Case study details:
Freda is 55years old, terminally ill with breast cancer that has progressively spread. She came to Nursing Home for End of Life Care. She has capacity and made decision to put DNAR in place. She has husband. She belongs to Christian religion.
Ethical Dilemma is Do Not Attempt Resuscitation
Four Quadrant Approach Ethical Framework has to be used in this case study. (Johnsen and Winslade)
Detailed Assignment Guidelines
| Introduction
(200 words)
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The introduction offers a general statement to introduce the main subject area and to set the context for the discussion. Including a broad background of information into your key ethical challenges and outlines all the ideas you are going to present in the assignment, such as:
– A statement/ definition of the importance of the topic and the context, background of and care delivery – Introduce the framework and link the learning outcomes – Introduce the service user/child you have chosen – Include statements dealing with confidentiality were necessary (NMC) |
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| Background
(250 words)
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Background information refers to a concise summary of the clinical & wider detail of this persons’ care which is relevant to the issues that you later discuss:
– Physical health – Mental health – Family and other relationships – Social circumstances- employment, religious/spiritual beliefs, sexuality etc. – Age and development (where appropriate) |
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| Key ethical challenge / Framework
(200 words) |
Short paragraph identifying what your key ethical challenge is, this is then expanded in your framework below. Outline the use of ethical frameworks and present reasoning for your preferred framework(s). | |
| Main discussion
(1400 words) |
Utilise your preferred ethical framework(s) as the structure to aid the discussion and identifying key issues regarding this person/child’s treatment, while using the legislation and ethical theories to support throughout.
Suggested structure to use combined 4 quadrant approach (Jonsen, Siegler, and Winslade, 2006) with considering of 4 principles of bioethics (Beauchamp and Childress, 2019) frameworks: – Medical indications (Beneficence and Non-maleficence) o Is the problem acute or chronic and / or reversible? What are the goals to treatment? Will treatment be successful? How can this patient benefit from medical / nursing care, and can harm be avoided? – Patient Preferences (Autonomy) o Does the patient have capacity? How do you determine this? What is the patient’s wishes / preferences with the treatment? Is it an informed choice? Is the shared decision making? Is there any advance directives? Is there someone making the decisions for the patient (LPA)? Is the patient’s right to choose being respected to the extent possible within ethics and law? Risk of paternalism? – Quality of life (Beneficence and Non-maleficence) o Can the patient return to normal life? Are there any expected deficits expected to the patient’s physical, mental and social life? Is there any biases that may cause prejudice to the evaluation of the patient’s life? Is there any plan to forgo treatment? Any comfort or palliative care plans? Could there be any harm / is the intent good for the patient? – Contextual Features (Justice) o Any family issues to consider? Are there any nursing issues that may influence treatment decisions? Financial factors? Religious / cultural factors? Confidentiality / information sharing issues? Law effecting treatment options (especially palliative care)? Any conflict of interest? Is the treatment fair? In each of these sections you need to be drawing upon the relevant legislation / policies / theories to critically discuss the key ethical challenge; Utilising them to support all your points / discussions (as references).
Critically analyse the role of the nurse, throughout each section of the framework and consider the learning outcomes when writing your report.
The Key Legislation, Policies / Guidelines and Ethical Theories, will be discussed throughout the module with dedicated revision session to collate all the information together towards the end of the module. See key legislation on AULA. |
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| Nurses Role
(300 words) |
Appraise the nurses’ role throughout – you may also want to also include a section at the end to discuss this concept more generally. Be careful not to repeat yourself – from discussions within the framework(s).
Consider – if not done previously: – Accountability and Advocacy – Risk of Paternalism – Virtue Ethics / the need for nurse to be ethical practitioners / compassion fatigue? – Are there limitations to the nurses’ role within decision making? – How is this relevant to the changing role of the nurse and future standards of education and proficiencies/competencies? – Resolving Conflict – What legislation / guidelines exist to support nurses and others in managing complex ethical, legal and policy issues? (The Constitution, the Code, etc.) Reflect on professional/national guidance to support practitioners in your field and draw from other’s where appropriate.
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| Conclusion
(200 words) |
No new information is required within the conclusion.
Summarise your discussions and highlight some of the key points. |
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| CU APA Referencing | No less than 20 relevant references – ensure you reference the framework(s) and all legislation used. You can directly reference the legislation i.e. Human Rights Act (1998). |
Recommended Reading and Reference Material
Avery, G. (2016). Law & Ethics in Nursing and Healthcare – An Introduction, 2nd edition. Essex University: Sage
Framework – Beauchamp, T., and Childress, J. (2013) 7th edition. Principles of Biomedical Ethics. New York: Oxford University Press
Bradshaw, P., and Bradshaw, G. (2010) Health Policy for Health Care Professionals. London: Sage
Cranmer, P. and Nhemachena, J. (2013) Ethics for Nurses- Theory and Practice. University of Huddersfield: Open University Press
Cuthbert, S. and Quallington, J. (2017) Values and Ethics for Care Practice. Lantern
Dimon, B. (2011) Legal Aspects of Nursing. England: Pearson Longman
Dimond, B. (2016) Legal Aspects of Mental Capacity: A Practical Guide for Health and Social Care Professionals, 2nd ed, Oxford: Wiley-Blackwell Publishing.
Graham, M. and Cowley, J. (2015) A Practical Guide to the Mental Capacity Act 2005. Jessica Kingsley Publishers.
Griffin, R. and Tengnah, C. (2020) Law and Professional Issues in Nursing, 5th edition. Swansea Univeristy: Sage.
4 Quadrant Approach – Jonsen, A., Siegler, M. and Winslade, W. (2010). Clinical Ethics, 7th ed. UK: McGraw-Hill
Seedhouse, D. (2009) Ethics: The Heart of Health Care. Chichester: John Wiley and Sons
Selman, D. (2011) What makes a Good Nurse- Why the Virtues are Important for Nurses. London: Jessica Kingsley Publishers.
