REPLY1

Moral distress has been something that every healthcare professional has encountered in their career. “Researchers have shown that moral distress is a wide spread problem for health care providers including nurses, pharmacists, social workers, physicians, and health care managers in a wide range of acute and community health care settings” (Pauly et al., 2012). A clinical situation that a nurse may encounter that may cause moral distress is when a patient in critical care unit has a poor prognosis and on the ventilator. Family would still want to have everything done on the patient and keep the patient on the ventilator even if the physicians state that the patient might not be able to be weaned off the ventilator. The Four A’s is used as a guide to identify and analyze moral distress. The four A’s are: ask, affirm, assess, and act. The first A is ask. Ask the appropriate question to be aware that moral distress is present. The questions that should be asked in this situation are: “what would the patient want,” “what are the reasons for the family to have the patient kept on life support,” “what is the prognosis of the patient.” The next A is affirming the distress. Affirming the distress is letting your fellow colleagues know and aware why you feel that way. Next A is to assess sources of moral distress to prepare for an action plan. The sources would be the patient’s prognosis and the family’s decision about the patient. Last part of the Four A’s is to act to implement strategies to preserve integrity and authenticity (Butts, 2016). By talking to family and the healthcare team, that would be acting to preserve integrity and authenticity to have the moral distress addressed.   

REPLY2

  Moral Distress is caused by nurses’ work that involves hard moral choices that result in an emotional or physical suffering, painful ambiguity, contradiction, frustration, anger, guilt and an avoidance of patients (Butts, 2015). Furthermore, it is a situation when a nurse feels that task differs from what he/she thinks it is ethically the correct thing to do. According to American Association of Critical-care Nurses (2004), nurses use the Four A’s plan as a guide to identify and analyze moral distress:

1. Ask appropriate questions to become aware that moral distress is present. For example, a nurse is faced with a situation when family members decide to remove do not resuscitate (DNR) orders for a 90 year old terminally ill patient because the family states “We are not yet ready to let go, we need to give our dad a fighting chance”. They still decided this even though they were given all the information they needed to make a decision. The nurse follows the wishes of the family to get the order done, even though the nurse feels like it is the wrong decision to do. The nurse feels angered and frustrated with this decision. The nurse then asks herself “Am I feeling this way because of this decision by my patient’s family?”
    
2. Affirm your distress and commitment to take care of yourself and address moral distress. The nurse in this situation acknowledges the feeling of distress and decides to make a commitment to address the moral distress.
    
3. Assess sources of your moral distress to prepare for an action plan. In this situation the nurse recognizes that the source is the decision of family members to remove DNR orders for the patient who is elderly and terminally ill. She feels it’s futile. She feels like the patient would suffer unnecessarily when the patient arrests.
    
4. Act to implement strategies for changes to preserve your integrity and authenticity. In this situation, she may decide to seek support from her charge nurse or other senior nurses on how they dealt with this type of situation. 

The client is a 98-year-old female, admitted to the ER as a result of falling down her stairs. She has been diagnosed with rheumatoid arthritis, a fractured hip and a sprained arm. She has been moved to the ICU and will have a total hip replacement tomorrow. Lorazepam 1mg IV times one dose has been ordered. (20 points each)
• Describe the four elements of the pre-operative check list: identify the nurse’s priority assessments, diagnostics, and anticipated medical orders? Assess for pain,
 

• What potential complications does the nurse need to assess before and after giving the Lorazepam?
 If Lorazepam comes in 2mg/1ml, how many ml does the nurse need to administer?
 

• Your client is now post-op and has an order for an anticoagulant. The order is for Enoxaparin 40mg BID. Provide the rational for using this medication versus Heparin?
 

• Describe postoperative priority assessments for your client given her age, surgery and history.
 

• Discuss any nonpharmacological treatments that can be used instead of narcotic pain medications and identify if there are any contraindications given the client’s comorbidities.

Week 2 Project

This assignment will help you understand your personality type. Through this assignment, you will analyze how your specific personality type can enhance or hinder effective leadership in the health care environment.

Using the South University Online Library or the Internet, research about personality types.

Note: You can use the following link to access the online assessment: Jung Typology Test

Based on your research and understanding, write a 3- to 4-page Microsoft Word document that:

• Integrates how your specific personality type can enhance or hinder effective leadership in the health care environment.
• Explains all four aspects of your personality gleaned from the assessment.
• Includes 2- to 3-journal article references.

