The Ethical and Legal Issues Which Arise with Health Care - Essay Example

? Introduction The ethical and legal issues which arise with health care, specifically in drastic situations, create different responses and questions of how to respond. By changing specific approaches in given environments, there is also the ability to change drastic situations that arise. The case of Martin is one which shows how there were several ethical and legal changes which could have been made. These arose from the internal environment and the organizational efficiency that was related to the case study. The main problems which arose were based on not following the necessary procedures for nutrition, eating and care while other problems arose with break downs in communication. If different actions were taken, then Martin’s life would have not been as threatened and changes could have been made. The ethical and legal considerations were important to note; however, it is also important to recognize that the basis of this came from the organizational structure and the lack of understanding about the situation of the patient. This case study was chosen because of the several layers of complexities which arose. The ethical and legal issues in the particular study were of interest because it didn’t arise because of specific and expected changes made by one individual. Instead, there were break downs in communication and in the way the organizational procedures worked in the environment. This altered the capabilities that were associated with the patient and didn’t offer the best responses. The ethical and legal problems which arose included looking at the condition of the patient, believing a specific response should be given and failing to give the response that was best associated with the needs of the patient. The lack of following several procedures and organizational policies is of interest because this relates directly to ethical and legal ideologies; however, it is not necessarily an expected component with the organization. The interest in this article is then based on the understanding that ethical and legal issues are not always associated with the conscious neglect of a patient, but instead come from deeper problems that are within a health care setting. Ethical and Legal Issues The case of Martin is one which carries interest because of the known concerns that pertain to stroke as well as the capacity which the hospital had to respond, but didn’t. This first began when Martin was admitted to the hospital, which raises ethical concern with the responses that were required and not acted upon. It is known that when an individual suffers from stroke, certain reflexes began to be prompted, specifically to try to balance out the body in a different manner. With this, is a known change with the body that leads to pneumonia, often which leaves the body too weak for an operation. Feeding tubes and alternative feeding methods are common expectations with patients, especially if the stroke is too severe for post – stroke patients. It is noted that this is the only way to not have reflexes respond and to make the right movements for nutrition and alterations for feeding among patients (Nakajoh et al, 2000: p 39). The known problem which arises is one which indicates that the hospital should have immediately responded to the conditions in terms of feeding and nutrition, as opposed to hiring a speech therapist to try to change the condition of Martin first. Another problem which is associated with the case of Martin is based on the inability for him to talk and the dependency which was created with his condition in the hospital. This issue is furthered with the processes which were not carried through, not only in terms of the nutritious and physical state, but also in response to the other difficulties which are known to accompany those suffering from a stroke. This is inclusive of psychological responses, social difficulties, changes in cognitive ability and personality processes. Hospital personnel are required to understand the ethical concerns and the way in which this links to the cognitive, psychological and social responses which one may have. This is specifically associated with finding ways to assist with continuous recovery while monitoring and assisting the patient at all levels (Mukherjee et al, 2006: p. 1053). The ethical concern is based on looking at all the needs of Martin after having the stroke and understanding the potential responses which would arise physically, emotionally and psychologically. Instead, the hospital only worked toward hiring a speech therapist when the rest of the responses of Martin were obviously deteriorating. Ignoring these aspects raises concerns and question about valuing Martin’s condition and overlooking the concepts associated with his condition. The question of ethics is one which then becomes based on a combination of actions and not taking actions for those facing the chronic conditions. The ethical analysis is one which is based on the belief that the condition of the patient is overlooked in terms of severity, specifically with the belief that the condition of the patient is one which is manageable and is not chronic. Many hospitals assume that patients who suffer from a stroke still have some capacity to offer self – management and to find different ways to work with communication. According to one study (Redman, 2007: p. 88), it was found that prolonged interventions are common because of social class and the type of care which is unavailable, as well as care which may be lacking. This leads to many hospitals not examining and measuring the social conditions of those that are in society and doesn’t offer a true understanding of the condition. The study indicates that the only way to change this is through models such as PSM, which changes the measurements of the state of the patient so the correct responses can be made, instead of assumptions being made or a lack of care given to the patient (Redman, 2007: p. 88). In this case study, it is seen that Martin didn’t have the needed condition measured or the responses to the nutrition levels measured over a period of time. It was this that created the main problems with the needs being ignored and not monitored for the patient. The associations with this are related to not assessing Martin according to the MUST scale or other forms of feeding which may have altered the responses. Each of the ethical concerns relate directly to the concept of intervention, which