Case Presentation in Mental Health Nursing
This (10-12 pages) essay must contain two sections plus a conclusion
I Critical Analysis & II Case Review
- Critical Analysis: (no more than 5 pages)
You reflect on (your experience as a student not a provider!) in this semester’s seminar series. What you learned and how you benefit from it. You may discuss the following using the relevant provided articles:
- Quality of Life
- In which ways can quality of life be a problematic category in discussions on treatment decisions?
- How would you describe the relationship between quality of life and futile treatment?
- Spirituality in ethics consultation
- How does working as a chaplain relate to ethics
- You may talk about that (as a student) this was kind of new to me.
- The difference between religion and spirituality in healthcare
- Same thing, you may say that the seminar and the peer discussion helped in understanding more this concept.
- Truth Telling
- In your view, what are some of the most important things doctors should pay attention to while communicating bad news?
- In which ways could the doctor’s attitude contribute to better communication?
- What may clinical ethicists learn from the ways in which doctors communicate bad news to patients
- Case Review: (See the folder# Clinical Ethics Consultation. Word files examples, must see and follow the idea, plus the Four topics Pdf file for case analysis)
Case: read the case by following the link
Start with the ethical question related to the case scenario in this case study format:
Given [uncertainty or conflict about values], what decisions or actions are ethically justifiable? OR Given [uncertainty or conflict about values], is it ethically justifiable to [decision or action]?
- Medical indication reflect on the case with the link using the for topics pdf
- Preferences of Patients reflect on the case with the link using the for topics pdf
- Quality of life reflect on the case with the link using the for topics pdf
- Contextual features reflect on the case with the link using the for topics pdf
- Discussion reflect on the case with the link using the for topics pdf
- Recommendation ( please note that this is a clinical ethics consultation so create your own recommendation.
Notes: Chicago style with Endnotes. Look at the pdf named 646 Sample Capstone which is a sample of this whole essay, instead, the sample was a clinical rotation reflection, but this paper is a seminar series reflection due to COVID. Try to make the first section more personal experience (do not say as a provider! As a student more fittable in this essay)
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- Critical Analysis
- Quality of Life
Currently, many people are living longer with chronic illnesses and comorbidities, thanks to the advancements in medicine and the healthcare sector at large. However, the quality of life of these people significantly declines. It is imperative for care providers to consider the quality of life of their patients to be able to provide optimal care. This involves understanding how the various conditions affect psychosocial, physiologic, and the overall quality of life of the affected. Furthermore, as advocates for patients, I feel that it is important to ensure that patients get honest, open, as well as transparent answers regarding the healthcare questions that they might be having. Such is instrumental for them to make informed decisions. Besides, with the relevant information, they are better positioned to reflect on their wishes, which I believe can enhance the quality of their lives.
When making decisions related to the health of a patient, especially those under critical conditions, it is crucial to consider the expected physiologic and psychological changes due to an injury or an illness, which is integral to minimize the related anxiety, while at the same time maximizing the safety of a patient. Such can contribute to improvements in the quality of life of a patient. At the same time, I also feel that illnesses and injuries adversely affect the psychosocial health of an individual, thus leading to a deterioration of the quality of their life. Based on what I have learned, I think that it is integral to collaborate with the relevant interdisciplinary team members to maximize the quality of life. At the same time, working with, or ensuring that a multidisciplinary team is also instrumental for the minimization of elements such as delays in communication of diagnostic, patient treatment, and discharge planning. Such aspects are instrumental to maximize on patients’ quality of life.
Additionally, various factors also affect the quality of life of a patient. Among the most important is the protection of patient privacy. Most patients value their private health information, and knowing that such information is not safe or kept private can have some negative effects on their quality of their life. If a patient is mentally functioning, it is imperative to understand their views regarding their health information, including aspects such as sharing it with their immediate family members. Besides, I also feel that it is critical to reduce environmental stimuli whenever communicating health information that is of a sensitive nature. For instance, when communicating about undesirable health results, I think it is imperative to consider elements such as the effect that such communication may have on a patient’s quality of life. They might even need some time to proves the information, which would also enable them to ask questions, which may lead to some improvements in the quality of their lives even when chronically ill.
