Adult Holistic Care Across The Age Continuum Nursing Essay.

The patient that will be discussed within this care plan using a systematic approach using the ABCDE, is a female named Mrs J, aged 67 years old. Mrs J was brought to the hospital by her family, who informs the nursing staff of Mrs J past medical history of heart failure. In this instance there were no signs of any chest pain, Mrs J had sudden onset of dyspnoea with feelings of unable to swallow and coughing up frothy mucous. Mrs J also had a pale complexion and had dry skin, and was very tachycardia, hypertensive, respirations were over 20 and low saturation levels.Adult Holistic Care Across The Age Continuum Nursing Essay.

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Respiratory failure is a condition in which the level of oxygen in the blood becomes low or the level of carbon dioxide in the blood becomes too high. Causing the inability to maintain adequate gaseous exchange and is a life threatening condition. It is important to do an accurate assessment so nurses and the multidisciplinary team can give the appropriate nursing care and treatment can be administered and the evaluated effectively (Higgins, 2008).

   Patients shows signs of dyspnoea this may cause the patient to appear anxious or exhausted or they maybe unresponsive. Hypoxemia can alter a patient’s mental state, and delirium or confusion might take place. Hypoxemia can be caused by decreased oxygen content of inspired gas, hypoventilation, diffusion abnormalities (Lippncott Williams & Wilkins, 2007). Dyspnea has been more specifically defined by as the “subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. (Sharma, Mukul Agarwal, 2010)The patient’s skin colour maybe pale and central cyanosis maybe present; which is a bluish discoloration of the skin. Central cyanosis (decreased oxygen saturation of haemoglobin in arterial blood) is best seen in buccal mucous membranes and lips. Peripheral cyanosis (slow blood circulation in fingers and toes) is best seen in nail beds. (Carpenito-Moyet, 2009). Mrs J’s general presentation was showing signs of anxiousness, pale skin, but no late indicators of cyanosis, she also appeared to be confused.

  Mrs J adopts a posture to make the most of lung expansion, Pursed lip helps Mrs J with her breathing so she can control shortness of breath. It is a quick and easy way to slow your pace of breathing, making each breath more effective. The accessory muscles as a compensatory mechanism to improve gas exchange; it is typically only used when the body needs to process energy quickly (Richardson, 2006). Mrs J appeared to be in respiratory distress as she was using her accessory muscles like her neck, shoulders and diaphragm and leaning forward with her shoulders hunched.

   The respiration rate is measured when the patient is at rest and it simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates can increase with fever, illness, or medical conditions. When checking respiration, it is also important to check whether the patient has any difficulty breathing likes of Mrs J. There are Electronic devices are available to perform this task of measuring the respitaroy rate but maybe unreliable so manual counting of the number of breaths is preferred (Timby, 2009). The patient will be observed for rate, depth and pattern on breathing. Respiratory rate in adults are between 12 – 20 breaths per minute. (Marieb & Hogan, 2007). Mrs J’s respiratory rate was high at 25 breaths per minute and was showing signs of tachycardia which is increased pressure from the heart due to not enough oxygen to the tissues and vital organs. This means the heart was pumping faster to compensate (Waugh & Grant, 2006). With Mrs J having respiratory disease she is likely to have an elevated respiratory rate to make it easier to gain the right amount of oxygenation air and ventilation of air (Brooker & Nicol, 2003).Â

   Observations of the rhythm and depth of breathing indicate the quality of each breath. Mrs J’s has a rapid irregular breathing pattern that does not allow expansion of the lower lobes of the lungs will also result in ventilatory failure (Brooker & Nicol, 2003). Changes in the pattern of respiration are often found in disorders, Mrs J was suffering from hyperventilation which will increase in both the rate and depth of respiration. This follows extreme exertion fear and anxiety which was in Daisy’s circumstance (Dougherty & Lister, 2008).    Â

