1
Q
federal governments healthcare responsibilities
A
- Canada Health Act- deciding on principles
- Holding provincial/ territorial gov’ts accountable to following the principles for delivery (and adjusting $ based on this) (providing funding to provinces)
- Financial support for provincial delivery of health care
- Delivering direct health care services to veterans, First Nations and Inuit persons, persons living on reserves, military personnel, inmates of federal penitentiaries, and RCMP officers
- Shared role in health protection, disease prevention, health research, and health promotion
2
Q
provincial/territorial healthcare responsibilities
A
- Delivering and managing insured health services (hospital and physician care) such as OHIP
- Evaluating physician and hospital care
- Planning, financing, and evaluating hospital and physician care
- Managing some public health and prescription care
3
Q
challenges in healthcare
A
- Sustainability- $$$
- Currently reactionary and problem-based with heavy investment in acute care vs. health promotion and illness prevention (downstream vs. upstream)
- Not all Canadians have access to a primary care provider
- Aging population- living longer with chronic illness
4
Q
access and equity for healthcare
A
- Geographic and contextual barriers to accessing health care, especially in rural areas
- Need to pay more attention to SDOH and needs of marginalized/ vulnerable populations
- Provision of social support systems for those affected by poverty and promoting access to basic needs is one way to sustain a health care system
- Primary health care focused on equity among populations with a progressive approach to distribution of comprehensive health care resources
- Immigrants face language and cultural barriers as well as lack of knowledge about how to navigate this complex healthcare system
5
Q
policies
A
plans that guide actions (reflect values)
6
Q
social policy
A
legal age for purchase of alcohol
7
Q
public policy
A
smoking policies/ bi-laws
8
Q
institutional/organizational policy
A
staffing ratios
9
Q
health policies
A
formal and authoritative decisions centered around health; intended to influence actions (e.g. eligibility for services)
10
Q
allocative policies
A
- Determine how priorities are set and how resources are allocated
- Distributive justice
- e.g. Ontario Drug Benefit Act; Canada Health Act
11
Q
regulatory policies
A
- Designed to guide/ direct actions, behaviours, and decisions of individuals or groups
- e.g. Regulated Health Professions Act; Food and Drugs Act, controlled drug and substances act, canadian environmental protection act
12
Q
health policy process
A
1) policy formulation - agenda setting, development of legislation
2) policy implementation - enactment of legislation; taking action; decision making related to implementation
3) policy modification - improvement of legislation, changes/adjustment as needed
13
Q
lobbying
A
- advocacy and activism
- As the largest group of HCPs in Canada, nurses are highly representative of the Canadian public
- Nurses see the individual effects of public and social issues and may have ideas about strategies that can inform legislation protecting public interests
- Nurses have strong opinions about professional issues
- Nurses are morally and ethically sensitive advocates for patients and the public
14
Q
micro level issues
A
- local level
- specific policy on your unit
15
Q
mess level issues
A
- organizational level
- organizational (hospital wide) staff cuts
16
Q
macro level issues
A
- population level
- lack of awareness in the population
-Structural determinants of health inequities
17
Q
overview of todays health care economics
A
- We have a system with progressively higher standards regardless of cost.
- Heavy focus on technology and personal autonomy that ignores basic principles of social responsibility and distributive justice.
- Split between those who make spending decisions (patients, HCPs) and those who must actually pay for the decisions (government, insurance plans).
18
Q
frivolous care
A
frivolous, wasteful, useless, ineffective, pointless
(eg. ICU life support for someone that has a very poor prognosis for recovery)
19
Q
SES as a determinant of health
A
- Income is a significant contributor to health and, consequently, health inequalities
- Research indicates a significant difference in disease prevalence and in years of life lost between the highest and lowest income brackets
- Canadians have seen an overall increase in personal income due to decreases in unemployment and increases in basic wages; however, the poverty rate has not decreased proportionately. The gap between those with the highest and lowest incomes is widening
20
Q
egalitarian
A
Equality
People who are similarly situated should be treated similarly
21
Q
utilitarian
A
The greatest good for the greatest #
22
Q
libertarian
A
Protect the rights of each person, allowing people to improve their circumstances on their own.
