Practitioner Values in Dementia - Essay Example

?Practitioner Values in Dementia - Portfolio 2 Number: ial Time: This report aims to address thefollowing: 1 Write about how you would personally explore and incorporate issues relating to your best interest, advocacy, and empowerment; 2 Critically explore your level of responsibility and accountability; and 3 Incorporate how you would ensure and gain consent while meeting confidentiality. Table of Contents Abstract 2 Practitioner Values in Dementia - Portfolio 4 Level of Responsibility and Accountability 7 Ensuring and Gaining Consent while Meeting Confidentiality 7 Reference List 10 Practitioner Values in Dementia - Portfolio 2 The DSM-IV-TR Diagnostic Criteria of Dementia defines and characterises dementia with symptoms of loss of memory, deterioration of language function, and loss of ability to think and plan abstractly and to initiate, sequence, monitor, or stop complex behaviors (Koutoukidis, 2009, p. 872). These symptoms have been very evident on one of my residential home care patients named Ms. X. Ms. X is an 80-year old residential home care patient who is pleasant and receptive. She does not want to ask the help of others frequently but acknowledges the advice of the medical practitioners. Although her doctor told her that she has memory problems, Ms. X reports that it does not affect her daily life, except that her niece has to remind her of most of the things to do like turning the stove after cooking, closing the faucets, and even looking for her eyeglasses. Ms. X does not want to take a bath. Often, she would yell at me if I tell her that it’s time to take a bath. As she is receptive towards the help of others, she always insists on dressing up herself but got confuse and wears her underwear over her regular clothes. She wants to do the cooking and laundry in the nursing home but her frequent forgetfulness often leads to accidents such as making the residential home care at risk for fire and switching the powdered milk for laundry detergent. When I would remind her of these things that she cannot do, she would yell at me and humiliate my caring abilities. I felt much stressed about the full-time responsibilities of caring for Ms. X in the residential home care setting and this stress has escalated over the past few months because of the frequent yelling of Ms. X. She is also very impatient towards the nursing care I’ve given to her and there comes a time when I would like to quit from caring her but got guilty feelings towards these thoughts as there is no nearby family who could help her. In a case like this, I began to question myself of how would I personally explore and incorporate issues relating to my best interest, advocacy, and empowerment. Then, maybe, I have not yet fully understand the situation of Ms. X. I could have understood her clinical situations but not her personal shortcomings. It was not easy to have dementia and worst, to be far away from your family which serves as your major social support in life. In addition, it must be also sad for her that she does not have a partner in life which could help her in her fight for dementia. If I would explore and incorporate issues related to my best interest, I would probably resign and request to not take good care of Ms. X as her frequent yelling is humiliating my status and morals as a nurse. However, I also think that staying and caring for her would also be promoting my best interest as this experience will help me grow professionally and will guide me in handling future patients with dementia. In the latest report of (http://nursingstandard.rcnpublishing.co.uk, 2013), the nurse has the full responsibility in exploring and incorporating issues of advocacy; thus, being a patient advocate may mean that a nurse assists, defends, pleads, or prosecutes for the patient while having collaboration with other professionals. In the case of Ms. X, I should act as an advocate in referring to the medical provider her progress report while inside the residential home care and her psychological needs to the in-setting psychiatric doctor. As a residential home care nurse, I have to be professional and remove the feeling of frustrations as it may hinder effective patient advocacy. In addition, I believe that I could be of the best patient advocate for Ms. X if I could equip myself with appropriate education and training regarding ethics and advocacy. Deciding not to quit in caring for Ms. X is my ethical duty as an advocate; and as a nurse, I am expected of my profession to do this duty. What about empowerment? Will I be empowered if I stayed caring for Ms. X or if I left because of moral degradation? Cutcliffe and McKenna (2005, p. 111-112) defines empowerment as increasing the level of autonomy and power in nursing through participation in local, national, and specialty groups, attending continuous professional education and conferences, and evaluating contract agreements with the health care settings. Therefore, the decision to leave or not Ms. X does not define my empowerment as a nurse; rather, it is the rationale behind the action that I would take that would define empowerment. To explain this clearly, my decision to resign from caring Ms. X must consider