would have saved the life of Martin. This problem is one which doesn’t offer the correct acute care to patients and doesn’t recognize the several levels of needs which each patient has. It is noted that an individual who dies directly after stroke has a direct link to the severity of the stroke, which causes the loss of life. However, an individual who dies after receiving acute care is typically linked to a lack of care or assessment that is provided (Stevens et al, 2007: p. 323). The ethical concern which is raised in this instance is one which is linked to the understanding that Martin didn’t receive direct care at basic, physical levels. The ethical concern which arises is based on the lack of acute care, which may have been directly linked to his death. If this were identified, then it would have prevented the severity of Martin’s situation and would have altered the capabilities of Martin. The result with the situation is one which shows that not taking provisions also questions the regard for life and the amount of care which is not provided to patients that are within a given situation. The problem with the ethics relating to Martin not receiving basic care links to the complexity of the situation which didn’t lead to the hospital recognizing the importance of the basic care. The ethical problem with this situation is one which is based on the understanding that the communication disabilities which arise means that the hospital has the right to find the best way to care for the patient. The hospital failed to do this, both with basic policies as well as the expectations that were a part of the care received. Instead of focusing on the basics for being responsible in the care for the patient, there was a focus on the communication disability, which should have remained secondary until the conditions of a patient improve (Ferguson, Worrall, Sherratt, 2009: p. 1795). The legal issues which arise in the same terms are based on the incapacity for the hospital to offer the correct assessment and responses to the given situation. There were specific policies used in the policy, including an internal feeding policy and the MUST scale that is used as a test that are used for basic physical needs. These were each ignored when working with Martin. Instead, a speech and language therapist was hired to assist Martin and basic principles were ignored. The problem isn’t only associated with what was offered or not offered in the given situation. There is no statement that Martin approved or disapproved of any of the given requirements, such as the speech and language therapist. While this is a common problem among stroke patients, it also creates an understanding that the basic physical needs should be the main approach when the condition of the individual is too difficult to approach. Even if there wasn’t a specific policy for nutrition and physical health, the situation could have been considered emergency because of the initial condition of Martin, which would have allowed the hospital to take necessary decisions to assist with saving Martin’s life, most which were ignored. The question of legalities is then based on both the basic guidelines of being able to work with an individual who is in an emergency situation, as well as ignoring the policies which are directly associated with how an individual works in society (Lemaire, 2007: p 122). The legal requirements which are associated with the case of Martin are furthered with the understanding of quality monitoring. The policies both within hospitals and in regards to federal policies indicate that patients should receive basic care and be monitored continuously while in a situation in which care is needed. This includes structured data assessments and indicators that display the actions which should be taken within the hospital. The legality also includes the need to take proactive measures and prevention measures for the patient in terms of therapy and other needs. While this is based on the hospital policies, there is the need to work specifically with those suffering from stroke because of the communication difficulties and the need to work on several levels with the patient (Grau et al, 2010: p. 1495). Implications of Failures The ethical and legal concerns which were associated with Martin’s condition also had direct implications that the failures were taking place. These began as soon as Martin was brought into the hospital, specifically because there wasn’t a direct way which was given to assist him in eating and providing nutrition. The implication of the failures continued with the speech and language specialists requiring the alternative feeding methods but not being listened to. At the same time, the specialists were associated with the hospital but not with the care, meaning the assistance shouldn’t have come from this group, but through the monitoring of the hospital. These two major signs were followed by the several physical signs which indicated deterioration of Martin’s health as well as the inability for the given procedures to work. Finding the nasal feeding tube coming out of Martin and looking at the complexities that were associated with this also created a different understanding of what was needed for the given situation. Interprofessional Working The first association which was based on the interprofessional working was based on the multidisciplinary communication failure which occurred. The specific situation which arose was based on the belief that Martin was being fed with a nastro – gastic tube when he wasn’t. There weren’t any actions taken to investigate the problem or to look into the situation which Martin was in with the feeding and how this was associated with his needs. The problem which arises is one which is first based on the perceptions of doctors and nurses that are working in acute care. The perceptions of how to work together within the hospital is one which could have minimized the situation. Noting that the tube wasn’t used, communicating this to other professionals and trying to find a fast solution to ensure that the change was made would have altered the situation. However, the perceptions of the nurses indicate that there wasn’t the correct level of responsibility given to each of the nurses and the relationship which was held with the patient. This main problem of not holding the responsibility needed is one which created the main problems with helping to change the nutritional levels with Martin (Atwal, 2006: p. 51). The second