Privatized healthcare (commodity not a right)
23
Q
communitarian
A
Community (vs. individual, country) at the centre of the value system
Value of the public good
24
Q
health expenditure
A
1) hospital
2) physician
3) drugs
4) other institutions
5) other professionals
6) public health
10) public health
25
health care cost drivers
-High costs of new technologies and the push to use them in managing illness/ disease is driving up health care costs in acute care
-increase 3.9% total
-1% due to population growth
- 0.9% due to aging population
- 1.9% general inflation
26
recent economic trends and challenges
- the continued aging of the population will steadily increase future health spending
- Health care policy and decision-makers will be challenged to innovate in order to reform the way health care is provided
- Public drug programs limiting pricing for generic drugs, and expiring drug patents, have saved $; however, spending on specialized meds such as biologics and antivirals to treat hepatitis C have increased
- Physician spending has increased since 2005, due to an increase in the supply of physicians and the rise in physician fees
- Lack of accountability in the health care system
27
poverty & health
-Prevalence of poverty and homelessness continues in Canada.
-Poverty had decreased significantly in canada, but millions still live in poverty
-Poorer people are sicker than people with adequate financial resources.
-Psychological effects of poverty include helplessness and lack of control over one’s daily life.
- 20% of people in Ontario live in poverty
-1 in 7 Canadians live in poverty
-1 in 10 families in Canada experience food insecurity
-At least 35,000 people are homeless on a given night
-Over ⅓ of food bank users are 18 and under
-Lower income is associated with increased burden of diseases and higher mortality
28
according to WHO health institutions can deal with poverty, health, and equity in 5 ways
1) poor and marginalized are considered the priority population
2) upstream approaches
3) those with the least resources pay the least
4) promote access and ensure quality
5) monitoring, advocating and taking action to address the potential health equity and human rights
29
screening for poverty
-This tool encourages primary providers to
screen everyone; consider poverty as a risk factor; and intervene.
-20% of families in Ontario are living in poverty
30
homelessness
-At least 235,000 Canadians experience homelessness in a year
-35,000 Canadians are homeless on any given night
-Premature death is 8 to 10 times higher among people who are homeless
-Precarious housing - unaffordable, substandard amenities, poor construction, overcrowding, health hazards, hygiene risks
Relative homelessness- living in sub-standard housing
-Hidden/concealed homelessness- living in a car, with friends and family, moving often
-Absolute homelessness- living on the street or in shelters
31
health inequity
-Significant interface of poverty, homelessness, intimate-partner violence, an increasing elderly population, and racism
-Poverty underpins homelessness
-Women experiencing intimate-partner violence move frequently and often deal with homelessness and poverty
-Poverty and homelessness are linked to a higher rate of intimate partner violence and other abuse
-The elderly may experience homelessness as they face mounting health/ medication costs + living costs on a fixed income
-28-34% of the shelter population is indigenous; 24.4% of shelter users are older adults and seniors
32
The WHO Commission on the SDOH: Recommendations
1) Improve daily living conditions
-Emphasis on early child development, education, living/ working conditions and social policy
2) Tackle the inequitable distribution of power, money, and resources
-Strong governance valuing collective action
3) Measure and understand the problem and assess the impact of action
-Acknowledge there is a problem, measure and monitor health inequity at the national and international level, and evaluate the health equity impact of policy and action
33
racism
Minority groups are more likely to be intertwined with poverty, homelessness, intimate-partner violence, an increasing elderly population, and racism.
34
workplace ethics
Employee relationships
Accounting practices
How to treat suppliers
Reporting of misconduct
35
bioethics
Case consultation
Ethics education
Policy development
Research on ethical issues
36
what do bioethicist's do?
Consultation
Education
Policy review & development
Research
37
common bioethics issues
1) Consent, capacity, SDM
2) transition/discharge
3) Withholding or withdrawal of treatment
4) Living at risk
5) Disclosure
38
codes of ethics
Outlines what you should do or should not do
Minimum set of rules & obligations
Established by a regulating body (eg. CNO)
39
ethical theories
Frameworks that help support and navigate ethical decision making
Ethics decision making tools are often informed by different theories
40
Tool for Decision Making - IDEA
I - Identify the facts
D - determine the ethical principles in conflict
E - explore the options
A - act on your decision and evaluate
41
gender
-socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men. Society is moving toward acceptance of gender as a more fluid and diverse concept.
-Examples of gender characteristics: in most countries women earn less $ than men for similar work
42
sex
-the different biological and physiological characteristics of males and females, such as reproductive organs, chromosomes, hormones, etc
-Aspects of sex will not vary substantially between societies, while aspects of gender may vary greatly.