   Oxygen saturation is a percentage of haemoglobin molecules saturated with oxygen. The normal arterial oxygen saturation is approximately 95 – 100% (Harvard University, 2002). A pulse oximeter measures the oxygen saturation of a patient’s. It will be attached to a monitor Mrs J so staff can see the her oxygenation at all times, it is a simple, non invasive way of measuring oxygen saturation of blood to see whether it is in normal range (95-100%). “In hypoxiaemia, the blueness of the blood will be measured by the pulse oximetry. This can be really useful but pulse oximetry has its limitations. It doesn’t detect changes in carbon dioxide levels” (BMJ, 1998) Pulse oximetry should be available in all places where emergency oxygen is used (Dougherty & Lister, 2008).

An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery. This test is used to check how well your lungs are able to move oxygen into the blood and remove carbon dioxide from the blood. As blood passes through your lungs, oxygen moves into the blood while carbon dioxide moves out of the blood into the lungs. An ABG test uses blood drawn from an artery, where the oxygen and carbon dioxide levels can be measured before they enter body tissues. Oly the doctor can do this test or people that are trained to do so (Timby, 2009). Mrs J’s blood test was sent to microbiology to be tested, this is so it can help us to make a diagnosis and indicate the severity of Mrs J’s affect of the her illness. ABG’s provides the multidisciplinary team with information on the patient’s oxygenation, adequacy of ventilation and acid base levels. These are some of the things that are looked at within the blood sample given; blood ph for acidosis, carbon dioxide levels for any signs of respiratory problems and it also looks at your oxygen levels (Timby, 2009).Adult Holistic Care Across The Age Continuum Nursing Essay.

  There is also an orthopneic position which allows maximum vertical and lateral chest expansion, also provides comfort for resting and sleeping, however this was not appropriate for Mrs J condition (Timby, 2009).

   Oxygen will be prescribed by a doctor for Mrs J and the prescription should include flow rate, concentration, delivery device, duration and method for monitoring treatment for Mrs J (Dodd, 2000). Oxygen therapy is for administrating more oxygen that is present within the environment around us to prevent or relieve hypoxemia (Carpenito-Moyet, 2009). Oxygen can be administered using a simple mask, partial or non re-breather masks, or a venturi mask. (Timby, 2008). The nasal cannula carries 1-6 litres of oxygen per minute. The oxygen fraction provided to the patient ranges roughly from 24% to 35%, or the cannula may merely supply humidified air. Nasal cannula would be the best method to use for Mrs J as it is non invasive and promotes comfort and less likely to feel suffocated, as Mrs J is feeling very anxious with everything that is going on around her. The oxygen mask that was used for Mrs J with constant reassurance by using distraction or relaxation techniques by the nursing staff was a non – re-breather mask, which delivers 90% to 100% oxygen (Timby, 2009). Patients who use non-breather masks need high concentrations of oxygen. This mask has a one-way valve to allow only oxygen from its source as well as the reservoir bag, to be inhaled all exhaled air leaves the mask rather than entering the reservoir bag therefore supplying Mrs J with higher level of oxygen. (Timby, 2009).Adult Holistic Care Across The Age Continuum Nursing Essay.

  Salbutamol is used for respiratory infections by acting on receptors in the lungs called beta 2 receptors. When salbutamol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open (Science Direct, 2006) So salbutamol was prescribed by the doctor and was administered to Mrs J by an ultrasonic nebulizer and it usually takes 8 – 10 minutes to breathe in one complete treatment. Nebulizer is commonly used for treatment of COPD and other respiratory diseases. It is a type of inhaler that sprays a fine, liquid mist of medication, through the mask, using oxygen under pressure. (NHS, 2008). Bronchodilators such as salbutamol are used to open up the small airways of the lungs (bronchi) in order for Mrs J to breathe more easier, this was used short term to provide short term relief as Mrs J was experiencing an episode of breathlessness and showing signs of anxiety. (NHS, 2008).

