Ethical Principle
Long Term Care
Palliative Care
End of life Care
Sprituality Among Older Adult
Ethical Delimma
What is Long Term Care ?
Long Term Care refers to variety of
services that includes medical and non-
medical care.
LongTerm care is to assist people with
support services such as Activities of Daily
Living (ADL) like dressing, bathing and using
the bathroom
DID YOU KNOW ?
In 2009, it was estimated that 9 million men
and women over the age of 65 would need
long term care
By 2020, 12 million older Americans
will need long term care.
Who is Long Term Care for ?
Long term care services are utilized by
people who have a chronic illness or
disability
It is important to remember that you
may need long term care at any age
What are the various roles in a
long term care facility ?
Everyone that interacts with residents and/or
family members, plays an important role that
enables the facility to develop an individualized
plan of care for every resident while in the
facility.
The role of an Adminitrator
adminitrators have a variety of oversight
responsibilities have a variety of oversight
responsibilities, including handling the
residents medicinal requirements, creating and
implementing facility, and handling the financial
aspects of running a nursing home
establishment.
THE ROLE OF A DON
Director of Nursing or DON is the little given to
the nurse who performs a supervisory role for an
entire nursing department in a long term care
facility.
A director of nursing is required to interact with
doctors, patients, families and other nurses, making
the position one of the most important in the field
of nursing.
The Role of an RSM
A rehab Service Manager or RSM is resposible for
directing the clinical and operational aspects of a
rehabilitation departments.
Coordinates the rehabilitative services provided
to patients by all disciplines in the facility.
Leads the communication between the
rehabilitation depatment and all other facility
departments.
ADL - Activities of Daily Living
These activities are those performed to those residents that
cannot perform these tasks themselves.
1. Personal Hygiene - Bathing, grooming and oral care.
2. Dressing - the ability to make appropriate clothing
decisions and physically dress oneself.
3. Eating - the ability to feed oneself though not necessarily
to prepare food.
4. Maintaining continence - both the mental and physical
ability to use a restroom
5. Transferring - moving oneself from seated to standing
and get in and out bed.
Levels of Long Term Care
Rehab Hospital
Skilled Nursng Facility
Nursing Home
Assisted Living
Home Health Providers
HOME HEALTH - care is a wide range of health care servcies
that can be given in your home for an illness or injury.
the idea behind home health care is to provide independence as
injury and illness is treated. It also helps maintain the patients
self-sufficience.
ASSISTED LIVING FACILITIES
An independent alternative for the elderly who require minimal
assistance with daily living and personal care.
Those who live in these facilities do not require the medical
and nursing care that is provided in “ nursing home “
NURSING HOMES
is a local or residential facility for individuals with a
disability or chronic illness.
Those individuals with disabilities are able to live in
nursing homes and receive care there.
SKILLED NURSING FACILITIES
is a type of nursing home. This type of nursing home is recognized
by CMS as a type of facility that meets the medical needs of
individuals who have the potential of functioning independently
after a limited time of care.
It is important to note that these residents have severe
deficiencies in their ability to perform activities of daily
living.
Challenges of LTC
1. Finance
A significant problem that is facing Long Term care facilities
is its ongoing reliance on medicaid funding.
The cyclical nature of the state government revenues makes it
difficult for theses facilities to have a high profit margin.
2. Quality Staff
Another major problem of LTC facilities is finding and
maintaining quality staff. The caregivers, or CNA’s perform
reflects the overall morale and reputation of the facility.
PALLIATIVE CARE
is a term derived from Latin palliative, “to cloak”
is a multidisciplinary approach and specialized medical caare for
people with serious illness.
The goal of therapy is to improve the quality of life
It’s focused on providing patients with relief from the
symptoms, pain, physical stress and mental stress of a
seriuos illness.
ISSUES ADDRESSED IN PALLIATIVE CARE
palliative care can address a broad range of issues, integrating an
individual’s specific needs into care. The physical and emotional
affects of cancer and its treatment may be very different from
person to person.
Physical
Emotional and coping
Practical
Spritual
PHYSICAL
Physical symptoms such as pain, fatigue, loss of appetite, nausea,
vomiting, DOB and insomia can be relieved with medicines or by
using other methods, such as nutrition therapy, physical therapy
or deep breathing techniques.
EMOTIONAL and COPING
Depression, anxiety and fear that can be addressed through
palliative care. Experts may provide counseling, recommend
support groups, hold family meetings or make referrals to mental
health professionals.
PRACTICAL
Patients may have financial and legal worries, insurance
questions, employment concerns about completing advance
directives.
SPIRITUAL
An expert in palliative care can help people explore their
beliefs and values so that they can find a sense of peace
or reach a point of acceptance that is appropriate for
their situation.
MODELS of PALLIATIVE CARE
HOSPICE CARE
A well established program to provide patients with a prognosis of six
months or less.
PALLIATIVE CARE PROGRAM
Institutional based program in the hospital or nursing home to
serve patients with life-threatening or life-limiting illnesses.
OUTPATIENT PALLIATIVE CARE PROGRAM
Occur in ambulatory care settings to provide continuity of care
for patients with seriuos or life-threatening illnesses.
COMMUNITY PALLIATIVE CARE PROGRAM
Occur in communities as consultative teams who collaborate with
hospices or home agencies to support seriously ill patients who have
not yet accessed hospice.
DOMAINS of QUALITY PALLIATIVE CARE
Domain 1: Structure and processes of care
Domain 2: Physical aspects of care
Domain 3: Psychological and Psychiatric aspects of care
Domain 4: Social aspects of care
Domain 5: Spiritual, Religious and Existential aspects of care
Domain 6: Cultural aspects of care
Domain 7: Care of the Imminently Dying Patient
Domian 8: Ethical and Legal aspects of Care
END OF LIFE CARE
Palliative Care
Making life as easy as possible for patients and families
living with serious illness.
