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Palliative Care: Ethical Analysis / Ethical Analysis in Healthcare Sector

Communication to move strategy forward

The term 'leadership' is defined as a person's behavior when he/she guides a group's activities in pursuit of a common aim. The main elements of a leader's role include managing change and guiding group activities. One challenge concerning leadership in the healthcare context is that a majority of theories were not formulated keeping healthcare in mind. Rather, they were created for mainstream businesses, and later utilized in healthcare settings (Al-Sawai, 2013). The keystones of ethical clinical practice include avoiding patient harm and delivering quality care. Healthcare professionals wish to do what is ethical, however, how they must proceed is not clear to them in some cases. All scenarios differ in some or other way, and ethical issues may appear even if a healthcare institute establishes policies for dealing with them. A few ethical issues include avoiding situations where personal and organizational interests clash, equalizing charity care and organizational profits derived from serving patients, overcoming dilemma with equality in delivering treatment vs. special treatment for influential patients (e.g., donors), taking care of geriatric and pediatric patients incapable of making the right decisions, and dealing with the moral distress of nurses in regard to care delivery with marginal returns (AMN Healthcare, 2010). A specific example in which modern-day leadership and ethical challenges are posed to healthcare leaders is palliative care. Though a majority of healthcare organizations largely appear to be managed well, with advance planning for a majority of scenarios and situations, this is not the case at all times, particularly in regards to specific actions/decisions nurses must take, acts/services they must refrain from doing, and the reasons for these stipulations. A simple example to explain this would be circumstances wherein a palliative approach is perhaps, or certainly, required, but no clear protocol can be found regarding its precise time/situation of onset as well as, what criteria have to be employed. Patients faced with this sort of scenario are, in fact, terminally ill or, at least, no cure exists for their ailment (e.g., an individual suffering from a case of cancer that, according to doctors, has reached an incurable stage). The lack of a leader to handle protocols of palliative care necessitates collaboration by nurses, who must initiate suitable level of care when there is a lack of interest to bear the responsibility of leadership or initiative. Palliative care situations refer to those situations in which patient care is limited to reducing their pain and managing comfort. Patients who qualify for palliative care include those suffering from cancer, those having chronic, incurable pain conditions, etc. It would be ideal and an indication of leadership for hospices, hospitals, and other healthcare facilities to have clear protocols for palliative care initiation and the way it should progress after commencing. Not every healthcare facility, however, pays sufficient attention to the subject. Frequently, nurses are seen making such decisions -- they set patients on a palliative path and make decisions according to the subsequent condition of the patient, to the best of their ability and knowledge. Also, at present, numerous alternatives exist to care for terminally ill patients. The increase in methods and types of palliative care is mainly because of multi-dimensional technological evolution. Ethical issues arise when healthcare workers have to decide on the ideal type of care for dying patients. An example of the decisions they face is concerning using machines to sustain the life of a patient, or terminating his/her life by taking the patient off life support. Such decisions pose an ethical quandary for all involved parties. In older times, one could conveniently define death as the end of life, but in the modern age, conditions are different. There are machines, now, for sustaining vital bodily functions (e.g., breathing), lending increased complexity to definition of death. Shaughnessy (2004) aptly states that in the new age, a new type of patient can be seen, who is brain-dead, but has functional lungs and heart. CPR (cardiopulmonary resuscitation) and other similar technologies have made restarting of the function of vital organs possible, via machines. Such ethical problems, and care of individuals who are at death's doorstep, result in burnout of several healthcare providers, owing to the emotional stress, and psychological and physical demands of their profession. Pereira and coworkers (2011) indicate that this distress of palliative care personnel arises from the fact that they see death on a daily basis. Some issues encountered by them include the decision of complying with advance patient requests, the decision of aiding in euthanasia or suicide, the decision of withholding CPR, or of withdrawing or withholding treatments they know are essential for sustaining life. Thirdly, ethical challenges typically surface in the context of palliative care, on account of concerns pertaining to the amount and type of care suitable for patients with not many days left to live. There is, generally, a conflict between doctors, nurses, other healthcare workers, patient family, and the patients themselves in connection with what constitutes proper care, particularly as those who are terminally ill near the end of their life (EOL). Lastly, EOL care is often complex, and can compel patient care providers to make hard decisions including: Whether the patient should be put on life support, how long it should be continued, when life support must be terminated, whether or not to put the patient on a tracheostomy or feeding tube, whether or not CPR must be administered to a patient in palliative care who suffers a heart attack, etc. Frequently, it is the patient's families who make such key decisions, as the patients themselves are unable to do so. One major difficulty palliative care personnel encounter is prognosis uncertainty -- when they must broach the topic of EOL with the patient's family.

Proposed Strategy

In general, handling ethical quandaries in the healthcare setting entails prioritizing patient needs. Usually, however, this may mean granting precedence to the majority's needs over the needs of few. Healthcare leaders who can voice their opinions concerning ethical decisions (be it to team members, an ethical board, patients, or patient families) can handle the emotional challenges associated with ethically tough decisions more effectively (Lennon-Dearing, Lowry, Ross, & Dyer, 2009). Ethical issues form an integral part of clinical practice and healthcare workers cannot escape them. However, in the present day, healthcare executives are required to manage ethical problems by taking a balanced perspective of the situation they face (McClellan, 2013).

Clear Guidelines by leaders

Palliative care leaders and physicians need to define what has to be done, why and when. Nurses, according to a researcher in the field, must not shoulder the burden of such a critical responsibility. Secondly, in the pain management context, a few key potential downsides exist, which need due consideration as pain relievers, such as narcotics that may prove addictive. This, however, will not be of much significance if the patient is approaching EOL stage. On the other hand, when a patient's situation is characterized by continuous, long-term pain, a very different series of considerations are witnessed. The likely concerns and problems go beyond these considerations. For instance, healthcare is, at times, rather segmented. The term 'silo' is widely used in this context. A fine example is that the practices and rules of pain management followed by emergency room and hospice nurses will probably differ. Saving lives is the primary goal of emergency room personnel, and pain management techniques are adopted only if possible. However, in a hospice care setting, pain reduction is usually one of many tissues, which may be considered, since hospice patients' days are numbered. The important thing is that consistency be maintained in the decisions of all nurses practicing at the same healthcare facility and scenario (such as palliative care). Moreover, a facility's medical experts and leaders must keep learning the subtle lessons from examples and teachable moments to demonstrate to staff what was performed well, where shortfalls were observed, and the rationale for these appraisals. Leaving a gap for nurses to fill is a totally bad idea; consistency is reduced, as is the emphasis on attaining ideal patient outcomes, even if it means experiencing pain just prior to dying (Lennon-Dearing, Lowry, Ross & Dyer, 2009).

Adaptation of authentic leadership by Leaders

Authentic leadership is capable of influencing nurses and the nursing profession as well as healthcare delivery structure and the overall society. Developing a positive workplace atmosphere for nurses is critical for ensuring a sufficient number of nurses. Nursing profession's stressful nature frequently results in burnout and, often, high rate of absenteeism, and disability, and eventually promotes the escalation of nurse shortages. Leaders have a critical part to play in retaining nursing staff by influencing the atmosphere of their respective healthcare facilities in order to bring about quality patient and staff outcomes. However, not many guidelines are present that aid in developing and maintaining the key components of a positive workplace ambience. The AACN (American Association of Critical-Care Nurses), in the year 2005, issued a major… [END OF PREVIEW]

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