Decision Making in a Nursing Ethical Dilemma

Decision Making in a Nursing Ethical Dilemma Introduction Decision making in an ethical dilemma circumstances could be difficult at time as one is prone to use similar past experience as a yardstick to analyse the circumstances. McGhee and Perrin (2008), define ethical dilemma as a situation that gives rise to conflicting moral claims resulting in disagreements about choices of action. Therefore using a framework as a tool to guide one through the ethical dilemma would aid in arriving a client-centred decision. This paper aims to look into Ranjit’s decision to die in his own home instead in a hospital as requested by his children using the model for ethical decision making by Kerridge, Lowe and McPhee (2005). Clearly state the problem Ranjit, a 77 year old man diagnosed with Parkinson’s disease lost his motor functions. He prefers to be cared and die at home however his children are concerned about not being able to meet his needs as they do not possess with necessary skills to handle his disease if he deteriorate. Ethical Problem Ranjit may have Parkinson’s disease however it does not limit his freedom to make his own decision. Therefore the ethical issue is raised in contradiction of his autonomy. Social Problem No one is able to care for Ranjit when his condition required more attention, therefore a caregiver is required if Ranjit wish is passed through. Legal Problem Ranjit is of a legal age in the eye of the law; he is capable to make sound decision for himself. His diagnosis may lead others to make baseless assumption about his capability to make a decision. Get the facts Parkinson’s disease is defined as chronic neurodegenerative disorder, which is related to loss of dopaminergic neurons in the substantia nigra. Symptoms such as tremor, brandykinesia and rigidity present in early stage and later stage non-motor features including autonomic dysfunction, falls, and sleep disturbances as loss in non-dopaminergic areas (Ministry of Health, 2007). According to Hoehn and Yahr (1967), Parkinson is classified into five stages, from stage one tremor over one limb to stage five confinements to bed. The prevalence rate in Singapore was found to be 0.3% for the population aged 50 and above (MOH, 2007). People with Parkinson do not only experience distress with their own movement, but the increasing motor deficit also diminishes their ability to express, communicate and interact with others (Doyle Lyons, Tickle-Degnen, Henry, Cohn, 2004). Disability is seen more prominent as the disease progresses, caregiver may experience strain, burnout or financial bur dened (Tan 2013). Therefore communication is critical for patient and caregiver to discuss openly about the disease, understanding their frustrations will help them to live with the disease (Chiong-Rivero et al., 2011). Although with pharmacotherapy can improve the quality of life ancillary approach in managing disease cannot be overlooked. Utilisation of rehabilitation services for Parkinson patients will go a long way to keep them active within the community to prevent isolation and depression. Occupational therapy can be involved in teaching client and care givers in coping with activities of daily living. Physiotherapist can be involved in gait training and strengthening muscles to prevent falls. Caregivers can consider sending Ranjit to various alternative services such as Agency Integrated Care (AIC), day care centre or respite care. Consider the four principles Autonomy Autonomy is defined as the freedom and ability to exercise one’s choice and the ability to decide for oneself. The principle in autonomy is to respect a person’s decision, privacy and confidentiality and receive full disclosure (Staunton and Chiarella, 2008, p. 31; Butt and Rich, 2008, p. 42). His children are against Ranjit decision to be cared and die at home, despite his disease his right to choose should not be stripped off. As healthcare provider it is important to respect and promote client’s autonomy (Singapore Nursing Board (SNB) Code of Ethics and Professional Conduct, 1999, p.4). Beneficence Beneficence is described as taking action to help other; the desire to do good (Butt and Rich, 2008). The nurse would advocate client’s interest accordance to SNB Code of Ethics and Professional Conduct (1999, p.8) value statement 7, to promote client’s best interest by ensuring desires are acknowledge and considered by the healthcare team. The team shall consider Ranjit’s decision to be cared at home as it is deemed good for him. Non- Maleficence Non- maleficence is defined as â€Å"above all, do no harm’ (Staunton and Chiarella, 2008). (ANMC) Code of Professional Conduct (2008) conduct statement 4 stated nurses to ensure the safety and quality of care are not compromised. If Ranjit’s decision was granted, a caregiver should be nominated to prevent harm at home such as fall. Justice Justice is based on the concept of fairness (Hendrick, 2000, p. 121). This suggests that one shall be treated fairly and be given equal chance to make decision. Statement 2.3 under Australian Nursing Midwifery Council (ANMC) National Competency Standards for Registered nurses (2006), to demonstrate respect for client’s legal right in relation to health care. Identify Ethical Conflicts Beneficence versus Autonomy The first conflict to be addressed her is whether Ranjit should be cared at home or die in hospital. No doubt hospital is well equipped with equipment and healthcare team to provide a care plan for him till he die but however Ranjit has the right to refuse admission, treatment or care from the hospital. Therefore his primary treating doctor should provide a full disclosure on the disease process, risk and potential problems to allow him to make an autonomous choice. Beneficence versus Non Maleficence The second conflict here is his children perceived hospital is the best place for him as they do not have the necessary skills to look after him. However what seem to be best may not be as it place Ranjit at risk for acquiring infection or develop depression to his wish rebuked. Non Maleficence ethical principle here is involved if Ranjit’s decision is approved by his children. Due to the lack of care at home, he may be faced with potential issues such as falls, pressure sores and chest infection. Consider the law Consent Mr Ranjit has the mental capacity to take consent as evidenced by his active commitments with various activities. His consent may be deemed valid if he is able to understand and retain information and communicate his decision as stated in Mental Capacity Act (2008). Right to refuse treatment As the children wanted him to be institutionalised, Ranjit can refuse admission to a hospital or a nursing home. Advance directives An advance medical directive (AMD) an Act to provide for, and give legal effect to, advance directives to medical practitioners against artificial prolongation of the dying process and for matters connected therewith (Advance Medical Directive Act, 1996). Mr Ranjit may consider AMD to safeguard his wishes, case he became unconscious or terminally ill. Making the ethical decision Ranjit’s decision to be cared at home should be granted as he is competent to make his own decision and what is deem best for his interest. Family conference involving patient’s treating doctor, patient and his family may be helpful in this circumstance to hear from individual’s perspective to reach a conclusion that may benefit all. However the ultimate decision is still on Ranjit thus his children should respect his decision and look for alternative revenue to provide care for their father. Document the decision In accordance to statement 6.3 of ANMC National Competency Standards for the Registered Nurse (2006), Documentation must be written clearly and concise to provide accurate assessments. Therefore it is important for nurses and doctors to document all discussion shared as evidence to prevent unnecessary miscommunication. Evaluate the decision Ranjit’s care plan will need to be evaluated when there is a change in his condition or needs (ANMC National Competency Standards for the Registered Nurse statement 8.2, 2006). As Ranjit is able to make an autonomous decision to be cared at home, his children can employ a caregiver to be home to look after the father, the care plan will need to be evaluated every three months to better support and meet his needs.

