Class Book: Role development in professional Nursing Practice. 

After reading Chapter 14 and reviewing the lecture powerpoint (located in lectures tab),  please answer the following questions.  Each question must have at least 3 paragraphs and you must use at 3 least references (APA) included in your post.

1.  What signs might alert you to a potential professional boundary violation or crossing?

2.  Contrast the terms terminal sedation , rational suicide, and physician-assisted suicide.

3. Identify at least 3 moral dilemmas that occur during end-of life care and decision making.

Thanks

 

 The following is another student DQ post to wish a have to reply adding some other information related to the post. Remember APA and less than 20 % similarity. 

Professor instructions:

All your postings should have references and citations

All your postings should have three paragraphs with three sentences

Student Post:

 

Question 1

Boundaries exist in every context whether it is professional or personal. As stated by Masters, professional boundaries draw a line between the nurse’s power and the patient’s vulnerability (2020). A nurse has power because of the knowledge and the role she plays in the patient’s care and the amount of information she has access to regarding their health. The balance must be maintained for the integrity of nurse-patient relationship to be intact (Masters, 2020).

A violation of a professional boundary occurs when said balance is altered from either part. This creates a lack of trust and puts in jeopardy the relationship. There are many ways in which a nurse can cross or violate professional boundary such as lying, disrespecting, altering information and more serious ones include sexual misconduct or exploitation (Masters, 2020).

Patients are often extremely grateful for the hard work nurses do. In their effort to show this they can engage in gift giving. However, nurses allowing or receiving compensation of some sort such as monetary for the services given constitutes a violation of boundary (Masters, 2020). Also sharing personal information, intimate details or behaviors such as flirting can be considered a violation or crossing of boundaries (NCSBN, 2018).

Question 2

Terminal sedation is usually considered for terminal patients. As the term implies, these patients have reached a stage in their disease where relief of symptoms such as pain and agitation are not obtained despite attempts (van Delden, 2007). Along with other decisions, the decision to artificially feed or provide fluids has ben also withheld. Terminal sedation refers to a sedation that precedes an expected death (van Delden, 2007). Terminal sedation is another way of ensuring compassionate end-of-life care and not just hastening death (Masters, 2020).

Rational suicide differs from suicide in the sense that the person involved in it is not emotionally disturbed, understand the magnitude of the situation and would seem logical to anyone not related to her (Masters, 2020). This continues to be an ethical issue because the idea of encouraging suicide despite circumstances goes against a nurse’s oath. In understanding the situation as a nurse, we are honoring a patient’s right to decide what to do at the end of life.

Assisted suicide brings many negative connotations and outrage. Assisted suicide means to facilitate a patient’s death by providing a doe of medication that is lethal. In this case the patient administers the medication provided by a physician. The Oregon Death with Dignity Act was the first law that allowed for this method of dying to be used (Masters, 2020).

Question 3

End of life care can be conflictive for many disciplines in the health care field. Personal philosophies and beliefs often seem to influence the way it is viewed. One of the many moral dilemmas experienced by nurses during end-of-life care is their perception that by sharing the truth they are taking hopes of recovery away from the patient (Masters, 2020). This affects how information is relayed.

A fundamental concern during end of life is pain relief. Many people die without proper relief because practitioners fear they are contributing to their death or aiding an addiction. Adequate doses are not provided in many cases because it is thought to contribute to a rapid decline and death (Masters, 2020).

Another moral dilemma and perhaps a very heavy one is the fact that nurses feel their moral integrity is at stake when these modalities contradict their own views (Masters, 2020). There needs to be a thorough assessment of one’s personal beliefs and ideas as to not have them impair or shape the experience of caring for a patient at the end of their life. However, if this becomes distressful for the nurse and alternative could be to have another nurse provide the care for the patient while assisting in other aspects that can benefit the patient.

