According to this case study, I discovered some ethical, dignity, and respect standards that were not followed in the case of the 40-year-old elderly woman (Ms. Y).
The oath must be followed by both medical and non-medical staff who are tasked with caring for the elderly in a care and nursing home. The Hippocratic Oath's goal, according to Jacelon, Connelly, Brown, Proulx, and Vo (2004), is to sustain beneficence and nonmaleficence, to enlighten and educate future health care professionals, and to protect secrecy. Beneficence principle was not followed by medical professions who worked at the hospital where 40 year old patient was admitted before being taken to the residential and nursing home. Beneficence principle governs health care providers to work towards the good of the patient and their best health physical, mental and emotional interest. Beneficence requires health care providers to be compassionate to a patient. In this case the health practitioners giving the elderly patient freedom to smoke independently is a breach of the beneficence principle.
Smoking for an elderly patient who suffered serious illnesses and is still recovering can lead to more illnesses in the future including chest problems, bronchitis, lung congestion and lung and throat cancer. Therefore, the medical healthcare professionals were not compassionate to the patient. They should have forbidden her form smoking after carefully explaining to her the consequences of smoking especially in her condition. Furthermore, at the nursing home breach of ethics is seen when the health care providers allow the 40 year old patient to go out unaccompanied in her delicate condition. Only after returning to the home at 2:00 am do they take further action of considering an extra hand for her during the evening. This is another example of health care providers not being compassionate to the patient whereas their task is to work towards the interest of the patient by providing protection, love, care and respect.
In this case study, there is no indication of the health care professions involving the patient’s loved ones and family in medical treatment options for her condition. They should be able to bring concerns and discuss on the patient’s smoking habits and risky social habits so that the family too can offer suggestions on how to help the patient. Involvement of the patient and/or close family members in treatment options falls under the autonomy principle of ethics. It is quite important that the health care providers involve the patient’s loved ones in decision making because they know what is best and preferable for the patient’s healthcare and recovery. This will lead to empowerment and more satisfaction with healthcare services of the nursing home. It will also foster patient-medical staff relationship thus creating synergy.
The patient is not formally informed of her medical condition in an informal consent set-up. The case study shows no indication of the patient’s discussion with a specialized healthcare provider who would have informed her of the possible risks of going out unaccompanied or the consequences of smoking. There should have been a dialogue to help the patient understand the repercussions of her risky social behavior and actually agree to stop smoking in order to improve her health. In this case, the health professionals refused to let the patient go out in the evening without company. They went further to forbid her from smoking and did not provide an environment that encourages smoking. It would seem like she was coerced to stop her way of living instead of being involved in decision-making through guidance in a respectable way. Being forced to adhere to rules and regulations without proper explanation and information consent could lead to depression, isolation, illness and early death among the elderly in nursing homes.
Ms. Y suffers at the nursing home due to dearth of experienced and specialized health care givers (Pleschberger 2007). The case indicates that the nursing home is short staffed thus evening support cannot be offered to her. Failure of the nursing home to employ adequate health care givers is a breach of ethics. This is because elderly patients are special and they have different needs and requirements. They should be adequately staffed to ensure that every patient’s needs are well catered for. Adequate staffing will ensure specialization and sensitivity to a patient’s concerns without generalization. Additionally, nursing home for the elderly should hire staff that is well trained and specializes in elderly healthcare. According to the case study, it seems like the staff at the hospital wing for the elderly and dementia patients along with those at the residential nursing home were not adequately trained to care for elderly patients. Elderly patients require special medical in a respectful manner but in this case, there is lack of sensitivity to the patient’s well-being.
Breach of ethics is also committed when the patient is not allowed to write her ethical will also called legacy letters where she would express her wishes and values. Ethical wills enable health providers understand their patients better and offer services that are satisfactory. They also result to closure between the patient and loved ones (Hall, Dodd & Higginson 2014). Provision for an opportunity to write the legacy letters result to the patient feeling valued and respected in a health care setting.
According to the code of principles that maintains elder dignity, elders should not be shut down or excluded from taking part in decision making on matters pertaining to their healthcare. Health practitioners in this case study did not involve Ms. Y in decision making for healthcare that suits her needs. Instead she is forbidden from smoking and forced to stop her evening social gathering with her friends. Moreover, her family did not actively involve her in decision making. They shifted her from the hospital that offered care for elderly and dementia patients to the residential nursing home without asking of her opinion or getting her consent.
Another code of principle outlines that nursing care workers should not treat elderly patients as objects. The voice of the elderly should not be overlooked; instead they should be listened to, protected and respected (Jacelon, Connelly, Brown, Proulx & Vo 2004). Healthcare providers at the residential nursing home breached this principle by not offering Ms. Y protection as she went for evening social gatherings with her acquaintances. Medical and non-medical professions should also maintain the right attitude towards elderly patients to ensure their needs are always met and maintain dignity.
