Diploma of Nursing Essay 2022

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Diploma of Nursing
Student’s Name
Institutional Affiliation

DIPLOMA OF NURSING 2
Introduction
The essay focuses on a 58-year-old gentleman, Mr. Joseph Webber, who was recently
diagnosed with stage IV mesothelioma that has spread to his hips, spinal column, and brain. He
lives with Hepatitis B and is at the end stages of cancer and has been admitted to the health care
facility for palliative care. The essay identifies and describes key ethical issues within the case
study and discusses how to ensure the interactions with the patient or family reflect ethical
concepts with a brief discussion of nursing ethics. Also, it demonstrates how to implement
nursing interventions for every key ethical issue and exhibits an understanding of the
implications of current legislation and how they are incorporated into the nursing interventions.
The essay identifies and relates consumer rights and responsibilities to the ethical issues
identified and also outline the major ethical principles and relate them to the key ethical issues.
Ethical issues
In the management of patients at the end of life, withdrawal and withholding life-
sustaining therapy is an issue that may be relevant both ethically as well as medically (Fischer,
2015). Particular strategies may clearly be clinically futile in which case there are no medical,
legal or ethical requirements to provide attention that provides no benefit. The decision to
withdraw or withhold cardiopulmonary resuscitation is an issue commonly experienced in the
scenario of the end of life care. If the patient has the “do not resuscitate” order it means that the
client has opted for cardiopulmonary resuscitation to not be instituted in the instance of cardiac
arrest. Electing to have this order is a hard but prevalent clinical decision that patients close to
the end of life always make (Fischer, 2015).
Hastening death is an ethical issue where clinicians have to make decisions that generate
both desirable and undesirable effects. A clinical practitioner may administer pain medications
like opioids to mitigate the client’s suffering and pain but this same strategy may result in a
hastened death. In this case, the practitioner must always consider what the expected impact of
the strategy is.
Medical futility is another health issue that is identified in the case study. This issue is a
medical condition in clinical ethics that may alleviate difficulties in delivering attention at the
end of life. It is described as a strategy that does not enable the accomplishment of the
anticipated objective of the strategy (Rostami & Jafari, 2016). Conflicts concerning futility often
originate when the patient has lost decision making capability and decisions concerning his care

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lies in the hands of the proxy decision-makers. The conflicts may result due to the
misunderstanding of the proxy decision-makers of the diagnosis, the difference in values or loss
of trust in the health care system.
Nursing ethics
Nursing ethics entail equitable and fair treatment of all patients regardless of their
disability, ethnicity, economic status, citizenship, sexual orientation and age (Robinson-Wood,
2016). While interacting with the patient and his family, I will ensure independence in decision
making. This involves giving the right and sufficient information to the patient and his family to
let them be free and independent to decide on the diagnosis, therapy of his condition. Another
way to ensure I reflect on the ethical concept while interacting with the patient is to demonstrate
the ability and disposition to sympathize deeply with the patient's plight.
Nursing interventions
Since Mr. Webber seems to be in so much pain, I would try palliative sedation
intervention as well as potentially life-shortening opioid use intervention as a last effort to relieve
his suffering. I will sedate him to a point in which refractory signs are monitored. Its objective
would be to control symptoms and the patient is anaesthetized to a point at which they are
insensible to attain the goal. Its intention is not to hasten death or cause injuries but to mitigate
pain that has not reacted to any medication.
On the issue of medical futility, advance care planning is a suitable intervention to
prepare for the end of life problems and it exquisitely entails a living will and a durable power of
attorney for healthcare (Carter, Detering, Silvester & Sutton, 2016). Also, it includes a specific
end of life therapy preferences. Besides, communication with the patient and family will improve
the incidences of futile medical strategies. I will provide correct, up to date and periodic
prognosis assessment, address the emotional needs of the family and attempt to comprehend the
issue from the family's prospect.
Furthermore, regarding the withdrawal of therapies, I will give an advance directive
which is an instruction that relates to the provision of health care when the person is unconscious
or incompetent (Mills et al., 2015). The process is aimed at enabling the facility to comply with
the Patient Self-Determination Act. Besides, I will plan for a family ethics consultation and hold
a meeting with the family members to resolve ethical issues, questions or conflicts involving the
patient’s care.