Legal And Ethical Issues In Mental Health Nursing Nursing Essay

Legal And Ethical Issues In Mental Health Nursing Nursing Essay This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. It will explore how ethical decisions are reached and how they can directly influence patient care. To achieve this aim the author will examine a case study of a patient whose care he was involved with whilst in placement. We will look at how, after an episode of self-harm, the patient refused any medical treatment for the wound and how this posed an ethical dilemma for the nursing staff involved in their care. Using the application of the Mental Capacity Act (MCA) (Great Britain (GB) 2005) and an established model for ethical decision making, we will look at how the decision of whether or not to enforce treatment for the wound was formulated and actioned. Ethics can be seen as the study of human conduct and morality (Buka 2008). It is about people reasoning, thinking and applying a process of reflection (Adshead 2010); however these people may have opposing views, values and experiences on which to base their moral judgements to define what is the right and wrong course of action (Hendrick 2009) and the principles used to decide this, not only by the individual but also within social groups and societies. (Adshead 2010). From this we can surmise that ethics is a complex system of reflective thinking, which is used in the search for a standard that can be used to judge your own actions, or the actions of others, within your own moral code. The Nursing and Midwifery Council (NMC 2008) stipulates that nurses must respect a patients right to confidentiality at all times and ensure that the patient is informed about how information concerning them is shared. In accordance with this the name of the patient has been changed and permission has been sought from the patient to use them in the case study (Appendix 1). Case Study. Anitas story. Anita is a young woman with a primary diagnosis of emotionally unstable personality disorder borderline type as defined by the World Health Organisation (WHO 2010). During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. As such the therapeutic session concentrated on exploring her feelings surrounding her impulses, alternative coping mechanisms to manage her thoughts of self-harm and strategies to help maintain her safety upon the ward. As she felt that the pressure of being constantly watched would unsettle her further, thus not allowing her to manage her own feelings it was initially agreed to place Anita on intermittent observation as opposed to constant within the policy on self harm produced by the service that was caring for her (Oxford Health DATE). This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions. Later in the shift Anita approached staff and stated that she had overwhelming urges to self-harm and that she had acted upon them. She was taken to the clinic room where the wound could be cleaned and assessed. Anita presented with a laceration to the inside of her thigh which was deep enough to expose the adipose tissue beneath, however was not deemed by the medical staff to be life threatening. Staff explained to Anita that the wound was deep enough to require stitching although not life threatening and advised her that she would need to attend the minor injuries unit of the local general hospital for assessment of the wound. At this time Anita, due to her mental state, could not fully appreciate the nature of the wound and felt that she needed to punish herself further by refusing treatment. The nurses on duty cleaned and bandaged the wound and allowed Anita time to consider the implications of her decision further. When Anita had calmed the nurse had a discussion surrounding the implications of not having the wound sutured such as infection, Anitas possible need to attack the wound in the future and pain relief issues, However Anita maintained her decision not to have the wound sutured. Following a wider team discussion around whether Anita understood the severity of the wound, thus having capacity to make a decision to refuse treatment, the Responsible Clinician (RC) spoke to Anita and attempted to persuade her to have the wound sutured. As Anita was still refusing to have the wound sutured the RC decided that an assessment would need to be carried out to ascertain whether Anita had the capacity to decide to refuse treatment. Upon completion of the assessment it was decided that Anita did have capacity to make decisions surrounding treatment at that time, within the framework of the Mental Capacity Act (GB 2005). This decision was reached due to Anita being able to understand the information being given to her, being able to retain the information and weigh it up to make a decision to refuse treatment. Although this appeared to be an unwise decision, which felt uncomfortable to the team, it was agreed to monitor the wound, keep it clean and dry and continue to talk to Anita about her thoughts and feelings surrounding getting medical treatment for the wound. This collaborative approach allowed Anita opportunities to explore her emotions, thoughts and feelings and promote her autonomy whilst still allowing her to decide to have the wound sutured should she change her mind. The main legal and ethical dilemmas that can be extracted from this case study are whether the Anitas capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anitas