Blood Brothers :: Drama

Blood Brothers My practical work in September to December was for my acting option. It was a scripted piece of work based on the play Blood Brothers. There are various themes in Blood Brothers, a clash of class, romance, jealousy, and betrayal. My contribution to the performance was as a seven-year-old child. I played Edward. Edward is a very reserved character. He is well spoken and polite and is very surprised and shocked at many things Mickey (his friend) does. He comes from a wealthy background and so is used to having everything he needs. He enjoys helping other people out. When acting as Edward I needed to have a very good posture. Holding myself well, this showed a contrast between Edwards’s upper class and Mickey’s lower class. I also needed to speak well, pronouncing my words clearly. This again showed a clear contrast between Mickey and Edward’s class. To help me in my work I looked for information on the Internet and books I looked at pictures of young boys in the 1950’s, this helped me choose my costume. I also listened to the Blood Brothers sound track, and watched a professional performance of Blood Brothers at the Phoenix Theatre. I also read a play called Blue remembered Hills by Dennis Potter. The most useful material I looked at was the production of Blood Brothers at the Phoenix theatre. This is because it helped me with many things. To begin with I watched and listened to Edward very carefully. I took note of the way in which he moved and the facial expressions he used. I also listened very carefully to the pace at which he spoke and the tone of his voice. I could then use this to improve my personal performance. I also observed the costume Edward was wearing. This helped me to decide what I should wear for my performance. I am now going to contrast and compare Blood Brothers with Blue Remembered Hills; our piece was set in the 1950’s. However, the other play was set in 1943 during the Second World War. The plays were similar because they both started off with people very happy, playing and enjoying themselves. However as they continued both plays became more serious and in the end at least one person was killed in both. There also some differences. To begin with Blood Brothers is a cyclical play. This means it starts at the end, then goes to beginning then the end again. Blood Brothers also skipped large time gaps. The play showed scenes with the same characters as children teenagers and adults in the 1850’s 60;s 70’s and 80’s.