Therefore, codes of conduct were breached in this case study when the health care providers treated the 40 year old patient as an object and did not give an informal consent of her health condition in a way she could comprehend. The family also committed breach of dignity and respect when they changed her environment without acquiring her permission. Medical profession performed medical intervention without the consent of Ms. Y and did not allow her speak for herself and giving her opinion. They also showed lack of respect for Ms. Y’s personal habits, values and her way of living. They also demonstrated lack of consideration for the comfort and active participation of the patient to establish her sense of belonging and self-worth. Health care givers have authority over their patients because they are medical experts and know the best treatment options for each patient depending on their health status. Dominative power can be exercised over stubborn patients who refuse to undertake medication for instance violent psychiatric patients.
Question 2
With the following ethical principles, the nursing home can improve its services to ensure patient satisfaction.
2.1 Offering Respect
Health care professions should respect the needs and requirements of patients and their family members in order to maintain close relationships and improve decision-making. Respect envelopes recognizing a patient’s dignity, having the right to judgment, avoiding and eliminating patient suffering and paying close attention to patient’s specifications (Pleschberger 2007). The nursing home can improve its services by respecting patients through attending to patient’s needs. The medical and non-medical staff should be sensitive to patient’s specifications. In this case, Ms. Y has an active social life where she likes to interact with her friends in a social setting. The nursing home should meet her needs by enacting someone to accompany her in the evening. Another form of respect is demonstrated by engaging patients in decision making processes instead of making decisions for the patient. The healthcare providers should involve Ms. Y in decision making regarding her smoking issue. Instead of prohibiting smoking in the premises they should engage Ms. Y in a discussion so that a common ground is reached where both parties are in agreement. Thirdly, the healthcare providers should appreciate and respect choices of their patients. This will ensure that the elderly maintain their dignity. Thus they should allow patients to have freedom of deciding what is favorable to them instead of forcing a decision upon them.
Another act of respect is effective communication. Healthcare providers should actively communicate with their patients. This will assist in building a relationship between patients and the staff. The staff will also have a better understanding of every patient and know how to best serve patients depending on their different values, needs and specifications. In this case, health professions at the nursing home should openly communicate with their patient Ms. Y; through this she will be able to able to express herself more often and the staff will have a clear view of how to deal with her concerns. The medical professional team should refrain from exhibiting judgment on their patients. Communication and health action should be undertaken in a neutral manner without condemnation on the patient. Thus the staff at the nursing home should refrain from condemning Ms. Y’s lifestyle or exercising judgment on her actions. Instead of prohibiting smoking as an illegal activity, they should deal with her smoking case with neutrality in a way that does not display judgment for her action.
2.2 Exercising Confidentiality
Confidentiality requires that medical practitioners keep sensitive information shared by patients and/or their family private. Confidentiality entails that the medical team be trustworthy, loyal and demonstrates integrity. When health care providers maintain confidentiality patients build trust in them, which leads to stronger patient-staff relationship. Thus the nursing home health providers should maintain confidentiality of information shared by patients. This will ensure sense of value in the patients.
2.3 Moral Courage and Accountability
Moral courage simply means standing up for what is right according to moral values despite contradictions from society expectations. In this case, the medical staff at the hospital responsible for care of the elderly and dementia patients lacked moral courage. They allowed Ms. Y to proceed with her harmful smoking behavior despite her health vulnerability. Despite the nursing home exercising moral courage, they did not respect the patient enough to value her judgment and involve her in decision making.
2.4 Offering Medical Care that is Cultural Sensitive
Ethical principles require medical practitioners to give culturally sensitive medical care in a trusting, respectful and responsible manner. Culturally sensitive care involves considering the patient’s verbal and non-verbal cues. The nursing home should give equal care to patients regardless of their health situations or economic, social or political background. In accordance with Hall, Longhurst and Higginson (2009), cultural sensitive care is best offered when communication is elaborated in the right comprehension and understanding of health care options as well as treatments. Effective communication that is culturally diverse consists of the following dimensions:
2.4.1 Conversation Tone and Pace
In some instances, silence is an indication or respect and acknowledgement. Sometimes the word “no” may be perceived as rude. The loudness and abruptness of a conversation varies with the culture. People of a certain culture give volumes of information while others may give concise and precise information. For instance Italians are often loud and volatile while Native Americans are soft spoken and direct; they view loudness as being inconsiderate. Russians are always concise and precise.
2.4.2 Maintaining Eye Contact
Eye contact may vary from direct and intense to a roving stare. According to some cultures, avoiding eye contact indicates respect and non-invasion of privacy. For example, people from Vietnam do not encourage eye contact between people of different status, age or gender. According to Iranians people of same status should maintain eye contact.
2.4.3 Personal Boundaries
Standing away from someone could mean respect for one’s personal space while standing too close could signify aggressiveness. For instance Chinese maintain a distance of 4 to 5 feet when engaging in a conversation. They also prefer side-side conversations to face-face conversations. Poland people maintain close proximity with people familiar to them but a distance with strangers.
