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NUR 601 Week 3 Discussion 1: Borderline Case: Ethics of Patient Care NUR 601 Week 3 Discussion 1: Borderline Case: Ethics of Patient Care NUR 601 Week 3 Discussion 1: Borderline Case: Ethics of Patient Care In this discussion, I will be defining attributes related to a patient case relating to dementia, death, and dying. According to Wilkinson (1997), the issue here is the vagueness of the definition. They describe autonomy as functioning independently, determining and defining self, and being able to act at will with independent thought and control over choice. The issue here with dementia is the person is not able to make decisions as they are not in their right mind. The person with dementia is not of sound mind to make such a decision, and they do things like opening their mouth and eating out of reflex. In this particular case, the ethical issue that is raised is would this person, who when they were of sound mind stated that they would not want to eat or drink in such circumstances, would they want to die of starvation? Or would this person who is now diagnosed with dementia, unlike the person they were before, would they want to be fed? This is an ethical issue because it is like we are dealing with two different people, one of sound mind and one with a neurological diagnosis such as dementia, so is it right to starve this person because the person of sound mind they used to be would want that, or would they not? Research done by Shurrrmans et al. (2020) in the Netherlands adds information to the legal physician assisted suicide, but questions how it would work with people with dementia. They found there was no simple answer, but that decisions were better made if the physician had a “buddy” or a medical professional with them through the entire process, to decrease ethical issues that may arise. An article written by Schenell et al. (2020) describes how the right to make decisions in ones’ own life is evident to most people; but not people with dementia. They created a model which gives the person with dementia a large amount of autonomy over their decisions such as power over their own life and to help them plan end of life care. They found that there were many obstacles to self-determination in dementia patients and residential care, but their model shows that there are ways to give them an amount of control over their choices. I think it is extremely important that we carry out their wishes, as they are still people too. If it were changed to meet criteria for a model case, the ethical issues that would ensue are does this person have autonomy? Is the person with dementia aware of their actions, are they aware they are eating because they are hungry or are they opening their mouth out of reflex of someone feeding them with a spoon? This opens up another whole can of worms in relation to how do we know what goes on in the mind of dementia patients, as the only way we can see their brains is after death. Even then, even with all of the current research, we do not truly understand the concept yet. Lastly, this carries into an article I read by Daniel Sulmasy (2020), on why dementia specific advance directives are a misguided idea. The main concept being that living wills, and advance directives are subject to interpretation. As in the case above, when the person is in their right mind, they could say I don’t want to eat or drink I want to die, but it might get interpreted differently depending on who is reading it. Overall, we need more research on patients with dementia, and we need to provide the best care for our patients as providers, making the decisions we think that they would want, not to be influenced by what we think is best for them. References Schenell, R., Ozanne, A., Strang, S., & Henoch, I. (2020). To make and execute decisions throughout life: A person-centred model that facilitates self-determination in residential care, developed through participatory research. Applied Nursing Research, 55, N.PAG. https://doi.org/10.1016/j.apnr.2020.151318 Schuurmans, J., Vos, S., Vissers, P., Tilburgs, B., & Engels, Y. (2020). Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings. British Journal of General Practice, 70(700), e833–e842. https://doi.org/10.3399/bjgp20X713093 Sulmasy, D. P. (2020). Why Dementia‐Specific Advance Directives Are a Misguided Idea. Journal of the American Geriatrics Society, 68(7), 1603–1605. https://doi.org/10.1111/jgs.16493 Wilkinson J. (1997). Professional issues. Developing a concept analysis of autonomy in nursing practice. British Journal of Nursing, 6(12), 703–707. https://doi.org/10.12968/bjon.1997.6.12.703   Initial Post Please respond to the following prompts: Review Wilkinson’s (1997) defining attributes and describe how the NPR podcast, If You Have Dementia, Can You Hasten Death As You Wished? case story meets the definition of a borderline case. Describe the ethical issues the case raises. If it were changed to meet criteria for a model case, what ethical issues would come to the forefront? Your initial post should contain two- to three-paragraphs with three- to four-sentences per paragraph. The post should integrate a minimum of three readings and/or other evidence-based research articles no more than three years old and use APA formatting for citations and references.. Reply Posts Compare and contrast your ethical viewpoint, using a minimum of two scholarly sources using APA style, with two of your colleagues. Please refer to the Grading Rubric for details on how this activity will be graded. The described expectations meet the passing level of 80 percent. Posting to the Discussion Forum Select the appropriate Thread. Select Reply. Create your post. Select Post to Forum. The purpose of this week’s discussion is to apply Walker and Avant’s defining