43
gender equity in health
-Refers to a process of being fair to women and men with the objective of reducing unjust and avoidable inequality between women and men in health status, access to health services and their contributions to the health workforce
-Women and men have equal conditions to realize their full rights and potential to be healthy, contribute to health development and benefit from the results. Achieving gender equality will require specific measures designed to support groups of people with limited access to such goods and resources
44
gender/sex culture and history
-Legalization of same-sex marriage in Canada in 2005 through the passing of the Civil Marriage Act
-Legalization of same-sex marriage (and the related resistance/ controversy) shows there is still discrimination against lesbians and gay men
45
How can issues related to gender or culture manifest in professional relationships?
-Employment equity, employment opportunities, sexual harassment, role strain
46
gender in nursing
-The feminization of nursing and women’s work, alongside the social construction of gender, has contributed to the real and perceived lack of power of nurses relative to physicians (a historically “masculine” profession)
-Gender is an important part of the position of nurses relative to other HCP, in particular physicians
-Many would argue this, citing evidence of the increasing numbers of females in medical school and males in nursing school; however, societal views of these two professions remain entrenched in images of the female nurse and male physician
47
gender - societal expectations in nursing
-As nursing continues to be a predominately female profession, social issues that have affected women have also been reflected in nursing, including:
-Lack of women in positions of power.
-A history of oppression.
-Biomedical curative model of health care.
-Lower salaries then other comparable professions.
-However medicine is predominantly male
48
men in nursing
-7% male vs 4.6% in 2008 (growing)
-Attrition from nursing school (50% vs. 20% for females) and job dissatisfaction are higher for nurses who are male
-Some areas of nursing have more male nurses than others: mental health, ICU, OR, ER
49
sexism in nursing
-Sexism is the assumption that members of one sex are superior to those of the other
-Sexism may manifest itself in power struggles for equal pay, access to opportunities, or recognition
-The text refers to a study conducted in 1995 (note this is >20 years ago…) which found physicians view male nurses as being more competent and value their opinions above those of female nurses
50
sexual harassment
-sexual harassment is unwanted words or actions that are related to gender or of a sexual nature
Inappropriate touching
Staring or making sexual comments
Verbal abuse related to gender
Making sexual requests, jokes, or remarks
Displaying sexually offensive images
51
heterosexism
- is the assumption that everyone is or should be heterosexual as it is superior and expected
52
sexual orientation
a person’s experience of affection and attraction. Not always binary (male/female) and can be a fluid experience of having feelings for any number of individuals
53
gender identity
a person’s internal sense of gender, being male, female, both, or neither
54
transgender patient care
3 categories of health disparities of transgender people
- health disorders and risk behaviours (Higher rates of alcohol drug, tobacco use, mental health disorders, suicidal thoughts, lower education, low income, difficulty finding employment, lack health insurance, avoid healthcare from fear of discrimination )
-social influences
-access to quality care
3 most common experiences in healthcare setting
- insensitivity to sex/gender, including incorrect pronouns and names or not accepting the patient’s gender identification (32%);
-experiencing discomfort in providers, making interactions awkward or negative (29%); and
-denial of requested health services such as hormone treatments or referrals for gender surgeries (21%)
3 themes of responses from nurses about transgender care
-Discomfort
-Transition
-Harsh consequences of being transgender
55
rainbow health ontario
-Rainbow Health Ontario (RHO) is designed to improve access to services and to promote the health of Ontario’s lesbian, gay, bisexual, trans, and queer (LGBTQ) communities.
-The needs of lesbian, gay, bisexual, trans, and queer people are often overlooked in our health and social service systems, and there are gaps and inequities in services and in the health status of LGBTQ people. Ontario’s Ministry of Health and Long Term Care funds RHO to act as a catalyst in improving services, increasing knowledge, showcasing innovative practice and encouraging networking and collaboration.
-RHO works with LGBTQ communities, service providers, researchers, policy makers and the government.
-Services include: Info and consultation; education and training; research and policy
56
LGBTQ RNAO recommendations
- human rights and health equity
- Client-Centred, Inclusive, and Appropriate Health Care
- Quality Work Environments
57
culture
-should be regarded as the set of distinctive spiritual, material, intellectual and emotional features of society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs
-total lifeways of a group of interacting individuals, consisting of learned patterns of values, beliefs, behaviours, and customs shared by that group.