   Respiratory infections can be diagnosed by sending sputum samples. It is matter that is expelled from the respiratory tract, such as mucus or phlegm, mixed with saliva (Dougherty & Lister, 2008). It is usually associated with air passages in diseased lungs, bronchi, or upper respiratory tract to microbiology for testing. The observations for sputum are colour, viscosity, odour and the amount is vital. Thick viscous sputum that is coloured indicates infection; white frothy sputum indicates pulmonary oedema (Dougherty & Lister, 2008). Mrs J’s sputum was white and frothy and was showing signs of oedema on both of her ankles. Suctioning was on standby as Mrs J was showing white frothy sputum and has difficulty in swallowing since being discharged six years ago due to cancer of the oesophagus, just to prevent any further obstruction. Routine of suctioning should be avoided and careful assessment of Mrs J respiratory function should be carried out instead (Pryor & Prasad, 2001). We should look for the location of secretions and whether this can be reached by catheter, each suctioning should last no longer than 10 – 15 seconds to decrease the risk of trauma, hypoxia and other side effects (Dougherty & :Lister, 2008)

By looking at Mrs J’s respiratory status by doing observations, looking at her respirations to see if they have decreased, listening to her breath sounds to see if there is any wheezing noises or gurgling sounds. These observations will determine the effectiveness of mechanical ventilation of Mrs J also to see if her condition has improved (Carpenito-Moyet, 2009). As well as Monitoring Mrs J’s oxygen saturation using the pulse oximetry, this was be monitored every 2 – 3 hours. Recordings will be documented on an assessment tool called the Modified Early Warning Score (MEWS) this provides a baseline for future reference (Timby, 2009). Oxygen therapy should be titrated downwards and stopped when Mrs J is showing signs of being stable and the oxygen in the blood is stable (British Thoracic Society (BTS), 2009).

   MEWS charts, this is an assessment tool that records patients vital signs such as Blood pressure, pulse, respirations, oxygen saturation, temperature and urine input and output, it also measures the patients pain. Mews charts help nurses and people within the multidisciplinary team to do an evaluation of clinical interventions and nursing care, to improve the patients’ quality of care (McArthur-Rouse, & Prosser, 2007). (As cited in: Dougherty., & Lister, S., 2008).

By using the Roper et al (1996, 2000) model for nursing based on a model of living will also provide the basis for a discharge plan and to facilitate safe discharge back into the community. Prior discharge Mrs J had surgery for a Percutaneous Endoscopic Gastrostomy tube (PEG). A PEG is placing a feeding tube directly into the stomach through a small incision in the abdominal walls using an instrument known as an endoscope (Tortora & Grabowski, 2003). This procedure is performed for providing nutrition to Mrs J who cannot have food by mouth, as Mrs J has had treatment for cancer of the oesophagus six years ago and has poor control over her swallowing ever since (Patient UK, 2010)). Oesophageal cancer the most common symptom is dysphasia (difficulty in swallowing) usually, there is a feeling that food is sticking on its way down to the stomach, liquids maybe swallowed easily at first, but in Mrs J’s circumstances this was becoming a problem (Pryor & Prasad, 2001).

General Practitioners (GP) are responsible for co – coordinating community services, Therefore should inform Mrs J on discharge of any feeding regimen changes. Feed preparation and regimes are generally advised by dieticians and prescribed by the GP (Patient UK, 2010). General Practitioners provide a complete range of care in the local community A discharge letter will be posted to Mrs J’s GP by nursing staff on the day she is going home and the Feeding regimes will be devised by a dietician. (British Dietetic Association, 2010)

   There are a variety of different types of feed which the dietician may use. Standard feeds are generally 1kcal/ml. There are also fibre containing feeds which will help Mrs J with her constipation. Mrs J was put on a feed called jevity 1500ml which was administered to Mrs J as instructed by the dietician (Timby, 2009).Adult Holistic Care Across The Age Continuum Nursing Essay.

