Discuss about the Legal and Professional Issues in Nursing for Guardianship Forms.
Palliative care refers to the specialised medical get generally provided to people suffering from serious illnesses, with the aim of providing them relief from a plethora of symptoms. The goal of palliative care is to improve the overall health wellbeing and quality of life for the patient, suffering from a life-threatening disease. Hence, in addition to appropriate prescription of medications, it also focuses on releasing the patient from physical and mental stress, and pain during a terminal diagnosis (Quill and Abernethy 2013, p.1173). All healthcare professionals involved in providing palliative care to a patient have the moral obligation to strive to relieve the pain, and help all patients with unlimited life expectancy. The essay will focus on a case study of a patient Tom, and will apply ethical and legal principles in the clinical decision making process while caring for this patient.
End-of-life care of a patient to not only refers to the final days of their life, but broadly encompasses providing care to all patients suffering from terminal condition (Koller and Rockwood 2013, p.171). End-of-life issues can be extremely complex, uncomfortable, and difficult to address in some patients (Sprung et al. 2014, p.857). Shared decision making is an integral component of patient-centred healthcare, where the patients and clinicians work together to make appropriate medical decisions, and select the treatment or care plan, based on available clinical evidences. This is generally done to balance the risks and expected outcomes, in accordance to the preferences and values of the patients (Oshima Lee and Emanuel 2013, p.6).
In certain instances when the patient becomes unable to take decisions for them in future, they officially appoint a person (friend or family member) to make decisions related to their health. This is referred to as power of attorney. A similar incident had been encountered in this case where, following obtaining informed consent of Tom, for administration of morphine/midazolam syringe, his daughter Carina arrived and provided documents with suggested she had the power of attorney. Owing to the fact that the power of attorney is a legal document, taking Carina’s suggestions into consideration is integral in this clinical decision making (Brinkman-Stoppelenburg, Rietjens and van der Heide 2014, p.1008). However, legal issues were met when Jimmy confirmed the fact that his mother was the enduring guardian. An enduring guardian is appointed to make health, lifestyle and medical decisions for a person, not capable of doing this for oneself.
The major legal conflict that arose in this case was deciding between the person with the power of attorney and the enduring guardian. The latter was responsible for setting out the values, wishes, and directions that need to be considered before medical decisions were made, on the behalf of the patient (Mullick, Martin and Sallnow 2013, p.31). Furthermore, the fact that Jimmy has speculations about presence of an advanced care paper of his father, increased legal complications. Advance care planning involves discussion between the patient, family members and healthcare professionals about the desired direction and goal of the end-of-life care. This will hold particular importance when Tom will lose the capacity to participate in decisions as his end-of-life nears (Halpern et al. 2013, p.411). Such advanced care directives are also promoted by the Healthy Dying initiative in Tasmania that aims to increase understanding of the community about the role of palliative care, and the importance of facilitating open discussions, regarding the wishes and values of the patient (Ashby, Thornton and Thomas 2013, p.188).
It is essential for the nursing professionals to be knowledgeable about use of several medications as a part of palliative care. Pharmacologic symptom management forms an important aspect of a pain-free, palliative care (Boddy et al. 2013, p.41). The patient Tom had provided his informed consent for the use of morphine/midazolam, to reduce the severity of pain. Hence, aspects of shared decision making were taken into account before administration of medicines. Providing an informed consent can be attributed to the fact that he was made aware of the probable health benefits that morphine would exert, related to reducing pain (Minozzi, Amato and Davoli 2013, p.688). It belongs to the opioid class of analgesics, generally administered to control pain or shortness of breath in end-of-life patients. Action of the drug on the central nervous system decreases pain feelings, by predominantly interacting with the opioid receptors. These receptors are distinctly located in high density in the hypothalamus, thalamus, posterior amygdala, putamen, and nucleus caudatus. The drug binds to and activates the µ-opioid receptors in the CNS, thereby exerting its pharmacological effect related to sedation and analgesia (Navratilova et al. 2013, p.5). The major clinical issue can be related to the fact that Tom’s daughter suggested administration of any other drug.
