Introduction
Dementia is a term used to refer to a wide range of diseases resulting from abnormal brain changes. With the brain changes, people suffering from this condition have memory loss, are unable to make sound decisions, have a decline in thinking, incapable of handling daily tasks, and become dependent on functions in society. Furthermore, persons who have dementia show peculiar behaviors, feelings, and relationships. Alzheimer’s diseases are the most common type of dementia, and statistics reveal that it accounts for about 60-80 percent of dementia in the world (Podgorica et al. 2020, p. 887). Vascular dementia is the type that results due to microscopic bleeding and blood vessel blockage in the brain and has been proven to be the second most type of dementia affecting the world (Podgorica et al. 2020). Vascular dementia, though, is not severe as Alzheimer’s disease dementia.
Moreover, a person may experience multiple brain changes and thus may have simultaneous symptoms of dementia, termed mixed dementia. Caring for persons with dementia is a matter of concern because these individuals have decreased brain functionality and depend on others to make sound decisions. Therefore, this paper critically outlines professional, ethical, and legal dilemmas that nurses must consider when providing palliative care for patients who have dementia.
Professional Consideration
Doctors, nurses, and health practitioners are bound by rules and codes that oversee their clients’ quality of care. According to Kaya and Boz (2019), health practitioners must hold onto NMC codes to render quality services. NMC codes aim to safeguard the general public’s health, set education and training standards, and accept conducts that all practitioners need for quality services. As the NMC code requires, nurses and doctors caring for dementia patients must treat their clients as individuals, despite their conditions. Caregivers need to respect patient dignity, be kind and considerate, give care free of discrimination, and advocate for patients (Scott 2017). Nurses and doctors caring for dementia patients must ensure that they gain the consent of patients’ conditions and need. According to Scott (2017), the NMC code demands that caregivers achieve consent before administering care plans to their patients. Moreover, they need to respect and back patients’ right to choose or decline the interventions they want for themselves. A nurse must also involve dementia patients when deciding the care these individuals need.
Risk management in a healthcare facility is another critical issue that nurses and care providers must address. Patients’ safety and well-being should be at the heart of all care providers. The NMC code requires that nurses and other employees in healthcare facilities be risk cautious in safeguarding patients (Rajan-Brown & Mitchell 2020). NMC code advises nurses and other care providers to act without delay when other colleagues’ acts could put patients in danger. The code also demands that nurses report health concerns issues to relevant authorities for prompt address (Rajan-Brown & Mitchell 2020). Risk management is crucial when caring for an adversely affected patient with dementia. From its characteristics, patients suffering from the condition show memory loss and an inability to make an informed decision; as such, they are prone to making uninformed decisions that could impact an individual’s or other patients’ lives (Rajan-Brown & Mitchell 2020). Therefore, risk management in dementia care facilities is paramount, and care providers should exploit their professional risk management skills to reduce sources of risks.
The Four Ps for Patient’s Experience
The focus of the four Ps of patient experience describes the individuals responsible for care deliveries (physician and partners), the process, and the places patients experience as they receive medication. According to Reilly and Houghton (2019), the four Ps levers are the physician, partners, places, and processes followed when rendering care. Physicians are the primary and the first contact that people suffering from dementia contact or build a relationship with (Reilly & Houghton 2019). The lead physician is often the primary care provider to patients. As such, organizations or healthcare facilities should pay special attention to employing lead physicians with adequate skills and experience to enhance the quality of care as dementia patients are concerned. Partners are the second lever in the Ps, including nurse practitioners, assistants, and nurses, among other care team members. These individuals contact patients before, during, and after interacting with the physician (Reilly & Houghton 2019). Health organizations should partner with an appropriate body that provides customer service training and support for effective care delivery.
The third level of the four Ps is where nurses and other care providers can provide care. According to Sorato et al. (2021), not all dementia patients prefer hospitalization, but some prefer home care. As such, healthcare organizations offering palliative care for dementia need to secure appropriate places such as outpatient centers and emergency departments for acute care. Strategic positions and places are vital in caring for dementia patients because severity varies from one patient to another. The last lever of the Ps is the process responsible for developing effective patient-centered care that matches current patient demands. Therefore, healthcare providers and nurses must incorporate the four Ps framework in their palliative care for patients with dementia to provide quality care.