Reference

A Nurse’s Guide to Professional Boundaries (2018). National Council of State Boards of Nursing, Inc. Retrieved from https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf

van Delden J. J. (2007). Terminal sedation: source of a restless ethical debate. Journal of medical ethics, 33(4), 187–188. https://doi.org/10.1136/jme.2007.020446

Masters, K. (2020). Role development in professional nursing practice (5th ed.) Burlington, MA: Jones & Bartlett Learning

 The following is another student DQ post to wish a have to reply adding some other information related to the post. Remember APA and less than 20 % similarity. 

Professor instructions:

All your postings should have references and citations

All your postings should have three paragraphs with three sentences

Student Post:

 

Question 1

There are some behaviors that indicate potential boundary crossing by nurses when dealing with patients. The first red flag is spending more time than is required with a patient. This shows that the relationship between the two has moved from professional to personal businesses that may negatively affect output (Erikson & Davies, 2017). Secondly, showing favoritism to a particular patient is another alert sign of professional boundary crossing.

Another common alert sign of professional boundary crossing is discussing intimate issues with patients. While a nurse may need some personal information about a patient while taking care of them, such data as likes and dislikes and other intimate details is often a sign of professional boundary crossing (Erikson & Davies, 2017). Also, engaging in behavior that could be reasonably interpreted as flirting constitutes an alert sign.

Meeting patients in settings other than those for provision of care is also a warning sign of professional boundary violation (Erikson & Davies, 2017). This include meeting patients at home or for coffee after they have been treated. Also, if patients start asking questions about a particular nurse, professional boundaries may be crossed.

Question 2

Terminal sedation is an end-of life intervention to end suffering as the last result. To relieve suffering that has not responded to other means, the patient is sedated to the point where refractory symptoms are controlled. With no intention of causing death, the patient is sedated to an unconscious level (Bryer et al., 2019). These drugs may result in his/her slow and painless death.

Rational suicide involve a well-thought out decision by an individual to die. Rational suicide occurs when a person reasons and decides to end their own life. In this case, the patient in end of life care should also be capable of action so that they can administer the drug (Bryer et al., 2019). Therefore, they administer the lethal drug on themselves rather than by a medical professional or other persons.

Assisted dying involve the hastening of death by administration of a lethal substance. In assisted dying, a drug or lethal substance is administered to the patient to end their life (Bryer et al., 2019). In this case, there can be active euthanasia where someone other than the patient carry out the action that ends the life.

Question 3

One major moral dilemma with end of life care is regarding hastening death or the principle of double effect. Some decisions that a nurse will make produce both negative and positive effects. For example, while a nurse may need to administer pain medicine, the drug may have negative effect on the patient (Masters, 2017). Here while the principle of non-maleficence apply, the nurse is in a dilemma or whether or not to administer.

Another moral dilemma in end-of life care is that involving respect for autonomy. According to Harwood (2020), patients have the right to make decision in regard to their treatment preferences. However, there are limitations when it comes to observing certain patient requirement which may have negative effects. Nurses often find themselves digressing from the patient’s preferences in treatment.

Another major challenge with end of life care is in regard to disclosing prognosis or diagnosis to patients. Due to religious beliefs, emotional reactions and other factors, family members may request nurses not to disclose results of diagnosis to patient (Harwood, 2020). As this act against nursing ethics, it present an ethical dilemma due to potential consequences of the disclosure.

References

Bryer, E., Neault, M., & Mintzer, D. (2019). Managing Dying: Medical Care and Decision Making at the Very End-of-Life. Palliat Med Care, 6(1), 1-6.

Erikson, A., & Davies, B. (2017). Maintaining integrity: How nurses navigate boundaries in pediatric palliative care. Journal of pediatric nursing, 35, 42-49.

Harwood, R. H. (2020). Ethical and moral dilemmas including do not attempt resuscitation orders, advanced care planning, and end-of-life care. Stroke in the Older Person, 283.

Masters, K. (2017). Patient-centered care and professional nursing practice. Role development in professional nursing practice, 273-278.

 

Hearing loss is common in the aging population and there have been tremendous advances in the past few years in hearing aid technology. 

Provide an overview of the etiology of hearing loss, the types of hearing tests, how hearing loss can be prevented, and the pros/cons of different hearing aid options.