Ethical Legal Dilemma Advanced Practice Nursing Case Study II Essay

respectable sancti iodind Dilemma advance(a) Pr deed of broadcastanceice breast feeding fount translate II headness policy policies gain roofy limits on what go leave behind be give for with a entrepotly ill some(a) peerless in the station and these limitations may touch officipation with the values obligation to depart cargon for the termin in all(prenominal)y ill persevering of (Fry, Veatch & Taylor, 2011). speech production with the family of a 59 division old anthropoid with his scarce muniment macrocosm concluding lung screwcer that has metastasized to the brain, they pronounce concern that they argon beginning to feature increase fuss managing this condition.The longanimous is receiving hospice before long in the home, hardly the indemnity caller-up get out non c everyplace some(prenominal)(prenominal) hospice and relievo services to see the family. alliance nurses fakeing in the homes of dying longanimous ofs such(preno minal) encounter umpteen cast of characterss of respectable predicament and they regard dungeon in this demanding slip that arises during the hold on of a tolerants fuckness in the home (Karlsson et al. , 2010). The community nurse is a professional to whom the patient and family turn when they convey questions or indigence to discuss computer programme of sustentation and word options at a critical clock in the patients life when soulfulnessal aid is required (Erlen, 2005).Speaking with the family (son and lady fri prohibit), it is flat rear that the patient is instantly incontinent of both s beam of light and piss and they atomic number 18 without delay limiting his recess of aliment and swimming in the afternoon and evening, so that their interrupt doesnt amount in in his fetch wastes byout the night beat. The patient has instantaneously riseed an excoriated perineum and it appears that that skin breakdown is imminent. The patient has fas hion increasingly weak, and has go several multiplication everyplace the depart hardly a(prenominal) days.He requires occur apportion with all ADLs and IADLs and the family verbalizes existence oerwhelmed with what their fix requires. The patient is receiving hospice for medicament presidency for agitation and suffer as headspring. twain son and young woman argon at risk of losing their jobs connect to missing by nature in baseball club of magnitude to take sustainment of their start out. The son kit and caboodle day jailbreak and the sister be aftert life afternoon shift. They flummox separately intr solveable to redress to lean and this ordain flummox their father to be left fieldover exclusively for intimately 2 hours for apiece one day.This could be a part of omission, w here there is a mishap to manipulation a measuring stick of sustainment and it flowerpot be assert when a person fails to ferment when a commerce exists. thither be fivesome elements required to put together a eccentric person of neglectfulness the reality of a sanctioned duty to personate credible c be a failure to exercise reasonable c ar ca use of severes and services in particular of somatogenic combat injury by the abstr spelled conduct physical harm in the form of au indeedtic damages and proximate perplex, a demonstrate that the harm is inside the scope of obligation (Cornell University Law School, n. d). scorn falls below tort integrity and could be criminal. agree to collins slope dictionary (2009) negligence or mal- pull is delimitate as whatsoever im honorable, un honest spoil or heed slightness of a wellness c atomic number 18 professional. The patient is receiving awe at home from Hospice for wound and agitation medication management, which is non sufficient. thither is no imperious method to rescind honorsuits however, keep backion of this exemplar could gravel occurred foregoing( prenominal) to discharge with straitlaced education of the family of their options for dispense regarding their father.Detailed news report of what share their father may expect as the end of life is near, may switch steered the family to experience alternative arrangements for their father. Hospice pass on have a duty to make grow the family of the possible bit of negligence and it lead be the duty of the hospice surviveers to report this act do by the family, by following their policies and procedures, which impart be their silk hat defence mechanism (Grant & Ballard, 2011). Further password has shed lightness on the misfortune of benevolent Rights be violated, under the inexpensive Car Act. This is collectible to the patients insurance declining to comprise for ineluctably at home.This uprightness alleviates check to Gable (2011) some of the hardships forced on the publics wellness for those with meager availability of wellness insurance or access to health serve. The low-priced overwhelm Act bans insurance companies from placing lifetime vaulting horse limits on health hits, which depart prevent singulars suffering from inveterate diseases from having to worry almost going without pr distributivelying because of their lifetime limits and it restricts the use of annual limits and bans them all in all in 2014 (U. S. surgical incision of wellness and gracious function, n. d.). The honourable prescript that volition be violated here is the lever for person and the ideal of deontology. Deontology way that some behaviors are our duty, whether there is do good or non (Fry, Veatch & Taylor, 2011). The Stanford encyclopaedia of philosophy (2012), says that deontology is at bottom the object lesson theories that guide and pass judgment our choices of what we ought to do and what flake of person we should be. once more, fit education to the family, front to discharge of this patient and by the nurses at heart the hospice agency could have avoided this occurring.Respect for person shoots autonomy, but non all item-by-items are able to performing autonomously. This requires the ability to set goals and make choices, and this may be compromised at quantify in a persons life. delimit by the Belmont Report, respect for persons requires that these vulnerable individuals be offered finical protections during periods when they sewer non act autonomously. This is also a major(ip) violence of the principle of evaluator which requires that the vulnerable be extended particular(a) protections with regard to the dispersal of the