-Culture influences values, beliefs, and behaviours.
58
cultural sensitivity
ability to incorporate the cultural perspective of the patient into nursing assessments and modify care to achieve congruence
59
transcultural issues
Transcultural issues arise when nurses, patients, and families hold differing views of what is important or necessary regarding health, recovery, illness, or death.
60
culture - legal considerations
-Cultural misunderstandings can provide grounds for litigation.
-Determine patient’s understanding of nurse’s language.
-Use skilled interpreters to communicate in the patient’s own language.
-Have consent forms and other written documents translated into the patient’s language OR use skilled interpreters to interpret the forms for the patient/family.
61
cultural competency
-An approach that focuses on practitioners’ attaining skills, knowledge, and attitudes to work in more effective and respectful ways with Indigenous patients and people of different cultures.
62
cultural humility
-An approach to health care based on humble acknowledgement of oneself as a learner when it comes to understanding a person’s experience. A life-long process of learning and being self-reflective.
63
rural communities
-An estimated 20-30% of Canadians live in a rural environment
-Demographics of rural communities indicate a higher proportion of individuals <19 or >65 years of age as education and employment opportunities may be limited
-Families in rural areas tend to have lower levels of education and lower socioeconomic status
-Demanding need for health services in rural areas
- Active recruitment of nurses into rural areas is needed
64
health issues in rural communities
-Higher incidence of smoking and obesity
-Lower rates of healthy heart practices such as healthy diets, increased physical activity, and smoking cessation
-Higher rate of mortality due to respiratory disease; however, women in some rural areas report less respiratory disease (e.g. asthma) than women in urban environments
-Higher rate of deaths due to circulatory disease, suicide, and injuries
-Higher rates of accidents (incl. MVA) and disabilities
65
rural nursing - strengths
- Nursing care to a small population
- More independent/ autonomous practice and broader scope of practice
- Personal relationships with patients; strong ties to community
- Communication technology has made it easier to stay connected reducing feelings of isolation in many communities
- Opportunities for financial compensation
66
rural nursing - challenges
- Limited resources (funding, equipment, human resources)
- Expanded scope of practice
- Lack of support and mentorship
- Few opportunities for privacy
- Isolation (social and professional)
- Limited access to goods and services; potentially limited access to communication technology
67
rural nursing - constraints
-Staff shortages
-Old equipment/lack of resources
-Less interdisciplinary team (nurse takes on broader role)
-Increased scope of practice (determined by necessity)
-More difficult to attain continuing education (online modules helpful)
68
The Canadian Association for Rural and Remote Nursing (CARRN), an associate group of the CNA, has 7 objectives:
1.To promote development and dissemination of standards of practice
2.To facilitate communication and networking
3.To present the views of the CARRN to government, educational, professional and other bodies
4.To explicate the evolving roles and functions of rural and remote nurses
5.To identify and promote educational opportunities
6.To promote the conduct and dissemination of research
7.To collaborate with key stakeholders on the development of sound health policy for those living in rural and remote Canada
69
8 Attributes of Nursing Professional Practice
1.Knowledge
2.Spirit of inquiry
3.Accountability
4.Autonomy
5.Advocacy
6.Innovation and visionary
7.Collegiality and collaboration
8.Ethics and values
70
rural nursing - recommendations for future
-Need for different recruitment and retention strategies for outpost nursing positions.
-Need to determine the best ways to support nurses in remote areas.
-More Indigenous history and health needed in nursing curricula.
-Need for more opportunities for nursing students to experience clinical placements in rural settings.
71
main 4 SDOH affecting indigenous health
Physical environment, poverty, education, health behaviours
72
shannens dream
-about making sure that First Nations children and youth have the same education opportunities as others but in ways that respect their language and culture and takes into account that they may not be starting from the same place.
-Shannen Koostachin, her classmates, and their community of Attawapiskat fought for a new school for over three decades after a diesel spill near the school that was making students and teachers sick.
-Shannen sadly passed away in 2010 and never saw the new school that was built in 2014.
-With the support of her loving family, friends and community, Shannen’sDream was named in her honour because Shannen believed that all children deserved to go to a good school
73
jordans principle
-Jordan was born in 1999 with multiple disabilities and stayed in the hospital from birth.
