...execution of an advanced directive and Power of Attorney. Advance Directives are put in place for this very reason. It eliminates the need for family members to make a choice in the heat of the moment and also respects the wishes of the person whom it affects directly. Although Mr. E’s hypoxia could affect his ability to think clearly one cannot assume that he has an altered level of consciousness nor the inability to execute an advance directive prior to this situation. His advance directive clearly states that he does not wish to be placed on a ventilator. The Wyoming Nurse Practice Act clearly states in Chapter 7, Section 6 (ii) Advocates for the client, and then further states in subsection (A) respects clients rights, concerns, decisions, and dignity (Fowler, 2008). Failure to follow the nurse practice act in your state could mean that you will have your license suspended or may lose your license completely. It would depend on what the State Nursing Board decides and what they find in their investigation. It would be very unfortunate for a nurse to lose their license this way. Unfortunately the nurse in this situation did not advocate for this patient, she allowed the physician to violate the patients advanced directive wishes to not be placed on a respirator as well as allow someone who was not legally responsible to make medical decisions for this patient. This nurse also withheld pertinent information regarding the knowledge of and stated in the Advanced Directive. According...
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...Nursing Roles and Values Task One Western Governors University State Regulations and Nursing Standards The State of Tennessee Board of Nursing’s Rules and Regulations of Registered Nurses, Rule # 1000-01-.13-1r states that unprofessional conduct is defined in part by "failing to take appropriate action in safeguarding the patient from incompetent health care practices" (State of Tennessee, 2011). There are a number of arguments in this case study that incompetent health care practices are being performed, from the decision to place a patient on a ventilator for an oxygen saturation of 88%, circumventing the patient’s written and verbal advanced directives, utilizing an unauthorized family member to get consent for a medical procedure, and discussing confidential medical information in a public location and with and unauthorized family member. The nurse clearly violated this rule because the nurse did not take any action at any point to stop the physician from taking these incompetent actions. Implications Rule # 1000-01-.13-1r applies because, as mentioned above, the nurse failed to take any action to prevent the physician from performing a number of incompetent acts related to the healthcare of the patient. First and foremost, the patient likely does not even need to be placed on the ventilator. The physician’s decision to place the patient on the ventilator is based on an oxygen saturation of 88%. Although the patient’s oxygen saturation does need...
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...becomes ill or if something tragic happens to have an advanced directive for healthcare prepared to help their family make an ultimate decision regarding their life and health. “Advanced directives limit the type and amount of medical care and treatment that patients will receive if they should become incompetent and have a poor prognosis.” (Fremgen 313) With having an advanced directive it helps communicates a person’s wishes about making decisions if they become incapable of making their own health care decisions; which also makes it easier for family members to have everything planned out. Many make a decision and only tell their family what they want without having it in writing, but its best to have everything in writing for a smoother process. There are two important types of advance directives; a power of attorney or a living will. A durable power of attorney for healthcare “is a legal document that empowers another person (proxy) to make healthcare decisions for an incompetent patient. It goes into effect after the person becomes incompetent and only pertains to healthcare decisions”. (Fremgen 102) The power of attorney becomes effective when someone becomes incapable of making their own health care decisions. Medical power of attorneys covers a great amount of healthcare decisions based on the patient wishes. The power of attorney is capable of reviewing the patients’ medical records, discussing and questions to the doctor and medical staff about the care and treatment...
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...Argument from Nonmaleficence. The ethical principle of Nonmaleficence in regard to medical practice is defined in generic terms as the physician will not cause undue harm to the patients in his care (Wilmot, 2003). In the case of Mrs. B we would need to determine if the cessation of life sustaining treatment MANH would cause her harm. In the case of a persistent vegetative state (PVS) as with Mrs. B the cessation of MANH would lead to harm in the form of death on the part of the patient. However the continuation of MANH would lead to the possibility of recovery and thus decreased harm to the patient. Is it even possible to cause harm to a patient in a PVS? The medical definition of a PVS as described by the Multi-Society Task force on PVS...
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...The Prime Directive, as the article states, takes a sort of Kantian approach. A black and white image where it is pertinent that the Federation does not interfere with other cultures that are not at warp capacity. I, however, am of the utilitarian stance. The Federation should help another culture if it will yield the greatest amount of good for everyone involved. Especially in the case of a whole race being wiped out in a completely preventable event. In the episode “Pen Pals”, we encounter a planet ready to implode on itself. Data receives a radio from a little alien girl, Sarjenka, who is asking for someone to help her and her family. The crew of the starship enterprise faces the question of when to bypass the Prime Directive, if you should anyways....
