICU unit that my classmates and I took care of. He experienced a thyroid storm, a watershed stroke and showed signs of locked in syndrome. He was kept in the ICU, where he had gotten thrush, continues to lose movement, developed pressure ulcers, couldn’t breathe without the ventilator and overall chances of survival kept decreasing.The first and second dilemma in this case was the family vs. care givers views and withholding vs. withdrawing life support, where the family wished to keep him alive and receive futile treatments but the care givers saw this as continued suffering for the patient. The consequence of this case would be the loss of a loved one or continued suffering for the patient. The third dilemma in this scenario would be cost of sustaining life vs. cost of ending life. This patient kept receiving treatments to extend his life which would in turn have increased his hospital bill. The cost of producing care services and medicine is increasing the expenditure involved in providing these treatments (Karnik & Kanekar, 2016). The consequence for this dilemma would be an expensive hospital bill or ending life for a reasonably priced invoice. Lastly, there is the dilemma of longevity of life vs. quality of life. As stated before the family decided to increase his life span with technology and medicine however healthcare services should not only target lengthening the life of people but also improving the quality of life (Karnik & Kanekar, 2016). For this patient this was not the case. His quality of life just continued to deteriorate. The consequence for this dilemma would be to continue patient suffering because the quality was poor or loss of the loved one. To fix this nursing issue policies are being created to be put to use. Healthcare organizations are working towards developing and implementing guidelines and policies for end of life care decision making, especially policies for withholding or withdrawing the treatment options so as to avoid the ethical dilemmas (Karnik & Kanekar, 2016). Another thing that can be done is effective communication between the care providers, the family and the patient. This will ensure the family and patient have all the information needed and all questions are answered in order to use their good judgment to make decent decisions for better outcomes. Current research on improving the decision-making skills on end of life care include the kinds of team-based models used to approach the patient. In this evidence-based article, they reviewed six types of team methods which were the hospital; direct contact, home; direct contact, home; indirect contact, comprehensive; indirect contact, comprehensive; direct contact and comprehensive, direct with early contact (Health Quality Ontario, 2014). In each model there was at least one nurse or doctor who was trained in end of life care. The training included symptom management, psychosocial care, development of patient care plans, end of life care planning and coordination of care. The evidence favored a comprehensive team-based model with direct patient contact, meaning the patient stays with the same team throughout treatment and is seen by the caregivers themselves. When this model was used the patients lived longer than expected with a better quality of life. This research should be applied in our clinical setting to see what difference it makes in decision making for care for end of life patients. In the evidence-based article entitled “A systematic Review of End of Life Care Communication Skills Training for Generalist Palliative Care Providers” the objective was to identify and appraise how end of life care communication skills training interventions for palliative care providers are developed, delivered, evaluated and reported. Training content included communication skills with end of life care, cancer, psychological care, living wills and giving bad news (Brighton, Koffman, Hawkins, McDonald, O’Brien, Robinson & Selman, 2017). Skills were taught by lectures, reflections, discussions, role paly, group work, case studies and clinical experiences or visits. Course durations lasted anywhere from forty minutes to sixteen months. The results yielded that despite the numerous trainings in the literature, evidence is limited because of poor reporting. The experiment would be done again using a stronger research design and outcome measures as a priority. This issue is a global nursing issue because it happens in every part of the world in every health care setting. This problem can never fully be solved but the process can be made easier. As stated, effective communication between the health care providers, family and patient will bring about everyone to a common understanding and remove any obstacles in the way. Another step that can be taken is making it necessary for care providers to enrol in end of life training to develop methods that will make it easier for the patients and their families to make decisions for the betterment of everyone. Lastly, patients should be sat down and spoken to about advance directives and living wills so that there is no fuss about what happens after they’ve passed the point of survival. Reference PageYourdictionary. (2020). Ethical dilemma dictionary definition | ethical dilemma defined. [online] Available at: https://www.yourdictionary.com/ethical-dilemma [Accessed 21 Jan. 2020].nhs.uk. (2020). What end of life care involves. [online] Available at: https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/ [Accessed 21 Jan. 2020].Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-of-Life Care: A Narrative Review. Healthcare (Basel, Switzerland), 4(2), 24. doi:10.3390/healthcare4020024Health Quality Ontario (2014). Team-Based Models for End-of-Life Care: An Evidence-Based Analysis. Ontario health technology assessment series, 14(20), 1–49.Brighton, L. J., Koffman, J., Hawkins, A., McDonald, C., O’Brien, S., Robinson, V., … Selman, L. E. (2017). A systematic review of end of life care communication skills training for generalist palliative care providers: research quality and reporting guidance. Journal of Pain and Symptom Management, 54(3). https://doi.org/10.1016/j.jpainsymman.2017.04.008

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