Besides, I believe that there is a close link between quality of life and futile treatment. According to Karimi and Brazier, quality of life relates to the standard of comfort, health, or the degree of happiness that an individual, or group, experiences. It is closely related to futile treatment, which is described as a treatment that only preserves permanent and unconscious state, or it cannot end a patient’s dependence on intensive medical care. For instance, if a patient is under futile treatment, but against his wishes, I believe that the quality of life may be adversely affected. The wishes of a patient, if he or he has the mental capacity to make decisions regarding their health, need to be given precedence above others. If their wishes are not respected, the might be a compromise on the quality of their life.
- Spirituality in ethics consultation
Working as a chaplain relates to ethics in various ways. Chaplains provide a host of services to patients and their families, including answering faith-based questions as well as providing spiritual guidance. However, while performing these activities to patients, I think it is important to ensure that they observe the various ethical standards. Among these is beneficence, or concern for the safety and well-being for those they are attending to, nonmeleficence, which is related to refraining from causing intentional harm to patients, and confidentiality and autonomy, which is associated with respect to the opinions and rights of patients. As such, for the services of chaplains to improve on the quality of life of their patients, it is imperative to observe these ethical standards. For instance, it might be unethical for a chaplain to disclose the confidential information that a patient shares with him or her, to other people, including the immediate family members of the client. The readings and the discussion have were instrumental in enhancing my understanding of the relationship between chaplaincy and ethics.
Moreover, I have also developed a better understanding of the different between religion and spirituality especially in the context of healthcare. From the readings and the various discussions that I have participated in, I now understand that religion is about the specific sets of organized practices and beliefs that are usually shared by a group or a community. On the centrally, spirituality tends to be of a personal nature. It tends to be an individual practice, and includes aspects such as a sense of purpose and peace. In healthcare, I believe that spiritualty is more important since it can help patients to have internal peace, which can significantly improve the quality of their lives.
Furthermore, while spirituality tends to be a difficult concept for one to define, I feel that it is integral to support the individuals spiritual needs of patients, which can be instrumental in enabling them to cope with their illnesses or conditions. Moreover, spirituality integral for a holistic approach to addressing the healthcare needs of patients. It assists patients to have a better understanding of their illness. Spiritual practices and perspectives can assist patients in developing contexts, especially in situations where there are anxieties regarding mental and physical functioning, Thus, it is imperative to incorporate spirituality aspects in the treatment of a patient. They can develop inner peace, which can improve the quality of their lives significantly.
- Truth Telling
While communicating bad news to patients, doctors need to pay attention to various things. One of the most important is the need to consider the effect that communicating such news may have on a patient. Doctors need to evaluate the mental state of a patient to determine the suitable method for communicating such news. For instance, they may need to inform patients while their loved ones surround them to minimize the impact that such news may have on their mental well-being. Besides, I think it is imperative for doctors to evaluate what their patients know regarding their condition, which can inform the approach that they take when communicating the bad news. Such can also offer insights regarding how well a patient is prepared to receive the news regarding their health. Privacy is another critical consideration, whereby they need to respect the privacy of patients when communicating such news. Moreover, doctors need to consider the therapeutic environment, some of the most important aspects being the preferences of the patients and the extent of the information that they may wish to known, the availability of close family members, or other supportive persons, at the discretion of the patient. It is also important to consider how the patient may react to the bad news, and how well he or she is prepared to support the patient to cope with the bad news.
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Furthermore, a doctor’s attitude may significantly contribute to better communication of the bad news to the patient. For instance, factors such being friendly to the patient, being empathetic, and showing sincere concern for their well-being may have an impact on how a patient receives and reacts to the bad news. On the contrary, appearing as if one does not care, or not being empathetic to the patient may have a negative effect on the way a patient receives and reacts to the bad news regarding their health. Doctors need to maintain an attitude that shows patients that despite everything, there is still hope, and that they are there to assist the patients although.