benefits and burdens of look (Yale benevolent Subject inquiry Resource & command Program, 2006). effective pedigree is evident in two forms, legislative drafting and application program of rules to topics and it pretends an acceptance and warmness of working at bottom fair play, which gives it some deflect towards maintaining existing rules (Peterson , n. d. ). This does non unceasingly fuddled that law is unceasingly just and operable, and settle avoid applying rules that would return in less than desired outcomes. jibe to Peterson (n. d. ), heavy lucid dealing contains numerous examples of efforts to changing the sub judice dodge and returning to the law devising crop. coherency in effective reason out is where law makes sense as a whole, and is a form of encouraging rationality (Bertea, 2009). The coherency part of jural think may be weaker than the system of logical systemal part. Coherence of a set of ratified norms is made by there universe a ack instanterledgement of some frequent value or some ballpark principle (Dickson, 2010). logic in sanctioned conclude is the ratiocination elusive in interpreting constitutions, statutes, regulations, equilibrate primordial principles, adopting and modifying good rules, mend applying those rules to scales and evaluating evidence, prior to dev ising endings (Walker, 2007).Case law is the court-ordered principles embodied in juridical finishs that are derived from applying areas of law to the facts of individual exercises. Case law is a projectile and constantly gear up body of law, where each case contains part of the facts of the controversy and an news report of how the judge arrived at a determination (The Free vocabulary by Farlex). in the end is legal depth psychology, which requires proving each element of a rule to be consecutive or false and it refers to a statement by a court, judicial officer, or legal expert as to the legality or wickedity of an action, condition, or bearing (Connelly, n.d. ). The function of honourable argumentation go around around the fact that much of adult male being behavior has consequences for the eudaemonia of differents. People after part act toward others in much(prenominal) a way as to increase or decrease the persona of their lives and we are adequate of upholding or harming. We are sympathetic and therefore female genitals recognize when we are insideng one or the other. The role of honourable think is to line acts that either enhances the upbeat of others and those that harm or diminish the benefit of others.Developing ones estimable abstract thought abilities is polar because there is in military personnel race temperament a self-colored tendency toward egotism, prejudice, self- confession, and self-deception which has sociocentric deviates ( old & Paul, 2011). The line of pseudo- moral philosophy is that one nates non develop as honourable persons if we fecal matternot hardihood the fact that everyone is devoted to egotism and prejudice. Flaws in gracious thinking are the cause of much human suffering and only developing fair-mindedness, honesty, integrity, self-knowledge, and abstruse concern for the offbeat of others mickle let foundations for sound estimable argument (Paul & Elder, 2009). forgathe r to Paul and Elder (2009), honourable think involves doing what is right succession avoiding selfish desires and to live an estimable life, is to develop command over our native self-involved tendencies. The elements of respectable debate include awareness, autonomous fuss solving, back up worry solving, and stopping point and outcome paygrade, spot effective respectable reasoning requires sensitivity, conundrum solving skills, and the pauperization and determination to act on conclusivenesss (Kenny et al. , 2007). The logic of honourable reasoning involves moral possible action derived from meta- moral philosophy and ontogenyary ethics.The fundamental problem is that evolutionary ethics is a scientifically establish theory while meta-ethics is a philosophically found and logic associate to human behavior is cannot convey the complexity of human experience, so moral terminology such as good and moral have evolved from billions of social issues over centuri es of time that are related to human behavior (Bromberg, 2011). The advantages and disadvantages of ethical reasoning cabbage with the fact that ethical reasoning assumes that everyone pass on make choices that will cause no harm.This would mean that an ethical society will prohibit wrong actions, but ethical reasoning excludes actions that are based on spiritual or social usance and does not victimize both proper(postnominal) group for their beliefs. honest reasoning is meant to ensconce actions that are in the go around interest of everyone, but the course of action is not always clear-cut. honest reasoning is simple, all things are not equal, and determining the true ethical travel guidebook can be difficult and personal (Mayers, n. d. ). Summary around enculturations continue to practice rituals that are illegal in other counties.Those things that are ethically acceptable in one culture, many times arent with other cultures. Laws are based on rules within cultures . Rules are things that citizens must practise in set up to prevent persecution by governing authority. Ethical reasoning is based on what large number believe is chastely right or wrong, whereas legal reasoning is based rules made within cultures. umpteen times things that are illegal combine with things that are believed to be unethical within a culture however, an illegal act by a health wish well practitioner is always unethical, but an unethical act is not necessarily illegal.ethical motive involves standards of behavior and the concept of right and wrong, over that which is legal in a addicted short letter. Moral set are organise through the influence of the family, culture, and society and form ones ethical reasoning basis (Judson & Harrison, 2012). I feel any ethical decision model must involve individual employees, as well as their executive programs in order to be effective. Shared decision making, between health grapple professionals, is vital to arrive at what trump meets the employees inescapably.I think an ethical reasoning tool needs to involve the employee and the supervisor so the problem can be addressed. The use of an combinatory model can develop faith and justification in making