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...Act of 1990 required consumers to be provided with informed consent, information about their right to make advance health care decisions. This act is also called advance directives. The act requires that patients be given information about state laws that impact legal choices in making health care decisions. Health care facilities in every state are required by this act to notify patients 18 or older of their right to have an advance directive in their medical records. Advanced directives include living wills; do not resuscitate (DNR) orders, medical power of attorney, health care proxy, or organ or tissue donation. Every patient must be informed in written form by health care facilities of the laws in their state that are related to advance directives. Every patient has to sign the advance directive notification form stating that they have been informed of their right to have advance directives. This provides proof for the facility that they have informed the patient. This form has made laws concerning patients right’s stricter. Records management procedures have had to make some changes to the way they do things in order to respond to this legislation. They have had to make sure when a patient comes to the hospital that they find out if they have advanced directives. Before this act this was not a question they asked when you came to the hospital. Doctor’s and the health care team have to pay closer attention to what the patient wants and do as the patient wishes. This act...
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...Advance Directives Irene was a 78-year-old female getting ready to leave for an appointment with her daughter. The nursing home staff assisted Irene out to her daughter’s car but then Irene collapsed. Concerned, the staff dialed 911 per facility protocol and made Irene comfortable, waiting with Irene’s daughter, for the ambulance to arrive. The ambulance personnel arrived to the scene and immediately proceeded with performing cardiopulmonary resuscitation (CPR). Do Not Resuscitate (DNR) Ethical Dilemma Irene’s daughter and nurse instantly stated that Irene was a DNR resident of the facility. Emergency personnel stated that they would have to view the DNR documents and would continue procedures until they examined the required paperwork. Irene’s nurse ran into the facility to grab her record; however, by her return the emergency personnel had already resuscitated Irene. There are many scenarios where ball dropping can occur in healthcare and it is at those times when ethical legal decision-making dilemmas appear. Marjorie is a 91-year-old female residing in a long-term care facility (Kase, 2013). Marjorie’s daughter filed a lawsuit against the long-term care facility and the hospital for attempting to resuscitate Marjorie and perform multiple and painful interventions to sustain her...
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...there was clear and convincing evidence that Mrs. Schiavo would have wanted her feeding and hydration discontinued, as the Mr. Shciavo claimed. The parents disagreed with this finding and constantly challenged the claim. The parents did not believe that their daughter would have wanted this and because there was no medical advanced directive, that Mrs. Schiavo should be taken off of life support. Because the federal courts refused to act, Mrs. Schiavo died of starvation and dehydration. QUESTION PRESENTED: The question presented in this case is, who has the right to terminate life support when there is no advanced medical directrive when a spouse wants one thing and...
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...into practice. The FICA Tool and HOPE Questions provide serve to assist clinicians in the spiritual assessment process. By examining the research done using these tools, it has been determined that the FICA Tool is easy to use and provides basic data on a patient’s spirituality. The FICA tool is both reliable and valid. The HOPE Questions are easy to use and provides details on a wide range of aspects related to multicultural beliefs. The HOPE Questions is not supported by research thereby it is not valid or reliable. Key Words: spiritual assessment, FICA Spiritual Assessment Tool, HOPE Questions Spiritual Assessment Taking patients spiritual needs into account is an integral component of providing holistic care. Research has linked positive health outcomes with patients whose spiritual needs have been addressed. However, spirituality is not always considered an important part of a patient’s well-being; leading to spiritual assessments not being completed. To aid in addressing a patients spiritual needs, there are spiritual assessment tools available. Some of the tools available include the FICA Spiritual History Tool and the HOPE Questions. This paper aims to examine the above mentioned spiritual tools ease of use, comprehensiveness of data, reliability, and validity as well as techniques to incorporate a spiritual assessment into a medical encounter. Spiritual Assessment Tools Spiritual assessment tools contain questions that enable health care providers...
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...Running head: AMERICA’S AFFORDABLE HEALTH CARE CHOICES OF 2009 1 America’s Affordable Health Care Choices of 2009: Advanced Care Directives Denise Renna Ball State University Abstract This paper explores Section 1233 of Health Related (H.R.) Bill 3200, America’s Affordable Health Care Choices of 2009, introduced to the House of Representatives. Under this section of the bill, the Qualified Health Benefit Package (QHBP) would be required to explain end-of-life planning to individuals who seek this information. Currently physicians are not reimbursed for providing end-of-life planning for individuals on Medicare. Some larger groups such as the American Medical Association (AMA) are in favor of passing the bill. This paper examines groups in favor of the bill as presenting opposition from other groups regarding this piece of legislation. America’s Affordable Health Care Choices of 2009: Advanced Care Directives Health Related Bill The House of Representatives introduced H.R. bill 3200: America’s Affordable Health Care Choices of 2009 on July 14, 2009, as a means “to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes” (H.R. 3200-111th Congress, 2009). HR 3200 is an active bill that was referred to the House Committees on Energy and Commerce, Ways and Means, Education and Labor, Oversight and Government Reform, and Budget,...
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...well-informed decisions that are in accordance with personal preferences and values. Similar to the Values History, Fischer, Min, Sauaia, & Kutner (2012) highlight the fact that advanced directives may include various documents, including a “broader more comprehensive document outlining goals, values, and preferences for care in the event of decisional incapacity” (p. 3). Questions from various areas of a patient’s life are addressed with this tool; therefore I believe this form is an excellent way to explore personal feelings and attitudes that patients may not have taken the time to think about. However, after reviewing the Values History form, my concern is that it is not a legal document. It would be...