A dietician is an expert in food and nutrition. They help develop, modified diets, participate in research, and educate individuals and groups on good nutritional habits. Dietician may provide specific artificial nutritional needs to patients unable to consume food normally. Dietary modification to address medical issues involving dietary intake is also a major part of dietetics. (Timby, 2009). As Dietician instruction Mrs J was using an Abbott’s pump, a feeding device widely used within hospital setting and home environment (Abbott Laboratories, 2010). As Mrs J was going to be on this feeding regime for a long period due to restriction of the oesophagus Mrs J felt this was suitable for her more than the bolus feed because of her dignity as she feels embarrassed on where the feeding tube was situated. The dietician should be involved at the earliest stage of discharge planning (Bapen, 2009)

   Mrs J will need to be referred to the district nurses, so a completed district nurses’ referral form is needed, this will be accepted from any member of the multi disciplinary team. On the referral form you need to be clear on what you want the district nurse to do or the reason for the visit (NHS , 2006). District nurses provides care from General Practitioners, Health Centres, and in patients homes, the team provides a 24 hour access care, support and advice. The team also includes a community matron; who are nurses with additional skills to support people with health needs. They play a central role in the assessment of care planning, co ordination and evaluation of nursing care to ensure Mrs J gets all help and support she needs (NHS Careers, 2010) District nurses role would be to look after Mrs J’s Feeding regime and any complications that may occur, such as toleration to the feed, Checking the stoma site for any infections that may occur or any signs of blockages within the tube it’s self (NHS Westminster, 2008). The district nurse is also to administer Mrs J’s medication most medications that come in tablet or pill form can be crushed and dissolved in water and passed through the feeding tube. District Nurses are there to also educate and advise with Mrs J and her family when needed; also they leave contact details as they provide 24 hours Care. The district nurse liaisons with the community dietician and documentation are filled out correctly (Timby, 2009)

  COPD is characterized by airflow control. Air flow limitation is usually progressive and is due to inflammatory in the lungs encouraged by irritants. The common cause of COPD is cigarette smokie, air pollution.The community dietician will be visiting Mrs J at home weekly or fortnightly to do a review on Mrs J’s weight to see if the feeding is working properly.The dietician will ensure that the feed is prescribed by the General practitioner and all equipment that needs will be ordered. Support and Advise is available at all times and the dietician will give all the necessary leaflets and contact numbers to Mrs J and her family in case of emergency. “The community dietician arranges necessary update training on eternal feeding for the multidisciplinary team as required Timby, (2009)”, also the dietician liaison with the multidisciplinary team on Daisy’s care. Adult Holistic Care Across The Age Continuum Nursing Essay.

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Legal And Ethical Issues In Mental Health Nursing Essay.

This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. It will explore how ethical decisions are reached and how they can directly influence patient care. To achieve this aim the author will examine a case study of a patient whose care he was involved with whilst in placement.Legal And Ethical Issues In Mental Health Nursing Essay.

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We will look at how, after an episode of self-harm, the patient refused any medical treatment for the wound and how this posed an ethical dilemma for the nursing staff involved in their care. Using the application of the Mental Capacity Act (MCA) (Great Britain (GB) 2005) and an established model for ethical decision making, we will look at how the decision of whether or not to enforce treatment for the wound was formulated and implemented.

Ethics can be seen as the study of human conduct and morality (Buka 2008). It is about people reasoning, thinking and applying a process of reflection (Adshead 2010); however these people may have opposing views, values and experiences on which to base their moral judgements to define what is the right and wrong course of action (Hendrick 2009) and the principles used to decide this, not only by the individual but also within social groups and societies. (Adshead 2010). From this we can surmise that ethics is a complex system of reflective thinking, which is used in the search for a standard that can be used to judge your own actions, or the actions of others, within your own moral code.Legal And Ethical Issues In Mental Health Nursing Essay.

