End-of-Life Issues

With our framework of ethical theories and principles in hand, we begin our look at some of the critical ethical issues in our contemporary world, starting with end-of-life issues. This assessment covers ethical questions related to end-of-life care. Passive euthanasia is the removal or refusal of life-sustaining treatment. Examples of passive euthanasia include removal of a feeding tube or a ventilator, or forgoing a life-prolonging surgery. Passive euthanasia is legal in all 50 states, and the principle of autonomy gives informed patients the right to refuse any and all treatments. Patients who are unable to make such decisions in the moment (because they are unconscious, for example) might have made their intentions clear beforehand with an advance directive or similar document. Things become more complicated, however, when a patient who is unable to make treatment choices has not made his or her wishes clear, either formally in a written document, or informally in conversations with family members or friends. Another problem concerns cases in which there is disagreement about whether the treatment is sustaining the life of a person in the full sense or merely as a body that, because of severe and irreversible brain trauma, is no longer truly a living person.

Active euthanasia, or assisted suicide, introduces further difficult moral questions. A patient who has a terminal illness and who has refused treatments that would merely prolong a potentially very painful and debilitating death might want the process of dying to be hastened and made less painful. The patient might want to take his or her own life before the disease reaches its horrible final stages. Should patients be legally allowed to have help in this endeavor? If suicide itself is not morally wrong, at least in cases like these, is it wrong for another person to directly help bring about the patient’s death? Is it wrong for doctors, a role we naturally associate with healing and the promotion of life, to use their medical expertise to deliberately end a patient’s life if the patient wants this?

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Articulate ethical issues in health care. 
  • Articulate the moral issues associated with limiting life support.
• Competency 2: Apply sound ethical thinking related to a health care issue. 
  • Demonstrate sound ethical thinking and relevant ethical principles when considering limiting life support.
  • Explain important considerations that arise when contemplating limiting life support.
• Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals. 
  • Exhibit proficiency in clear and effective academic writing skills.

Preparation

• Case Study: Mr. Martinez. 

This media piece provides the context for this assessment; make sure you have reviewed the case study thoroughly.

Additionally, it may be useful to think through the following issues as they relate to Mr. Martinez’s case:

• Should Mr. Martinez be transferred to intensive care, where his respiratory failure can be treated by a ventilator, and by CPR if necessary, and his oxygen level can be monitored? 
  • What are the key ethical issues or models at play in this case study?
  • What are the key end-of-life issues at play in this case study?
  • How can an understanding of models and best-practice help to guide health care practitioners to make ethical and legal decisions?

Instructions

In a 2–3 page analysis of the case study, address the following:

• The patient’s directives.
• The patient’s quality of life.
• The family’s stated preferences.
• The moral issues associated with limiting life support.
• The ethical principles most relevant to reaching an ethically sound decision.
• Important considerations such as implications, justifications, and any conflicts of interest that might arise because of the patient’s respiratory failure.

When writing your assessment submission assume that doctors cannot contact Mrs. Martinez and must make this choice on their own. To help you reach an objective, ethically sound decision, draw upon concepts and arguments from the suggested resources or your independent research. Support your response with clear, concise, and correct examples, weaving and citing the readings and media throughout your answer.

 

You and your partner have been practicing safe sex for since the beginning of your sexual relationship two months ago. You both agree to an HIV test, and the results are negative for both of you. How will this influence your behavior? The ELISA that you received detects the presence or absence of antibodies against HIV. Antibodies can take one to six months to develop after exposure to HIV. During this time between exposure and antibody production the virus can reproduce rapidly and the amount of virus present in body fluids is high. How does this information influence your behavior?

 

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

The Assignment:

Learning Objectives

Students will:

• Evaluate clients for treatment of mental health disorders
• Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis

• Which Decision did you select?

• Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

• What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

• Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

• Decision #2: Treatment Plan for Psychotherapy

• Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

• What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

• Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

• Decision #3: Treatment Plan for Psychopharmacology

• Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

• What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

• Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

• Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

•  Note: Support your rationale with a minimum of three academic resources less than five years In APA Format Including Introduction and Conclusion 

Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Note: the answer of this post should be in a positive way 

 

                                                            Main Post

In the past, nursing educational programs did not focus on the undertakings of evidence-based research, the integration into practice settings, or the mere skills to research appropriately (Tagney & Haines, 2009). However, Tagney and Haines (2009) explain that the integration of evidence-based research is a gap that needs to be addressed among health care professionals that require improvements to research and critical appraisal skills and the ability to conduct a research project. Polit and Beck (2017) state that research can commence by the construction of a theory and a person who can interconnect the evidence and take note of themes.

