Planning the Care of Terminally Ill Patients

Planning the Care of Terminally Ill Patients Critical care nursing is a challenging field in which nurses must be frequently confronted with ethical dilemmas. One of the most frequently encountered dilemmas that occur in this field is the management of care for terminally ill and actively dying patients. When providing care to such patients, it can become emotionally burdensome for the nurse to carry out medical interventions that may be uncomfortable or painful to the patient while not providing much of a benefit. Nurses in these environments often feel the desire to relieve the patient’s suffering and a sense of accountability for their comfort. When aggressive medical interventions are implemented for patients that are actively dying, it is important to recognize if any worthwhile benefits are achieved by the interventions. Sometimes in the ICU setting, the provided aggressive medical treatments do not offer notable medical or palliative benefit to an actively dying patient. The question that arises in these situation s may be: Should aggressive treatments be continued when they can be considered medically futile? One of the biggest challenges that surfaces when considering medically futile interventions is that there has been no universal agreement between medical professionals on how futility should be defined. For the most part, futility in relationship to medical interventions is defined as any clinical action which no longer serves a useful purpose in reaching a given patient’s goals and outcomes (Kasman, 2004). If a certain treatment only has the potential to prevent bodily death while not improving the health status of the patient or providing palliative benefit, it may be considered medically futile. When planning the care of terminally ill clients, it is important to weigh the effectiveness of the medical interventions against the benefits the treatment will bring as well as potential harms. The health care team must look at the patient as a whole instead of simply focusing on treating their specific diagnosis. Many factors come into play when considering which treatments may be appropriate and effective for these patients. Each patient’s unique goals should be evaluated thoroughly when the health care team creates their plan of care. For example, if an actively dying patient’s goal is to have a dignified and peaceful death, it may be considered maleficent to implement aggressive treatments such as intubation and cardiopulmonary resuscitation (CPR) (Kasman, 2004). It is important for the wishes of the patient and the patient’s family to be documented and known to the healthcare team when planning care. The problem of providing medically futile care has the p otential to affect everyone involved with the care on an emotional and intellectual level. This includes the patient, their family members, and members of the health care team involved. There are four ethical principles that must be considered when providing care to critically ill patients. These principles include beneficence, veracity, justice, and autonomy. The principle of beneficence in this context may be described as acting in a way which promotes the wellbeing of the patient. Veracity may be described as the truthful communication between healthcare providers and patients. The idea that all patients deserve to be treated equally according to their needs and that they should receive the appropriate level of care for their conditions describes the principle of justice. Autonomy is the principle that a patient has the ability to make their own individual decisions regarding their medical treatments. Beneficence is a commonly referenced principle in the context of providing interventions that may be considered medically futile. Because this principle is based on the idea of acting in a way that will have a positive impact on the patient, it would not be beneficent to provide care that is considered medically futile. This kind of care may succeed in prolonging the life of the patient, but it will likely have no net improvement on the patient’s quality of life, and may even result in a decreased quality of life. Veracity is a very important principle to implement in the critical care setting. Health care providers should be communicating with patients and their families in an honest manner about their medical condition. In some cases, providers may continue with life-sustaining treatments that will not result in a patient’s meaningful recovery for primarily emotional reasons including having concerns regarding the family’s reaction to the actual medical status of their family member (Suprising reasons for continuing futile treatment, 2012). This is an example in which the provider is not practicing veracity. It is important for the patient and their family to be given realistic expectations on the outcome of any treatment, even if it is a difficult discussion to have. Justice may be practiced in this setting by the careful consideration of each patient’s case individually. The healthcare team should evaluate each patient’s situation and consider what treatments will improve their condition as opposed to simply prolonging the life of their body. Even if a patient has decided they no longer desire to receive aggressive medical treatment, they still should be receiving adequate care