Question

The Case: You are the Registered Nurse who is looking after John. John is a 20-year-old Aboriginal Torres Strait Islander (ATSI) man living with end-stage renal disease (ESRD). He normally lives in a remote Indigenous community and he is currently in a hospice 500km from his home. John is receiving dialysis in the hospice which the health care team has advised he requires to maintain his current health status. John has been told by the medical team he is not expected to survive more than three months on dialysis. John has decided that he wants to return home with no further treatment. The doctor has advised him that his life expectancy will be much shorter if he stops treatment.

Question: What are some ethical decision making, cultural care requirements, and your personal beliefs when caring for John?

Answer 1

END STAGE OF RENAL DISEASE

It is last stage of chronic kidney disease and kidney gradually loses it function ,kidney is no longer able to function to meet the body need patient should be rely on dialysis and his life expectancy is very low.

Dialysis – it is a process in which removal of toxic waste from the blood of patient , whose kidney not able to perform the normal function

ETHICAL DECISION MAKING

AUTONOMY( right for self determination) – we should have to encourage the john use of advance directives so that the autonomy is preserved as his decision making capacity is lost, patient should be participating in making medical decision.

BENEFICIENCE- acting according to the patient interest and it should be good be good for patient.

NONMALFECIENCE- avoidance of the infliction of intentional harm , sometime physician participation in the physician assisted suicide which is violation of principle .

JUSTICE – fairness in the delivery of healthcare , as patient is dying we should advocate the treatment without any discrimination and

FIDILITY- truthfulness and faithfulness in the delivering healthcare , as healthcare professional we should be truthful about treatment , prognosis and diagnosis of dying patient even when decision making capacity is lost.

Right to refuse for medication ,withdrawal of supportive treatment including nutrition and hydration, “no code” decision , assisted suicide.

Physician should have mutual agreement while withholding the treatment by telling drawbacks of unrealistic events.

CULTURAL CARE REQUIREMENT

Every body have certain, belief and custom that are related to cultural background of ATSI , as part of health care team we should know the specific cultural practice of the patient. These practices act as healing process .These are

1. Personal hygiene

2. Diet

3. Special national or holidays

4. Sexual orientation to loved ones

5. People from ATSI have strong relation from water , traditional land

6. Preparation for Ceremonies (pukamani) related for end of life

PERSONAL BELIEF WHILE CARING JOHN

My persona belief is to provide comfort to the patient so that he can die in the peace. Providing religious comfort make the journey of end of life easier for the patient, supporting the cultural belief may delays the death process. Keeping a touch with the lordship may help to decrease his/ her suffering.

Communication help for the verbalizing the fear and anxiety of the client , including the loved one In the care of john will be grateful for both patient and family. Allowing for thought sharing and feeling to family members. Making a emotional comfortable environment for easy dying process .helping the client in forgiving the other if he has any previous issue to relief burden form the hear. Completing of unfinished work might having with family and friends. Involving sense of john and music therapy its way to support physical, mental and spiritual heeling. therapeutic touch or accupressure to releif pain if cleint have.keep loving the people and remain open to them.

i HOPE YOUR DOUBT IS CLEAR YOU CAN ADD SOME MORE PERSONAL BELEIF FOR THE CARE OF JOHN