Essay: Ethics – nursing case study

Ethics are standards of behaviour which nurses act on when caring for patients (Tschudin, 1986; Edwards; Holland et al, 2008, Kozier et al, 2008. Conflict between ethics and moral dilemma is enshrined in the NMC (2015) code ethics their role as nurses and duty to the patient who want to know the truth and the patients’ health and wellbeing (Benjamin and Curtis, 1993, Edwards, 1996).
 
Omar was allocated a bed in the stroke unit, his family was with at his bedside. Omar’s wife would have been present during the assessment as she could help with information. Alfaro-LeFevre (2008) recommend that nursing assessment are done in a separate for confidentiality as it allows the patient and family present to participate in the assessment. Omar’s assessment would have had his wife be present, even though he has a left side stroke which means he is unable to communicate. The healthcare professionals will explain to Omar what is going on and ask him simple questions which he can answer with a nod or pictures/symbols. NMC (2015) states the need to speak with appropriate volume when asking for personal details to maintain confidentiality. As he is unable to communicate he requires a lot of attention of ensuring successful interpretation of tone and register of language, facial expressions, body language and gestures that are between communicants about the context if exchange (Bradby 2001).

The assessment form which was used had personal details and the 12 daily activities of living. Holland (2008) says that these have to be legible so the next of kin can be contacted easily and that the patient name and age are clear to identify the patient correctly. Information of the patient’s job and the type of house the patient lives in helps to know how they might cope after discharge, in addition Holland states that religion of the patient should be known if the patient wants privacy during prayers, then it should be in the care plan.

A moving and handling assessment form was completed due to his mobility status, at the moment he immobile which means that he needs help with everything such as eating and drinking, personal care etc. Omar’s mobility will also be assessed, Omar walked unaided up until he had his stroke, since his stroke he has been bed bound as he can’t walk due to left-sided weakness. He is being washed and dressed in his bed as he unable to do it himself, he requires assistance in personal hygiene such as he uses a bed pan to go to the toilet. This can affect Omar because before he had a stroke he was independent but now he is dependent on others for toilet, bathing and washing which can be humiliating for some people therefore it is very important that we keep the patient’s dignity and cater for the individual’s preferences (Henley and Schott, 1999).

As Omar is immobile he will need help with personal care but due to his religion he may be reluctant to be examined or cleaned by health carers of the opposite sex. Omar will need help going to the toilet using a bed pan and bottle which means that you can ask him if would like a male or female to help as due to his religion he might have rules on who and who can’t help him with personal care.

As Omar is Hindu he may have food beliefs as he may not eat beef or pork and many follow a vegetarian diet and many can follow ayurvedic dietary practice which is a system certain foods are classified as hot or cold and the foods can have a positive affect or negative effects on health conditions and emotions. However, as Omar is nil by mouth at the moment due to his stroke put it should still be noted in his care plan for when he can eat again. Omar is currently unable to eat and drink as he has dysphagia which is difficulty in swallowing he hasn’t eaten since the party. They are going to put an NG tube in which will feed him and provide him with the vitamins and supplements he needs. They can put up IV fluids to ensure that he stays hydrated. His fluids should be monitored to ensure that he is staying hydrated. A stroke can affect the strength, speed and coordination of the muscle movements. Omar will have to have a nutritional assessment from a dietician consideration of possible enteral tube feeding as Omar is unable to eat or drink anything. In addition, they will also have to take into account his dietary requirements due to his religion.

In addition, Omar is incontinent has he unable to move and he has already developed a pressure ulcer (PU)on his sacrum. Omar is incontinent makes it worse as his skin can be exposed to faeces for an extended period (Doughty et al.2012, Gray et al.2012). Skin breakdown from incontinence is differentiated from other types of skin damage and can cause PU and skin tears (Gray et al.2012). PU can cause the patient to be distressed and have impaired psychological and social functioning (Gorecki et al.,2013), it can also decrease the patient’s quality of life (Rees et al.,2001). There is PU risk assessment tool which can be used for prevention assessment and management which is what the National Institute for Clinical Excellence (NICE) recommended. A systematic review of support surfaces to prevent PU reported that an alternative foam mattress shows improvement in PU as it alternates pressure whereas continuous low pressure is unclear (Chou et al., 2013). Alternating pressure mattress mould to the person shape therefore redistributing pressure whereas continuous low-pressure mattress alters the pressure surface (RCN 2005). Another way would be repositioning Omar every 2 hours as this will relieve pressure plus placing pillows underneath Omar will help. Place one pillow underneath his head and place is one leg on one pillow and place a pillow beneath his hip, pillows will help relieve the pressure and after two hours they can be changed to the opposite side. (Saintlukeshealthsystem.org,2017).

Hinduism encourages pain and suffering as part of consequences of karma as it seen as natural consequence of past negative behaviour, this may be a problem for nurses as they wouldn’t want to leave Omar in pain. NMC (2015) states that we care people equally no matter race, creed, religion or belief they come from and respect, and support and document a person right to accept or refuse care and treatment. (Health care providers’ handbook on Hindu patients, 2013).

The second part of assessment will focus on physical assessment and the 12 activities of daily living. When considering the activities of daily living there are two parts which should be looked at; usual and current routines as identifying the patient’s current habits and daily life will help in care planning and setting goals. They also do physiological, spiritual, social, economic and environmental needs which have to take into account when delivering individualized care (Roper, Logan and Tierney 2008). “Assessment is the cornerstone on which the patients care in planned, implemented and evaluated” (RLT 2008). “Poor or incomplete assessment leads to poor care planning and implementation of the care plan” (Sutcliffe 1990). A full assessment has to consider how the patients was before they became hospitalized in relation to their medical diagnosis, how they are now, what is the change /difference (Barrett et al). RLT (2008) says that there are 5 factors which influence the 12 activities of daily living; biological, psychological, sociocultural, environmental and politico economic not all of these will affect every single patient but they still have to be take into consideration.

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