Ethical Legal Dilemma Advanced Practice Nursing Case Study II Essay

good Legal Dilemma groundbreaking Practice Nursing Case Study II Health insurance policies throw off set limits on what work pull up stakes be paid for with a closely ill soul in the seat and these limitations may conflict with the carrys obligation to provide c be for the termin eachy ill longanimous (Fry, Veatch & Taylor, 2011). Speaking with the family of a 59 year old male with his still history creation terminal lung raisecer that has metastasized to the brain, they express concern that they atomic number 18 beginning to have increase difficulty managing this condition.The affected role is receiving hospice shortly in the home, but the insurance company get out not even up both hospice and respite services to dish out the family. Community nurses working in the homes of dying patients often encounter many forms of ethical predicament and they need support in this demanding stead that arises during the end of a patients life in the home (Karlsson et al. , 2010). The community nurse is a professional to whom the patient and family turn when they have questions or wish to discuss plan of c ar and discussion options at a critical time in the patients life when personal assistance is required (Erlen, 2005).Speaking with the family (son and female child), it is at present found that the patient is now incontinent of both s jibe and urine and they are now limiting his intake of food and nomadic in the afternoon and evening, so that their yield doesnt lay in his own wastes throughout the dark. The patient has now collapseed an excoriated perineum and it appears that further skin breakdown is imminent. The patient has become increasingly weak, and has locomote several times over the give out few days.He requires total electric charge with all ADLs and IADLs and the family verbalizes being overwhelmed with what their father requires. The patient is receiving hospice for medication administration for agitation and cark as wholes ome. two son and daughter are at risk of losing their jobs related to missing work in distinguish to take deal of their father. The son works day shift and the sister works afternoon shift. They have individually decided to return to work and this will cause their father to be leftfield wing totally for almost two hours each day.This could be a pillowcase of sloppiness, where there is a failure to lesson a standard of upkeep and it can be alleged when a person fails to act when a debt instrument exists. There are five elements required to establish a case of negligence the world of a levelheaded duty to exercise well-founded care a failure to exercise reasonable care cause in particular of corporeal harm by the negligent conduct physical harm in the form of actual damages and proximate cause, a showing that the harm is inwardly the scope of liability (Cornell University Law School, n. d).Negligence falls under tort law and could be criminal. fit to Collins English vocabulary (2009) negligence or mal-practice is defined as any im moralistic, unethical bollix up or neglect of a wellness care professional. The patient is receiving care at home from Hospice for pain and agitation medication management, which is not sufficient. There is no absolute method to avoid lawsuits however, prevention of this case could have occurred prior to discharge with proper education of the family of their options for care regarding their father.Detailed explanation of what care their father may need as the end of life is near, may have steered the family to make alternative arrangements for their father. Hospice will have a duty to educate the family of the possible act of negligence and it will be the duty of the hospice workers to report this act made by the family, by following their policies and procedures, which will be their better(p) defending team (Grant & Ballard, 2011). Further discussion has shed light on the possibility of Human Rights being violat ed, under the low-priced Car Act. This is due to the patients insurance declining to pay for of necessity at home.This law alleviates harmonise to Gable (2011) some of the hardships forced on the publics health for those with insufficient availability of health insurance or access to health care. The cheap Care Act bans insurance companies from placing lifetime dollar bill limits on health benefits, which will prevent individuals suffering from chronic diseases from having to worry about going without give-and-take because of their lifetime limits and it restricts the use of annual limits and bans them completely in 2014 (U. S. Department of Health and Human serve, n. d.). The ethical tenet that will be violated here is the respect for person and the theory of deontology. Deontology means that some behaviors are our duty, whether there is benefit or not (Fry, Veatch & Taylor, 2011). The Stanford Encyclopedia of Philosophy (2012), says that deontology is deep down the moral theories that guide and rate our choices of what we ought to do and what type of person we should be. Again, proper education to the family, prior to discharge of this patient and by the nurses within the hospice agency could have avoided this occurring.Respect for person contains autonomy, but not all individuals are able to performing autonomously. This requires the ability to set goals and make choices, and this may be compromised at times in a persons life. Defined by the Belmont Report, respect for persons requires that these vulnerable individuals be offered special protections during periods when they cannot act autonomously. This is also a major emphasis