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NURS 3510 - Supportive and Palliative Care > Week 6 > Flashcards

Week 6 Flashcards

1
Q

define ethics

A
  • a branch of philosophy that deals with questions of right and wrong , and of ought and ough not in our interactions with others
  • how broad societal issues effect health and wellbeing
  • extends past “big ticket items” –> relevant in all interactions between providers, pts, and families
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2
Q

what are the 4 main ethical principles

A
  • autonomy
  • beneficence
  • non-maleficence
  • justice
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3
Q

what is autonomy

A
  • ensuring the informed pt’s right to participate in medical decision making
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4
Q

what is beneficence

A
  • clinicians act in the best interests of their patients

- promote wellbeing & do good

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5
Q

what non-maleficence

A
  • do no harm, including physically and psychosocial
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6
Q

what is justice

A
  • all people are to be treated well and fairly

- and also that health resources are used equitably

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7
Q

what is relational ethics?

A
  • overarching and underlying process that guides all clinical practice in palliative care
  • ethics of the everyday
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8
Q

what is an ethical dilemma

A

when we:

  • know what the issue
  • know what the 2 competing courses of action are
  • understand that choosing one course of action means that we cannot pursue the other
  • both courses of action have merit –> equally important reasons for doing or doing not something
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9
Q

what is ethical distress

A

when we:

  • know what the issue is
  • know or believe to know what course of action to take
  • but cannot take the action that we think is the right thing due to barriers
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10
Q

what are potential barriers in ethical distress (2)

A
  • environmental factors

- moral courage

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11
Q

what are some sources of ethical distress (5)

A
  • causing harm to pts
  • treating pts as objects
  • constraints related to policy
  • inadequate staffing lvls
  • issues related to resources
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12
Q

what are some consequences of ethical distress (2)

A
  • negative emotions and behaviors

- burnout

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13
Q

what are some examples of negative emotions and behaviors experienced w ethical distress (5)

A
  • frustration
  • anger
  • guilt
  • anxiety
  • self blame
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14
Q

what should you do when experiencing emotional distress (2)

A
  • identify the situation

- try identify solutions

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15
Q

describe decision making for minors in canada

A
  • no set age
  • varied and individualized
  • uses the “concept of maturity” –> assessment of capacity to participate in decision making is made on a case by case basis

(quebec = age 14)

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16
Q

what is an exception to the “concept or maturity” for decision making for minors in canada

A
  • MAiD –> must be 18
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17
Q

what are some examples of potential scenarios that might cause ethical challenges (7)

A
  • DNR
  • withdrawing or withholding treatment
  • pain mngmt at end of life
  • requests from family to withhold info
  • palliative sedation
  • assisted dying
  • artifical nutrition and hydration
18
Q

what is the principle of double effect

A

used to explain a situation in which we know an action has two effects:

  1. one anticipated and wanted
  2. one that is anticipated and unwanted
19
Q

what is the key to understanding if an action that related to the principle of double effect is permissable (ethically acceptable)

A
  • the intent of the action

- if the intent is a good outcome = permissable

20
Q

what are 2 examples of the principle of double effect

A
  • pain management at the end of life

- palliative sedation

21
Q

describe how pain mngmt at the end of life is an example of the principle of double effect

A
  • use of aggressive titration of opiods at end of life to manage symptoms = desired outcome
  • may hasten death = undesired outcome
  • justified bc the meds are intended to achieve pain relief, not hasten death
22
Q

what is palliative sedation

A
  • admin of meds (typically aggressively titrated) to help manage intractable symptoms such as pain, SOB, sufferring, etc.
  • involves giving meds to make a pt less aware , providing comfort that cannot be achieved otherwise
23
Q

describe how palliative sedation is an example of the principle of double effect

A
  • desired outcome = relief of intractable symptoms
  • undesired outcome = hasten death
  • justified as long as we want to relieve suffering (intent), not hasten death
24
Q

what is the criteria for palliative sedation

A
  • death foreseeable or immenent –> min of 2 weeks of less
25
Q

what is MAiD

A
  • occurs when an authorized HCP provides or administers meds that causes the individuals death at the request of the individual
26
Q

what is the criteria for MAiD (6)