-When he was 2 years old, doctors said he could move to a special home for his medical needs. However, the federal and provincial governments could not agree on who should pay for his home-based care.
-Jordan stayed in the hospital until he passed away at the age of 5.
-In 2007, the House of Commons passed Jordan's Principle in memory of Jordan. It was a commitment that First Nations children would get the products, services and supports they need, when they need them. Payments would be worked out later.
-Today, Jordan's Principle is a legal obligation, which means it has no end date. While programs and initiatives to support it may only exist for short periods of time, Jordan's Principle will always be there. Jordan's Principle will support First Nations children for generations to come.
74
Dilico primary care traveling team
-Mobile clinics to serve rural communities in Robinson-Superior Treaty district
-Goal is to provide services in remote communities to minimize need to travel to access care
-Implemented in 2018, this phase included building trust and relationships with communities (ongoing)
-Team includes: RNs (mental health nurses), RPNs, NPs, social workers, pharmacist, dietician, psychologist, chiropodist, traditional healing liaison, speech pathologist (coming soon)
-Challenges: health records/ documentation (siloed systems, intra and inter team, multiple providers), recruitment and retention (some roles hard to recruit into, willingness to travel), travel time and logistics (distance/ geography, weather, charting, clinic times, rental cars, etc.)
75
Dr Patty Hajdu
-Member of Parliament for Thunder Bay-Superior North since 2015
-Minister of Status of Women, Minister of Employment, Workforce Development and Labour, Minister of Health and is currently the Minister of Indigenous Services and Minister responsible for FedNor.
-previously worked in public health and focused on drug policy, youth development and homelessness
-she ran the largest homeless shelter in Northwestern Ontario (served 80% indigenous people at shelter house)
76
threats to autonomy
-paternalism
-Presumption that a patient’s values, knowledge level, and ways of dealing with issues are consistent with those of health care providers.
-Failure to acknowledge a different level of understanding regarding health
-Greater attention to technology than caring.
-Availability of resources.
-Economic circumstances
77
paternalism
-Paternalism implies well-intended actions of benevolent decision making, leadership, protection, and discipline.
- In relation to health care, paternalism manifests itself in the making of decisions on behalf of patients without their full consent or knowledge.
78
Determining the adequacy of information disclosed in Informed Consent is based on what standards
- Professional practice standard – the disclosure is consistent with the standards of the profession.
- Reasonable person standard – what a reasonable person in similar circumstances would need in order to make an informed decision.
- Subjective standard – what the particular person wants or needs to know.
79
nursing role with consent
-Verifying that the patient is aware of options and the implications of each.
-Advocating for the patient to ensure criteria for autonomous decision making is met.
-If the nurse believes the patient does not understand the implications of the choices, the nurse is required to intervene on the patients behalf (notify the physician, request further information for the patient, stop the process until the patient can make the decision)
-Nurse’s signature as witness attests the patient is giving consent willingly, is competent in that moment to consent, and the patient signature is authentic.
80
advanced directives
- instructions indicating health care interventions to initiate or withhold, or that designate someone who will act as a surrogate/proxy in making decisions in the event that we lose decision-making capacity.
-To ensure patients have the end-of-life care they prefer, it should be discussed openly and clearly with family, surrogate/proxy, and health care professionals and then placed in writing.
-Advance directives include living wills and durable power of attorney
81
living wills
- legal documents giving directions to health care providers related to withholding or withdrawing life support if certain conditions exist.
82
power of attorney/proxy/SDM
This person would be responsible for ensuring that the patient’s wishes are carried out in the event of the patient’s incapacity.
83
instruction directive
set of instructions for the SDM to carry out
84
Evaluating the patient or SDM for decision-making capacity means they must have the:
-Ability to understand all relevant information.
-Ability to communicate understanding and choices.
-Personal values and goals that guide the decision.
-Ability to reason and deliberate over the available choices
85
competence
-Competence is the ability to make meaningful life decisions.
-Legally, a person must be ruled incompetent by a judge, and this ruling will generally remain in effect for the rest of the patient’s life.
-If someone is deemed incompetent someone must become the SDM
-If no one is appointed in the advanced directive the healthcare workers work closely with the family to decide who would be the best option
-If no family to become the SDM, a court-appointed guardian becomes the SDM (recall the hierarchy!)