and attention to their needs by the principle of justice. Autonomy is a vital component in providing care to critically ill patients. If at all possible, it is important for the patient to make their own decisions regarding their wishes during the end of their life. If the patient is not mentally competent or physically able to declare their decisions, the durable power of attorney would make these decisions if this person has been assigned prior to the patient’s incapacity. If there is no durable power of attorney, then the court will appoint a proxy that must act in a morally valid way and will make decisions with the patient’s best interests in mind (Kasman, 2004). When caring for critically ill patients, it can be challenging to understand the difference between interventions that are actually benefiting the client and interventions that will simply prolong the life of the client’s body. This is a concept that is especially difficult for family members who may not understand the severity of the patient’s medical status to understand. In some cases, the opinions of the healthcare providers and the opinions of the family members differ regarding what treatment options should be carried out for the patient. If this occurs when the patient is unable to make decisions for themselves and they have a surrogate appointed, the surrogate will make decisions on behalf of the patient. If the decisions made by the surrogate are not congruent with those of the physician, the physician may deny to carry out requested treatments if there are concerns of potential risks associated with them. If the surrogate continues to insist on the controversi al treatment, the patient’s case may be presented to other physicians. If the physician has serious concerns regarding the surrogate’s decisions, they have the right to request the court to replace the patient’s surrogate with one that has morals that are more sound. A recent case regarding medically futile care involved a man named David James who was originally hospitalized due to complications that arose with his stoma. During his stay at the hospital, he suffered from multiple organ failure. He was moved to the critical care unit with cardiovascular failure, respiratory failure, and renal failure where he was put on a ventilator. The patients medical condition was so bad that even aggressive medical treatments were unlikely to benefit him. As his condition continued to worsen, the hospital used the principle of beneficence and decided to place a Do Not Resuscitate (DNR) order in the patient’s medical record. The family disagreed with this decision, and the medical team took the case to the Court of Protection (Griffith, 2013). The court originally decided that treatment for this patient would not be futile and therefore withholding treatment would not be in the patient’s best interest. The ruling was not well accepted, and the case then moved to the Court of Appeal where the original decision was overruled. Here, it was decided that the results that the proposed treatments sought out would not be able to be produced in this patients case. The treatment that could be provided would likely not offer any therapeutic benefit to the patient or palliate the patient’s condition, so it was ruled to be medically futile treatment (Griffith, 2013). The decisions made in the care of critically and terminally ill clients are not usually obvious or straightforward. It seems as though as technology develops further, death appears to become viewed more as an option rather than a fact (Paris, Angelos, Schreiber, 2010). Because of the principle of justice, patients will still receive quality medical treatment for their illnesses even if they have a DNR status. It is important for all patients, especially those who do not have a long life expectancy left, to be knowledgeable about their options for end of life care. Everyone deserves the right to making autonomous decisions regarding their health. For a patient that does not desire to endure aggressive medical treatments at the end of their life, an alternative option could be either palliative care or hospice care depending on their individual case. The client would still be treated and more effort would be put towards relieving the symptoms of their illness rather than implementing aggressive medical treatments that could prolong their life at the risk of decreasing their quality of life. This could allow the client to have a more peaceful, dignified death, rather than having to endure several medical interventions that may be intrusive and painful such as intubation, ventilation, and CPR. It is important for the family to understand that just because many life-prolonging options are available due to modern medicine, it is not always the best choice to implement these options. Some opponents of the idea of medical futility claim that physicians aim to overpower less knowledgeable patients and their families. This leads opponents to believe that healthcare providers who have end of life discussions with families regarding medically futile care are consequently delivering paternalistic care. Some also believe that the idea of medical futility is simply a decoy used by physicians to convince patients and families to withdraw medical treatments in order to lower the costs associated with end-of-life care and to help ration the