of the principle of justice which requires that the vulnerable be extended special protections with regard to the dissemination of the benefits and burdens of research (Yale Human Subject Research Resource & Education Program, 2006).Legal logical thinking is evident in two forms, legislative drafting and application of r ules to cases and it involves an acceptance and spirit of working within law, which gives it some prepossession towards maintaining existing rules (Peterson, n. d. ). This does not always mean that law is always just and hardheaded, and judges avoid applying rules that would takings in less than desired outcomes. gibe to Peterson (n. d. ), legal argument contains many examples of efforts to changing the legal strategy and returning to the law making act.Coherence in legal reasoning is where law makes sense as a whole, and is a form of supportive rationality (Bertea, 2009). The coherence part of legal reasoning may be weaker than the logical part. Coherence of a set of legal norms is made by there being a realization of some common value or some common principle (Dickson, 2010). logic in legal reasoning is the reasoning worryatical in interpreting constitutions, statutes, regulations, balancing aboriginal principles, adopting and modifying legal rules, while applying those rules to cases and evaluating evidence, prior to making decisions (Walker, 2007).Case law is the legal principles embodied in judicial decisions that are derived from applying areas of law to the facts of individual cases. Case law is a dynamic and constantly commenceing body of law, where each case contains part of the facts of the controversy and an explanation of how the judge arrived at a conclusion (The Free Dictionary by Farlex). Lastly is legal analysis, which requires proving each element of a rule to be true or false and it refers to a statement by a court, judicial officer, or legal expert as to the legality or illegality of an action, condition, or intent (Connelly, n.d. ). The function of ethical reasoning revolved around the fact that much of human behavior has consequences for the welfare of others. People can act toward others in such a way as to increase or decrease the quality of their lives and we are capable of helping or harming. We are empathetic and therefore can recognize when we are doing atomic number 53 or the other. The role of ethical reasoning is to decipher acts that either enhances the well-being of others and those that harm or diminish the well-being of others.Developing ones ethical reasoning abilities is crucial because there is in human nature a robust tendency toward egotism, prejudice, self-justification, and self-deception which has sociocentric influences (Elder & Paul, 2011). The problem of pseudo-ethics is that one cannot develop as ethical persons if we cannot face the fact that everyone is inclined(predicate) to egotism and prejudice. Flaws in human thinking are the cause of much human suffering and only developing fair-mindedness, honesty, integrity, self-knowledge, and deep concern for the welfare of others can provide foundations for sound ethical reasoning (Paul & Elder, 2009).According to Paul and Elder (2009), ethical reasoning involves doing what is right while avoiding selfish desires and to live an ethi cal life, is to develop command over our native egocentric tendencies. The elements of ethical reasoning include awareness, independent problem solving, back up problem solving, and decision and outcome military rating, while effective ethical reasoning requires sensitivity, problem solving skills, and the motivating and determination to act on decisions (Kenny et al. , 2007). The logic of ethical reasoning involves moral theory derived from meta-ethics and evolutionary ethics.The fundamental problem is that evolutionary ethics is a scientifically based theory while meta-ethics is a philosophically based and logic related 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 centuries of time that are related to human behavior (Bromberg, 2011). The advantages and disadvantages of ethical reasoning start with the fact that ethical reasoning assumes that everyone will make c hoices that will cause no harm.This would mean that an ethical society will prohibit unethical actions, but ethical reasoning excludes actions that are based on spiritual or social customs duty and does not persecute any specific group for their beliefs. Ethical reasoning is meant to determine actions that are in the scoop up interest of everyone, but the course of action is not always clear-cut. Ethical reasoning is simple, all things are not equal, and determining the true ethical route can be difficult and prejudiced (Mayers, n. d. ). Summary Some cultures 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 obey in order to prevent persecution by governing authority. Ethical reasoning is based on what people believe is morally right or wrong, whereas legal reasoning is based rules made within c ultures. Many times things that are illegal coincide with things that are believed to be unethical within a culture however, an illegal act by a health care practitioner is always unethical, but an unethical act is not necessarily illegal.Ethics involves standards of behavior and the concept of right and wrong, over that which is legal in a given situation. Moral values are form 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 supervisors in order to be effective. Shared decision making, between health care professionals, is resilient to arrive at what best meets the employees needs.I think an ethical reasoning tool needs to involve the