On a separate references page, cite all sources using APA format. Helpful APA guides and resources are available in the South University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the South University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.
• APA Citation Helper
• APA Citations Quick Sheet
• APA-Style Formatting Guidelines for a Written Essay
• Basic Essay Template

Please note that the title and reference pages should not be included in the total page count of your paper.

 Reply 1

There is not a single specific point in an illness, when end-of-life care begins. It depends on an individual and progression of their illness. At stage of terminal illness, despite best care, attention and treatment. If your loved one comes to the end of their life, the focus would be to make them comfortable as possible. Depending on nature of disease, the final stage period may last weeks, months, or several years. This time palliative care help to control pain, other symptoms, shortness of breath, hospice care, support emotionally and spiritually to both patients and their families.

Dying at home a major challenge; a severe shortage of professional home care giver, the expense of hiring-quality help, the difficulties of pulling together a community of family and friend for 24-hour care, medical advances of recent decades. Depending on what is available near you, some hospice offering include in-home care, but Medicare has limited coverage. Families prefer alternatives that are expensive or require endless hours. The options come in mind is nursing homes, 5 thousands-10 thousands/month. Though, at home you have the smell of cooking, grand children coming, is more comfortable for elders. Some elders love their life at home but need more service at home. Dying at home is realistic? Sandi Hebley, an educator at faith presbyterian hospice in Dallas, shares her visit to japan and New Zealand, observed and found out that the resources at home are larger more extensive. In Great Britain, hospice movement started in 1960. Hospice advocate, Cicely Saunders placed teams that went to home with case manager several nurses. That setup made a huge difference there.

To support patient regarding end-of-life. I like the POLST paradigm, a framework to help and guide a conversation about what kind of care a patient wants when future health crisis occurs. Some changes in health care system can improve care of individual with progressive illness. For example, we should broaden end-of-life to mean the last years of life, by developing a health care pathway for chronically ill and declining people who are at their last years of life as described in “Medicaring” white paper by Dr. Jonne Lynn. The UK has developed a “Gold standard Framework” along similar lines. We can learn their work by studying their approach.

Furthermore nurse can support by communicating with members to manage family involvement t, by focusing on values by knowing wishes, help to seek financial and legal advice such as living will, attorney, address family conflicts by involving social worker or hospice specialist, preparing early by hospice and palliative care services.

Reference

Bill. W. (2018). How realistic is dying at home. The difference between where American would prefer to die and where they do?

Grand Canyon University (2018). Health assessment: foundation of effective practice.

Health assessment of aging adult. Retrieved from http// www.gcumedia.com.

Melissa. W. (2019). Late stage and end-of life care. Help guide.

Leslie. K. (2013). How we can get to better end-of life care. Practical information for aging health and family care giver

Reply 2

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend?

“Dying at home is not favored in certain cultures (due to cultural taboos) and some patients may wish not to die at home, out of concern that they might be a burden on the family.” (Stanford School of Medicine, 2020) Being a burden on family or lack of family is a big concern for many patients. Another reason many patients are not dying at home is due to the multiple physical issues requiring nursing care occurring at the time of death. (Ward, 2018) Limited coverage by Medicare for in home care during the final days is another barrier. Cost for in home care can be very expensive and if a lack of finances occurs then it would be impossible to utilize those services.

Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.

Nursing plays an important role in end-of-life care. Not only do nurses assist the patients during this difficult time but they also support the family members. Ensuring patient’s wishes are met is something the nurse needs to strive to complete during the end of life timeframe. If the patient wishes to have spiritual support, the nurse will help coordinate that. (Pathways Home Health and Hospice, 2020) Create a plan with the patient, if able, to remove the gray areas on the patient’s wishes. Nurses will act as the mediator between the family and patient in order to support the patient’s wishes. (Pathways Home Health and Hospice, 2020) “Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.” (Rights, 2016) If nurses follow the code of ethics and patient’s wishes it will provide a positive experience in this difficult end-of-life care situation.

References

Pathways Home Health and Hospice. (2020). Retrieved from https://pathwayshealth.org/hospice-topics/the-critical-role-of-nurses-in-end-of-life-care/

Rights, A. C. (2016). ANA. Retrieved from American Nurses Association: https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf

Stanford School of Medicine. (2020). Retrieved from https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/

Ward, B. (2018, December 6). Next Avenue. Retrieved from https://www.nextavenue.org/how-realistic-is-dying-at-home/