Clinical ethicists may learn various things regarding the ways in which doctors communicate bad news to patients. Some of the important lessons include on aspects such as how to break the bad news to minimize the effects of the news on patients’ wellbeing, the attitude to maintain during the process, and the communication approach to use. They also learn the importance of respecting the privacy of a patient, including the people who should be involved when communicating such news.
II. Case Review
Given Ms B’s mental status, what decisions or actions are ethically justifiable?
- Medical indication
The patient is a 65-year-old woman who is suffering from an altered mental state that is progressively worsening. She also suffers from anxiety, depression, and paranoia. In the past, she received treatment at various inpatient psychiatric centers, but her condition did not improve with the various treatments and modalities. The treatment goals for the patient include interventions to for her psychiatric symptoms and altered mental status. However, the patient does not cooperate, and refuses tests and medications. For further work up, the patient requires a lumbar puncture, yet she objects.
She has to undergo the procedure for the doctors to determine the condition she suffers from and the interventions and treatment that they should use. On further assessment, it emerges that she does not have the mental capacity to refuse or accept the lumber puncture. Besides, while admitted and during her previous hospitalizations, friends or close family members of the patient have not been identified, which complicates the issue. Furthermore, the treatment outcomes remain unknown considering she has to undergo the lumber puncture for a diagnosis to be done.
- Preferences of Patients
Ms B has rejected the lumber puncture procedure, which makes it difficult for the doctors to treat her. The procedure involves the insertion of a hollow needle in the spinal column to draw cerebrospinal fluid for diagnosis of serious infections, or injection of medicine. However, it is determined that she lacks the capacity to make decisions regarding her health on her own. The patient appears to be aggressive towards her physician. Her problem is compounded by the fact that she does not have relatives or surrogates who can make decisions on her behalf. Furthermore, considering her current state, the physicians at the hospital cannot allow her to make preferences regarding her treatment.
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- Quality Of Life
The patient had been experiencing significant reductions in her ability to function normally and independently. Her mental health problems had made it difficult for her to leave a normal life. For instance, she had been homeless before her hospitalization. Moreover, because of her condition, it would have been difficult for her to take medications as prescribed, or even to go back to hospital for further treatment. Her being homeless as well as not having any family members or friends visiting her are also indicative of a poor quality of life. She might have been experiencing financial difficulties and other challenges considering her advanced age, which might have made it difficult for her to get a job. With the depression and paranoid, coupled with the lack of the proper support, the patient’s quality of life appears to be unbearable. Moreover, if the patient is diagnosed and is treated, it is expected that she would still need help considering she is homeless and does not have people who are close to her to help. It is likely that the patient will be transferred to an assisted care facility or a nursing home, where s
The patient’s family history is unknown. As such, it is difficult to understand her treatment preferences considering she lacks the ability to make decisions regarding her health on her own. Besides, she has financial difficulties, considering that she is homeless. Thus, financial barriers are evident. There is no information regarding her home or her family members who can assist in making decisions on her behalf. This is because her condition is influencing her decision to object the lumber puncture. Therefore, considering the presenting conditions, it is imperative for the physician to determine how to help the patient with making decisions regarding her health, and getting the support needed after discharge from the hospital.
The hospitalization of unrepresented patients remains to be a challenge in the healthcare sector. The case of Ms B highlights the complexities associated with the treatment of such patients. On the one hand, there is a need for doctors to respect the autonomy, and on the other, there is the problem of the lacking the capacity to make decisions regarding her health. Furthermore, unrepresented patients such as Ms B tend to have a high vulnerability because of their inability to make decisions about their health and the lack of surrogate who can make decisions on their behalf. In her case, there is high risk that she can be marginalized because of her homelessness, lack of financial capacity, being elderly, as well as her mental health problems.
In her care, it is imperative for the physician to consider the applicable state laws regarding surrogacy. In the event that no surrogate is identified, clinicians can assume the responsibility of making decisions on her behalf. However, there are various considerations that have to be made, thus the need for involving a multidisciplinary team and an ethics committee when making the patients treatment decisions. With the involvement of the appropriate teams, it is imperative to conduct a risk and benefit analysis of the procedures and treatments to determine whether they are suitable for the patient.
