The Critique Of Ethical Consideration Of Patients

The Critique Of Ethical Consideration Of Patients With D

The critique of ethical consideration of patients with dementia 8 The Critique of Ethical Consideration of Patients with Dementia Yeni Hernandez GCU NRS-433V August 19, 2018 The critique of ethical consideration of patients with dementia Introduction Based on Pan et al. (2013) study, the severities of the behavioural and psychological symptoms that are evident for vascular dementia are clearly presented. The research focuses on the application of quantitative measures to understand the severity of the symptoms using a sample of 51 patients with vascular dementia (Pan et al., 2013). The analysis considered the fluctuation of the behavioural symptoms based on diurnal, evening, and nocturnal activities. The ageing population has been outlined as being a risk factor for the continued prevalence and rise in the cases of dementia for decades. This paper will critique the PICOT statement on the grounds of those living with dementia in their daily lives. PICOT statement for patients with dementia P- (problem/patient/population): the research will focus on patients living with dementia (PWD) I- Intervention will come in the form of integrating regular exercises to dementia patients to help improve memory loss and maintain a healthy fit. C- Comparison: if a patient cannot engage in productive and useful forms of exercises, provide a supportive environment through informal caregiving to facilitate relaxation and safety. O- Outcome: the outcome of the study is an improved overall safety of a patient living with dementia to reduce re-hospitalizations that result from injuries. T- Time- this will show the time required in addressing the problem of dementia among home care patients. Background information Dementia generally is used to refer to the symptoms shown by individuals and mostly relate to memory. There have been complaining about the existence of rare signs amongst patients who visit clinical institutions. This included the loss of memory hence reducing their ability to carry out their daily tasks appropriately. However, it had been clearly proven that there was little that was done in realizing the desired the desired solutions to help out the patients. At higher stages patients showed problems in communication and language, focusing and paying attention, perceptions relating to visions, judgment and how the patients reasoned out. This, therefore, prompted the need to carry out a qualitative and quantitative study with a major aim of presenting ethical issues that relate to patients with dementia. The study was based on scholarly articles to present appropriate information that can help curb such instances in most or all medical and clinical institutions hence saving the patients. It is evident that the lack of patient care and safety acted as the major reason as to why there was the need to carry out the study. The care and safety can best be provided by the members of the family and the clinical attendants in a bid to improve the quality of life. The close attention needed to the patients is because of their age bracket which is majorly the aged (Neubert, Kà¶nig and Brettschneider, 2018). The method of study In collecting relevant data relating to the statement or the problem, both qualitative and quantitative methods were used in the study. The relevant directions were achieved through the inclusions of the values, concepts, perspectives and individuals that acted as guidelines in the entire process of data collection and analysis. When dealing directly with the dementia patients questionnaires were used by the nurses (Pan, Yoshida, Liu, Wu, Wang, Zhu and Cai, 2013). However, there were different scales and assessment tools used in the establishment of the dominant symptoms as exemplified using the Neuropsychiatric Inventory (NPI) for assessment. Based on the assessment, vascular dementia (VD) was found as one of the forms of dementia that is linked to the presence of atherosclerosis (Pan et al., 2013). Some of the BPSD (behavioural and psychological symptoms of dementia) like aggressive behaviour, mood alterations, hallucinations, day-night rhythm disturbances, and agitation are common in the late course of dementia like VD and Alzheimer’s disease (AD) (Pan et al., 2013). Among the different symptoms, agitation is identified as being noticeably burdensome on family members and professional caregivers. The research identifies the necessity of using the BEHAVE-AD (behavioural pathology in Alzheimer’s disease rating scale) while monitoring BPSD. However, the BEHAVE-AD assessments fail because of their subjective nature and the overdependence on personnel resources in the hospital setting (Pan et al., 2013). The use of the NPI scale may demand the use of a semi-structured interview that is administered by the research or a clinician with the caregiver of the person with dementia. A research a few years presented the guidelines concerning dementia. The span of the study that was conducted took around six months in the year 2009 to December 2011. Further, the research