Evidences have established the strong correlation between overdose of morphine and death by respiratory depression or asphyxia, in absence of proper medical attention. Although the minimum lethal dose is 120mg, in cases where the patient body shows hypersensitive reactions, 60mg can also bring sudden death (Rudd et al. 2016, p.1325). These factors, in addition to the concerns about drowsiness should be taken into consideration, while providing analgesics for pain relief. All the pain medications are responsible for creating a confused state of mind or drowsiness. Provisions will be created for clinically education the patient and his family members regarding the mechanism of action of morphine on the nervous system and the probable ways by which it will exert an analgesic effect on Tom. Administering morphine at regulated doses will help in successfully reducing pain and will also eliminate all concerns related to breathing, thereby providing comfort to the patient. The family members are also feeling anxious on observing Tom getting agitated. However, agitation is the most common manifestation of anxiety that occurs during the aging process. Hence, efforts will be taken to educate the family members about the features that Tom will manifest in end-of-life. Consent will also be taken from the family members to treat manage agitation by administering benzodiazepines (Barr et al. 2013, p.264). Hence, there is a need to foster an effective communication with Carina, and other family members to help them gainer sound understanding of the care plan, the probable benefits that it will exert, and the reasons why they should adhere to the medications. This communication will help in forming trust and an effective therapeutic relationship, thereby increasing treatment adherence and patient outcome.
While providing palliative care to all patients there is a need to acknowledge the Aboriginal and Torres Strait islanders as indigenous people. Quality palliative care at end-of-life patients are realised when these are culturally appropriate to the particular preferences and needs of the individuals (Panaretto et al. 2014, p.651). A holistic end-of-life care approach must be adopted, which embraces the emotional, spiritual, cultural, and physical dimensions of the aboriginal life. Aboriginal people have often been found to be generally ambivalent towards the healthcare approaches adopted by the western world. They often demonstrate a resistance and reluctance to use these services, which can be related to lack of aversion to the principles of holistic family centred care models that under been the contemporary palliative care approaches (O’Brien et al. 2013, p.3). Therefore, efforts must be taken to provide care in a way that enhance is not only the physical well being of the individual, but promotes the emotional cultural and social well being of the entire community, with a focus on the cyclical concept of life-death-life.
Hence, the palliative care model needs to be implemented in a way that addresses the specific needs of the cultural group and respect their basic right, when providing them equity of excess to same levels of services as other Australians (Shahid et al. 2013, p.26). Implementing a culturally inappropriate care service, can often lead to psychological distress, and unnecessary sufferings, for the patients and their families. Hence, there is a need to ensure proper addressing of the culturally relevant requirements and preferences, while working with healthcare professionals and liaison officers who have the adequate experience and knowledge about the local community. Efforts must also be taken to gain knowledge about the cultural perspective related to end-of-life care issues, while providing these services to the Aboriginals (Johnston, Vukic and Parker 2013, p. 62). Hence, the practice of advanced learning should be fostered and family case conferences should be organized, where the patients and the broader family will be involved in decision making, about culturally appropriate care. The place of death or dying is often spiritually and culturally significant for most indigenous people. This can be addressed by providing social support and showing other adherence to the ethical principles of fidelity (Pesut et al. 2014, p.71). Involving spiritual leaders while offering end-of-life care services can also act as a significant source of strength, and provide comfort to the patient. This will help in accommodating the cultural and spiritual beliefs of the individual. In addition to maintaining the ethics for beneficence, autonomy and non-maleficence, trusting relationships should also be established that includes keeping the promises and doing what is expected from the healthcare professionals.
Thus, it can be concluded that in this case scenario palliative care was given to the patient Tom, who is suffering from serious illness, in addition to psychological, spiritual, and social distress. The care process must be focused on taking efforts to resolve all ethical and legal complications that might lead to deterioration and the health outcome of the patient, by influencing the shared decision making process in a negative way. Efforts must also be taken to provide care services in a way that increases comfort of the patient, by reducing pain and stress, in addition to controlling the major symptoms. This can be achieved by facilitating end-of-life communication and implementing a care plan that is able to meet the cultural and traditional beliefs and preferences of the Aboriginal people.
References
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