At the same time, when caring for the patient, there are certain ethical standards that the physicians have to maintain. For instance, it is imperative to respect her autonomy. This is because she accepts or rejects procedures and treatments depending on her state of mind. Such implies that there are fluctuations in her ability to make decisions, which calls for a frequent reassessment of her decision-making abilities to ensure that whenever possible, she gets a chance to make decisions regarding her treatment. Furthermore, it is also imperative for clinicians to assist Ms B to articulate her fears and wishes, or offer explanations on why they reject certain procedures and treatments. This is applicable in the case of Ms be since she tends to be verbally patient and is alert, although she has a diminished mental capacity. The insights that the clinicians get by engaging with her can enhance their relationship, thus developing personalized treatment plans, even if the patients loses her cognitive abilities later.
· One of the recommendations is consulting an ethics committee and the hospitals legal team to understand the laws that applicable laws regarding surrogacy. The purpose consulting is to ensure that the physician and the primary care team do not breach the law while trying to help the patient. By consulting, they would be able to know the persons who can become surrogacies for the patient, including the clinicians.
· Another recommendation is the frequent assessment of the patient to understand her decision-making abilities considering she rejects procedures and treatments intermittently. As such, the care team can determine whether to consider her preferences when she is on her right mental state, when she becomes incapacitated.
· Consulting the relevant support networks considering the Ms B is homeless, does not have any known friends or family members, and lacks financial capacity. The support networks will ensure that is she is discharged from hospital; the quality of her life will become bearable. For instance, the organization can search for an assisted living facility that can accommodate her.
· The primary care team should also respect the various ethical standards applicable to the healthcare system, which include beneficence, nonmeleficence, and confidentiality. Their treatment decisions should be after conducting a risk and benefit analysis to ensure the safety of the patient is prioritized.
Overall, the course has equipped one with the relevant knowledge on clinical ethics and their practical application. One through the various readings and discussions on ethics, one has learned how ethical standards apply in healthcare settings. Additionally, the case study, which involved an unrepresented patient, has assisted one in conceptualizing the challenges associated with such patients and the delicate decisions that have to be made. One has a better understanding of clinical ethics, including some of the least discussed elements, such as the breaking of bad news to patients. Moreover, one has a better understanding of the steps to take in the event if faced by a challenge such as the one the physicians treating Ms B encountered. Therefore, I have improved on my knowledge of the ethical dimensions that have to be considered in patient care, including the conflicts and dilemmas that have to be resolved.
Choi, Philip J., Vinca Chow, Farr A. Curlin, and Christopher E. Cox. “Intensive Care Clinicians’ Views on the Role of Chaplains.” Journal of Health Care Chaplaincy 25, no. 3 (December 5, 2018): 89–98. https://doi.org/10.1080/08854726.2018.1538438.
Hamilton, Jill B. “Religion and Spirituality in Healthcare: Distinguishing Related and Overlapping Concepts from an African American Perspective.” Cancer Nursing 43, no. 4 (July 2020): 338–39. https://doi.org/10.1097/ncc.0000000000000749.
Ho, Anita, and Stephen Pinney. “Redefining Ethical Leadership in a 21st-Century Healthcare System.” Healthcare Management Forum 29, no. 1 (December 8, 2015): 39–42. https://doi.org/10.1177/0840470415613910.
Karimi, Milad, and John Brazier. “Health, Health-Related Quality of Life, and Quality of Life: What Is the Difference?” PharmacoEconomics 34, no. 7 (2016): 645–49. https://doi.org/10.1007/s40273-016-0389-9.
Lai, Carlo, Beatrice Borrelli, Paola Ciurluini, and Paola Aceto. “Sharing Information about Cancer with One’s Family Is Associated with Improved Quality of Life.” Psycho-Oncology 26, no. 10 (January 24, 2017): 1569–75. https://doi.org/10.1002/pon.4334.
Lamers, Romy E. D., Maarten Cuypers, Olga Husson, Marieke Vries, Paul J. M. Kil, J. L. H. Ruud Bosch, and Lonneke V. Poll‐Franse. “Patients Are Dissatisfied with Information Provision: Perceived Information Provision and Quality of Life in Prostate Cancer Patients.” Psycho-Oncology 25, no. 6 (September 25, 2015): 633–40. https://doi.org/10.1002/pon.3981.