The Nursing and Midwifery Council (NMC 2008) stipulates that nurses must respect a patients right to confidentiality at all times and ensure that the patient is informed about how information concerning them is shared. In accordance with this the name of the patient has been changed and permission has been sought from the patient to use them in the case study.

Case Study.

Anita’s story.

Anita is a young woman with a primary diagnosis of emotionally unstable personality disorder borderline type as defined by the World Health Organisation (WHO 2010). During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. As such the therapeutic session concentrated on exploring her feelings surrounding her impulses, alternative coping mechanisms to manage her thoughts of self-harm and strategies to help maintain her safety upon the ward.

As she felt that the pressure of being constantly watched would unsettle her further, thus not allowing her to manage her own feelings, it was initially agreed to place Anita on intermittent observation (as opposed to constant) within the scope of the policy on safe and supportive observations of the service that was caring for her (Oxford Health 2010). This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions and actions.

Later in the shift Anita approached staff and stated that she had overwhelming urges to self-harm and that she had acted upon them. She was taken to the clinic room where the wound could be cleaned and assessed. Anita presented with a laceration to the inside of her thigh which was deep enough to expose the adipose tissue beneath, however was not deemed by the medical staff to be life threatening.

Staff explained to Anita that the wound was deep enough to require stitching although not life threatening and advised her that she would need to attend the minor injuries unit of the local general hospital for assessment of the wound. At this time Anita, due to her mental state, could not fully appreciate the nature of the wound and felt that she needed to punish herself further by refusing treatment. The nurses on duty cleaned and bandaged the wound and allowed Anita time to consider the implications of her decision further. When Anita had calmed the nurse had a discussion surrounding the implications of not having the wound sutured such as infection, Anita’s possible need to attack the wound in the future and pain relief issues, However Anita maintained her decision not to have the wound sutured.

Following a wider team discussion around whether Anita understood the severity of the wound, thus having capacity to make a decision to refuse treatment, the Responsible Clinician (RC) spoke to Anita and attempted to persuade her to have the wound sutured. As Anita was still refusing to have the wound sutured the RC decided that an assessment would need to be carried out to ascertain whether Anita had the capacity to decide to refuse treatment. Upon completion of the assessment it was decided that Anita did have capacity to make decisions surrounding treatment at that time, within the framework of the Mental Capacity Act (GB 2005). This decision was reached due to Anita being able to understand the information being given to her, being able to retain the information and weigh it up to make a decision to refuse treatment.

Although this appeared to be an unwise decision, which felt uncomfortable to the team, it was agreed to monitor the wound, keep it clean and dry and continue to talk to Anita about her thoughts and feelings surrounding getting medical treatment for the wound. This collaborative approach allowed Anita opportunities to explore her emotions, thoughts and feelings and promote her autonomy whilst still allowing her to decide to have the wound sutured should she change her mind.

The main legal and ethical dilemmas that can be extracted from this case study are whether the Anita’s capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence.Legal And Ethical Issues In Mental Health Nursing Essay.

The Legal Dilemma. Mental Capacity.

What legal dilemma can be hypothesised as underpinning the decision making process of the mental health professionals in this case? Anita initially made her decision to refuse treatment shortly after self-harming. Self-harm has been strongly associated with borderline personality disorder (Motz 2008) where thoughts of self-loathing and self-punishment are common precipitators; the act of self harm can be seen as a symptom of internal turmoil, an expression of internal pain or as controlling factor to maintain a level of care (Grocutt 2009). This may indicate that Anita was under a great deal of distress at the time, which could have affected her capacity to make sound decisions; however her later decision of continuing to refuse treatment was based on her own morals and values towards her body that may have included these thoughts of self-loathing and the need to be punished. Although a person, under part four of the Mental Health Act (GB 2007) can be treated for mental disorder without their consent, it is important to note that a physical problem can only be treated without consent should the person lacks capacity or treatment is deemed to be in their best interests under the auspice of the Mental Capacity Act (GB 2007, MIND 2009).Legal And Ethical Issues In Mental Health Nursing Essay.

