This assignment will explore the case study of Jeremy and it will be divided into different sections. Firstly, it will consider defining dignity and then, will identify one nursing problem on the Nursing care theme. Then, it will go on and explain why that problem poses a risk to the dignity of the patient. Secondly, will choose one nursing care intervention and then discuss why the intervention would promote the dignity of the patient. On section two, I will first choose another nursing problem on Nursing care theme and then on Empowerment scenario, I will first define empowerment and then use the collaborative care scenario to identify a situation where the patient needs to be empowered and then one collaborative initiative, intervention, resource or organization that could be used to increase the empowerment. Then I will also identify possible barriers to implementation and how they can possible be overcome. On section three, for the law and ethics, I will identify a situation that has legal and ethical implications using the End of life scenario, and one ethical principle including the Human Rights Act, then will critically analyze the rights of the patient within the situation I have chosen.
Challenging behavior and the intervention
According to (RCN,2008) dignity is described as a basic human right which is associated with individual’s feeling and behavior relating to the value or importance of themselves and others. Treating someone with dignity clearly indicates that to treat them as an important person by respecting them as a valued individual (Parse, 2010). On the other hand, Lin et al. (2011) also highlights that in absence of dignity people feel devalued and uncomfortable. Lack of confidence and control make them indecisive in this situation and individuals feel embarrassed and ashamed.
The challenging behavior of Jeremy includes the alteration in sleeping habits. From the case study it is known that he often slept during the day and would awake during the early hours of the morning. He has been found adjusting the rate of flow of his neighbors drip. During the morning Jeremy can usually understand that he is a patient and is ill and hence is admitted in the hospital. But during the afternoon he becomes very anxious, he repeats words, usually Shirley and Mama frequently and tried to leave via the fire escape. He has urinated in the waste paper box and tried to get into the bed with a female patient. Such changes in Jeremy’s behavior scared the other patients within the ward and few of the patient relatives have also lodged complaints against Jeremy. In addition, Jeremy feels reluctant to take his medication and his medicines are found under his pillow. It is also seen that when nurses enquire him about his certain changes in behavior, Jeremy feels angry with them and many of the nursing staff believe that Jeremy can hurt any of them and any patient at any point of time. Intervention and management of such behavioral changes are vital skills for all the nursing staffs. Jeremy’s safety along with the safety of the engaged nursing staffs and other patients should be considered with the highest priority. The nurses should open the doors from outside and should make sure that Jeremy cannot lock him from inside. Nurses should take care of the fact that Jeremy has less accessibility to movable objects, jewellery or any sharp instruments that might increase the risk of harm at any point of time. Nurses who are taking care of Jeremy may prefer to present few important observations in a firm and calm but respectful way (Braine, 2005). They should maintain proper space between Jeremy and them. This is because few patients appreciate the matter of maintaining less distance between care provider and them. Patients feel comfortable with their healing touch (Lettice and Thomond, 2008). But in this case it is seen that Jeremy is mentally disturbed and it is quite difficult of the health care professionals to understand him and his sudden way of behaving in an awkward manner. There is also a chance that Jeremy can hurt the care providers, so to ensure proper safety the care providers should maintain proper space between self and Jeremy. According to Valle (2014), nurses should avoid verbal and physical threats, restraining patients, false promises and they should build rapport with Jeremy (Valle, 2014). In case of physical threats or application of restraints, Jeremy might act more aggressively and there might be a chance to develop a sense of revenge inside him. This in turn can disturb a safety environment within the ward. Building up a good rapport with Jeremy might help the nurses to properly communicate with Jeremy and this could build a trusting relationship between Jeremy and his care providers (McGill, 2005). This kind of approach helps the nurses to serve the patient with a quality care. Jeremy’s Mini Mental State Examination result has demonstrated that Jeremy has developed ‘mixed dementia’, that means both Alzheimer’s disease and vascular dementia. Nursing interventions for Alzheimer’s disease include maintenance of safe environment, promotion of function and mobility, teaching care givers and patients with efficient coping patterns, promoting sufficient sleep, hygiene, provide medication understanding and support to the care providers (Morris, 2008).