Hospice Care
Is given when there is life expectancy of 6 month or less
GOAL
Provide comfort and supportive care during process
Improve the quality of remaining life.
Help to ensure dignified death.
PRINCIPLES
Respecting patient goals, preferences and choices
Attention of the medical, emotional, social and spiritual
needs of the dying person.
Using strengths of interdisciplinary resources
Acknowledging and addressing care giver concerts
Building mechanism and system of support
TECHNOLOGY and END OF LIFE CARE
Technological advances in health care have extended and
improved the quality of life for many, abilities of technology to
prolong life beyond the point that some would considered
meaningful has raised troubling ethical issues.
CHANGES AT END OF LIFE
1. Physical changes
Sensory changes
Hearing and touch Urinary system
Taste and smell GI system
Integumentary system Musculoskeletol system ‘
Cardiovascular system
Respiratory system
2. PSYCHOLOGICAL CHANGES
Variety of feelings and emotions affect the dying patient
and family at the end of life.
Grief: It is the emotional and behavioral changes to loss. It is
positive coping mechanism which also helps in individual well
being.
STAGES OF GRIEF: Legal documents used in end of life care
D - Denial 1. Advance directives
A- Anger 2. Durable power of attorney
B - bargaining 3. Medical power of attorney
D - depression 4. Directives to physicians
A - acceptance 5. Directives to physicians
6. Organ and Tissue Donation
7. Euthanasia
8. Resuscitation
Aspects of End of life care Preparation of end of life
Palliative Care Despite a doctor best efforts and
Preparation of end of life hard wok, disease treatments
Crae for terminally ill child’ sometimes stop working and a cure
Hospice care or long term remission is no longer
Advance directives possible.
Understanding CPR and DNR
1. Advanced
2. Terminal
3. End stage
SPIRITUALITY AMONG OLDER ADULTS
AGNOSTIC
a person who claims not to know with certainly whether or
not God exists.
ATHEIST
a person who believes God dos not exist.
RELIGION HUMAN
Created structures, rituals, symbolism, and rules for
relating to god/higher power
SPIRITUAL DISTDRESS
a state in which one’s relationship to god or other higher power
is disrupted or at risk of being disrupted spiritual needs cannot
be fulfilled.
SPIRITUALITY
relationship and feelings with that which transcends the
physical world.
SPIRITUAL NEEDS: All humans have spiritual needs,
regardless of whether they realize or acknowledge them.
1. Love
2. Purpose
3. Hope
4. Dignity
5. Forgiveness
6. Gratitude
7. Transcendence
8. Faith
ASSESSING SPIRITUAL NEEDS
Is a crucial aspect of holistic care. it involves understanding a
person’s faith beliefs, practices, community affiliation and
whether their spiritual needs ( such as love, meaning, purpose,
hope, dignity, forgiveness, gratitude, transcedence and
expressiom of faith) are met.
SPIRITUAL DISTRESS
occurs when a person’s connected with a higher power is
disrupted or at risk, and their spiritual needs are unmet.
GOAL
Is to help the patient maintain religious practices, openly
discuss spiritual concerns and build support systems for
spiritual well-being.
Nurses can assist
patients dealing with spiritual distress by identifying
contributing factors. They should support the patients
religious practices.
1. Being Available - with a patient implies that the nurse is not only
physically with the individual but also offering undivided
attention to facilitate a true connection.
2. Providing opportunity for solitude - allowing for
solitude is a vital part of expressing sprituality.
3. Promoting Hope
4. Assisting in Discovering Meaning in Challenging Situations -
some people’s faith can enable the to be comforted in believing
that their current challenging serve a positive purpose for god.
5. Facilitating Religious Practices
6. Praying with and for
ETHICAL DILEMMA
AIMS and OBJECTIVES
To understand meaning of the term ethical and dilemma
To Analyze the concept of Ethical Dilemma
Learners will be able to illustrate with example the concept of ethical
dilemmas.
To be able to differentiate b/w different type of ethical dilemma
To be able to apply the concept of ethical dilemmas in school settings
To understand why is important dor teachers
To Critically Analyze why Ethical Dilemmas is important to education.
DILEMMA: A situation in which you have to make a difficult choice.
A moral/ethical dilemma is a conflict in which a person must
choose between two or more actions, all of which they have
the ability to do. There are moral reasons for each choice.
No matter which choice you make, someone will suffer or
something bad will happen.
Types of Ethical Dilemma
1. Epistemic dilemmas vs Ontological Dilemmas
2. Self- imposed vs. World imposed dilemmas
3. Obligation vs. Prohibition Dilemmas
4. Sigle Agent vs. Multi- person Dilemmas
Epistemic dilemmas take place in a decision making context
where moral standards conflict and the agent cannot readily
determine which ethical principle should take precedence over,
while Ontological Moral dilemmas invloves situation wherein
two or more moral requirements conflicts with each other.
Self- imposed dilemma is one created by the agents own errors
in judgement, such as making competing promises to multiple
organizations that cannot be fulfilled simultaneously. In contrast,
a world-imposed dilemma is caused by circumstances outside the
agent’s control.
An Obligation Dilemma is one where an agent has multiple
options and more than one of them is obligatory, while a
Prohibition Dilemma occurs when all available options are
prohibited.
Single - person moral dilemma in which the moral agent is
compelled to act on two or more equally the same moral options
but she cannot choose both while multi-person dilemma occurs in
situations that involve several persons like a family, an
organization or a community who is expected to come up with
consensual decision on a moral issues at hand.
THANK YOU !!
