We have one resident in the long-term facility who has stage four cancer of spinal cord and he has been suffering from intense pain. Every time when I enter his room, he cries and implore to the god that he can minimize his suffering. He has prescription of hydromorphone 8 mg every 4 hourly PRN , oxycodone 5 mg every 6 hourly and 50 mcg of fentanyl path change every 3rd day. After giving all scheduled and PRN medicine his pain level remains same as before. When I see that patients I feel like to give highest dose of medicine as well as alternative pain management therapy so that he can have some comfort but ethically I have no right to do that. He is hospice but he has no comfort at all. Following are the nine steps of Uustal ethical decision making model. …show more content…
Step1: Identify the problem: Patient and nurses are involved in the situation because patient is not having comfort due to intense pain and low dose of pain medication and nurses do not have right to provide high dose of medicine as well as alternative treatment without prescription. Patient comfort is most important in this situation. Step 2: State your values and ethical position related to the problem.
In my opinion cancer patients can alternative pain management and higher dose of pain medicine so that they can have some comfort during their stage of dying. Step 3: Take into consideration factors that relate to the situation and generate alternatives for resolving the dilemma. Alternatives would be prescription of different dose of PRN and regular pain medicines and alternative pain treatment such as implanted pain pumps, nerve block therapy, massage therapy, relaxation and guided imagery , chiropractic treatment and oncology rehabilitation so that level of pain can be minimized. Step 4: Examine and categorize the alternatives. Identify those that are consistent and inconsistent with your personal values. Availability of nerve block therapy, chiropractic treatment and high dose of pain medicine which will promote numbness, reduce sciatic nerve pain, minimize fatigue and decrease pain sensation. Similarly, implanted pain pumps which delivers a medicine directly to the spinal cord and symptoms can be controlled by smaller dose than needed dose with oral medication. Step 5: Predict all possible outcomes for those acceptable
alternatives. Helps to improve the quality of life and promotes comfort of patient which will also foster the job satisfaction of nurses because when the nurses see the patient having more comfort by providing care they feel proud of their profession. Step 6: Prioritize acceptable alternatives. List them in order from the most acceptable to the least acceptable. In my opinion implanted pain pump is better choice because it provides more comfort with lower dose of medicine so that over dose of medication can be minimized. Step 7: Develop a plan of action utilizing the list of acceptable alternatives. Determine what you are going to do about this dilemma. Without the agreement of working team and higher authorities, I can not initiate the plan of action so, firstly, I would propose my opinion to the higher authorities through the chain of command. Step 8: Implement the plan. Through the chain of command I will provide my suggestions to higher authorities and once it is approved, patients can have alternative treatments so, I will help the patients to send to the appropriate centers and upon returning I will follow the direction of care for pain management. Step 9: Evaluate the action taken Availability of different type of pain management promotes the comfort of the cancer patients which will enhance the quality of life of patient. Also family members will feel better when they see their loved one is having more comfort and nurses will have job satisfaction when patient outcome is better. Cancer Treatment Centers of America. (n. d). Pain management. Retrieved August 5, 2015, from http://www.cancercenter.com/treatments/pain-management/ Ethical Decision Making. (2011). NRS-437V: Ethical Decision Making in Health Care. Phoenix, AZ: Grand Canyon University.
In order to address the above components, five decision making steps have to be put in place, these are; being attentive, being intelligent, being reasonable, being responsible, and being reflective. The first step, being attentive, involves evaluating the whole situation and coming up with the data and information about the problem at hand. In so doing the following questions are viewed; what facts to bear in mind, what direction to take so as to get the expected solution, and what is the main issue to work on. In the second step, being intelligent, the information is clearly studied to determine whether the collected data is revealing the correct details concerning the problem. Determine the stakeholde...
The change which is outlined in this paper relates to how early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management. PICO format question will be used , along with a supportive body of evidence regarding the fact that early onset into a hospice program is helpful with providing end of life pain control. Hospice programs available, and options associated with them will be discussed as well as common concerns associated with early admission to hospice. The methods used for payment of hospice, and how one qualifies for entrance into a hospice program will be explored. A literature search will be performed and its results detailed within the body of this paper. Recent publications on the subject matter and associated issues such as moral and ethical questions as well as the change question will be discussed. Planning, implementing and evaluation of the change proposed will be explored within this paper.