Nazarko (2011) highlights that challenging behavior can be challenging to nursing staff or other patients, but behavior that mainly affects the quality of life of the patient has been estimated that between 20% and 92% of people living with dementia will experience at least one behavioral disturbances during the illness (Nazarko, 2011). However, (Osborne et al, 2010) argues that such figures indicates that not all people with dementia display challenging behavior and that the determinants of whether a behavior thought of a challenging is likely to depend on the context within which the behavior occurs and the meaning that towards others (Osborne, Simpson and Stokes, 2010).
The nursing care intervention for reducing risk to dignity is that nurses must focus on promoting patient centered care practices for reducing the threat associated with dignity (Dignity Therapy Shown to Improve End of Life for Dying patients as Well as Families, 2011). A person-centered approach to understanding each individual and planning their care is most important to negating the need for challenging behavior (Butterworth 2012). The input of family and friends to help identify a person’s likes and dislikes can help care homes to put meaningful activities in place (Frankova, 2015).The nurses must explain to Jeremy what actually happened and its impact. As it is stated on the scenario that, in the morning, Jeremy behaves normally and this time can be capitalized for discussing with him.
Empower a person who has a problem of wandering around
Jeremy would wander around the house and try the doors to check if they were open. This made his sister worried that Jeremy would get out of the house at any point of time. Unfortunately, Jeremy went out at late night unnoticed by his sister. Jeremy’s social care group includes his sister, daughter-in-law and associated health care providers. His care might also be assisted by the NHS. Jeremy’s condition starts improving and according to her sister, she will be able to cope with him at home. Jeremy’s son is bit reluctant to take care of his father, so Shirley needs to play the key role in terms of her brother’s care. She meets all the members of the hospital social care team; however, she refuses offer of help at home by a nurse aide, as according to her, Jeremy would not like strangers in his home. She also does not want to take help from the NHS, as recently it is facing cuts. Ultimately, Shirley accepts the fact that she is unable to cope at home, as Jeremy is still wandering and is sometimes aggressive although improved than prior condition. It terms of social support, rather family support, it is very clear from the case study that Jeremy has received no help from James. According to Shirley, if no options are available then the ultimate option would be selling the house, which is ?500,000, her state pension and also Jeremy has ?40,000 in savings along with a good NHS pension. Shirley is taking care of her brother’s legal affairs. Jeremy’s recent hospital admission does not work well and after returning home he finds it difficult to settle even though Jeremy is familiar with his surroundings. To support Jeremy, Shirley asks for help to adapt the house so that the surroundings will be safer and more befitting to his needs. This would otherwise empower Shirley to continue caring for Jeremy at his own residence. So, with the help of this case study it can be said that with these supports one can empower a person who has a problem of wandering around. Mabbott (2006) defined empowerment “a process designed to facilitate self-directed behavior change” (Mabbott, 2006); whereas Hathaway (2009) states that “it is a process of enabling people to choose to take control and make decisions about their lives. It is also a process which values all those involved” (Hathaway, 2009). As empowerment promotes independency, it would be more help full for Jeremy to manage to do things on his own (Husain et al., 2009). Looking at the scenario, Jeremy needs to be empowered in managing to do more for him, therefore, putting pictures and signs on the toilet will help Jeremy to recognize where the toilet is and to be able to use it independently.
The idea of patient centered model has developed from patient empowerment. It stresses upon authorizing patient to find their own answers. As health care staff people feel most obliging while they have given advice. Nevertheless, the fact is that the professionals do not exactly assist patient to solve their complications or build up enduring alterations in their lives by advising them what they should achieve. Finally, the patients should find their own ways out and motivation and should take accountability for their health and here comes the great role of the health care professionals; they should empower them to perform just that. It can be said that for Jeremy’s condition achieving this is quite hectic and therefore, the care professionals might set some changes in Jeremy’s surroundings. For example: improved lightening, removal of rugs to assist fall prevention; installation of hand rails so that Jeremy can climb the stairs more safety; use of a nightlight to assist with disorientation in the dark; placing pictures and signs on the washroom door so that Jeremy knew where the toilet was which assisted to prevent some of the accidents he was having and labeled cupboards with pictures, which help Jeremy to identify where things were kept.