was conducted at the Department of Neurology of Shuguang Hospital where the subjects were recruited from. The researchers firstly examined 138 patients that had been diagnosed with different dementia-related conditions, including, AD, Lewy body dementia, and Parkinson-dementia among others. The exclusion and inclusion criteria further attest to the rigour of the research. To enhance credibility, the statistical method was also used in evaluating the eligibility of the major topics relating to dementia in relation to the clinical operations. For instance, it was found out that only 56 patients met the threshold based on the mean age of 60.2 with the acceptable deviation being ± 9.7 and the mean duration of the illness being 6.9 and a deviation of ± 5.2 years. Of all the 56 patients used in the study, different portions had signs of varied dementia types. 26 had been diagnosed with multi-infarct dementia and 30 with subcortical dementia. The use of the Ninds-Airen criteria served to enhance the credibility of the research as the subjects fulfilled the conditions for the probability of VD. Some patients were excluded from the original samples to enhance eligibility. Those patients who had a historical background of other infections like schizophrenia were excluded based on clear inclusion-exclusion criteria in relation to the nursing ability needed in curbing the dementia conditions. This was done with a major aim of ensuring security in relation to the nursing ethics in Shuguang Hospital and the declaration of Helsinki. In using the chosen methods, the nursing and the general medical ethics were to be considered for patients showing signs of dementia. Therefore, the patients were evaluated on the basis of how the nurses administered drugs according to the prescriptions of the doctors. This was majorly done with an aim of enhancing the reliability and credibility of the study in general. The methods were used as complements to each other hence enhanced the reliability of the findings. SPSS Windows Version 17.0 was used because of the statistical approaches that were incorporated in the qualitative section that was majorly accounting analysis. Results of the study The study was successful based on the methods selected hence statistical errors were minimized. The subjects under research dropped with the initial number reducing by five leaving 51 patients to affect the study. This was so because some patients who had historical disorders were excluded from the study. It was realized that the behaviour of patients with dementia disorder was thought to relate to the aged in the society who later on displayed signs like the lack of memory. There was little attention given to the dementia victims by their family members and the medical practitioners especially the nurses. The government had done very little to help curb the problems experienced by the dementia victims in the society. It was therefore proven that the assumptions and the thoughts that dementia was associated with the aged were true and that its major signs were the loss of memory, poor judgment and poor vision. This is based on pieces of evidence in the articles and the general life experiences. Therefore, as much as the nurses are blamed for the little concern towards the dementia patients, their laxity is as a result of the lack of facilities from the government and other health stakeholders. Safety and care facilities are among those are rarely provided by the government especially towards the dementia patients. Based on the study, it was limited by sample sizes and the number of participants involved. Lack of inclusion of the nurses and other medical practitioners limited the amount of information collected. It can be recommended based on the results that the elderly should be given the efficient care just as the females and infants. The nurses also need to take up responsibility and use the little available resources in solving the health challenges in the society. Ethical considerations The entire process before being carried out was approved by the necessary authorities; health providers. This means that there was valid authenticity in investing the 56 participants with dementia disorders. Any information provided was secure and private hence was prevented from unauthorized access. The study was carried out appropriately without causing harm to the environment and its inhabitants. The participants provided a written consent before their participation. After analysis, any information recorded was to be destroyed while others saved and protected with a strong passkey (Hughes and Common, 2015). Conclusion Dementia should be seen as a deadly disorder hence the government should take caution in helping out the patients. Nurses should be at the forefront of using the available facilities to save the patients to enhance quality life for all and promoting professionalism. They should provide care for these patients so as to help them see their worth in the society. However, the family members should provide the necessary attention needed so as to help the patients curb personal challenges in their daily lives.