ability to make autonomous decisions surrounding her care should outweigh the nurses obligation towards beneficence. The Legal Dilemma. Mental Capacity. What legal Dilemma can be hypothesised as underpinning the decision making process of the mental health professionals in this case? Anita initially made her decision to refuse treatment shortly after self-harming. Self-harm has been strongly associated with borderline personality disorder (Motz 2008) where thoughts of self-loathing and self-punishment are common precipitators; the act of self harm can be seen as a symptom of internal turmoil, an expression of internal pain or as controlling factor to maintain a level of care (Grocutt 2009). This may indicate that Anita was under a great deal of distress at the time, which could have affected her capacity to make sound decisions; however her later decision of continuing to refuse treatment was based on her own morals and values towards her body that may have included these thoughts of self-loathing and the need to be punished. Although a person, under part four Mental Health Act (GB 2007) can be treated for mental disorder without the ir consent, it is important to note that a physical problem can only be treated without consent should the person lacks capacity and treatment is deemed to be in their best interests under the auspice of the Mental Capacity Act (GB 2007, MIND 2009). To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. Firstly the practitioner needs to ascertain whether the person being assessed has some sort of disturbance of the mind and, if such a disturbance exists then it must affect their ability to make decisions when they need to (Department of Constitutional Affairs (DoCA) 2007:45). If this is not the case then the person cannot be seen as lacking capacity under the Act (GB 2005, DoCA 2007). In considering whether Anita needed to make the decision around treatment, we can see that, as the wound was not life threatening, it was decided to allow her time to settle and re-approach the question of treatment. The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. In deciding that the decision could be made at a later time not only complies with the Act but also promotes Anitas autonomy. As the wound could be safely managed in the s hort term upon the ward the decision to allow Anita time to weigh up the information was the correct one to make. Conflicting ethical principles and dilemmas Lakeman (2009) points out that an ethical dilemma occurs when there are a multitude of alternative courses of action to deal with a particular situation. Conflicting moral principles may create difficult ethical dilemmas for nurses by having to contravene one moral obligation to uphold another (Beauchamp Childress 2009). Anitas ability to make autonomous decisions surrounding her care should outweigh the nurses obligation towards beneficence. However this may not feel entirely comfortable for the nurse. In mental health nursing, autonomy is sometimes overridden in the interests of promoting the principle of beneficence (Lakeman 2009). Which can make the nurses ethical dilemma difficult to manage due to balancing the two valid ethical principles of autonomy (respecting and supporting decisions making) and beneficence (relieving or minimising harm in the best interest of the patient) (Hendrick 2004, Beauchamp Childress 2009). To answer the question we need to examine how the dilemma sits within an ethical theory and the principles that apply. Beauchamp and Childress (2009) devised four basic moral principles which function as guidelines for professional ethical decision making. The principles of autonomy (freedom to act on your own belief), Nonmaleficence (obligation to avoid doing harm), Beneficence (providing benefits and help) and Justice (fair distribution of benefits, risk and cost) which are derived from a duty based theory of Emmanuel Kant (1724-1804) (Beauchamp Childress 2009). Principle 1 Autonomy. Respect for autonomy flows from the recognition that all persons have unconditional worth, each having the capacity to determine his or her own moral destiny. To violate a persons autonomy is to treat that person merely as a means: that is, in accordance with others goals without regard to the persons own goals. Beauchamp Childress (2009: 103) after Kant Autonomy is the freedom and ability to act in a self determined manner (Butts Rich 2008: 42) and the right of a rational person to achieve personal decisions without any outside interference. Therefore the principle of respecting autonomy concerns the nurses acknowledgement of, and obligation in respecting, Anitas decision over her own life. It may be that Anita is already feeling a loss of autonomy or disempowerment by the very nature of being a patient upon a secure ward and being under the Mental Health Act (GB 2007) and the restriction of her basic autonomous decisions such as when to eat, sleep or who she resides with. Therefore it may need to be considered whether Anitas is refusal of treatment is something that she feels in control of, thus a way in which she feels empowered. Principle 2 Beneficence. Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfareà ¢Ã¢â€š ¬Ã‚ ¦ and à ¢Ã¢â€š ¬Ã‚ ¦[is therefore]à ¢Ã¢â€š ¬Ã‚ ¦ a moral obligation to act for the benefit of others. These beneficial actions fall under the heading of beneficence. Beauchamp and Childress (2009: 197) Beneficence can be seen as actions to benefit and promote the welfare of others (Butts Rich 2008). All actions that are performed by nurses can be regarded as having a moral dimension, most of which are for the benefit of the patient (Edwards 2009). The NMC Code of Professional Conduct is clear in stating that nurses have an obligation to both protect and promote the health and wellbeing of patients as their primary consideration (NMC 2008:2) and this is no different for mental health nurses working with patients who self-harm. This statement clearly incorporates the principle of beneficence and shows that the nurses in the case study are considering whether Anita should have medical treatment for the wound enforced upon her due to the principle of beneficence as described due to the worries of the wound becoming infected if not sutured. The dilemma. When nurses experience the ethical dilemma of having to enforce treatment irrespective of a patients right to autonomy, they can be seen as working in a paternalistic manner (Butts Rich 2008). In Anitas case, the nurses worry that the consequences of the wound becoming infected is driving their desire to treat the wound irrespective of Anitas wishes. However, although the actions on behalf of nurses is clearly driven by obligations towards beneficence, nurses need to weigh up the harms and benefits of enforcing treatment before acting in such a way as to produce the best outcome for Anita (Edwards 2009). A paternalistic approach is frequently used to infringe upon a persons right to autonomy. This infringement is supported by the principle of beneficence, which is the argument frequently used to impose treatment on patients whether they want it or not (Buka 2008: 29). Should the decision to treat Anita for her self harm regardless of her wishes have gone ahead, there may have been a risk of impacting on the nurse-patient therapeutic relationship. This relationship is built upon trust as well as purposeful and effective communication (Buka 2008) and is considered to be the cornerstone of nursing care (Lakeman 2009, Pryjmachuk 2011).Therefore the nurses would need to consider future risk as part of the ethical decision making process. Enforcing treatment on Anita may produce barriers to the therapeutic relationship such as difficulties in trusting the nurse in the future, disengagement from therapeutic communication, opposition and rejection of future treatment, increased self harming behaviours due to the trauma and hostility towards others (Kettles et al 2007, Byrt 2010), all of which may stop Anita from telling the nursing team when she self-harms in future episodes of distress. Which raises the principle of Nonmaleficence (doing no harm), in thi s instance to the therapeutic relationship, wellbeing and care of Anita. The decision to manage the wound on the ward and allow Anita time to calm and consider her options is, in the authors opinion, the correct course of action to take. As the wound was neither life threatening or of such a degree that it could not be safety managed upon the ward enabled the staff to consider the possibility of allowing Anita to make an autonomous choice. In considering Anitas wishes and agreeing a management plan to care for the wound incorporates both principles of Anitas autonomy and the nurses obligation towards beneficence. Beneficence could be interpreted to incorporate the patients autonomous choice as the best interests of the patient are intimately linked with their preferences [from which]à ¢Ã¢â€š ¬Ã‚ ¦ are derived our primary duties towards them (Beauchamp Childress 2009:207). If the nurses obligation to act beneficently is informed by the patients choices and preferences, then the respect for the patients autonomy will ultimately override any paternalistic actions on the part of the nurse (Beauchamp Childress 2009). This would not only encourage a supportive nurse-patient relationship but also provides care that is holistic, develops Anitas confidence in being able to negotiate her care and allows her to take greater personal responsibility, thus instilling empowerment and hope, all of which improve the potential for recovery. The practice of paternalism is now generally discouraged in health care (Butts Rich) and is considered unjustifiable in cases where the patient has capacity to make a decision (Edwards 2009, Beauchamp Childress 2009). Conclusion. Every decision that a nurse makes concerning the care of a patient needs to be considered from an ethical base. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance. The conflicting principles of autonomy and beneficence that have been presented within this case study would both be ethically and morally correct courses of action to take. From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation. Are large proportion of moral and ethical dilemmas that are faced by nurses stem from the conflicting principles of autonomy and beneficence. However, the nurses ability to critically appraise risks and benefits will help them to make decisions that are beneficial to the patient involved. In encouraging autonomy for Anita involves taking risks on the part of the nurses which may go against their principles of Nonmaleficence and beneficence. However with collaborative working practices this case study has shown that solutions can be found in even the most complicated of nursing dilemmas. Word Count 2687.