Law and Ethics
Jeremy went out at late night unnoticed by his sister. He already has cold and he got lost on a rainy night. He fell and was unable to get up and get home, which augments his complications. Jeremy had a stroke and readmitted to the hospital. Jeremy stated 10years prior that he does not want any unnecessary procedures or interventions if he has ever lost his mental or physical capacity by illness or injury. But the speech and language therapists have evaluated that it is unsafe for Jeremy to take diet and fluids orally because of the risk of inhalation, as a result he has had an insertion of naso-gastric tube. This initiates an ethical issue. His son would be happy in this matter as he wanted his father to be at hospital itself.
From the case study it is clear that Shirley is the legal executor of Jeremy’s affairs. Therefore, when such ethical concerns take place within the health care set up, the doctor should communicate the issue to Jeremy. It is true that 10years prior Jeremy stated that he does not want any unnecessary procedures or interventions if he has ever lost his mental or physical capacity by illness or injury (Guido, 2006). But if the present condition is considered, it would be vital to mention that without the naso-gastric tube insertion Jeremy will receive no nutrition and it is illegal to restrict a patient from getting his terminal life support (Tschudin, 2012). So, a proper way would be communicating first with Jeremy’s sister and then if the doctor has some other alternatives rather than the insertion of naso-gastric tube, they must opt for that or else, they should support the idea of insertion of naso-gastric tube. As a healthcare professional one should be responsible for his/her actions (Momoh, 2006). Nurses have legal, ethical, contractual and social accountabilities and are liable for the actions they undertake (Tingle and Cribb, 2007).
Therefore, this can be achieved by nurses ensuring that patients are able to decide what happens to them and then to respect those choices (Bailey, 2006).In addition, (Mental Capacity Act, 2005) make it clear that people’s advanced decisions should be taken into account in decision making, in particular, people’s advanced refusal of treatment should be respected. Therefore, Jeremy’s refusal to have a peg feed should be taken into account.
With reference to Human Rights Act Article 2, with Jeremy’s decision of not having a peg feed, the act states that the concept of everyone’s life shall be protected by law requires the states not only to refrain from taking life intentionally, but they must also take appropriate steps to safeguard life. Therefore, the right to life covers both the intentional deprivation and careless endangering life (Griffith et al, 2009). Whereas, (Wheat,2009) emphasises that on Article 8, which is the right to respect for privacy and family life, for Jeremy’ decision, healthcare professionals have to be aware that the law relating to privacy and confidentiality means that the patient information must not be disclosed to others without a very good reason for breaching the obligation of confidence. However, the obligation is an obligation that is based upon the respect for autonomy and privacy and upon utilitarian principle that people are more likely to seek medical advice if they know that the information will remain confidential (Wheat, 2009).
Legal and ethical implications were brought in to the assignment and one ethical principle as well as Human Rights Act was critically analyzed on the rights of the patient in having a peg feed inserted. Lastly, this assignment demonstrated awareness of how to recognize a nursing problem and to knowledge on how to deal with the nursing problems in order to promote the quality of life of the patient. It would also influence my future practice by having understanding and awareness of Human Rights Act and ethical principles when dealing with decision making processes.
According to the ANA Code of Ethics (2001), delegation is depend upon the nurse’s judgment regarding a patient’s status, the capability of all the health care professionals of a nursing team and the required level of supervision (Rcn.org.uk, 2015). Hence, the accurate delegation includes right task, right person, right circumstance, right communication and right supervision. This is very much needed in Jeremy’s case as the case study reveals that Jeremy’s condition is critical and engages various legal, ethical and professional accountabilities.
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