problem which was noted was based on the actions which didn’t take place over time. The initial response was to give Martin a feeding tube, which didn’t work; however, this wasn’t communicated to anyone in the area. This was followed by the speech and language specialist initializing the need to look at the condition of Martin because the health was deteriorating, while trying to find alternative feeding methods for the patient. The problem is one which is based specifically on the wrong type of communication being used between the teams in the hospital as well as with the speech and language specialist, which noted the lack of nutrition. The problem was based on a rising conflict with caring for Martin as well as difficulties in understanding the condition of Martin. The individuals responsible for the care of Martin didn’t look deeply enough into the condition or recognize the physical needs which were associated with this. If so, then there wasn’t a direct level of communication which was associated with the needs he carried. The roles of different individuals furthered the conflict as no one took the correct role in caring for Martin, noted as an organizational problem with patients (Jones, 2006: p 19). The other two issues which were based on the interprofessional associations were based on the two policies which are mandatory to follow in the hospital but which weren’t used. This included the Malnutrition Universal Screening Test (MUST) and the internal feeding policy which considers alternative feeding methods after 7 days. The problem with this is related not only to breaking the policies and standards but is also associated with the lack of clarity that was associated with the condition. It is noted that there are two needs which stroke patients have when in acute care. The first is the need to find a way to have a voice through speech assistance, specifically because of the loss of communication. This is followed by structures which are needed for basic care to aid in team roles and the structure of the team. It is noted that the structure of the team and the roles which individuals carry are the main area of importance in ensuring that the several needs of stroke patients are met while assisting with recovery. A team needs to be established, specifically which is based on reaching several objectives while ensuring that an individual is able to reach recovery while in the care of the hospital (Tempest, Mcintyre, 2006: p. 663). Interprofessional Team Working The interprofessional team work that was a part of the situation also indicated other difficulties that were a part of the situation. There were two main areas of team working which failed when working with Martin. The first was the multidisciplinary communication failure. The sign of this was with the belief that Martin was being fed with a nastro – gastric tube when this wasn’t occurring. The second was based on the team of speech therapists that were required to work with Martin. However, the lack of communication and the specialization which was associated with this caused the lack of communication to be increased while the correct results weren’t taken. The correct team work in the hospital would have stopped both of these conflicts from occurring while ensuring that the right amount of help was given with each individual having a given role in the situation. It is noted that both of these situations lacked two main approaches which could have changed the conditions of the situation. The first was based on the ideology of role understanding that was a part of the practice. The change which occurred in the situation made it seem as though Martin wasn’t being cared for and there were problems with being able to create the right decisions with the basic physical needs. This shows that the role understanding was not given and that those who were looking at the given condition were not aware of the activities which should be associated with Martin. This was followed by a lack of team practices that could have been initialized with core competencies. This particular ideology is associated with the roles of each of the individuals being based on the ability to create an understanding of what each individual is responsible for while allowing them to take direct action to change the condition of the patient (Suter et al, 2009: p. 41). This particular approach wasn’t used in assisting Martin and led to the complications and the lack of responsibility that was a part of the given situation. The concept of team roles and collaboration is one which can be furthered with the ideologies of building a micro structure that creates community through team. The ideology is to build one team which holds the same responsibilities for each patient. These responsibilities are then given to another individual that is able to create an understanding of what has or hasn’t been achieved for a patient. This helps with decision making processes and ensures that policies and procedures are followed within a given situation. This is furthered by the concept of creating a culture with the team work that is given. The culture is one which is based on communication, collaboration and the ability to work within a given framework. It is also noted that for this to work, there is the need to create a sense of leadership that is able to build and establish a team culture and to ensure that the progress of both patients and those working with several individuals is monitored for positive progress and success (Krogstad et al, 2006: p. 1478). In this given situation, there wasn’t leadership, monitoring or the ability to look at roles and responsibilities as a part of the micro-community. It can then be assumed that the gap with the situation of Martin is based on the lack of organizational structure that was a part of the main team. Changing this to work more closely together and to establish a sense of culture between each of the individuals could change the associations which were a part of the main objectives within the team while creating more significant collaboration. Working in Partnership To change the main objectives and problems that occurred with this situation is also the need to begin creating partnerships that are associated with the hospital. The first level to this is based on education and training. For a culture to be established and for practitioners to work effectively with the needs of patients, is also the need to establish a better understanding of communication and responsibility. The