Old, Jerry. “Communicating Bad News to Your Patients.” Family Practice Management 18, no. 6 (2011): 31–35. https://www.aafp.org/fpm/2011/1100/p31.html.
Rising, Margaret L. “Truth Telling as an Element of Culturally Competent Care at End of Life.” Journal of Transcultural Nursing 28, no. 1 (July 9, 2016): 48–55. https://doi.org/10.1177/1043659615606203.
Šarić, Lenko, Ivana Prkić, and Marko Jukić. “Futile Treatment-A Review.” Journal of Bioethical Inquiry 14, no. 3 (2017): 329–37. https://doi.org/10.1007/s11673-017-9793-x.
Shen, Nelson, Thérèse Bernier, Lydia Sequeira, John Strauss, Michelle Pannor Silver, Abigail Carter-Langford, and David Wiljer. “Understanding the Patient Privacy Perspective on Health Information Exchange: A Systematic Review.” International Journal of Medical Informatics 125 (May 2019): 1–12. https://doi.org/10.1016/j.ijmedinf.2019.01.014.
Taberna, Miren, Francisco Gil Moncayo, Enric Jané-Salas, Maite Antonio, Lorena Arribas, Esther Vilajosana, Elisabet Peralvez Torres, and Ricard Mesía. “The Multidisciplinary Team (MDT) Approach and Quality of Care.” Frontiers in Oncology 10, no. 85 (March 20, 2020). https://doi.org/10.3389/fonc.2020.00085.
 Romy E. D. Lamers et al., “Patients Are Dissatisfied with Information Provision: Perceived Information Provision and Quality of Life in Prostate Cancer Patients,” Psycho-Oncology 25, no. 6 (September 25, 2015): 633–40, https://doi.org/10.1002/pon.3981.
 Carlo Lai et al., “Sharing Information about Cancer with One’s Family Is Associated with Improved Quality of Life,” Psycho-Oncology 26, no. 10 (January 24, 2017): 1569–75, https://doi.org/10.1002/pon.4334.
 Miren Taberna et al., “The Multidisciplinary Team (MDT) Approach and Quality of Care,” Frontiers in Oncology 10, no. 85 (March 20, 2020), https://doi.org/10.3389/fonc.2020.00085.
 Nelson Shen et al., “Understanding the Patient Privacy Perspective on Health Information Exchange: A Systematic Review,” International Journal of Medical Informatics 125 (May 2019): 1–12, https://doi.org/10.1016/j.ijmedinf.2019.01.014.
 Jerry Old, “Communicating Bad News to Your Patients,” Family Practice Management 18, no. 6 (2011): 31–35, https://www.aafp.org/fpm/2011/1100/p31.html.
 Lenko Šarić, Ivana Prkić, and Marko Jukić, “Futile Treatment-A Review,” Journal of Bioethical Inquiry 14, no. 3 (2017): 329–37, https://doi.org/10.1007/s11673-017-9793-x.
 Philip J. Choi et al., “Intensive Care Clinicians’ Views on the Role of Chaplains,” Journal of Health Care Chaplaincy 25, no. 3 (December 5, 2018): 89–98, https://doi.org/10.1080/08854726.2018.1538438.
 Anita Ho and Stephen Pinney, “Redefining Ethical Leadership in a 21st-Century Healthcare System,” Healthcare Management Forum 29, no. 1 (December 8, 2015): 39–42, https://doi.org/10.1177/0840470415613910.
 Jill B. Hamilton, “Religion and Spirituality in Healthcare: Distinguishing Related and Overlapping Concepts from an African American Perspective,” Cancer Nursing 43, no. 4 (July 2020): 338–39, https://doi.org/10.1097/ncc.0000000000000749.
 Margaret L. Rising, “Truth Telling as an Element of Culturally Competent Care at End of Life,” Journal of Transcultural Nursing 28, no. 1 (July 9, 2016): 48–55, https://doi.org/10.1177/1043659615606203.
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