In this article, we are going to be discussing the ethical consideration a geriatric nurse need to have in mind in the care of the elderly
Geriatric nurse are most likely to encounter ethical dilemmas in their practice. These dilemmas usually arise due to medical interventions and decision making for elderly with cognitive impairments.
Care Of The Elderly
As a geriatric nurse, it is your responsibility to assist the elderly and their families in decision making and also refer them to the appropriate community agencies.
An elderly person has right to autonomy which is the person’s freedom to direct one’s own life as long as it does not impinge on the rights of others.
An autonomous person is capable of rational thought and is able to recognize the need for problem solving. The person can also identify the problem, search the solution that allows their continued personal freedom asl long as it does not cause any harm to others.
All adults are presumed to be competent by law for participating in legally binding decisions. Competent people are guaranteed all right granted by the constitution and state law. Also all adults who have not been declared incompetent by a judge have the right to make their own decision about medical treatment and health care.
As a nurse you are confronted with ethical issues of an elderly person’s ability to make reasonable decision, particularly when the person is cognitively impaired. When questions are raised about the person’s ability to participate in decision making as regards health care, the health proxy may assume the responsibility of decision making.
Read Also: Aging Theories As Applied To Geriatric Nursing
Decision Making In The Care of Elderly
Decision making refers to the ability of a person to consent or refuse a specific medical treatment or procedure. In contrast to competency which is determined by the law court, the decision making capacity is determined by health care practitioner or by an interdisciplinary health care team.
Decision making capacity of an individual is based on the following criteria;
- The person’s ability to appreciate the right to make a choice
- The person’s ability to understand the risk and benefit of the medical intervention or lack of the intervention.
- The person’s ability to talk about the decision.
- The person’s stability overtime
- The person’s ability consistency with personal beliefs and values.
Decision making capacity is not based on a particular diagnosis nor should it be influenced by a person’s chronological age, but on careful evaluation of the person’s ability to understand the issues involved in a specific decision making situation and to be able to communicate about these issues.
Advanced Directives.
Advance directives are legally binding documents that allow competent people to document what medical care they would or would not want to receive if they were not able to communicate their wish.
Advance directives also enable people to appoint a proxy decision maker, who is a person responsible for communicating their wishes if they are incompetent or unable to communicate.
Advance directives contain five wishes;
- Who does one want to make care decision for one when one cannot make decision for oneself.
- What kind of medical treatment does one want or not want when very sick or unable to speak for oneself.
- What would help one feel comfortable while one is dying.
- How does one want his/her loved ones to know about him/her feelings after one has gone.
- How does one what people to treat him.
This document must be drawn when one is capable of understanding the intent and it is only effective when the person lacks the capacity to make particular health related decision.
Type Of Advance Directives
The two types of advance directives are;
living wills
These are legal documents whose purpose is to allow people to specify what type of medical treatment they would want or not want if they become incapacitated and terminally ill.
Durable Power of Attorney For Health Care
This is an advance directive that takes effect whenever someone cannot for any reason provide informed consent for health care treatment decision. It permits a surrogate health care decision maker who is also called a health proxy to voice the wishes of the person who is incapacitated.
Advanced creatives is also designed to protect health care consumers by requiring the health care provider to do the following;
- Inform patient of their right to refuse treatment and make health decision.
- Provide written information about their health state.
- Ask each person whether an advance directive has been completed.
- Documentation of patient’s advance creative in their medical record.
- Provide education for their staff and community an advance directive.
We hope this information was helpful. Feel free to ask your questions on the comment section below.