To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. Firstly the practitioner needs to ascertain whether the person being assessed has some sort of disturbance of the mind and, if such a disturbance exists then it “must affect their ability to make decisions when they need to” (Department of Constitutional Affairs (DoCA) 2007:45). If this is not the case then the person cannot be seen as lacking capacity under the Act (GB 2005, DoCA 2007). In considering whether Anita needed to make the decision around treatment, we can see that, as the wound was not life threatening, it was decided to allow her time to settle and re-approach the question of treatment. The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. In deciding that the decision could be made at a later time not only complies with the Act but also promotes Anita’s autonomy. As the wound could be safely managed in the short term upon the ward the decision to allow Anita time to weigh up the information was the correct one to make.

Conflicting ethical principles and dilemmas

Lakeman (2009) points out that an ethical dilemma occurs when there are a multitude of alternative courses of action to deal with a particular situation. Conflicting moral principles may create difficult ethical dilemmas for nurses by having to contravene one moral obligation to uphold another (Beauchamp & Childress 2009). Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. However this may not feel entirely comfortable for the nurse. In mental health nursing, autonomy is sometimes overridden in the interests of promoting the principle of beneficence (Lakeman 2009). Which can make the nurses ethical dilemma difficult to manage due to balancing the two valid ethical principles of autonomy (respecting and supporting decisions making) and beneficence (relieving or minimising harm in the best interest of the patient) (Hendrick 2004, Beauchamp & Childress 2009). To answer the question we need to examine how the dilemma sits within an ethical theory and the principles that apply.

Beauchamp and Childress (2009) devised four basic moral principles which function as guidelines for professional ethical decision making. The principles of autonomy (freedom to act on your own belief), Nonmaleficence (obligation to avoid doing harm), Beneficence (providing benefits and help) and Justice (fair distribution of benefits, risk and cost) which are derived from a duty based theory of Emmanuel Kant (1724-1804) (Beauchamp & Childress 2009).

Principle 1 Autonomy.

Respect for autonomy flows from the recognition that all persons have unconditional worth, each having the capacity to determine his or her own moral destiny. To violate a person’s autonomy is to treat that person merely as a means: that is, in accordance with others’ goals without regard to the persons own goals.

Beauchamp & Childress (2009: 103) after Kant

Autonomy is “the freedom and ability to act in a self determined manner” (Butts & Rich 2008: 42) and the right of a rational person to achieve personal decisions without any outside interference. Therefore the principle of respecting autonomy concerns the nurse’s acknowledgement of, and obligation in respecting, Anita’s decision over her own life.

It may be that Anita is already feeling a loss of autonomy or disempowerment by the very nature of being a patient upon a secure ward and being under the Mental Health Act (GB 2007) and the restriction of her basic autonomous decisions such as when to eat, sleep or who she resides with. Therefore it may need to be considered whether Anita’s is refusal of treatment is something that she feels in control of, thus a way in which she feels empowered.Legal And Ethical Issues In Mental Health Nursing Essay.

Principle 2 Beneficence.

Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare… and …[is therefore]… a moral obligation to act for the benefit of others. These beneficial actions fall under the heading of beneficence.

Beauchamp and Childress (2009: 197)

Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). All actions that are performed by nurses can be regarded as having a moral dimension, most of which are for the benefit of the patient (Edwards 2009).

The NMC Code of Professional Conduct is clear in stating that nurses have an obligation to both protect and promote the “health and wellbeing” of patients as their primary consideration (NMC 2008:2) and this is no different for mental health nurses working with patients who self-harm. This statement clearly incorporates the principle of beneficence and shows that the nurses in the case study are considering whether Anita should have medical treatment for the wound enforced upon her due to the principle of beneficence as described due to the worries of the wound becoming infected if not sutured.Legal And Ethical Issues In Mental Health Nursing Essay.