education and training is one which is based on finding better ways to communicate, avoid conflict and to establish strong associations with those who are working together. The partnership is one which is inclusive of the different roles and responsibilities of each individual as well as how to effectively work with others that uses these initiatives for better responses in the given environment. The education provided will close the gaps of misunderstanding while establishing a better track record between individuals, both which are working in the internal components of the hospital as well as with the outside partnerships, such as the speech and communication specialists (Lumague et al, 2006: p. 246). Another concept which needs to be applied is to understand how to take the educational processes and concepts and work within the associations and partnerships to close the gaps between individuals. The communication processes and the ability to work correctly with the care of patients can change the way in which each associates with and experiences the work environment. The practicality which is associated with any situation is based on combining basic practices of communication with new tools that ensure that the basic procedures have been carried out and that the initiatives required have been given. The main ideology is to create practical skills that are based on the work practices used. This also creates a change with the rehabilitation centers having busy schedules and easily overlooking some of the needs of patients. By re-training for new processes that guarantee better results, mistakes and overlooking situations can be avoided while lessening the amount of time that is used for those that are a part of the main experience (Mackenzie et al, 2007: p. 358). The interpersonal relationships and partnerships which are built won’t work practically or in theory during education unless there are also drastic changes within the care systems. This is based first on the ability to create interpersonal relationships that also have available tools which can assist the nurses and doctors within the given situations. The concept used is one which is based on the capacity of implementing new tools and technology that closes the gap with partnerships which can be formed. The tools consist of basic monitoring practices to ensure that all policies have been followed and that basic alternatives have been met for the patient. This also is based on the ability to understand and document what is happening with the patient and to create roles and responsibility for the nurses and doctors to respond in the correct manner so there is avoidance of difficult situations that may occur. This will eliminate confusion within the hospital and will cause the problems with a patient to not be overlooked within the given situation (Stenner, Courtenay, 2008: p. 276). By adding in new tools, expectations and the beliefs about communication, there is the ability to re-create the dynamics that are a part of the main practice with the nurses and doctors while avoiding confusion within given circumstances. The concept which needs to be initialized is based on the ideology of collaborative practice. This states that the organizational environment first considers the practice of communication and monitoring of basic needs for patients. This can be done effectively by combining new tools, implementing training and education and by closing the gaps with professionals when working on different teams. By instigating these different alternatives, mistakes can be avoided while practices for high levels of communication and initiatives taken can provide better alternatives. The environment which is created first is one which immediately creates a difference in the responses among team members while ensuring that there are better responses given in the instances and among those that are in the environment (World Health Organization, 2008: p. 2). For the case of Martin, this would have immediately changed the assistance received and would have altered the dynamics of the situation. With the changes in communication as well as new standards which could be followed, there would be the ability to immediately implement the policies of the hospital and to look deeper into the critical condition of the individual. Conclusion The case study of Martin is one which shows several complex associations with ethical and legal practices as well as the responses which were associated with this. The legal problems with the situation were inclusive of not following basic policies for health and nutrition. This was followed with the inability to meet the needs of the patient as the health began to deteriorate and as warning signs were instigated both by communication in the environment as well as from the health and stability of Martin. The problem is furthered with ethical concerns, specifically which raises questions of the idea of care. If the individuals within the hospital don’t provide basic care which is needed by stroke patients, then it reverses the responsibilities of those in the given situation. The lack of ethic responsibility then becomes a question and an issue for those within the situation and led partially to the deteriorating health of Martin. While the analysis of the case study is based on ethical and legal implications, it can’t be separated from the basis of the problem within the environment. It can be seen that those caring for Martin were uncertain about what was being done to monitor and help his condition. The need to evaluate basic policies as well as the neglect of the nutrition needed both indicate that the problem wasn’t only associated with the deteriorating health and neglect. It also indicates that a lack of communication as well as misunderstandings of responsibility and roles were not a part of the main objective. The organizational environment and the association with the patient are at the basis of the problem, rather than being associated directly with ethics and legalities that were neglected on purpose. Changing this with education, communication and more practical options is the only way to avoid the situations in the future, specifically which may lead to better options for patients to live for a prolonged period when in critical condition. References Atwal, A. 2006. “Nurses’ Perceptions of Multidisciplinary Team Work in Acute Health Care.” International Journal of Nursing Practice 17 (2). 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