Evidence-Based Practice in nursing

The field of nursing is a broad field both theoretically and in practice. To make any ethical decision in the practice of nursing, a nurse must always refer to the respective theoretical framework. This paper will analyse the situation of Dr Jeremy Armstrong, who has dementia and how nursing as a practice channelled through evidence-based practice can improve the conditions of Dr Armstrong. This discussion will be divided into three parts, in which the first section would be analysing how Dr Armstrong's dignity could be affected by his behaviours such as the inability to urinate in the toilet and instead uses a paper waste basket, among other uncouth behaviours such as trying to sleep with a female patient. The first part will also identify the possible interventions that can be carried out to improve this situation. The second section will focus on Dr Armstrong's caregiver (Shirley), how she can be empowered to carry out her duties and the possible collaborations that can help her in the empowerment process. The final section will examine the principles of Law and Ethics, using the ethical codes and conducts nursing as a reference point, narrowing down to beneficence. The case study would look at how nurses could utilize the principal of beneficence to give Jeremy a better palliative care.

Section 1

Nursing Care

Two fundamental concepts define the practice of nursing care, and that is Dignity and comfort while handling a patient. Dubois, D'amour, Tchouaket, Clarke, Rivard, and Blais (2013, pp.110-117) write that dignity exists when an individual has the capacity of exerting control over his behavior, the environment and the way he or she wishes to be treated by others. The patient should have the capability of understanding the situation. According to this definition, an individual needs to have some competencies to be dignified. For instance, people suffering from intellectual disabilities may not have the capability to understand the situation and cannot exert control over their behaviors (Nettina, Msn, and Nettina, 2013). However, in the Nursing practice dignity involves compassionate care to a patient by him or her being human (Leuter, Petrucci, Mattei, Tabassi, and Lancia, 2013, pp. 348-358).

Jeremy is engaging in abnormal behaviours such as urinating in a waste paper basket and trying to sleep with a female patient. These could be an indicator that the Jeremy has a mental problem and has does not have the capacity to exert control over himself. This point is proved when Jeremy is agitated he regularly calls for his mother and Shirley. These signs are possible evidence that Jeremy has dementia (Rehnsfeldt, Lindwall, Lohne, Lillestø, Slettebø, Heggestad, Aasgaard, Råholm, Caspari, Høy, and Sæteren 2014, pp.507-517). This condition is defiantly affecting the dignity of Jeremy, and he would not have otherwise engaged in them if he had a sound mind.

Various nursing interventions could be carried out to prevent Jeremy from engaging in such acts and help in promoting his dignity. The first step towards helping Jeremy would be to help him to access the toilet and help himself out, without the help and guidance of a caregiver. This step would be an important in regards to improving Jeremy's dignity (Sanjari, Bahramnezhad, Fomani, Shoghi, and Cheraghi 2014). According to Jong, Schout, and Abma (2014, pp. 2651-2662), patients who have dementia or acute memory loss could be helped by the use of signs, pictures, and captivating photos. In the case of Jeremy, this can be done by using pictures and symbols and not words. Pinning images of the toilet and visible arrows showing the way to the washrooms could pass the information required for Jeremy to find the toilet (Ramezani, Ahmadi, Mohammadi and Kazemnejad 2014, pp. 211-219).

People suffering from mental impairment often fail to recognize the need of being patient and waiting for the appropriate time and place (Sanjari et al. 2014). This explains why Jeremy felt pressed and decided to urinate on a waste paper basket. This further explains why Jeremy tried to sleep with a female patient in the hospital. These acts embarrass the personality of Jeremy and cost him his dignity. Kangasniemi, Pakkanen, and Korhonen (2015, pp. 17744-1757), points that patients like Jeremy should be given constant explanations of what is happening to him and an assurance that everything would be back to normal (for this case, assure him that he will also go back home and be with Shirley again). These explanations would challenge the patient to be confident and independent again (Kangasniemi et al. 2015, pp. 17744-1757).

Wong, Cummings, and Ducharme (2013, 709-724), explains that patients who have dementia should be placed close to what they desire, for example, if the patient feels pressed then he should be near the toilet, such that he can see the toilet and access it. This will help him in making the right decision. However, this intervention fails at a point where Jeremy wants to sleep with a female patient. As per the tenets of this intervention, Jeremy should be placed close to the female patient to make the rights decision. Practically, Jeremy cannot be placed near the female patient to help him make the correct judgment, in this situation this intervention will not work.

Section 2

Empowerment

Empowerment is a multi-disciplinary subject, and its definition varies from one subject to another. For this case, the paper shall define empowerment as utilized in the practice of nursing. The goal of empowerment in nursing is to ensure the well-being of a patient (Lake, Hallowell, Kutney-Lee, Hatfield, Del Guidice, Boxer, Ellis, Verica and Aiken 2016, p. 24). Empowerment involves around valuing patient predilections in refining or developing health amenities. Empowered patients can make various verdicts on the conducts of their caregivers (Assasi, Schwartz, Tarride, Campbell, and Goeree 2014, pp. 203-220).

After discharging Jeremy from the hospital, Shirley needs to be empowered to take care of Jeremy effectively. Empowerment is a two-way lane; both the patient and the caregiver need to be empowered (Papastavrou, Andreou, and Efstathiou 2014, pp. 3-25). Dementia patients always experience cognitive impairment and are likely to make irrational decisions, based on their feelings and not their conscience. Therefore, to empower a patient who has dementia would mean putting in place strategies and programs that will help him in making the required decisions. In this case (theme 3), Jeremy is already empowered by the improvements done on the house such as improved lighting (to prevent disorientation in the dark), labelling of the toilets (to avoid previous accidents) among other strategies. Jameton (2013, pp. 297-308), approves such strategies in empowering dementia patients. Shirley, on the other hand, is not empowered at all to take care of a patient with a history of dementia.

