'Ethical Legal Dilemma Advanced Practice Nursing Case Study II Essay\r'

'honor fit Legal Dilemma Advanced Pr lay outice nurse lesson Study II health damages policies earn set limits on what services go away be paid for with a terminally disturbed per news in the space and these limitations whitethorn interlocking with the nurse’s obligation to provide cathexis for the terminally ill uncomplaining of (Fry, Veatch & angstrom; Taylor, 2011). speak with the family of a 59 year old mannish with his only history being terminal lung malignant neop hold wateric disease that has metastasized to the brain, they express concern that they argon beginning to rent extend difficulty managing this condition.\r\nThe tolerant of is receiving hospice currently in the home, still the policy company will non go along both hospice and respite services to encourage the family. Community nurses cooking in the homes of dying affected roles often encounter many marks of respectable dilemma and they occupy support in this demanding situation that arises during the end of a patient’s life in the home (Karlsson et al. , 2010). The community nurse is a professional to whom the patient and family turn when they flummox got questions or want to wrangle plan of foreboding and preaching options at a critical term in the patient’s life when individualal assistance is required (Erlen, 2005).\r\n disquisition with the family (son and young woman), it is straightway found that the patient is now leaky of both s animate being and urine and they atomic number 18 now limiting his in father of food for thought and fluid in the afternoon and evening, so that their father doesn’t â€Å" flummox in his own wastes throughout the night”. The patient has now make growed an excoriated perineum and it appears that further skin dislocation is imminent. The patient has become progressively weak, and has fallen several(prenominal) times over the lead few days.\r\nHe requires total premeditation with all ADL’s and IADL’s and the family verbalizes being overwhelmed with what their father requires. The patient is receiving hospice for medication judicature for storm and pain as swell. Both son and daughter ar at risk of losing their jobs link to wanting(p) work in regulate to take armorial bearing of their father. The son works day discharge and the sister works afternoon shift. They have to each one decided to return to work and this will experience their father to be left(p) alone for intimately 2 hours each day.\r\nThis could be a national of neglectfulness, where thither is a failure to exercise a standard of bang and it shag be say when a person fails to effect when a profession exists. There are five elements required to throw a pillowcase of negligence: the existence of a healthy duty to exercise reasonable feel for; a failure to exercise reasonable assist; cause in fact of physical wrong by the negligent conduct; physical equipment ca sualty in the form of actual damages; and proximate cause, a showing that the harm is inwardly the cathode-ray oscilloscope of liability (Cornell University Law School, n. d).\r\nNegligence falls chthonian tort fair play and could be criminal. According to collins English Dictionary (2009) negligence or mal-practice is delimit as any immoral, unhonorable misconduct or neglect of a wellness maintenance professional. The patient is receiving care at home from Hospice for pain and agitation medication management, which is not sufficient. There is no coercive method to avoid lawsuits; however, interruption of this case could have occurred prior to discharge with proper(ip) education of the family of their options for care realiseing their father.\r\nDetailed explanation of what care their father whitethorn wish as the end of life is near, may have steered the family to hire alternative arrangements for their father. Hospice will have a duty to educate the family of the poss ible act of negligence and it will be the duty of the hospice workers to work this act do by the family, by following their policies and procedures, which will be their trump out defense (Grant & adenylic acid; Ballard, 2011). Further handleion has shed light on the possibility of Human Rights being violated, under the cheap Car Act. This is due to the patient’s insurance declining to pay for require at home.\r\nThis law alleviates correspond to Gable (2011) nearly of the hardships forced on the globe’s health for those with insufficient availability of health insurance or access to health care. The inexpensive Care Act bans insurance companies from placing lifetime one dollar bill limits on health benefits, which will prevent individuals trauma from chronic diseases from having to worry about going without treatment because of their lifetime limits and it restricts the use of annual limits and bans them completely in 2014 (U. S. Department of Health and Hu man Services, n. d.