NURSING DILEMMA : TRUTH-TELLING IN TERMINAL CARE PATIENT INTRODUCTION:
Cancer is one of the leading cause of mortality and morbidity in Singapore. In fact, top 5 leading cause of cancers breast cancer 63.4%, colorectal 38.7%, lung 33.8%, prostate 28.1% and liver cancer 16.6%. Based on statistics, there is an increasing number of death related to cancer each year. Nowadays, people tend to be more cautious about cancer and involve in self awareness program. Patients understanding about cancer means "death" and most likely need to hide the diagnoses to them.. "It 's very unpleasant to tell the patient that they have a terminal illness. One can understand why most doctors and nurses neglect this duty" (Varga,1980). Few things need to consider when telling to patients and patients family with regards to their prognosis like patients reactions or emotions and even financial resource. Health care professional are expected to give the detailed information to their client whether it is desirable or undesirable news. But on the other hand, they need consider whether telling truth would help or make situations more worst. Ethical dilemma among health care professional arises, either telling the truth or withholding the truth would benefit the patient.
In health care settings, truth telling about terminal care is a common ethical dilemma: either by telling truth or withholding the truth is the main concern. More often, doctors and nurses work closely
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Today's health care system is difficult to understand. It has undergone dramatic changes over the years. There are many changes that shift the movement from "an indemnity plan to a managed care system. " Not only has the U.S. health care system undergone dramatic changes, but as well continues to evolve to a rapid pace (Conklin, 2002).
This is a part of the stage where finding recovery and answers challenge doctors and the loved ones that are suffering. In the Institute of Medicine’s critical report Dying in America, there is an idea that emphasizes the importance of making a decision for the patient that is on the stage of death. JoAnn Grif, writer of Dying in America, identifies that decisions for a patient should be made before as a living will from the patient’s own preference and decision. Letting the doctor know so it can improve communication and awareness for the individual that is on treatment, and this consent should ahead of time and planned out. Although, how soon should patients reveal a will to their doctor, some will ask.
Death is a natural process that will be experienced by everyone at some point, desirably at the end of a long, well lived life. The reality is that no one knows when that time will come or how it will happen. Unfortunately, for the terminally ill, death is in the near future and it is a sobering reality. Therefore, when that time comes, people need to know that they will have options, and the assurance that death does not have to be an agonizing end. They can choose to endure the annihilating pain that comes with the disease and allow it to take its natural course or choose to put an end to it, surrounded by those who love them.
In the UK, policies for health, safety and security are not only give positive impact it also creates dilemma in relation to implement. Dilemma refers to a situation in which a difficult choice has to he made between two or more alternatives, especially equally undesirable ones. There are different types of dilemma in safety. This includes * Resource implications
Truthfully I would not want to be the one to tell a patient they are dying. If it is part of my responsibility I will do it the best of my ability. I believe I would tell the patient in a gentle voice and stay with them as they process the news. If the patient is upset, I would offer them any knowledge I have and sit with them until they have calmed down.
In “ How Doctor Die”, an article written by Ken Murray, is about the way to prolong the life of doctors and patients when they have terminal illness. In most cases, a doctor home went, closed their practice and never set foot in a hospital again. They want to have more time with family. Doctor is a person treat the desease and save the patients; however, when they have illness, they are also like other patients. They can meet a difficulty with their patients in treament,but they feel easy when they are a patient.
Some cancer patients pass away feeling little pain or discomfort. Both diseases have misconceptions about them. The reason these misconceptions exist is because both diseases have been associated with death (Sontag 18). However, cancer is still associated with death and it is impossible to try and romanticize cancer like tuberculosis was
An Integrative Review. JAN Journal of Advanced Nursing, 1744. Karlsson, M. B.-F. (2015). A Qualitative Metasynthesis From Nurses’ Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care. International Journal for Human Caring, 40-48.
Some suffer more than others, people experience death differently due to different causes of death. Moreover, in health care, physicians experience difficult situations that require ethical decisions. Patients at the end of life process do not always have the capability to make decisions for themselves. The burden to make medical decisions is left to families and physician’s. Some cases are so intense, because patients voluntarily request assisted suicide.
In all my experiences as a nurse, I’ve realized the importance of communication, providing holistic care to an individual and empowering them with the knowledge to manage their health. When an illness strikes a person, it affects not just his body, but also his mind and spirit. The art of communication is invaluable to patient interaction and establishing a therapeutic nurse-patient relationship, that facilitate coping mechanisms for patients, moreover it prepared myself as a nurse to meet their individual needs. Furthermore, there is at the moment an insurmountable demand for survivorship care as a result of the advancement in technology and medicine, which made living beyond life expectancy possible for increasingly more people. Living after cancer treatment is not free of complications as there are acute and chronic side effects of treatment that requires constant monitoring and attention, and this information spurred me to shift my focus from palliative to survivorship care.
It brought to my awareness both the limitation and the capacity of medicine. Although there was no medical intervention that could cure the diseases of those terminal patients, their quality of life was improved by an outstanding team of doctors, nurses and volunteers. This awareness helped reconcile myself to the fact that certain things, such as death and terminal illness, can not be avoided or changed. By viewing death as a natural part of life, I will be able to offer my dying patients the best care possible while also understanding my limitation as a physician and a human being.
When a patient is at the end of life it is very important to value the patients self dignity and their decisions at the mere end of their lives. The end of life care is to relieve the weight of the patient 's shoulders physically and mentally. I approve of end of life caring. Basic end of life care is summarized by improving the care of quality of life and dignity of the ill person. The important themes to good ethics of end of life care is a combination of human rights,respect,dignified care,and privacy.
When it comes to tell the truth most of the time is sounds like a very easy thing to do especially for people who work in health care industries. Nurses ranked as the most trustworthy, with 82 percent of American ranking their honesty and ethical standards as high or very high. Nurses have continuously been listed at the top of the survey, beating out other professions including doctors, teachers, and pharmacists. (Gallup poll, 2015).But sometimes telling the truth it depends with situation/carcermstamces. As health care provider sometimes you find yourself to be in the situation where you have to withhold the truth for therapeutic privilege.
Truth telling and confidentiality depend upon the situations. It is right to tell the truth in certain but it is also right to hide something from the patients in certain situations. According to utilitarianism one should usually tell the truth and keep one’s promise because you should always perform an action that provides maximum utility and if keeping a promise and telling the truth makes someone happy then it is providing maximum utility.