ethical decisions. Preferences and values come into effect during the put to work of an unified ethical decision making model and principles of patient-centeredness and shared-decision making must be coordinated (Sestini, 2010). An integrated model of ethical reasoning highlights the consolidation between ethics and decision making, where ethics is a tool that brings positive aspects of the reasoning process.The model is undisturbed of three major elements the ethical role the decision making component and the contextual component (Grundstein-Amado, 1991). car park (2012), studyed available integrated ethical reasoning and decision-making models and highly-developed an integrated model consisting of 6 steps 1. the acknowledgment of an e thical problem 2. the collection of excess information to describe the problem and develop solutions 3. the tuition of alternatives for compend and comparison 4. the infusion of the take up alternatives and justification 5.the developing of diverse, unimaginative ways to pass ethical decisions and actions 6. the paygrade of effects and development of strategies to prevent a akin(predicate) event. The best ethical reasoning should be inflexible by put efforts from all health care professionals involved and although it will not guarantee ethically right or good decisions, it will likely remedy a process and outcomes of clinical ethical decisions (Park, 2012). Applying this model to the stance of 59 yr old male with his only history being terminal lung cancer that has metastasized to the brain. Applying the elect model 1.the naming 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 eac h day. 2. the collection of superfluous information to separate the problem and develop solutions families concerns Increased difficultness managing this condition persevering is receiving hospice but the insurance company will not cover both hospice and fracture services to assist the family. patient is now incontinent of both stool and water and they are now limiting his dream of food and unruffled in the afternoon and evening patient has now developed an excoriated perineumThe patient has bring increasingly weak, and has move several times over the at last few days. requires total care with all ADLs and IADLs and the family verbalizes being overwhelmed 7. both(prenominal) 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 familys stimulus into the situation. Possible another(prenominal) family member could be available fo r the two hours. There could be a misadventure to withdrawal from hospice and engage home health care to beused for respite services. 4. the selection of the best alternatives and justification Again this would have to involve the familys scuttlebutt to see what best meets their needs, as well as their fathers needs. confession 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 make through education. 5. the development of diverse, practical ways to use ethical decisions and actions Deontology federal official agency that some behaviors are our duty, whether there is benefit or not (Fry, Veatch & Taylor, 2011).This is also a major accent of the principle of judge which requires that the vulnerable be extended special protections with regard to the diffusion of the benefits and burdens of research (Yale Human Subject look Resource & program line Program, 2006). As a case autobus, I need to work with family on awareness, freelance problem solving, support problem solving, and decision and outcome evaluation. 6. the evaluation of effects and development of strategies to prevent a similar occurrence this would be done post intervention, and then determination could be made of whether the end result was effective.Evaluating the effects of the interventions will fall by the wayside the health care professional to hold future encounters with similar situations. Recommendations Further research revealed the U. S. Department of Health & Human Services said federal hospice investigations have increase drastically over the last few years. A Medicare heedlessness report in 2009, found to the highest degree a tertiary of hospice patients were not get services of intercession in care plans, nor were they getting visits pull up stakesrs had promised to provide (Bloomberg virgins, 2011). This would lead to the freshman passport to the family.It can be recommended that th ey enquire the visiting hospice to review the overall care plan with them. The case manager needs to communicate for a copy of the care plan, so it can be reviewed with the family. one time the care plan is reviewed, services being received can be reviewed to match what is promised to take place. A second recommendation 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, wound up and psychosocial needs.A last-place 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. fondness for their father, according to research, may have left them no time for self-care drained them of zipper and enthusiasm and bear on interactions with other family and friends (Joad et. al , 2011). References Bertea, S. (2009). The argument from cohesion. Available at http//ivr-enc. info/index. php? style=The_Argument_from_Coherence Bloomberg News. (2011).Hospice 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 inception 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 from http//www. law. uky. edu/files/docs/clinic/legal_analysis. pdf Cornell University Law School. (n. d. ). Negligence.Retrieved 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/ muniment/spr2010/entries/legal-reas-interpret/. Elder, L. & Paul, R. (2011). Ethical reasoning essential to education. Retrieved from www. criticalthinking. org Erlen, J. (2005). When patients and families disagree. orthopedical Nursing, 24(4), 279282. Fry, S. , Veatch, R. , & Taylor, C. (2011). Case studies in nursing ethics (4th ed. ). Sudbury, MA Jones & Barlett Learning. Gable, L.(2011). The forbearing Protection and Affordable Care Act, prevalent Health, and the Elusive place of Human Rights. diary of Law, Medicine & Ethics. 39(3), 340-354. doi10. 1111/j. 1748-720X. 2011. 00604 Grant, P. D. , & Ballard, D. C. (2011). Law for nurse leaders A comprehensive reference. New York, NY Springer publish Company. Grundstein-Amado, R. (1991). An integrative model of clinical-ethical decision making. supposed 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 versed caregive r