Theory

Concerning research, a theory can be defined as two ideas that are associated or related which places the intentions of a theory to explain the relationship between the two ideas to describe a single phenomenon (Polit & Beck, 2019). Often, theories are descriptive, as they are used to describe individual characteristics of the subject of interest by observation of common features (Polit & Beck, 2017). Polit and Beck (2017) state that descriptive theory is occasionally an indication or suggestion to explanatory or predictive theories. 

The Theory of Planned Behavior gives understanding of how people behave and why from a phycological standpoint (Polit & Beck, 2017). When someone is unstable from anger their behavior can be determined by their intention to act on the behavior (Polit & Beck, 2017). Collectively, the personal attitudes, the social norms, and how easy or difficult the behavior is to partake in all relate to the intention to perform or not to perform the behavior (Polit & Beck, 2017). Notably, the perceived importance of the personal attitudes, social norms, and the ability to follow through on the intention of the behavior are different through different scenarios and situations (Polit & Beck, 2017). Simply put, a theory is an explanation of how two phenomena are interconnected or linked (Laureate Education, 2012). 

Research Article Using the Theory of Planned Behavior

Chang-Chiao, Tsui-Ping, Bih-O., and Chia-Chi (2015) put forth a cross-sectional study that consisted of 548 nurses that worked on general hospital wards and intensive care units with an aim to study how nurses’ attitudes and intentions affected medication administration errors and the reporting of the errors. The theory of planned behavior was used as the as the framework for this study. Chang-Chiao et al. (2015) explain that medication administration errors reporting is a professional obligation where the clinicians consider behaviors before reporting. The barrier of medication administration errors reporting behaviors was investigated as this issue still occurs in todays practices. 

Many obstacles around reporting errors exist such as leadership styles on the unit, unfriendly work environments, lack of knowledge of the importance of reporting errors, and nursing shortages (Chang-Chiao et al, 2015). According to the theory of planned behavior, beliefs and attitudes are the fundamental determinants of behaviors and to change or influence the behavior the attitudes and beliefs need to be addressed (Chang-Chiao et al, 2015). To tackle this, intentions need to be changed via attitudinal beliefs, control beliefs, and normative beliefs.

In this study the biggest factor that played a role of intentions towards not reporting medication errors were the attitudes of nurse managers and coworkers which involved the nurse to feel blame which consequently influenced their own attitude to not report (Chang-Chiao et al, 2015). Thus, the conclusion is that the intent of reporting errors is concerned with patient safety and not blame and that there should be increased awareness as to why errors need to be reported to change the intent and the nurses’ belief systems (Chang-Chiao et al, 2015).

How the Theory Provides Structure and Value to the Research Study 

The theory provided structure to this study because of the investigated underpinnings around the nurses’ behaviors, attitudes, and intentions (Polit & Beck, 2017). The relationship between the intent to choose to not report medication errors and the perceptions used provided the framework for the hypothesis of fear of the manager and coworkers to place blame and to a conclusion to increase education around patient safety to change nurses’ beliefs around subjective norms of the unit (Polit & Beck, 2017). The theory provided has given a valuable framework by contribution of a starting point for the researchers and a guide to follow through to a logical conclusion.

References

Chang-Chiao, H., Tsui-Ping, C., Bih-O, L., & Chia-Chi, H. (2015). Nurses’ Attitude and intention of Medication Administration Error Reporting. Journal of Clinical Nursing, 25(3-4). Retrieved from the Walden University Library database.

Laureate Education (Producer). (2012). Selecting a Framework. Baltimore, MD: Author. 

Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Tageny, J., & Haines. C. (2009). Using Evidence-Based Practice to Address Gaps in Nursing Knowledge. British Journal of Nursing, 18(8), 484-489. Retrieved from

https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=1&sid=06adf448-2563-4f18-9a8f-23de83a12610%40pdc-v-sessmgr02Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.