86
active voluntary euthanasia
physician both provides the means of death and administers it
87
assisted suicide
patient recives means of death from physician but activates the process themselves
88
nurses role in MAiD
explore the reasons why the patient feels that way
Attending to the nature and cause of the patient’s suffering and providing treatment for those should be explored
89
7 grandfather teachings
-courage/bravery
-humility
-truth
-honesty
-respect
-love
-wisdom
90
courage/bravery
-Facing the event that sends you reeling and the event that sends you healing.
- The historic legacy Indigenous peoples (and others) have inherited would heal if the experience of critical (childhood) trauma stopped.
- Many families have learned how to create safe circumstances and “break the cycle” as it is sometimes referred to.
- The incidence of trauma remains high in every population, but we can change the outcomes by acknowledging the past, responding differently in the present, and providing strong supports for the future.
How? Learning about Cultural Intelligence, Safety and Humility, creating sanctions against discrimination, no longer by-standing, creating reassuring circumstances and following up with statements of care and inclusion.
By addressing societal influences directly…
91
indigenous and western medicine common ground
- universe is unified
- body of knowledge stable but subject to modification
- honesty, inquisitiveness
- perserverance
- open mindedness
- pattern recognition
- verification through repetition
- empirical observation in natural settings
- interference and prediction
- plants, animals, ecosystem
- properties of objects and materials
- position and motion of objects
- cycles, connections, and changes in earth systems
92
truth
- Show honour and sincerity
- True to yourself and others
- Adverse childhood experiences
- It began in 1985 with a miss-step…a question asked that revealed a secret, a secret that continues to resonate into the present for too many intergenerational survivors of IRS, War, Parental Addictions.
93
ACE's
abuse
neglect
household dysfunction
94
humility
1. We move between several different cultures – often without even thinking about it.
2. Cultural humility is distinct from cultural competency and reflexivity.
3. Cultural humility requires historical awareness.
95
respect
- Honour all creation
- What is cultural intelligence?
- Cultural intelligence is related to emotional intelligence, but it picks up where emotional intelligence leaves off. A person with high emotional intelligence grasps what makes us human and at the same time what makes each of us different from one another.
- A person with high cultural intelligence will tease out in a person’s or group’s behavior those features that would be true of all people and all groups, those peculiar to this person or this group, and those that are neither universal nor idiosyncratic.
96
honesty
- Accepting inclusion
- Integrity
- Is to know yourself and your own values, biases and beliefs, to speak from the heart and soul, to allow yourself to truly be seen, know and be known by others.
- The teaching of honesty is about being open in an emotional and spiritual sense and recognizing what is regarded as right.
-embracing a process of introspection, even when what one is likely to find within is extremely painful and brings personal and communal shame out into the open.
-It is also about developing services that are appropriate and flexible, suited to the needs of individuals within a community and framed to reflect the capacity of the group.
97
love
Generously applying compassion and empathy to every encounter & relationship
98
wisdom
- Transforming policy and practices
Don’t get wisdom until you complete the other teachings
Arriving at an expansive and inclusive view of the world.
To cherish knowledge, know what is true/right
These teachings and stages are not exclusive or final and each one has something that enhances and illustrates the others – they are launching points!
In order to understand the underlying principles of wisdom, we look at wise practices, those things Indigenous peoples have done for millennium and that continue to have good utility today.
It is important to understand how these values can be expressed as tools for change, where they might impact community mores, and how they potentially transform unhealthy behaviours in society today.
We might also ask how these values can move leaders and leadership training into a collaborative and inclusive experience.
99
4 aspects of reconciliation
equity
harmony
restoration
critical conversation about Canada
100
Practice Issues related to end-of-life care include
Use of technology
Quality of life
Medical futility
Decision making at the end of life
101
benefits of technology in end of life
save lives, improve quality of life, alleviate suffering, decrease incidence of some diseases
102
challenges of technology in end of life
availability, quality of life, does physical existence = living?
Use of technology may promote conflict between beneficence (do good) and nonmaleficence (do no harm)
103
sanctity of life perspective
all human life should be valued no matter what, all biological life must be preserved (pro life)
104
quality of life perspective
- A subjective appraisal of factors that make life worth living and contribute to a positive experience of living.
- Includes fulfillment, satisfaction, conditions of life, happiness, experiences of life, comfort, functional status, independence, socioeconomic status, environment.
