Objectives • Describe the key ethical principles that affect health care for older adults. • Discuss the difference between personal values and professional codes of ethics. • Application of a decision model to an ethical dilemma in nursing practice. 16 Patients` rights Patients` rights Direct action on ethical issues in the care of the elderly Patient Empowerment Act 1990: Patients have the opportunity to express their preferences regarding life-saving or life-sustaining care when entering a health service, including hospitals, long-term care homes and home care facilities. Decision-making capacity • Jurisdiction.Legal determination by a judge regarding intellectual disability or incapacity; whether a person is legally capable and qualified to testify or sign legal documents. • The law assumes that all adults are competent and have the capacity to make health care decisions. 4 Case Study: Ethical or Moral DilemmaAn 80-year-old patient under the care of the nurse only insistently told her during the admission process that he did not want life-prolonging interventions if he had to „code.” The nurse leaves the room to begin the appropriate references and documents for living wills. Upon return, the patient is not breathing or has no pulse. 12 Fiduciary ResponsibilityHealth professionals have an ethical duty to properly manage the Patient Fund and the Organization`s Fund Treat justice equally and treat those who are unequal according to their needs Fairness of an action or situation Veracity Veracity Do not mislead patients or their families Duty to be honest, to tell the truth, not to deceive others Ethical Principles • Substitute Judgment Standard – SDM • Best Interest Standard – Decision Based on what health care providers and/or families decide is best for that person. Ethical terminology • Ethics: explanations of right or wrong and what should be • Bioethics: application of ethics to matters of life and death • Ethical dilemma: a difficult problem that seems incapable of finding a satisfactory solution; Situation with two equally unsatisfactory alternatives • Nursing ethics: application of ethical principles in nursing practice Informed consent • Can make a choice • Understand and appreciate problems • Manipulate information rationally • Make a stable and consistent decision • Age-related factors: • Hearing and visual impairments • Communication disorders: written and oral • Values and beliefs • Fluctuating decision-making capacity or diminished 3 Learning Objectives (continued)To analyze the impact of fiscal, socio-cultural and medico-legal factors on decision-making in geriatric patient care. Identify strategies to promote an appropriate degree of autonomy and support the right to self-determination in the care of geriatric patients. Refusal of treatment • The right to refuse treatment, even if the refusal accelerates their death or results in death. • The required capacity must be determined: • Can make a choice • Understand and appreciate problems • Handle information rationally • Make a stable and consistent decision 2 Learning Objectives Define important ethical constructs related to geriatric patient care.
Relate ethical concepts to their impact on geriatric patient care. Recognize the influence of personal values, attitudes and expectations about aging on the care of older adults and their extended families. The Framework of Scope and Standards of Practice (ANA) for Ethical Decision-Making provides a basis for discussion when dilemmas arise and opens the door to compromises that save integrity. Living wills • Living wills • Permanent Power of Attorney for Health Care (DPOAHC) or Power of Attorney for Health (HCP) • Guardian; Conservative; Deputy; Health Care Providers • Advance Health Care Directive 6 Ethical and Legal Principles and IssuesEthics of Care in the Geriatric Population Complex and challenging Nursing practice requires full awareness of a person`s autonomy in changing capacities Ethical/moral principles Autonomy in advocacy Charity/non-malevolence Confidentiality Fidelity Fidelity Fidelity Loyalty Loyalty Responsibility Justice Quality of life Reciprocity Holiness Authenticity of Life 19 Ethics in Practice Medical errorsConsiderable efforts have been made to reduce errors and improve patient safety. An average hospital patient can expect to be exposed to at least one medication error per day 9 moral principles included in the Code of Professional ConductAdvocacy: Loyalty and advocacy for the needs and interests of others. Nurses advocate on behalf of patients by supporting them in their efforts to maintain as much independence as their abilities allow. – Protect the health and safety of clients by communicating needs, promoting safe environments and assisting in the enforcement of legislative rights. PowerShow.com is brought to you by CrystalGraphics, the award-winning developer and market-leading publisher of rich media enhancement products for presentations. Our product offering includes millions of PowerPoint templates, graphics, animated 3D characters and more.