the local, national, and specialty groups that I belong with. If these groups could support me in my care for Ms. X, then, why would I resign? If not, what are the alternatives that these groups could offer when I leave my current work? Next, attending continuous professional education will empower me in caring for Ms. X as this will update me on the current trends in caring for people with dementia in the residential home care settings. Last, before I would be carried away by my emotional outburst in caring for Ms. X, I have to review first my contract of agreement with my employer. This will help me in making autonomous decision whether to resign or not from caring Ms. X. Reviewing the contract of agreement will also prepare me for the different benefits and the legal and professional implications of resigning from work. Level of Responsibility and Accountability According to the report of (http://www.dementiarights.org/charter-of-rights, 2013), the accountability of people with dementia and their primary caregivers centered on the right to enjoy fundamental freedoms and human rights, preservation of human dignity and privacy, responsible and accountable treatment, and right to be free from discrimination. Ms. X and the nurse in-charge of her treatment must have these levels of accountability in order to deliver a competent, right-based, and quality care. Thus, it is the primary caregiver’s responsibility that these rights are being protected while meeting the patient’s needs inside the residential home care setting. Ensuring and Gaining Consent while Meeting Confidentiality Ethical concerns often arise when rendering care to a patient with dementia. Sometimes, the nurse may be torn between a client’s right to confidentiality and the importance of informing the patient’s family about a certain procedure to be done to gain a particular consent. The cognitive impairments of a person suffering from dementia have put the decision of care to family or caregiver. However, there are times when the patient does not want their family to know about their condition. In a case like this, how could we ensure and gain consent while preserving confidentiality of patient information? In the case of Ms. X, I have to inform and gain her family’s consent in introducing a new treatment for dementia. However, as we all know, Ms. X is very much receptive and does not want to accept any help. Furthermore, she does not want her family members to know that her condition is getting worst. If I would refer the case to her family, Ms. X might mistrust me and it would be discomforting and confusing to maintain a trusting and helping relationship with her as I will violate her right to confidentiality. Meanwhile, if I will not refer the case to her family, I will not be able to get the consent for the new treatment and I will be violating the principles of beneficence or the promotion of common good as the new treatment will not be rendered unless approved. As I was new to the profession, I asked the help of my colleagues in resolving this ethical dilemma. I also searched and followed the steps and questions to consider in making an ethical decision. These steps and questions (Koutoukidis, 2009, p. 876) are as follows: Gathering background information. Identifying ethical components. Clarification of agents. Exploration of options. Application of principles. Resolution into action. Applying the steps stated above to the case of Ms. X, an ethical dilemma exists between the right to informed consent of the family and principles of beneficence versus the patient’s right of confidentiality. Information were known regarding the context of the dilemma and the issues lie on which is more important – right or good? Ms. X, her family, and the nurse in-charge of care were the affected population. The family has the right to be informed and be consented of the medical decisions involved in patient care while Ms. X has also the right to confidentiality of information. Ms. X could be involved in decision making because the decision being made is for her but, the consent is highly needed for the betterment of her condition. In addition, because of cognitive impairments, ensuring and gaining consent of the family should be upheld. There are alternatives fort this situation but the potential consequences may harm the patient and may put the nurse or caregiver at legal risks. Thus, the criteria to be used must be the principle of beneficence which requires getting the consent of the family to introduce new treatment for dementia and withholding Ms. X’s right to confidentiality because of pre-existing cognitive medical impairments. Reference List Cutcliffe, J.R. and McKenna, H.P. (2005). ‘A Critical Examination of the Concept of Empowerment’. The Essential Concepts of Nursing: Building Blocks for Practice. London: Elsevier Health Sciences, pp. 109-124. Dementia Rights (2013). Available at http://www.dementiarights.org/charter-of-rights/ (Accessed: 20 April 2013). Koutoukidis, G. (2009). ‘Mental Health’. Tabbner's Nursing Care: Theory and Practice, (5th ed.). London: Elsevier Health Sciences, pp. 872-879. Nursing Standard (2013). Available at http://nursingstandard.rcnpublishing.co.uk/ (Accessed: 20 April 2013). Read More