105
quality of life - subjective dimension
the quality of life is highly personal and tied to deeply held values of what is meaningful
106
quality of life - multidimensional
contextual view of self based on our environment in which we live, our idea of what constitutes well being – related to our physical functioning and social, emotional and spiritual lives
107
Issues related to withholding/withdrawing end of life treatments
Ideas and beliefs about life, death, and dying.
Medical futility.
Advance directives – DNR orders.
Patient self-determination.
Nursing care
108
Ethical dilemmas are associated with life, death and dying
- Attitudes and beliefs about when life begins and ends.
- Attitudes about what constitutes death and who decides.
- Unreasonable expectations of medical interventions.
- Differing opinions regarding use of technology.
109
2 primary obligations in palliative care
comfort
company
110
palliative care
Comprehensive, interdisciplinary, and total care focusing primarily on comfort and support of patients and families who face illness of a chronic nature or who are not responsive to curative treatment.
Delivery of coordinated and continuous services in home, hospice, hospitals, skilled nursing facilities, and bereavement care.
111
nursing care in palliation
- Support dignity and self-respect of patient and family.
- Coordinate palliative care teams.
- Provide appropriate care and facilitate effective communication regarding concerns and understandings of care among all involved.
- Explain and negotiate patient care decisions.
112
medical futility
Situations in which interventions are judged to have little or no medical benefit or in which the chance for success is low
113
passive euthanasia
removing life sustaining measures (ventilators) and allowing the person to die as a natural progression of the illness
114
active euthanasia
causing painless death of a person in order to end or prevent suffering
115
nurses role in DNR
- Nurses need to know which of their patients have DNR orders and that these orders are documented clearly.
- DNR orders apply only to resuscitation–other treatment and comfort measures may be provided (code Levels at TBRHSC)
- Document requests by patients or surrogate for DNR, and bring to attention of physician when needed.
116
MAID quick facts
- The federal legislation does not force any person to provide or help to provide medical assistance in dying
- Cancer is the most frequently cited underlying medical condition, followed by respiratory, neurological and cardiovascular conditions.
- MAID is currently not allowed for, requests by mature minors, advance requests, and requests where a mental disorder is the sole underlying medical condition
117
MAID new legislation
- Removes the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for MAID
- Introduces a two-track approach
1) Existing safeguards are maintained and, in some cases, eased for eligible persons whose natural death is reasonably foreseeable
2) New and strengthened safeguards are introduced for eligible persons whose natural death is not reasonably foreseeable
- Temporarily excludes eligibility for individuals suffering solely from mental illness
- Allows eligible persons whose natural death is reasonably foreseeable, and who have a set date to receive MAID, to waive final consent if they are at risk of losing capacity in the interim
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2021 MAID Eligibility Criteria
- be 18 years of age or older and have decision-making capacity (competent)
- be eligible for publicly funded health care services
- make a voluntary request that is not the result of external pressure
- give informed consent to receive MAID, meaning that the person has consented to receiving MAID after they have received all information needed to make this decision
- have a grievous and irremediable medical condition (serious and incurable disease or disability) (excluding a mental illness, still under review)
- be in an advanced state of irreversible decline in capability
- Enduring and intolerable suffering
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nurses role in MAID
- only MDs and NPs can administer MAID
- nurses may perform activities such as educating clients, providing support to clients and family, or inserting an intravenous line (with an order) that will be used to administer medications that will cause the death of a client and acting as and independent witness
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Nurses that don't agree with MAID
- The law does not compel an individual to provide or assist in providing medical assistance in dying
- nurses objection of MAID must not be directly conveyed to the client
- nurses must transfer care of the client to another nurse
- Until a replacement caregiver is found, a nurse must continue to provide nursing care, as per a client’s care plan, that is not related to activities associated with medical assistance in dying
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political-ethical issues
Abortion
Reproductive technologies
Medical assistance in dying
Organ donation
Informed consent
Access to care
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political social issues
Confidentiality of health records
Health care reform
Listing and delisting of provincially covered health services
Tobacco legislation
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political issues with professional implications
Entry to practice
Scope of practice
Safety and workplace legislation
Non-regulated HCPs
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political issues involving public health
Harm reduction programs
Emergency preparedness and pandemic planning
Water quality
Mandatory reporting of STIs, child abuse/ neglect, etc.
Nurs 2213
flashcards
Decks in class (2)
# Cards