Paper For Above instruction

Dementia presents a profound ethical challenge for healthcare professionals, caregivers, and societies at large. The increasing prevalence of dementia, particularly among aging populations, underscores the urgent need to address these ethical considerations to promote patient dignity, autonomy, and well-being. Ethical issues in dementia care encompass informed consent, capacity assessment, autonomy respect, caregiving burdens, confidentiality, and resource allocation, among others (Hughes & Common, 2015). This paper critically evaluates these ethical issues, referencing recent scholarly research, with implications for practice and policy.

Informed Consent and Capacity:

A fundamental ethical concern in dementia care involves assessing patients’ capacity to provide informed consent. As dementia progresses, patients often experience cognitive decline, challenging their ability to make informed decisions (Sioui et al., 2020). Ethical practice mandates that healthcare providers evaluate capacity meticulously, respecting the patient's autonomy whenever possible. When capacity is impaired, substitute decision-makers or legal guardians are involved. However, this raises concerns about the adequacy and ethics of surrogate decision-making, which must balance respect for prior autonomous wishes against current best interests (Callaghan et al., 2017). Ethical frameworks emphasize transparency and best practices to ensure decisions prioritize the patient's dignity and previously expressed preferences.

Autonomy and Dignity:

Preserving the autonomy and dignity of dementia patients remains central to ethical care. Respecting autonomy involves enabling patients to participate in decisions about their care for as long as possible, which can be challenging as cognitive capacities diminish (Forde et al., 2018). Ethical dilemmas often arise when assessing the extent of autonomy that remains, especially in late-stage dementia where decision-making capacity is severely impaired. Care models advocating for person-centered care emphasize supporting patients’ preferences, identities, and routines, thereby respecting their dignity even when full decision-making is compromised (Rosenfeld et al., 2019).

Use of Restraints and Interventions:

The application of physical or chemical restraints raises significant ethical concerns. While restraints may sometimes prevent patient harm, their misuse can violate human rights and dignity (Hancock et al., 2017). Ethical guidelines advocate minimal use of restraints, prioritizing non-coercive interventions. Clinicians must weigh the benefits of safety against the risk of harm, including psychological distress, and ensure that restraints are used only as a last resort under strict ethical oversight (Burton et al., 2020).

Resource Allocation and Equity:

As the prevalence of dementia escalates, ethical issues regarding equitable resource allocation gain prominence. Limited healthcare resources often mean prioritizing patients with the most acute needs—yet, patients with dementia frequently require extensive long-term care, which strains systems (Bridges & Mor, 2017). Ethically, society has a duty to ensure fair access to quality care, including specialized facilities, trained staff, and caregiver support. Policies should foster equity, promoting community-based interventions and adequate funding to prevent disparities (WHO, 2021).

Caregiver Ethical Challenges:

Caregivers face their own ethical dilemmas—balancing their duties with personal well-being. Ethical support structures are crucial to mitigate caregiver burnout, which can impact patient care quality (Neubert et al., 2018). Respecting caregiver autonomy and providing psychological and financial support are essential ethical considerations for sustaining compassionate dementia care.

Confidentiality and Privacy:

Maintaining confidentiality is fundamental in all healthcare interactions. In dementia care, sharing information among caregivers, families, and health professionals must be balanced against the patient's right to privacy (Hughes & Common, 2015). Electronic health records and multidisciplinary communication should adhere to strict privacy standards, ensuring that personal information is protected while facilitating coordinated care.

Implications for Practice and Policy:

Effective ethical dementia care requires integrated approaches aligning clinical practice with legal and policy frameworks. Implementing advance directives and establishing clear guidelines for capacity assessment can enhance respect for autonomy. Education initiatives should prepare healthcare workers in ethical decision-making, especially regarding consent and restraint use (Rosenfeld et al., 2019). Policies aiming for equitable resource distribution and caregiver support are critical to uphold justice in dementia care.

In conclusion, ethical considerations in dementia care are complex, necessitating a delicate balance between safety, autonomy, dignity, and resource allocation. By adhering to ethical principles, respecting patients’ rights, and supporting caregivers, healthcare professionals can enhance quality of life and uphold human rights for individuals living with dementia.

References

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  • Callaghan, S., Finucane, J., & Mountain, G. (2017). Ethical aspects of surrogate decision-making in dementia. Journal of Medical Ethics, 43(2), 85-89. https://doi.org/10.1136/medethics-2016-103729
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