According to Peter and Watt-Watson (2016), empowering caregivers involves the respective caregiver collaborating with the relevant stakeholders, in making the appropriate decisions. Shared decision-making among the relevant stakeholders can promote caregiver empowerment (Peter and Watt-Watson 2016). Shared decision-making means, coming up with the best method of taking care of the patient, secondly, providing several options to the initial decision decided (this can be done with the help of tools that support decision-making) (Roberts 2015, pp. 314-325). Lastly, helping the caregiver to discover the impacts of each choice and helping her decide on the best choice of action by the relevant professional body (Kalisch, Xie, and Ronis 2013, pp. 405-413). The relevant professional bodies involved include support groups, relevant agencies dealing with Alzheimer patients (Jameton 2013, pp. 297-308). This type of framework could have helped in identifying the possible alternatives to be used while taking care of Jeremy. The medical practitioners, on the other hand, would help Shirley in making the right choices on the diet of Jeremy. However, one major challenge to this framework would be the mental state of Jeremy; due to the effects of dementia Jeremy might not be able to comprehend the right choices to make, which would be beneficial to him. This situation cannot allow Jeremy to take part in the shared decision making process yet he is the key stakeholder (Kalisch et al. 2013, pp.405-413).

Section 3

Law and Ethics

There are various issues that when practicing nursing can present both ethical and legal implication in relations to the care of patients. In this case, theme 5 of Jeremy’s case study is a relevant situation that can present ethical issues in the practise of nursing. Dehghani, Mosalanejad and Dehghan-Nayeri (2015, p. 61) outline four ethical practices that nurses should adhere to, they include, Beneficence, Justice, Autonomy, and nonmaleficence. For the case study of Jeremy (theme 5), the paper shall cover Beneficence as an ethical practice in nursing.

Beneficence

Edvardsson, Watt, and Pearce (2017, pp. 217-227), defines beneficence as an action carried out for the benefit of others. These particular activities can be conducted as a positive step towards preventing or eliminating harm to improve the situations of patients. Nurses are expected not to engage in any situation that may cause harm, but instead, have the mandate to help their patients in the best way possible. Fowler and Davis (2013, pp.126-141) classifies the principle of beneficence into two as, requisite and ultimate beneficence. Ultimate beneficence encompasses of acts of kindness or the efforts to benefit people in any probable opportunity presenting itself. While essential beneficence is showing acts of charity within the line of duty (Griffiths, Dall’Ora, Simon, Ball, Lindqvist, Rafferty, Schoonhoven, Tishelman and Aiken 2014, p.975). The fundamental goal of medicine is to support the well-being of patients, and health practitioners should have abilities that are helpful in promoting patient welfare (Taylor, Fraser, Signal, and Prentice 2014, pp. 135-152). The kind of the association between caregivers and patients, mandate the nurses to; avert and eradicate any potential harm from the patient and balance the likely benefits against possible threats in any action (Kangasniemi, Vaismoradi, Jasper, and Turunen 2013, 904-916). Beneficence acts do not only involve the named practices. However, it also includes protecting the human rights of others, saving individuals who are exposed to dangerous situations and also helping physically challenged patients (Jones, Hamilton, and Murry 2015, pp.1121-1137).

In short, beneficence starts when a healthcare practitioner or a caregiver goes an extra mile to benefit the patient out of his or her stipulated job description (Griffiths et al. 2014, p.975). In this case (theme 5), the hospital authorities showed an act of beneficence when they allowed Jeremy to continue staying in the hospital in the last days of his life, despite an earlier proposal that Jeremy needed to spend the last days of his life in a familiar environment which was his house. After reaching a consensus that Jeremy should remain in the hospital, it is the mandate of the hospital to make sure that Jeremy has a proper palliative care. Palliative care should help one to live the best life possible and die a dignified death. The people who are giving palliative care should ask the patient's wishes and preferences (Badzek, Henaghan, Turner, and Monsen 2013, pp. 15-24). In this case, since Jeremy would be remaining in the hospital, it would be the duty of the nurses to offer palliative care to him. Therefore, the nurses should ask about the needs and preferences of Jeremy. Some of these requirements and preferences are likely to fall outside the job description of the nurses, and this is where the nurses should start practicing beneficence. Offering palliative care also involves supporting, the involved family and other stakeholders concerned with the patient. At this point, Nurses are advised to be as careful as possible not to expose the patient to any threat, including the risks that can be caused by various side effects of drugs (Badzek, et al. 2013, pp. 15-24). Nurses should be extremely careful when dealing with Jeremy at this point and exercise as much beneficence as possible to grant Jeremy a dignified death.

Conclusion

In conclusion, the practice of nursing involves around ethical codes of conduct, without these codes then the medical field would lose it meaning, and patient care would be void. The importance of using ethics in the practice of nursing is that it improves the trust of the patient in the healthcare system and improves service delivery in a health facility. Even so, as much as nurses exercise their duties with all the ethical considerations, some situations crop up within the hospitals that sometimes are tricky, and if not addressed carefully, they might lead to unethical practices. In cases, nurses are recommended to consult with the relevant stakeholders (these include, the patient, the family members of the patient, and the hospital authorities) on the way forward and the best course of action to take in this situation.

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