hospital resources (Kasman, 2004). There are many examples of professional literature exploring this topic, which discuss the reality of medically futile care, some of which have been cited throughout this paper. I believe that aggressive medical treatment should not be carried out if multiple health care providers share the same opinion and have decided that the interventions will not provide any foreseeable therapeutic medical or palliative benefit to the patient’s condition. Through researching this topic, it has become clear that with the advancements in medicine, death is becoming a fact that is not as accepted as it once was. Many people want their loved ones to live as long as possible at any given cost. Death is a fact of life, and once that is better understood and accepted by family members it may be easier for them to let go of their loved ones once the time arrives. The last moments of some actively dying patient’s lives may be of higher quality if they are able to spend time with their families and have the chance to say goodbye, rather than having the health care team fight the inevitability that is death (Ufema, 2001). This decision does not come in any conflict with my value system. I realize that death is an inevitable part of life, and at some point, this should be accepted by patients and their families. The quality of life for patients who are actively dying, yet still receiving numerous medical interventions simply to keep their body functioning as long as possible, does not seem just. I would like to think that patients have the right to die a dignified death without having to suffer from extensive medically futile interventions. Planning the care of terminally ill clients in the critical care setting can be a challenging and emotional process for everyone involved. It is important for providers to be honest with those affected by end-of-life decisions regarding the patient’s medical status. Although death can be very difficult to discuss and accept, all patients deserve the right to die a dignified death. As technology in medicine continues to advance, it is likely that people will view death increasingly as an option. Patients should be educated on deciding and documenting their end-of-life decisions while they have the chance to state their wishes so that they can experience the last moments of their lives in the manner that they desire.

Community Development

Community Development Planning Lecture 1: Understanding the key concepts of Community, Community Development & Economic Development Course Learning Outcomes †¢ Explain the key concepts of social infrastructure in spatial planning †¢ Analyze social infrastructure issues in spatial planning †¢ Identify the various challenges of social infrastructure in spatial planning practices Community †¢ Various definitions: ? People who live within a geographically defined area and who have social and psychological ties with each other and with the place where they live (Mattessich and Monsey, 2004) ?A grouping of people who live close to one another and are united by common interests and mutual aids (National Research Council 1975) †¢ These definitions refer to people and the ties that bind them, then only to geographic locations †¢ It means, without people and the connections/ties, community will be only a collections of buildings and streets. †¢ However commun ity does not necessarily means â€Å"living physically close to one another†.It also refers to social connections at other than living place such as workplace, sports centre, clubs or groups, or political affiliations. †¢ Community can also be created through special interest or conditions such as disability, gender, belief †¢ In this era of social media (such as FB, Twitter) madness, communities can be created on virtual platform. Community Development (CD) †¢ Community Development is defined and described as.. – the process of developing stronger communities of people and the social and psychological ties they share. The educational process to enable citizens to address problems by group decision-making – Involvement in a process to achieve improvement in some aspect of community life – All these processes will result in an outcome which is the improvement of community capital. Community Capital Human Capital †¢ Labour supply, skills , experience, capabilities Physical Capital †¢ Buildings, streets, infrastructure Financial Capital †¢ Community financial institutions, micro loan funds, community development banksEnvironmental Capital †¢ Natural resources, weather, recreational opportunities Social Capital Social Capital †¢ Social Capital refers to the ability of residents to organize and mobilize their resources for the accomplishment of consensual defined goals †¢ It refers to the extent to which members of a community can work together effectively to develop and sustain strong relationships, solve problems and make group decisions, and collaborate effectively to achieve common goalsSocial Capital †¢ Some scholars make distinction between bonding capital and bridging capital †¢ Bonding capital refers to ties within homogenous groups (e. g. races, gender, people with the same economic background) †¢ Bridging capital refers to ties among different groups Community developme nt chains Capacity building process Developing the ability to act Social capital Ability to act