Through his discussion of quality of life and death, Singer offers ethical guidelines for the decision to refuse treatment to prolong life in the case of a terminal illness.
chronic pain could be handled at the bedside with no need to await a doctor's
Pain is often controlled with NSAIDS such as Advil (Ibuprofen) and Naprosyn (naproxen). Your doctor may also prescribe opiates such as Codeine, Vicodin (hydrocodone-acetaminophen), or Oxycontin
1. Identify the dilemma you are discussing and describe the choices the decision maker is facing.
Even though many dispute over the value and usefulness of treatment and care of terminally ill patients, the debate for the most useful care and pain reliever for these patients is the question that most patients, and their families, have to ask themselves daily. Wesley J. Smith suggests that Hospice care for patients with such a horrible illness is a beneficial program and that many patients need to utilize it. Smith also recommends that a valuable care option would be to “allow the terminally ill to enter hospice care without having to give up life-extending or curative treatments”. (Smith 3) With this statement, Smith demonstrates a way that these ill patients can be provided with treatment and also care for the patient’s quality of life.
This step depends on defining the right problem at the beginning of the process too create usable alternative to the objectives that will be used to make a decision. Identifying as many alternatives as possible will offer a wide range of possible solutions that can be used to make a decision. The alternatives selected should be the ones that will enable the decision made to achieve the objectives of the decision problem. Joan’s next step in the PrOACT decision making model is to understand the consequences and repercussion of every alternative identified. When she reaches this point of the PrOACT decision making model Joan can map the alternatives she selected for the objectives statement for her decision problem. At this point Joan can use decision matrix to identify the best alternative that can be used to accomplish the objectives of the problems she identified. The final step in Joan’s PrOACT decision making model is wrestling with trade-offs equalizing some alternative in order to apply the same weight when used in the decision making process. This is not a complex process but identifying similar items or process that can be weighted equally should be used when making trade-offs. This step involves identifying what will be given up by choosing one alternative comparatively to what will be given up by choosing another alternative for the decision that is being made.
Effective treatment of cancer pain is essential for ensuring the best outcomes for cancer patients, in terms of physical, psychological and social aspects. Although there are no NICE guidelines for management of cancer pain, WHO guidance should be used to inform clinical practice. Careful assessment is a critical element of the process to ensure that patients are offered the treatment which is likely to offer the best outcomes, yet without providing a greater than necessary risk of complications such as tolerance and addiction to opioids. The main outcome that this paper highlights is that “Pain is what the patient says it is and exists when he says it does” (McCaffery 1983
Ferrell, B., Levy, M. H., & Paice, J. (2008). Managing pain from advanced cancer in the
Anti-inflammatory drugs such as non-steroidal anti-inflammatory medicines (NSAIDs) like ibuprofen, or oral steroids, to relieve inflammation. Epidural steroid injections - a steroid injection. Steroids, with their strong anti-inflammatory effects, are delivered at the origin of the inflamed sciatic nerve roots. Manual therapy, Osteopathy or Physiotherapy can be very effective, reduce the recovery time and helps to prevent further episodes of sciatica. Surgery may be required if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.
Supports argue that patients who are terminally ill and in extreme pain should be able to ask for help from their physicians to seek relief; because it’s their duty to respect the patient’s autonomy. They rather seek a dignified death than live with pain and dependency. Even courts have found that just like how people have the right to refuse a medical treatment, there is a similar right to ask for
The right to die has raised many legal and ethical issues in the United States. We as a society rely on doctors in time of agony and discomfort because we believe in their healing capabilities. So when doctors deviate from the preservation of life and promote death, it creates an imbalance between what is ethical and what is best for the patient. The general rule of palliative care is to treat and care for patients, but when those patients are in a considerable amount of pain, should they not have the right to a choose their course of treatment? In this great nation, the greatest liberty that we have as humans is to live and die in our own right in accordance with our personal beliefs and free will.
Write the six questions of the Wise Choice Process and answer each one as it relates to your situation.
Terminal illnesses are most commonly associated with cancer, HIV and/or organ disorders. These diseases are known to debilitate the patient and cause extreme amounts of pain. This decision should be made entirely by the patient, as they are the ones dealing with the effects of these terminal illnesses. We can all understand that families and outsiders object to Euthanasia as an option, but the pain factor m...