attributes of concept analysis to an actual patient case. The assignment is titled Borderline Case: Ethics of Patient Care. According to Khan et al., (2019), the product of the defining attributes helps to determine the concepts meaning (p. 114), which we will analyze in this discussion. The NPR video ‘If you have dementia, can NUR 601 Week 3 Discussion 1 Borderline Case Ethics of Patient Care you hasten death as you wish?’ discussed a case of a nurse with dementia at near end of life. In this video, a case is presented of a nurse by the name of Margaret Bentley, who several years prior to presenting with Alzheimer’s disease, stated in a living will that if she ever became critically disabled, she did not want to eat or drink, then she would prefer to die (Henig, 2015). The family of Margaret Bentley is advocating to honor her wishes as they believe she now meets her own criteria to choose end of life over continuing to live. The nursing home of which she resides disagrees with the family’s choice to end her life based on her wishes, because the nursing home believes that by opening her mouth when a spoon with food is placed before her mouth signifies that she still wants to eat. Margaret’s family believes that this is only a reflex. The nursing home believes that this is Margaret displaying a will to live, by opening her mouth and wanting to eat (Henig, 2015). Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 601 Week 3 Discussion 1: Borderline Case: Ethics of Patient Care The fact that Margaret was a former registered nurse meets defining attribute 1, which states: practices within a professional context which is self-regulating (Wilkinson, 1997, p.704). According to Wilkinson (1997) the definition of the 2nd defining attribute is “makes decisions which are based on professional judgement and is able to act on these within his/her own sphere of practice” (p.704). In this case, Margaret was able to make her decision to end her life if she met her criteria of not wanting to eat or drink. Because Margaret was a registered nurse and of sound mind when writing her end of life wishes, her decision was made from professional judgement presumptively based on her experiences as a registered nurse. This case becomes borderline when looking at the 3rd defining attribute which is: “is cognizant with determining forces and has the knowledge to judge when these should be acquiesced, and when they should be challenged (Wilkinson, 1997, P. 704). This presents an ethical issue over whether Margaret should live or die. One could argue here that by opening her mouth to accept being spoon fed nutrition is showing a will to live, even though Margaret is unable to be cognizant of those prior wishes, secondary to her advanced stage of Alzheimer’s disease. Also, the verbiage Margaret stated in her living will that if she met her criteria of “not wanting to eat or drink” leaves much room for interpretation. According to Walker & Avant, (1997) a model case consists of 3 attributes which are covering, protection, and rebalancing (p.164). A borderline case will contain most of the defining attributes of the concepts being studied but not all of them (p. 164). In the case of Margaret Bentley, this is a borderline case because the case only partially reflects the defining attributes of the concept and is hence inconsistent with its full representation (Wilkinson, 1997, p.705). In order to make this a model case, the meaning of “not wanting” to eat or drink would need to be more clearly defined. Perhaps it could have been written in a way that clearly defined that if she was unable to feed herself, then she would prefer to die. This would leave little room for interpretation and her wishes could be met. References: Hening, R. M. (2015, February 10). If you have dementia, can you hasten death as you wished? All        Things Considered. Kahn, T.S., Hirschman, K.B., McHugh, M.D., & Naylor, M.D. (2020). Self-efficacy of family caregivers      of older adults with cognitive impairment: A concept analysis. Nursing Forum, 56. 112-     126.  http://doi.org.10.1111/nuf.12499 Walker, L.O & Avant, K.C. (2011). Strategies for Theory Construction in Nursing (5th ed). New York:     Pearson. Wilkinson, John. (1997). Developing a concept analysis of autonomy in nursing practice. British     Journal of Nursing,6(12). 703-707. http://doi.org/10.12968/bjon.1997.6.12.703 Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points) Discussion Question Rubric – 100 Points Criteria Exemplary Exceeds Expectations Advanced Meets Expectations Intermediate Needs Improvement Novice Inadequate Total Points Quality of Initial Post Provides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 points Components are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 points Components are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 points Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points 40 Peer Response Post Offers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 points Evidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post. All instruction requirements noted. 35 points Lacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 points Post is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from peer posts. Missing several instruction requirements. Submits post late. 27 points 40 Frequency of Distribution Initial post and peer post(s) made on multiple separate days. All instruction requirements noted. 10 points Initial post and peer post(s) made on multiple separate days. 8 points Minimum of two post options (initial and/or peer) made on separate days. 7 points All posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points 10 Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points 5 APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points 5 Total Points 100 Order Now