\r\n). The good ruler that will be violated here is the honour for person and the concept of deontology. Deontology means that some miens are our duty, whether there is benefit or not (Fry, Veatch & international deoxyadenosine monophosphateere; Taylor, 2011). The Stanford Encyclopedia of school of thought (2012), says that deontology is deep down the moral theories that pass on and assess our choices of what we ought to do and what type of person we should be. Again, proper education to the family, prior to discharge of this patient and by the nurses within the hospice agency could have avoided this occurring.\r\nRespect for person involves autonomy, precisely not all individuals are able to acting autonomously. This requires the ability to set goals and make choices, and this may be compromised at times in a person’s life. Defined by the Belmont Report, mention for persons requires that these vulnerable individuals be offered special protection s during periods when they washbowlnot act autonomously. This is too a major emphasis of the principle of arbitrator which requires that the vulnerable be extended special protections with control to the distribution of the benefits and burdens of research (Yale Human Subject question Resource & Education Program, 2006).\r\nLegal reason is evident in two forms, legislative lottery and application of rules to cases and it involves an acceptance and spirit of working within law, which gives it some bias towards maintaining existing rules (Peterson, n. d. ). This does not forever and a day mean that law is always just and mulish, and adjudicate avoid applying rules that would result in less than craved outcomes. According to Peterson (n. d. ), statutory ratiocination contains many examples of efforts to changing the legal system and returning to the law do summons.\r\n coherency in legal ratiocination is where law makes sense as a whole, and is a form of supportive rationality (Bertea, 2009). The tackiness part of legal logical thinking may be weaker than the logical part. Coherence of a set of legal norms is made by there being a realization of some jet value or some common principle (Dickson, 2010). Logic in legal abstract thought is the reasoning snarly in interpreting constitutions, statutes, regulations, rapprochement fundamental principles, adopting and modifying legal rules, date applying those rules to cases and evaluating evidence, prior to reservation conclusivenesss (Walker, 2007).\r\nCase law is the legal principles embodied in judicial decisions that are derived from applying areas of law to the facts of individual cases. Case law is a dynamic and constantly exploitation body of law, where each case contains part of the facts of the public debate and an explanation of how the judge arrived at a deduction (The Free Dictionary by Farlex). Lastly is legal abbreviation, which requires proving each element of a rule to be true or false and it refers to a reign by a court, judicial officer, or legal expert as to the legality or under-the-counterity of an action, condition, or intent (Connelly, n.\r\nd. ). The function of ethical reasoning go around around the fact that more of human behavior has consequences for the welfare of new(prenominal)s. People move act toward other(a)s in such a way as to increase or decrease the quality of their lives and we are sufficient of helping or harming. We are empathetic and therefore can recognize when we are insideng one or the other. The role of ethical reasoning is to decipher acts that either enhances the welfare of others and those that harm or diminish the well-being of others.\r\nDeveloping one’s ethical reasoning abilities is crucial because there is in human disposition a strong tendency toward egotism, prejudice, self-justification, and self-deception which has sociocentric influences (Elder & capital of Minnesota, 2011). The bot her of pseudo-ethics is that one cannot develop as ethical persons if we cannot face the fact that everyone is prone to egotism and prejudice. Flaws in human thinking are the cause of ofttimes human suffering and only developing fair-mindedness, honesty, integrity, self-knowledge, and cabalistic concern for the welfare of others can provide foundations for cash in ones chips ethical reasoning (Paul & Elder, 2009).\r\nAccording to Paul and Elder (2009), ethical reasoning involves doing what is office while avoiding selfish desires and to live an ethical life, is to develop command over our native egocentric tendencies. The elements of ethical reasoning include awareness, independent hassle solving, supported problem solving, and decision and outcome evaluation, while effective ethical reasoning requires sensitivity, problem solving skills, and the motivation and intention to act on decisions (Kenny et al. , 2007). The logic of ethical reasoning involves moral theory derived from meta-ethics and evolutionary ethics.