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25 Cards in this Set
- Front
- Back
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Benefits
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saves lives, alleviate suffering, support healthy living, earlier detection of disease, prolong life
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challenges
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availability, cost, patient self-determination, quality of life, issues of living and dying, futile care, controversial interventions
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Quality of life
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- a subjective appraisal of factors that make life worth living and contribute to a positive experience of living
- includes fulfillment, satisfaction, conditions of life, happiness, experiences of life, comfort, independence... - means different things to different people |
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Beneficence of nonmaleficence
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- prime nursing focus is to relieve suffering
-use of technology may promote conflict between beneficence and nonmaleficence -technology can both relieve harm and cause physical, emotional, or spiritual suffering |
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Basic understanding
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-appropriate utilization of health technology requires that health care providers, patients, and families understand its: purpose, benefits, and limitations
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Life-sustaining technologies
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Issues related to withholding/withdrawing these treatments when they are deemed to offer no benefit of have poor outcomes:
-ideas and beliefs about life, death -medical futility -advance directives-DNR orders -patient self determination -nursing care |
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Life, death and dying
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Ethical dilemmas are associated with:
-attitudes and beliefs about when life begins -attitudes about what constitutes death -difficulty with death as part of the life cycle -unreasonable expectations of medical interventions -differing opinions regarding use of technology |
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Remember:
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-dying is more than a medical occurance
-dying is a spiritual process touching individual, family, community, and health professionals involved |
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Nursing care consideration:
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-awareness of personal attitudes about life, death
-awareness of beliefs and expectations of other involved -relieve suffering- support dignified death -alert for ways technology separates patient from family and increases suffering |
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Medical Futility
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Situations in which interventions are judged to have little or no medical benefit or in which the chance for success is low. Ethical considerations: prolong live or death, suffering and quality of life, availability and cost
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Life-sustaining treatments
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-Ethical/legal arguments for starting or stopping treatments are based on relative benefit or burden for patient
-withholding or removing treatments where burden or harm is determined to outweigh benefits is allowing person to die as a result of the natural progression of the illness/disease process |
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Nursing care considerations
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-attitudes and values
-knowledge of institutional policies -communication: help patient articulate preference, facilitate communication with health care team -maintaining the human focus=when medical care deemed futile, nursing care is most essential |
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Do Not Resuscitate (DNR) Orders
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-written directives placed in the patients medical record indicating that the cardiopulmonary resuscitation is to be avoided
-require open communication about: clinical condition and prognosis, efficacy and desirability of CPR, potential harm and suffering CPR may cause |
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Charting DNR Orders
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-chart immediately
-include: reason order was written, who gave consent, who was involved in discussion, whether patient was competent, time frame for the DNR order |
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Nursing Care Considerations
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-DNR orders apply only to resuscitation- other treatment and comfort measures may be provided
-provide good supportive and comfort care -facilitate communication about DNR with patients, families, and physicians -document requests by patients or surrogate for DNR and bring attention of physician when needed |
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Artificial Sources of Nutrition
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Considerations as life-sustaining measure:
-ordinary or extraordinary measure -beneficial or harmful -patients condition and prognosis -patient or surrogate wishes -patient or surrogate understanding of the dying process -good comfort care |
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Legal Issues and Technology
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-Legal interventions when parties disagree
-standards of care -legal precedents related to evidence of a person's wishes -advance directives -guardian ad litem |
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Palliative Care
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-comprehensive, interdisciplinary, and total care focusing primarily on comfort and support of patients and families who face illness of a chronic nature or who are not responsive to curative treatment
-Delivery of coordinated and continuous services in home, hospice, hospitals, skilled nursing facilities, and bereavement care |
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Nursing Care Considerations
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-support dignity and self respect of patient and family
-coordinate palliative care teams -provide appropriate care and facilitate effective communication regarding concerns and understandings of care among all involved -explain and negotiate patient care decisions |
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Issues related to reproductive technology
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-potential for changing society's concept of family and parenthood
-relegating childbearing to production of a produce -custody of frozen embryos -exploitation of women -social justice> cost and availability |
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Issues related to genetic diagnosis, engineering, screening
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-therapeutic use versus inappropriate modification of human characteristics
-eugenics -skewed or harmful definitions of what is considered normal or undesirable -production of organisms harmful to humans or other beings -social justice> cost and availbility |
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Slippery slope
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Term used by ethicists to describe the potential that one decision based on relaxing criteria supporting the value of human life makes it easier to slide into acceptance of lower standards as ethical guides
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Issues related to organ/tissue procurement/transplantation
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-allocation of scarce resources
-regarding donor>determining when death occurs -voluntary informed consent -buying and selling of organs -potentials of coercion |
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Issues related to controversial technologies
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-cloning> violates the right to one's unique genetic identity, human dignity, integrity
-stem cell research: destruction of human embryo, altering human genetics, treating human life as a commodity |
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Technology, privacy, and confidentiality
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-use of electronic devices for storing, retrieving, and transferring personal health information (PHI)
-implement safeguards to protect privacy and security of electronic transactions of PHI -Be alert of breaches in confidentiality -HIPAA regulations |