employee and the supervisor so the problem can be addressed. The use of an integrative model can develop confidence and justification in making ethical decisions. Preferences and values come into effect during the process of an coordinated ethical decision making model and principles of patient-centeredness and shared-decision making must be co-ordinated (Sestini, 2010). An integrated model of ethical reasoning highlights the integration between ethics and decision making, where ethics is a tool that brings positive aspects of the reasoning process.The model is composed of three major elements the ethical component the decision making component and the contextual component (Grundstein-Amado, 1991). Park (2012), reviewed available structured ethical reasoning and decision-making models and developed an integrated model consisting of six steps 1. the identification of an ethical problem 2. the collection of additional information to localize the problem and develop solutions 3. the development of alternatives for analysis and comparison 4. the selection of the best alternatives and justification 5.the development of diverse, practical ways to go across ethical decisio ns and actions 6. the evaluation of effects and development of strategies to prevent a similar occurrence. The best ethical reasoning should be determined by putting efforts from all health care professionals involved and although it will not guarantee ethically right or good decisions, it will likely meliorate a process and outcomes of clinical ethical decisions (Park, 2012). Applying this model to the situation of 59 year old male with his only history being terminal lung cancer that has metastasized to the brain. Applying the chosen model 1.the identification 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 each day. 2. the collection of additional information to identify the problem and develop solutions families concerns Increased difficulty managing this condition Patient is receiving hospice but the insurance company will not cover both hospice and respite services to assist the family. pati ent is now incontinent of both stool and urine and they are now limiting his intake of food and fluid in the afternoon and evening patient has now developed an excoriated perineumThe patient has become increasingly weak, and has fallen several times over the last few days. requires total care with all ADLs and IADLs and the family verbalizes being overwhelmed 7. Both 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 input into the situation. Possible another family member could be available for the two hours. There could be a possibility to withdrawal from hospice and pursuing 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 input to see what best meets their needs, as well as their fathers needs. confession to the family re garding their father being left alone for two hours at a time, as well as withholding fluids and food from him can be done through education. 5. the development of diverse, practical ways to implement ethical decisions and actions Deontology means that some behaviors are our duty, whether there is benefit or not (Fry, Veatch & Taylor, 2011).This is also a major emphasis of the principle of justice which requires that the vulnerable be extended special protections with regard to the dispersion of the benefits and burdens of research (Yale Human Subject Research Resource & Education Program, 2006). As a case manager, I need to work with family on awareness, independent problem solving, supported 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 accordingly determination could be made of whether the end result was effective.Evaluating the effects of the interventions will allow the health care professional to adapt future encounters with similar situations. Recommendations Further research revealed the U. S. Department of Health & Human Services said federal hospice investigations have increased drastically over the last few years. A Medicare vigilance report in 2009, found nearly a third of hospice patients were not getting services of treatment in care plans, nor were they getting visits providers had promised to provide (Bloomberg News, 2011). This would lead to the first recommendation to the family.It can be recommended that they withdraw the visiting hospice to review the overall care plan with them. The case manager needs to ask for a copy of the care plan, so it can be reviewed with the family. Once 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 t o ask the family to discuss options with the patient and consider his preferences as well as special physical, emotional and psychosocial needs.A final 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. Caring for their father, according to research, may have left them no time for self-care drained them of energy and enthusiasm and affected interactions with other family and friends (Joad et. al, 2011). References Bertea, S. (2009). The argument from coherence. Available at http//ivr-enc. info/index. php? title=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 cosmos 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/archives/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. Orthopedic 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 Patient Protection and Affordab le Care Act, Public Health, and the Elusive Target of Human Rights. Journal 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 Publishing Company. Grundstein-Amado, R. (1991). An integrative model of clinical-ethical decision making. suppositional 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 informal caregiver