Stride Gum

Is It Ridiculously Long Lasting? In the recent Stride commercial, Shaun White endorses their new Whitemint flavored gum. The advertisement’s main purpose is to promote the gum by creating an ironic situation that grasps the audience’s attention with a humorous tone. Without stressing the product so heavily, they provide a less demanding approach for the audience to buy their product. The advertisement promotes the gum as ridiculously long lasting. Although, throughout the commercial, the marketer’s debate over solutions for the consumers to chew another piece.By the end of the commercial they come up with the solution for consumers to either â€Å"Spit it out. or Yeti will find you. † Stride Gum Inc. uses irony, social appeals, and tropes to lure the audience. The ironic situation in the Stride Gum commercial is how it is an advertisement within an advertisement. Obviously an advertisement’s purpose is to promote a specific product. But in this adve rtisement, it shows the marketing professionals for Stride Gum deciding on ways to promote their product. It is ironic to see a commercial that is about their company making their commercial.Another ironic appeal is Stride Gum’s use of a yeti. At the end of the commercial, Shaun White comes up with an idea to get the consumers to chew another piece and quickly gets on his phone. Suddenly, a giant yeti comes barging in the meeting room and punches the head-marketing executive in the gut, forcing his gum to shoot out of his mouth. The audience clearly knows a yeti would never come force their gum out by punching them in the stomach, let alone even encountering a yeti. This sets a humorous tone for the audience to relate to which increases their interest for the product.Another tool Stride Gum incorporates is their usage of a social appeal. In their commercial, Stride features Olympic gold medalist Shaun White. Just this year Shaun White was named the second most powerful athlet e behind Peyton Manning. Not only is White a tremendous snowboarder and skateboarder, he has become a celebrity and role model for the youth culture. Stride purposely uses Shaun White to target the youth audience because of his friendly face, personality, athletic ability, and popularity.Once the youth audience sees him on TV, they instantly feel a connection that the older generation cannot relate to. Being a popular hit for sports and role modeling for the fans, White makes Stride Gum a sure way to instant marketability. Lastly, Stride Gum uses the appeal through tropes to capture the audience. The first trope used for the Whitemint flavored gum commercial is, â€Å"The ridiculously long lasting gum. † When they first advertise this gum as long lasting, Stride’s main purpose is to suede the audience in believing their gum lasts longer than other competing products.But throughout the commercial the main concern for the marketers changes into getting the consumer to ch ew another piece. The change is ironic to see because at the beginning Stride really wants the audience to believe their gum is ridiculously long lasting. But by the end of the commercial, they act like the viewers have already believed their long lasting flavor proposal. This then puts the stress on the idea that the marketers are trying to find a way to get the consumers to stop chewing it and get another piece.By using these two different tropes, it represents Stride as being confident that their gum is long lasting, and its so long lasting they have to find a way for people to spit it out and chew another piece. By the end of the commercial the slogans change from â€Å"the ridiculously long lasting gum† to â€Å"spit it out, or Yeti will find you. † Stride purposely changes the tropes because they want the audience to believe that the Stride marketers have perfected long lasting gum. They now want the viewers to believe their Whitemint gum is so long lasting that they are facing the issue of getting the consumers to chew another piece.With the use of transforming tropes, social, and ironic appeals, Stride Gum Inc. attracts the audience’s interest and attention. Shaun White and the yeti implement a humorous tone that coincides with the ironic situation that appeals to the youth culture. Also, switching up the tropes sways the viewers to fully believe Stride Gum’s advertisement due to the confidence displayed by Stride in the commercial. By applying multiple appeals into their commercial, Stride Whitemint flavored gum is advertised effectively to sway the younger generation’s interest to consume their product.