2.4.4 Touch
The aspect of touch varies from culture to culture. In some cultures people of the same gender are allowed to touch while conversing while those of the opposite gender are forbidden from touching. Other cultures maintain it a taboo for a patient to be treated by a medical practitioner of the opposite gender especially if it involves handling of the genitals. For example Mexicans feel comfortable touching a close family member or comrade but physical contact with strangers.
2.4.5 Time Sensitivity
Observation of time is very important in some cultures especially in the US. In some cultures, time sensitivity is not vital as long as discussion is still achieved for example in the Jamaican, Central American and Philippine cultures. Germans are extremely time conscious and do not tolerate lateness to appointments.
2.5 Use of Power
Health care providers at the nursing home can exercise power by maintaining effective communication with patients, establishing alliances with patients and patients’ close family members, speaking patients’ language, being competitive medical staff and listening to patients’ complaints, suggestions and concerns (Hall, Longhurst & Higginson 2009). Power can also be exercised through continuous medical study and research, training, skill development and medical practice based on evidence. Therefore health care providers at the nursing home can improve their services through training and developing skills in specialized elderly care that is culturally sensitive. Furthermore, interpreters should be hired to assist in communication between the staff and those who are not English proficient at no extra cost and in a timely manner. Close friends and family should not be used as interpreters. Other ethical principles that are applicable to this case study include beneficence, non-maleficence, autonomy, fairness and justice. Beneficence ensures that every health practitioner exercises compassion and works for the well-being of their patients. Non-maleficence ensures that treatment options do not pose risk to the life of the patient. Risky treatment programs should be avoided at all costs. Autonomy ensures that patient rights are adhered to as well as those of close family members therefore treatment procedures cannot be undertaken without the consent of the patient or close family. Fairness ensures that health care providers involve the patient and close family members in decision making on healthcare matters and treatment plans. Justice ensures that a patient is not required to undertake a certain treatment plan against his or her will.
Question 3
As a care assistant at the nursing home, I see the importance of an informal consent. The policies of the organization do not encourage active discussions between patients and the healthcare team; therefore synergy may be lacking causing lack of patient-staff relationship, misunderstanding, and lack of attentiveness to patient needs leading to patient depression. As a care assistant, I would encourage an informal consent set-up, whereby I would be able to interact with patients, explain to them about their medical case in detail and treatment options available. I would also acquire their feedback, which health intervention method most preferable to them. This interaction will make the elderly patients feel valued and respected. It will also create a sense of trust for the medical staff.
It is also very important to encourage a patient’s family members to involve the elderly patient in decision making; this also applies to healthcare providers. In the case of Ms. Y her family did not consult her about the transfer from one care home to another. Therefore as a care assistant I would educate her caregivers on the importance of actively communicating with the patient to get her opinions and feelings about treatment plans. At the nursing home, I would advocate for patient involvement in decision making on matters pertaining their well-being. For instance instead of forcing Ms. Y to quit smoking by putting restrictions on smoking zones, her medical healthcare provider could take her through a rehabilitation program where they could discuss the repercussions of smoking to her health and establish a progressive recovery schedule.
I also see the importance of increasing the number of staff at the care home. This will prevent short staff in cases where specialized care is to be given to patients. According to healthcare principles, healthcare givers should be sensitive to patient needs. Increasing the number of care givers is a way of demonstrating patient sensitivity. Elders require special care and they do not all have the same needs hence every elder should have at least one special care assistant to cater for their needs. Providing a specialized care assistant to Ms. Y will ensure she is well taken care of she can continue with her active social life. It is also important for the staff to be educated and trained on how to offer specialized elderly care.
As a care assistant, I would advocate for proper follow-up of medical code ethics to ensure patient satisfaction with care services, synergy and protection of patient rights. Principles of autonomy, beneficence, non-maleficence, justice and fairness should be strictly followed at the care home.
Healthcare should be provided to patients in a neutral manner, which is free if condemnation and judgment despite patients health statuses and lifestyle choices. This also accompanies confidentiality of information. Healthcare providers at the nursing home should be trustworthy and loyal as not to disclose sensitive information about a patient’s life. Such information should be kept in hospital records under patients’ files.
Reference List
Hall, S., Dodd, R.H. and Higginson, I.J., 2014 “Maintaining dignity for residents of care
homes: A qualitative study of the views of care home staff, community nurses, residents and their families.” Geriatric Nursing, 35(1), pp.55-60
Hall, S., Longhurst, S. and Higginson, I., 2009 “Living and dying with dignity: a
qualitative study of the views of older people in nursing homes.” Age and Ageing, 38(4), pp.411-416
Jacelon, C.S., Connelly, T.W., Brown, R., Proulx, K. and Vo, T., 2004 “A concept analysis
of dignity for older adults.” Journal of advanced nursing, 48(1), pp.76-83
Pleschberger, S., 2007 “Dignity and the challenge of dying in nursing homes: the residents'
view.” Age and Ageing, 36(2), pp.197-202