Nursing Bioethics Principle Consideration
Bioethical principles are vital in determining patient care in today’s modern world. Nurse practitioners and other care providers must consider the four bioethical aspects of caring for dementia patients: respect for autonomy, beneficence, non-maleficence, and justice. Starting with autonomy, the term has a range of meanings that include self-rule and determination, freedom of will, and dignity. Other studies further define autonomy as independence, individuality, and self-knowledge (Schenone 2020). In medical ethics, respect for patient autonomy is a fundamental principle when deciding care plans. For dementia, respect for autonomy is a challenging issue that nurses and other care providers must understand to arrive at appropriate care plans. According to Schenone (2020), respect for autonomy is fundamental for a good quality of life, especially for older people. Nurses and care providers need to involve patients when making care decisions and should consider patients’ preferences. The essence of autonomy is to allow dementia patients to protect their abilities to act genuinely and informally.
However, with increased dementia severity, individual patients lose memory and the ability to think and make informed decisions. Therefore, the principle of beneficence comes into play. Veatch (2020) states that beneficence is a bioethics principle that strives to see the acts or care given to benefit the patients. Beneficence entails the moral obligation to act in a manner that helps patients and prevents harm. Nurses consider the gifts of their actions to the individual patients and the whole community. Another bioethical principle that nurse practitioners must consider when caring for dementia patients is non-maleness. According to Veatch (2020), non-maleficence implies that nurses and care providers must articulate their duties and obligations in a manner that does not harm individuals and their families. In some cases, nurses could override one’s respect for autonomy to prevent injustice to other people. This can be justified on the ground of non-maleficence and beneficence.
Conclusion
Nurses and care providers must consider various factors when developing patient care plans. First, it has been said that doctors need to refer to NMC codes that define accepted nurses’ and other care providers’ conduct to provide quality care for their patients. Moreover, nurses must consider bioethical principles to arrive at appropriate care plans that benefit their clients. The biomedical principles discussed in this paper are respect for autonomy, beneficence, and non-maleficence. Lastly, it has been presented that nurse practitioners must address the ethical dilemmas emanating from consideration for the freedom to devise a proper plan to meet a patient’s care needs. Generally, caring for people with dementia poses several ethical dilemmas that arise when nurses try to balance respect for autonomy and their well-being.
A moral dilemma is a choice between two or more equally unsatisfactory alternatives that only one can be met. Although studies have not found ethical dilemmas concerning caring for dementia, ethical conflicts arise when patients want to live at home rather than be hospitalized. Staying at home limits the quality of care that one gets, and forcing the patients to live in the care facilities breaches their respect for autonomy, a fundamental principle in medical ethics. As such, it can be concluded that respect for autonomy undermines patients’ quality of care. Moreover, it would be unethical to go against the patients’ will to be hospitalized because they have the right to be involved in decision-making regarding their care plans.
Reference List
Kaya, A. and Boz, İ. (2019). The development of the Professional Values Model in Nursing. Nursing ethics, [online] 26(3), pp.914–923.
Podgorica, N., Flatscher-Thöni, M., Deufert, D., Siebert, U. and Ganner, M. (2020). A systematic review of ethical and legal issues in elder care. Nursing Ethics, 28(6), p. 895-910.
Rajan-Brown, N. and Mitchell, A. (2020). The NMC Code and its application to the role of the midwife in antenatal care: a student perspective. British Journal of Midwifery, [online] 28(12), pp.844–849.
Reilly, J.C. and Houghton, C. (2019). The Experiences and Perceptions of Care in Acute Settings for Patients Living with dementia: A Qualitative Evidence Synthesis. International Journal of Nursing Studies, 96(96), pp.82–90.
Schenone, G.E. (2020). Injection-Induced Breast Siliconomas Clinical Implications, Evaluation and Treatment /. [online] lib.ugent.be. Web.
Scott, P.A. (2017). Key Concepts and Issues in Nursing Ethics. Cham: Springer International Publishing.
Sorato, M.M., Davari, M., Kebriaeezadeh, A., Sarrafzadegan, N., Shibru, T. and Fatemi, B. (2021). Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P’s (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review. BMC Cardiovascular Disorders, 21(1).
Veatch, R.M. (2020). Reconciling Lists of Principles in Bioethics. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 45(4-5), pp.540–559.