Case Study for North Country Auto

Case Study for North Country Auto, Inc. North Country Auto, Inc. was a franchised dealer and factory-authorized service center for Ford, Saab, and Volkswagen. The company maintains its competitiveness by providing full services to its customers. For customers looking for a car, the North Country Auto not only provided options for new cars from those three brands, but also provided options to buy used cars from it. In addition, for customers with cars, the company can provide a variety of services to their car, such as service and repair under warranty or at the customers’ expenses. Example service and repair work are quick oil change, auto repair, the body shop work and auto parts supply. Recently, the company adapted a new control system as a strategy to improve its sales and increase its profit. There were five departments within North Country Auto: the new car department, the used car department, the service department, the parts department and the body shop. Originally, these five departments operated as part of one business. And the performance of each department was not individually evaluated. Under the new control system, all five departments operated as an individual profit center. The owner assumed that, by doing this, all managers of the five departments would be encouraged to increase their departments’ profit so as to have better evaluation and better income. However, under this new control system, there were still problems needed to be dealt with, because the business conducted by these departments affected each other. In this case, if one department tried to maximize its profit, it may affect the profit of other departments. For example, when the new car department manager tried to sell a new car, he would offer a very high trade-in price for the customer’s used car so as to attract the customer. If this high trade-in cost was allocated to other departments, it would be unavoidable that the cost of those departments would increase and their profit would decrease. Therefore, the questions raised from this case would be: should all departments be treated as an individual profit center; and how the transfer price should be set between the departments; as well as how to correctly allocate the cost among different departments. In my opinion, I think the parts department and the body shop should not be considered as the profit centers, since most demands for these two departments were from service department. If these two departments tried to maximize their profit, it would be very difficult for the service department to maintain high profit. In my opinion, the parts department and the body shop should be considered as cost centers. In addition, the transfer price among all departments should be the market price instead of another price determined internally. And any losses on inter-departmental business like trade-ins should be proportionally allocated to three profit centers: the new car department, the used car department and the service department. In addition, under the current control system, the year-end bonus of each department manager was based on his/her department’s performance. The profit to be evaluated was the department’s gross profit instead of its net profit. This evaluation method may encourage all managers to focus on selling activities only. They may ignore other important responsibilities such as cost control or reduction, as well as inventory control. Therefore, I think the evaluation for each department’s performance should be based on the net profit. This would encourage the managers to be responsible for overall cost control and profit-making.

Disaster Preparedness Pl Homeland Security Concepts And...

My city, West Lafayette Indiana is all hazard arrange that builds up a solitary, thorough system for the administration of city occurrences. It gives the structure and instruments to the coordination of state backing to the affected nearby governments and influenced people and organizations around it. This disaster preparedness plan clarifies the regular train and structures that have been practiced and developed at the neighborhood, tribal, state, and national levels after some time. In particular, it expands upon the National Incident Management System, which gives a reliable format to overseeing occurrences. There are two major natural disasters that are often happen in my city mostly every year which are Snow Storm and Tornadoes. These out planned strategies would allow the steps involved measuring the consequence and another that measures the likelihood within my West Lafayette, Indiana jurisdiction. Disaster Preparedness Plan 2 Plan integrate homeland security concepts and directives Homeland Security is a ceaselessly changing term and idea the whole way across the United States and much all the more so here in the State of Indiana with the late rebuilding and transitioning of the few state organizations into the Indiana Department of Homeland Security. The State of Indiana has ten Homeland Security Districts. These Districts are included numerous