Community development outcome Taking action Community improvement Development ready communityEconomic development †¢ Community development and economic development is highly sinergistic. †¢ Community development – a planned effort to produce assets that increase the capacity of residents to improve their quality of life. The assets include: physical, human, social, financial, environmental †¢ Economic development – the process of creating wealth through the mobilization of human, financial, capital, physical and natural resources to generate marketable goods and services. The definitions are clearly parallel : community development is to produce and improve assets, economic development is to mobilize these assets which will bring greater benefits for the community ie. more goods, services, jobs etc. †¢ Both types of development are highly dependable on ea ch other as most businesses will look for development-ready communities that are equipped with strong and established communities, good infrastructure, abundant supply of labour, safety, telecommunication etc.Community and economic development chains Community development outcome Taking action Community improvement Development ready community Economic development outcome Job creation Increased income and wealth Increased standard of living Capacity building process Developing the ability to act Social capital Ability to act Economic development process Creating and maintaining ED programs Mobilizing resources The end Community Development Community Development Planning Lecture 1: Understanding the key concepts of Community, Community Development & Economic Development Course Learning Outcomes †¢ Explain the key concepts of social infrastructure in spatial planning †¢ Analyze social infrastructure issues in spatial planning †¢ Identify the various challenges of social infrastructure in spatial planning practices Community †¢ Various definitions: ? People who live within a geographically defined area and who have social and psychological ties with each other and with the place where they live (Mattessich and Monsey, 2004) ?A grouping of people who live close to one another and are united by common interests and mutual aids (National Research Council 1975) †¢ These definitions refer to people and the ties that bind them, then only to geographic locations †¢ It means, without people and the connections/ties, community will be only a collections of buildings and streets. †¢ However commun ity does not necessarily means â€Å"living physically close to one another†.It also refers to social connections at other than living place such as workplace, sports centre, clubs or groups, or political affiliations. †¢ Community can also be created through special interest or conditions such as disability, gender, belief †¢ In this era of social media (such as FB, Twitter) madness, communities can be created on virtual platform. Community Development (CD) †¢ Community Development is defined and described as.. – the process of developing stronger communities of people and the social and psychological ties they share. The educational process to enable citizens to address problems by group decision-making – Involvement in a process to achieve improvement in some aspect of community life – All these processes will result in an outcome which is the improvement of community capital. Community Capital Human Capital †¢ Labour supply, skills , experience, capabilities Physical Capital †¢ Buildings, streets, infrastructure Financial Capital †¢ Community financial institutions, micro loan funds, community development banksEnvironmental Capital †¢ Natural resources, weather, recreational opportunities Social Capital Social Capital †¢ Social Capital refers to the ability of residents to organize and mobilize their resources for the accomplishment of consensual defined goals †¢ It refers to the extent to which members of a community can work together effectively to develop and sustain strong relationships, solve problems and make group decisions, and collaborate effectively to achieve common goalsSocial Capital †¢ Some scholars make distinction between bonding capital and bridging capital †¢ Bonding capital refers to ties within homogenous groups (e. g. races, gender, people with the same economic background) †¢ Bridging capital refers to ties among different groups Community developme nt chains Capacity building process Developing the ability to act Social capital Ability to act Community development outcome Taking action Community improvement Development ready communityEconomic development †¢ Community development and economic development is highly sinergistic. †¢ Community development – a planned effort to produce assets that increase the capacity of residents to improve their quality of life. The assets include: physical, human, social, financial, environmental †¢ Economic development – the process of creating wealth through the mobilization of human, financial, capital, physical and natural resources to generate marketable goods and services. The definitions are clearly parallel : community development is to produce and improve assets, economic development is to mobilize these assets which will bring greater benefits for the community ie. more goods, services, jobs etc. †¢ Both types of development are highly dependable on ea ch other as most businesses will look for development-ready communities that are equipped with strong and established communities, good infrastructure, abundant supply of labour, safety, telecommunication etc.Community and economic development chains Community development outcome Taking action Community improvement Development ready community Economic development outcome Job creation Increased income and wealth Increased standard of living Capacity building process Developing the ability to act Social capital Ability to act Economic development process Creating and maintaining ED programs Mobilizing resources The end