The dilemma.

When nurses experience the ethical dilemma of having to enforce treatment irrespective of a patient’s right to autonomy, they can be seen as working in a paternalistic manner (Butts & Rich 2008). In Anita’s case, the nurses’ worry, that the consequences of the wound becoming infected, is driving their desire to treat the wound irrespective of Anita’s wishes. However, although the actions on behalf of nurses is clearly driven by obligations towards beneficence, nurses need to weigh up the harms and benefits of enforcing treatment before acting in such a way as to produce the best outcome for Anita (Edwards 2009). A paternalistic approach is frequently used to infringe upon a person’s right to autonomy. This infringement is “supported by the principle of beneficence, which is the argument frequently used to impose treatment on patients whether they want it or not” (Buka 2008: 29).

Should the decision to treat Anita for her self harm regardless of her wishes have gone ahead, there may have been a risk of impacting on the nurse-patient therapeutic relationship. This relationship is built upon trust as well as purposeful and effective communication (Buka 2008) and is considered to be the cornerstone of nursing care (Lakeman 2009, Pryjmachuk 2011).Therefore the nurses would need to consider future risk as part of the ethical decision making process. Enforcing treatment on Anita may produce barriers to the therapeutic relationship such as difficulties in trusting the nurse in the future, disengagement from therapeutic communication, opposition and rejection of future treatment, increased self harming behaviours due to the trauma and hostility towards others (Kettles et al 2007, Byrt 2010), all of which may stop Anita from telling the nursing team when she self-harms in future episodes of distress. This raises the principle of Nonmaleficence (doing no harm), in this instance to the therapeutic relationship, wellbeing and care of Anita.

The decision to manage the wound on the ward and allow Anita time to calm and consider her options is, in the author’s opinion, the correct course of action to take. As the wound was neither life threatening or of such a degree that it could not be safety managed upon the ward enabled the staff to consider the possibility of enabling Anita to make an autonomous choice. In considering Anita’s wishes and agreeing a management plan to care for the wound incorporates both principles of Anita’s autonomy and the nurse’s obligation towards beneficence.

Beneficence could be interpreted to incorporate the patient’s autonomous choice as “the best interests of the patient are intimately linked with their preferences … [from which]… “are derived our primary duties towards them” (Beauchamp & Childress 2009:207). If the nurse’s obligation to act beneficently is informed by the patient’s choices and preferences, then the respect for the patient’s autonomy will ultimately override any paternalistic actions on the part of the nurse (Beauchamp & Childress 2009). This would not only encourage a supportive nurse-patient relationship but also provides care that is holistic, develops Anita’s confidence in being able to negotiate her care and allows her to take greater personal responsibility, This in turn will promote empowerment and hope which will improve the potential for recovery and discourage overly oppressive practices.Legal And Ethical Issues In Mental Health Nursing Essay.

The practice of paternalism is now generally discouraged in health care (Butts & Rich 2008) and is considered unjustifiable in cases where the patient has capacity to make a decision (Edwards 2009, Beauchamp & Childress 2009).

Conclusion.

Every decision that a nurse makes concerning the care of a patient needs to be considered from an ethical base. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance.

The conflicting principles of autonomy and beneficence that have been presented within this case study would both be ethically and morally correct courses of action to take. From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation.Legal And Ethical Issues In Mental Health Nursing Essay.

A large proportion of moral and ethical dilemmas that are faced by nurses stem from the conflicting principles of autonomy and beneficence. However, the nurse’s ability to critically appraise risks and benefits will help them to make decisions that are beneficial to the patient involved. In encouraging autonomy for Anita involves taking risks on the part of the nurses’ which may go against their principles of nonmaleficence and beneficence. However with collaborative working practices this case study has shown that solutions can be found in even the most complicated of nursing dilemmas.Legal And Ethical Issues In Mental Health Nursing Essay.

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