All patients have rights. The patient’s family or guardian may exercise the patient’s rights when the patient has been determining to be incompetent to exorcise those rights. In this paper I will elaborate on patients’ rights and the ANA code of ethics in relation to advocacy for hospice patients. Provision 7 of the ANA code of ethics mandates for nurses to participate in advancement of the profession to continue to educate themselves and to contribute to practice, administration, and knowledge development.
Nurses must also help the profession to advance in active involvement in nursing and in health care policy. Nurses can also help the profession advancement by developing, maintaining, and implementing professional standards in clinical administrative and educational practice Provision 8 mandate nurses to collaborate with other health care professionals, and the public to promote national, community, and international efforts to meet health needs.
Nurses in general have a responsibility as to be knowledgeable about the health status of the community and the existing treats to health and safety by participating in community organizations and groups, nurses are to assist in educating the public, to teach them about their choices to identify conditions and circumstances to help in the prevention of illness. Provision 9 of the ANA code of ethics mandates the professional nurse to be responsible for articulating nursing values, for maintaining the integrity of the profession and its practice and for shaping social policies.
Nurses are to join in professional association to gain value and for the organizations to encourage and support self-reflection and evaluation within the profession. Ethical Dilemmas in Caring for a Hospice Patient One of the ethical dilemmas that arises in hospice care is the patients’ rights is often forgotten. Many times nurses are afraid to lose their jobs, and advocating for patients becomes the last thing on their mind. Caring for patients is secondary to pleasing patients’ family in the facility where I work, and because of that the patients have no one to advocate for them.
According to the patients’ bill of rights patients have the right to refuse health care, medications, and treatment, the ethical dilemma that frequently occurs on hospice is the fact that patient often refuse care, such as medications, (only want comfort medications) tubing, (G-tube,) And as the patient get closer to dying the patient’s family starts to have hard time accepting the fact that the patient is dying than they want to ignore the patients’ wishes by taking them to the emergency room to try to get G-tube, trachs and other life prolonging substances.
The Ethics Laws and Reporting Requirements that are Applicable to Hospice care When patients seek health care, he expects that the nurse or other health care professionals will provide good care in accordance with the modern standards in the health care industry. Hospice care should not be any different than any other health care industry, in the aspect of integrity, competency that is expected by other health care professional.
Each state has standards of care for all health care professional, and each professional organization has its own Code of Ethics, and actually provides care that meets the standards of care (Jennings, Ryndes, D’Onofrio, Baily, 2005). As a nurse I take pride in being competent at my job, which means I stay up-to-date, and I try my best to provide the best care for my patients.
Last month while caring for a hospice patient who happens to be a “VIP patient” the patient was the father of the hospital’s administrator, the patient was alert oriented times 3, refused dialysis and all medications, (only wanted comfort medications) and the family was having a hard time accepting the fact that the patient wanted to die with dignity and did not want prolong his life by getting dialysis, because of the way he felt after dialysis and he could no longer care for himself.
After admitting the to the care center, I notice the patient was on antibiotics IV, and routine medications, I attempted to administer the medications and the patient refused, the patient stated “I only have a few weeks left I only want to be comfortable please no IV, no medication”. Therefore, I told the patient okay I and I did not administer the medication, and the patient’s ex-wife was in the room, the patient’s ex-wife stated “give me the medication and I will put it in his mouth” I told the wife no I cannot, give you the medication to give to the patient because he refused the medication.
At that point the patient became angry, because the ex-spouse was ignoring his wishes, as the nurse I felt it was my duty to educate the ex-spouse about the hospice care, and the signs and symptoms of a dying patient. Later the patient’s family complained because I did not force the patient to take the medication. 2 days later I was called into human resources, and they made me feel like I was not doing my job. The nursing director and the human resources director told me I should have done what the family asked not what the patient wanted because of the nature of the business.
As a competent nurse I did my research on the patient’s rights to refuse care, and medication administration and gave it to my medical director and the human resources director and told them my view on caring for patients and my number one priority as a nurse is to advocate for my patient and to provide good nursing outcome, a week later the both apologized because they did their own research and found that I was correct. Although the apologized for their actions, the way they treated me traumatized me, I think I might think twice before advocate for another patient.
The Code of Ethics assists as notice to government officials that the Association expects its health care professionals to follow by all applicable laws and regulations. It is a requirement of members of the health care professional team in the Association that they follow the guidelines and that failure to act in accordance with the guidelines will result in dismissal from membership in the Association in addition to other penalties prescribed by law (National Association for Home Care and Hospice, 2012).
The Special Ethical Challenges that are Unique to Hospice Care One of the most ethical issues that unique to hospice care is artificial nutrition and hydration and the discontinuation of hospice care services. These problems are created be the health care system itself; some are related to the practice of hospice and some are related to the emotional, spiritual, and social meanings that is attach to them. They are many tools and resources available for hospice professional to use when the some of these challenges arise.
Many times the family need to be educated and information, and emotional supports are given to them to help them cope with these ethical issues (Casarett, Wellman, DeFord, 2005). Summary In order to understand the ethical dilemmas hospice nurses are faced, one must understand the pressure the hospice administrations and the family are placed on the nurse. Although nurses want to provide good patient care and advocate for their patients, nurse must also care for themselves and their families.
Now that the new health care act is emphasizing on customer services many health care organizations are pressure the nurses to provide good customer service not nursing care. As a nurse I think my job is to care for myself and my family first, and following my organizations guideline is more important than avocation for my patients because at the end of the day I need my job to be able to care for my patients(Kovner, & Knickman, 2011).. References National Hospice and Palliative Care Organization; http://www. nhpco. org Casarett D, Wellman C, DeFord B. Artificial nutrition and hydration: practical ethics at the bedside.
Program and abstracts of the 6th Annual Clinical Team Conference of the National Hospice and Palliative Care Organization; April 21-23, 2005; Atlanta, Georgia. Jennings B, Ryndes T, D’Onofrio C, Baily MA. Access to hospice care: expanding boundaries, overcoming barriers. Hastings Center Report. 2003;33:S3-S59 Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc. , custom ed. ). Sudbury, MA: Jones and Bartlett Publishers. Kovner, A. R. , & Knickman, J. R. (Eds. ). (2011). Health care delivery in the United States (Laureate Education, Inc. , custom ed. ). New York, NY: Springer Publishing.