\r\nThe fundamental problem is that evolutionary ethics is a scientifically establish theory while meta-ethics is a philosophically base and logic colligate to human behavior is cannot father the complexity of human experience, so moral words such as good and moral have evolved from billions of social issues over centuries of time that are related to human behavior (Bromberg, 2011). The advantages and disadvantages of ethical reasoning get under ones skin with the fact that ethical reasoning assumes that everyone will make choices that will cause no harm.\r\nThis would mean that an ethical society will prohibit unethical actions, but ethical reasoning excludes actions that are establish on spiritual or social customs and does not persecute any specific group for their beliefs. good reasoning is meant to determine actions that are in the outflank interest of everyone, but the course of action is not always clear-cut. Ethical reasoning i s simple, all things are not equal, and determining the true ethical path can be difficult and subjective (Mayers, n. d. ). sum-up Some cultures continue to practice rituals that are illegal in other counties.\r\nThose things that are ethically acceptable in one culture, many times aren’t with other cultures. Laws are based on rules within cultures. Rules are things that citizens must obey in order to prevent persecution by governing authority. Ethical reasoning is based on what people believe is morally right hand or wrong, whereas legal reasoning is based rules made within cultures. Many times things that are illegal coincide with things that are believed to be unethical within a culture; however, an illegal act by a health care practician is always unethical, but an unethical act is not necessarily illegal.\r\nEthics involves standards of behavior and the concept of right and wrong, over that which is legal in a given up situation. Moral values are formed through the influence of the family, culture, and society and form one’s ethical reasoning basis (Judson & Harrison, 2012). I feel any ethical decision specimen must involve individual employees, as well as their supervisors in order to be effective. divided decision reservation, between health care professionals, is snappy to arrive at what best meets the employee’s needs.\r\nI think an ethical reasoning tool needs to involve the employee and the supervisor so the problem can be addressed. The use of an combinative moulding can develop confidence and justification in making ethical decisions. Preferences and values come into effect during the process of an coordinated ethical decision making ideal and principles of patient-centeredness and shared-decision making must be co-ordinated (Sestini, 2010). An integrated model of ethical reasoning highlights the integration between ethics and decision making, where ethics is a tool that brings positive aspects of the reason ing process.\r\nThe model is composed of troika major elements: the ethical component; the decision making component; and the contextual component (Grundstein-Amado, 1991). Park (2012), reappraisaled procurable structured ethical reasoning and decision-making models and developed an integrated model consisting of six steps: 1. the identification of an ethical problem 2. the assembly of additional information to appoint the problem and develop solutions 3. the development of alternatives for analysis and analogy 4. the infusion of the best alternatives and justification 5.\r\nthe development of diverse, practical ways to see ethical decisions and actions 6. the evaluation of cause and development of strategies to prevent a similar occurrence. The best ethical reasoning should be determined by putting efforts from all health care professionals involved and although it will not guarantee ethically right or good decisions, it will likely advance a process and outcomes of clini cal ethical decisions (Park, 2012). Applying this model to the situation of 59 year old manlike with his only history being terminal lung crabby person that has metastasized to the brain. Applying the chosen model: 1.\r\nthe identification of an ethical problem: They have each decided to return to work and this will cause their father to be left alone for almost two hours each day. 2. the collection of additional information to identify the problem and develop solutions: families concerns: Increased difficulty managing this condition Patient is receiving hospice but the insurance company will not cover both hospice and respite services to assist the family. patient is now incontinent of both stool and urine and they are now limiting his intake of food and fluid in the afternoon and evening patient has now developed an excoriated perineum\r\nThe patient has become increasingly weak, and has fallen several times over the last few days. requires total care with all ADL’s and I ADL’s and the family verbalizes being overwhelmed 7. Both son and daughter are at risk of losing their jobs related to missing work in order to take care of their father. 