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...Ethical and Legal Issues in Nursing University of Phoenix Nursing 391 Ethical and Legal Issues in Nursing Marianne, the 79-year old woman who presented with a hemorrhagic stroke in a recent case study, brings up thought for ethical debate. Her outlook is poor, with or without surgery, and she has no advanced directive. Her husband and children cannot come to an agreement on whether life support should end or if all resuscitative measures should be attempted. The following paper will discuss how the American Nurse’s Association Code of Nursing Ethics would influence a final decision, how personal and societal values can influence ethical decision making, the fundamental legal aspects of each case study, and the legal responsibilities of nurses in the work setting. Regardless of any situation that may arise, every nurse has a set standard in place that must be followed. These are nonnegotiable, ethical standards, obligations and duties that every individual swears to when entering the nursing profession. These standards are all found within the American Nurses Association’s code of Nursing Ethics and Conduct. Whether dealing with patients and families during end of life decision making or dealing with nursing negligence within the court of law, the first provision in the code of ethics is the most imperative to remember. Nurses are always obligated to their patient’s best interest, therefore making them an unrelenting patient advocate. Many provisions are pointed...
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...The Feeding Tube 1. Explain how the Patient Bill of Rights applies to this situation. The patients of the country in the United States are provided a particular right. This right is called the Patient Bill of Rights (Kronenfeld, 2002). The Patient Bill of Rights has a significant impact and is essential for the people who are in the health care organization for the purpose of getting treatment properly and easily. In this scenario, June is suffering from anorexia and the doctors feel she may need to be placed on a feeding tube to save her life. June agreed to the procedure but became combative, disoriented and refused to have the tube place the evening before the procedure was to take place. The patient bill of rights applies, as the patient has a right to know what treatment options are available to one and what the possible outcomes may be. The patient has a right to decide one’s medical care. One also has a right to know of any side effects of treatments. June needs to be told what may happen without the feeding tube and what can be expected with the feeding tube. June also has a right to have her health information kept confidential, with information given only to those she designates as being allowed to have her health information (Showalter, 2008). It is noted that in the absence of a progressive terminal disease, the feeding tube may be used to prolong life and since the patient is not dying of another cause, discontinuing the feeding tube would imply a desire to cause...
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...Running Head: INTENT AND IMPACT OF PUBLICITY-ORIENTED LEGAL CHALLENGES TO PHYSICIAN-ASSISTED SUICIDE. Intent and Impact of Publicity-Oriented Legal Challenges to Physician-Assisted Suicide Elena Mikhaylov Student Keller Graduate School of Management – Online HS542 Keri Bahar February 2012 Introduction The word Euthanasia originated from the Greek language: eu means “good” and thanatos means “death”. In Ancient Greece it meant literally "the good death". The term euthanasia normally means that the person who wishes to commit suicide must initiate the act. The Oxford English Dictionary Online (2nd edition, 1989; online version Sep. 2011) provides the following definitions of euthanasia: "A gentle and easy death...[T]he means of bringing about a gentle and easy death... However, in today’s society term euthanasia includes both voluntary and involuntary termination of life. Euthanasia has many meanings. Except for involuntary euthanasia, all these terms are closely related because the victim requests the action. The only difference is who is actually committing the act, Voluntary euthanasia is a help to mentally competent person to die through the assistance of others and can be divided in two categories. Passive Euthanasia means causing the death of a person by withdrawing some form of support and letting nature take its course. For example: removing life support, stopping medical procedures, stopping food and water and allowing the...
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...A Patient’s Right: Respecting Patient End-of-Life Care Wishes Introduction As a citizen in today’s fast paced and medically advanced society, it is imperative to have knowledge and understanding of Advance Directives and what role they play in patient care. In the scenario presented we find Mr. E who is a 67 year old male who lives in a nursing home and has presented to the ER with lung congestion. Mr. E. has a history of diabetes, poor vision, and hypertension, impaired hearing, and is delayed developmentally. After an initial assessment, the physician, Dr. K. has diagnosed the patient with pneumonia secondary to aspiration. Mr. E. has a fever and his oxygen saturation level is 88% on room air. Dr. K has admitted Mr. E to the ICU and has determined that he needs to be placed on a ventilator. When the doctor explains the situation, Mr. E. vehemently states that he does not want a ventilator. Mr. E. has an advance directive that outlines his wishes. Body As a nurse in the state of Indiana, it is a responsibility and standard to advocate for the patient while providing competent care according to the patient’s wishes. Indiana law upholds a patient’s written or spoken advance directive in the event that the patient is unable to make decisions regarding their healthcare. In the scenario, Mr. E.’s advance directive was disregarded by the healthcare personnel because he was deemed incompetent of understanding the seriousness of the situation. Thus, the physician and the nurse...
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