History Of Vietnam And Its Culture - 895 Words

DOING BUSINESS IN VIETNAM Prepared for Business Communications Oklahoma City Community College Oklahoma City, Oklahoma Prepared by†¨Loan Le May 15, 2015 INTRODUCTION: ABOUT VIETNAM AND ITS CULTURE As AB Accounting Services is looking to expand our offices to foreign markets and governments such as Vietnam, I compiled a report to help our executives’ awareness on the social and business etiquette that should be practiced and known to ensure we can grow our company successfully abroad. I will also cover the economy to help our executives that will be visiting Vietnam a good amount of general knowledge. We will cover the following areas: What are the social customs of Vietnam? Examples will include the proper introductions and greetings, body language, and gestures of approval or disapproval. What is the family life and structure? Examples will include traditional family values, and gender roles. What is the economic structure? What are the main sources of income? Examples will include local businesses, growth potential, and average income. BACKGROUND: OVERVIEW OF VIETNAM To anyone that is not familiar with Vietnam, it is a country located in Southeast Asia. The country is long and narrow, and looking at a map you will notice that it is shaped like the letter â€Å"S†. Vietnam is a neighboring country to Laos and Cambodia on the west. There is a population of about 75 million people. There is a very dominant Vietnamese population in theShow MoreRelatedBook Review of Backfire: a History of How American Culture Led Us Into Vietnam and Made Us Fight the Way We Did764 Words   |  4 PagesBackfire: A History of How American Culture Led Us into Vietnam and Made Us Fight the Way We Did, a book by Loren Baritz, describes the myths America takes into wars, the decisions that made the Vietnam War and the bureaucracy at war. Loren Baritz writes this book about the time period o f 1945 to about 1975, which is post World War II to post Vietnam War. 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Sparta vs. Athens (Lycurgus vs. Pericles Funeral Oration) Free Essay Example, 1250 words

Sparta vs. Athens Lycurgus" vs. "Pericles Funeral Oration Introduction The importance of justice in building a formidable society cannot be overemphasized. This is because societies that thrive both economically and politically have been known to act in a justice and fair manner (Galston 18-78). Social justice is simply a moral conception and has to do with giving a person or a group of people what belongs to them in terms of entitlement and morality. Injustice breeds rebellion and discomfort. Such a state of mind is dangerous for any nation and thus cannot thrive. The freedom given to a people in terms of equal rights has a major bearing on the success of such a society. The existence of free and equal people in a society, presence of personal and political liberties, giving equal opportunity to all and an aspect of cooperation does benefit a society more (Bates 12-26). The idea of equal justice for all is seen to be evaluated in these two states. The poor treatment of women in so ciety comes into focus when we look at these two states. Injustices were committed to the female gender and actually what is referred to as equal justice is totally imbalanced (Keyt133–52). We will write a custom essay sample on Sparta vs. Athens (Lycurgus vs. Pericles Funeral Oration) or any topic specifically for you Only $17.96 $11.86/pageorder now This has to do with the weakness experienced within these two societies where equal freedom was infringed by the presence of social classes or limits put on the public life especially when it came to the female gender (Collins 67-87). Discussion There were in existence two major forms of governance in the ancient Greece in form of democracy practiced in Athens and Oligarchy in Sparta. Military capabilities became the main focus at the time for the Spartans while on the other hand the Athenians concentrated more on gaining comfort and cultural practices (Thucydides 202-209). The oligarchy kind of governance made Sparta have a war-like attitude which was the first priority given and seemed to meet the needs of the people. An authoritative and potent kind of state came into existence in Sparta empowered by such war-like attitude. There are various contrasting issues that were in place such as the rights of women, availability of social strata, and the value that was put to human life. The power was simply held by a group of ephors who were only five men. There was a general call from the constitution to all men to engage in military education at a tender age of seven for training on being tough and self-sufficient. The indiv idual’s life was meant for the state where one lived and died for it.