My Career Choice

It halogens not Just your abilities, but it also challenges your brain. It is never the same thing every day. My main reason for becoming a CSS is to get Justice for the victims. My professional reasons for becoming a Crime Scene Investigator are to get criminals off the streets. I would like to make a good career out of being a CSS. Another reason is that I will gain great skills out of this profession. There is always a want for Chi's and Criminal Justice majors. I will be successful because I will have my bachelor's degree in Criminal Justice. I will get a great deal of work experience In y field.I will gain a great deal of skills that can only help me go further. I plan to be as successful as I can be. My academic goals will help me succeed because without a degree you cannot get a good Job. You cannot go any further in your field of study. The academic goals should be realistic and time oriented. These goals should be within your period for schooling, and they should be In three lengths. A short-term goal, A medium term goal, and a long-term goal. My professional goals will help me succeed because they will get me a good Job, and work experience.They will help me gain skills that are needed in my area of work, and they will help me move up In my career. I believe that both academic and professional goals are the two major steps in becoming a Crime Scene Investigator. Being a Crime Scene Investigator could have both good and bad things about It. You must have the skills to be a CSS. Having a strong stomach Is a big thing with being a CSS. You see bodies everyday and you have to be able to handle the worst kind of smells. Patience, and having a sharp eye for detail are both key skills In being a CSS.You have to be patient and take the time to find the little details In every case. Having the skills and the experience for the Job can help you more than It could ever hurt you. Having the knowledge for this Job Is a big part of the academic goals. You can never go wrong with knowing as much as you can about your area of study. The mall thing that one should always remember about being a CSS Is that there Is a lot that comes with the Job. This Job Is not Just a normal nine to five Job, this Job could be a nine to five Job and then an on call every night Job.When they call you In the boss expects you to be there at a moment's notice. My Career Choice By Ashley my bachelor's degree in Criminal Justice. I will get a great deal of work experience in within your period for schooling, and they should be in three lengths. A short-term gain skills that are needed in my area of work, and they will help me move up in my have both good and bad things about it. You must have the skills to be a CSS. Having a strong stomach is a big thing with being a CSS. You see bodies everyday and you for detail are both key skills in being a CSS.You have to be patient and take the time to find the little details in every case. Having the skills and the experience fo r the job can help you more than it could ever hurt you. Having the knowledge for this Job is a big part of the academic goals. You can never go wrong with knowing as much as you can about your area of study. The main thing that one should always remember about being a CSS is that there is a lot that comes with the Job. This Job is not Just a night Job. When they call you in the boss expects you to be there at a moment's

Essay about abraham lincoln - 751 Words

Abraham Lincoln was born in Hardin County, Kentucky on February 12, 1809, to Thomas Lincoln and Nancy Hanks. Thomas had been apprenticed as a carpenter after the death of his father and the passing of the family property to his eldest brother as required under the system of primogeniture. Thorough dint of hard work or with funds from his family, Thomas acquired enough money to purchase a farm, but his ownership was soon challenged. Kentucky had been surveyed in such a primitive manner that boundaries were never certain. After having the titles of two other farm parcels challenged, Thomas tired of Kentucky and in 1816 moved his family to southern Indiana. The federal government had surveyed Indiana in a manner that insured sound titles.†¦show more content†¦Dispossession and penury were not uncommon. The Lincolns crossed the Ohio River and homesteaded near Little Pigeon Creek in Perry County, Indiana. Their family consisted of Thomas and Nancy, young Abraham, and his older sister Sarah. In a biographical sketch written in 1859, Lincoln recalled the scene: quot;We reached our new home about the time the State came into the Union. It was a wild region, with many bears and other wild animals still in the woods.quot; Abraham was put to clearing timber so the land could be farmed. quot;A. though very young, was large of his age, and had an axe put into his hands at once; and from that till within his twenty third year, he was almost constantly handling that most useful instrument -- less, of course, in plowing and harvesting seasons.quot; Lincoln endured a youth of rough conditions, of mind-numbing and muscle-straining manual labor, of prolonged physical exertion that gave him a physique so lean and muscular that doctors performing his post-assassination autopsy remarked upon it. The perils of frontier life were brought home to the Lincolns in 1818 when the quot;milk sicknessquot; visited southern Indiana. 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