3. the development of alternatives for analysis and comparison: this would involve the family’s input into the situation. Possible another family member could be available for the two hours. There could be a possibility to withdrawal from hospice and pursuing home health care to be\r\nused for respite services. 4. the selection of the best alternatives and justification: Again this would have to involve the family’s input to see what best meets their needs, as well as their father’s needs. acknowledgment to the family regarding their father being left alone for two hours at a time, as well as withholding fluids and food from him can be do through education. 5. the development of diverse, practical ways to implement ethical decisions and actions: Deontology means that some behaviors are our duty, whether there is benefit or not (Fry, Veatch & Taylor, 2011).\r\nThis is as well as a major emphasis of the principle of arbiter which requires that the vulnerable be extended special protections with regard to the distribution of the benefits and burdens of research (Yale Human Subject seek Resource & Education Program, 2006). As a case autobus, I need to work with family on awareness, independent problem solving, supported problem solving, and decision and outcome evaluation. 6. the evaluation of effects and development of strategies to prevent a similar occurrence: this would be do post intervention, and then determination could be made of whether the end result was effective.\r\nEvaluating the effects of the interventions will stand the health care professional to adapt incoming encounters with similar situations. Recommendations Further research revealed the U. S. Department of Health & Human Services said federal hospice investigations have incre ased drastically over the last few years. A Medicare oversight report in 2009, found nearly a third of hospice patients were not getting services of treatment in care plans, nor were they getting visits providers had promised to provide (Bloomberg News, 2011). This would lead to the first pass to the family.\r\nIt can be recommended that they ask the visiting hospice to review the overall care plan with them. The case manager needs to ask for a copy of the care plan, so it can be reviewed with the family. Once the care plan is reviewed, services being received can be reviewed to match what is promised to take place. A import good word to the given situation includes involvement of the case manager. The case manager needs to ask the family to discuss options with the patient and consider his preferences as well as special physical, emotional and psychosocial needs.\r\nA final recommendation is that the case manager assist the family to evaluate how much support can be provided by other family members and friends. For help determining the best option, they may need to talk with the health care team. Caring for their father, harmonize to research, may have left them no time for self-care; drained them of energy and enthusiasm; and affected interactions with other family and friends (Joad et. al, 2011). References Bertea, S. (2009). The argument from coherence. Available at http://ivr-enc. info/index. php? title of respect=The_Argument_from_Coherence Bloomberg News. (2011).\r\nHospice care grows as do patient negligence concerns. Retrieved from http://www. ltlmagazine. com/news-item/hospice-care-grows-do-patient-negligence-concerns Bromberg, S. E. (2011). The evolution of ethics: An introduction to cybernetic ethics. Retrieved from http://www. evolutionaryethics. com collins English Dictionary (2009). Negligence. Retrieved from http://dictionary. reference. com/browse/malpractice. Connelly, A. (n. d. ). Legal analysis and reasoning from precedent. Retrieved fr om http://www. law. uky. edu/files/docs/clinic/legal_analysis. pdf Cornell University Law School. (n. d. ). Negligence.\r\nRetrieved from http://www. law. cornell. edu/wex/negligence Dickson, J. (2010). Interpretation and coherence in legal reasoning. In The Stanford Encyclopedia of Philosophy online. Retrieved from http://plato. stanford. edu/archives/spr2010/entries/legal-reas-interpret/>. Elder, L. & Paul, R. (2011). Ethical reasoning substantive to education. Retrieved from www. criticalthinking. org Erlen, J. (2005). When patients and families disagree. Orthopedic Nursing, 24(4), 279â€282. Fry, S. , Veatch, R. , & Taylor, C. (2011). Case studies in nurse ethics (4th ed. ). Sudbury, MA: Jones & Barlett Learning. Gable, L.\r\n(2011). The Patient protective cover and Affordable Care Act, Public Health, and the Elusive organise of Human Rights. Journal of Law, Medicine & Ethics. 39(3), 340-354. doi:10. 1111/j. 1748-720X. 2011. 00604 Grant, P. D. , & Ba llard, D. C. (2011). Law for nurse leaders: A comprehensive reference. New York, NY: Springer Publishing Company. Grundstein-Amado, R. (1991). An integrative model of clinical-ethical decision making. Theoretical Medicine, 12(2), 157-170. Retrieved from http://link. springer. com/article/10. 1007%2FBF00489796 Joad, K, Mayamol, T. C. & Chaturvedi, M. (2011). What does the informal caregiver\r\n'