A
  • have a serious and incurable illness, disease, or disability
  • in advanced state of decline
  • sufferring unbearably
  • 18 or older
  • informed consent
  • make a voluntary request without outside influence
27
Q

describe the relation between MAiD and palliative care

A
  • palliative care does not aim to hasten death

- but important to remember our role as nurses

28
Q

why might an ethical dilemma occur with requests from family to withhold info from the pt

A
  • stems from wanting to respect the family’s wish

- but also upholding our professional to be honest w pts and respect their autonomy

29
Q

what should you do if the family requests that you withhold info from the pt (5)

A
  • respond to the family w empathy (the request usually comes from a place of love & care for the pt, or maybe trying to protect them)
  • find out more from the fam –> what would the pt want
  • find out more from the pt –> how much info do they want, what is their understanding, how do they want info delivered
  • develop & continue a therapeutic relationship w the fam & pt
  • delve deeper into the request: try & understand where they are coming from
30
Q

what should you consider regarding artificial nutrition & hydration (5)

A
  • helpful vs harmful
  • goals of care
  • pt and fam wishes
  • diagnosis –> helpful or harmful
  • point of disease trajectory
31
Q

when addressing ethical issues, what tools should you use (7)

A
  • self reflection
  • 4 ethical principles (maximize beneficence, decrease harm)
  • the healthcare team (diff viewpoints)
  • CNA code of ethics
  • ethical frameworks
  • instituional ethics committee
  • palliative care team
32
Q

what is the role of the instituional ethics committee

A
  • helpful for challenging situations where despite our best efforts, too difficult to navigate situation
  • do not take over decision making but guide convo
33
Q

what reflective questions can you ask yourself when addressing ethical issues (6)

A
  • what are my beliefs and values
  • what are my fears
  • what are my attitudes
  • what are my biases
  • are my relationships w others in this care situation supportive & nurturing?
  • am i being pateint? compassionate?
34
Q

what is an approach to dealing w ethical dilemmas

A
  • time limited trial
35
Q

when is a time limited trial useful

A
  • helpful in situations where two parties are in disagreement over the use of a particular med interventions, and whether a specific interventions would be of benefit to the pt
  • when it is unclear if an intervention should be initiated and the outcome is uncertain
36
Q

describe how a time limited trial works

A
  • the healthcare team and pt agree to a trial of treatment over a specified period of time to see if the pt improves or deteriorates according to agreed-on clinical outcomes
  • if the agreed on outcome is met, treatment continues
  • if it is not, then treatment is withdrawn
37
Q

discussion prior to a time limited trial includes

A
  • what is the goal of the intervention (ex. decrease dyspnea)
  • what is the time frame that intervention will be trialed
38
Q

what are ethical frameworks

A
  • additional tool for when nurses are faced w a particular issue
  • set of guiding and reflective questions that help facilitate discussion
  • many different frameworks available
39
Q

what are example questions included in Oberle and Raffin’s Model of ethical framework (lots, im assuming we dont have to memorize?)

A
  • what relationships are inherent in this situation?
  • who is significant in this care situation, and how could they be involved?
  • are my relationships with others in this care situation supportive and nurturing?
  • what are the goals of care in this situation?
  • are these goals shared by the person in care, the nurse, and others?
  • what are my beliefs and values?
  • what values in the Code are inherent in this situation?
  • what values are imp for others in the situation, including other HCP?
  • do individuals involved have diff values? do these differences create conflict?
40
Q

what is moral courage

A
  • the willingness to take a controversial stand or one that challenges the healthcare organization or those in it, even when a person’s job may be jeopardized.
  • nurses who have moral courage & act on it are less likely to feel moral distress
41
Q

what is the canadian nurses association (CNA) code of ethics

A
  • document for all nurses that provides guidance for ethical relationships, behaviors, and decision making
  • nurses are to practice in accordance to the code of ethics
  • discusses ethical duties
42
Q

according to the code of ethics, nurses: (4)

A
  • work to relieve pain and sufferring
  • allow pts to live and die with dignity
  • encourage pts to discuss their wishes & goals
  • provide a palliative approach to care throughout the lifespan and illness trajectory (from time of diagnosis)

NURS 3510 - Supportive and Palliative Care (11 decks)

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