Life decisions and moral dilemmas

Life decisions and moral dilemmas Introduction: This assignment illuminates the use of ethical decision making model in taking decisions while managing patients in their best interest. Ethical decision making is very challenging for the health care professionals while working for the benefits and the interests of the patients. While caring for the dying or the terminally ill patients, health care providers address various issues of pain and suffering in relation to the psychological, spiritual, mental and physical complexities of the person having the terminal illness. The ethical decision making models act as guide to make decisions in different complex situations addressing various issues which includes ethical principles, persons own values and beliefs, institutional policies, legal considerations and social values Nurses can improve results of ethical decisions by: †¢ preferring client wishes. †¢ encouraging the importance of ethical issues in care of patient. †¢ obtaining necessary consultation on ethical concerns †¢ becoming involved in the development of policy on ethical issues †¢ advocating for safe and competent nursing care within Alberta communities †¢ encouraging and facilitating cooperation and collaboration between professionals and between agencies to effect improvements within health care †¢ participating in the development of practice standards, issues statements and position papers on professional issues †¢ working with colleagues to identify crucial ethical issues for the profession, including: − the implementation of evidence-based practice − shaping the direction of health-care reform †¢ linking of resource allocation decisions to client outcomes In this assignment i am going to use STORCH Model for ethical decision making. This model was developed by Jan Storch for use in health policy decision making, but later it was adapted for use in ethical decision making. Dr. Storch suggested the use of this circular model as a way of reminding us that it is important to return to each consideration as we move towards decision making. This model involves three major steps: Information and identification Concern People/population Ethical components. Clarification and evaluation. Ethical principles Autonomy Nonmaleficence Beneficence Justice Social expectations and Legal requirements Range of actions/ anticipated consequences Professional code of ethics Ones values beliefs, values of others and value conflict 3. Actions and Review. Case study: Eighty four years old Mr. Adam, was admitted to the ICU. He has been suffering from throat malignancy for 18 months. Now his disease condition has become worsen. His life expectancy is about 3 months. He has difficulty in breathing, difficulty in swallowing and cries with pain. He is on mechanical support and has nasogastric tube in place. He lives with his 82 years old wife. He was a active social worker. His wife tells that he believes in living life in a productive way. He used to drive cancer patients to the rehabilitation centre voluntarily. He has two daughters who live in Ontario, but now they are here to visit their father. He requested the nurse to remove the nasogastric tube and mechanical ventilation as he does not want to live life in this way. His wife agreed to his decision as she does not want to see him suffering anymore. She want him to die peacefully and painlessly. According to Storch Model of ethical decision making, in this case scenario, Information and identification: Nurse Need to gather all the information regarding Mr. Adam. Nurse can arrange a family conference including his wife and the daughters also the family physician can be involved. She should listen to the views and concerns of all the family members related to the request of the patient. Nurse should consider the medical condition of the patient, Mr. Adam is terminally ill and now as his condition has become worsen he has become totally dependent on life support system. He has severe pain which he cannot tolerate. His life expectancy is very short and the prognosis is really poor. Mr. Adam is suffering from throat cancer and is on the last stage but his decision making capacity can be intact, so nurse should assess the reason for his decision. Nurse should assess if there is depression, as it may effect the decision of the patient. Mr. Adam is staying alone with his wife, so the financial resources may be limited to bear his stay in hospital. He was an active social worker. Mr. Adam used to drive cancer patients to the rehabilitation centre. He may have strong social connections and a positive quality of life. Mr. Adam believes in active living of life not in this dependent manner and he spends his life living for others and helping others in their time of need. He had very positive attitude towards life. He believes in life worth living rather living. Nurse should assess the expectations of his family regarding the condition of the patient. Mr. Adams wife and daughter should be asked about their expectations for Mr. Adams health status and prognosis. His daughters live far away from him so they may not have as much familiar with his condition as Mrs. Adam do. Nurse can consult the doctor regarding the condition of the patient and also about the outcome of the decision. Identify the surrogate decision makers for Mr. Adam. According to the second step: Clarification and evaluation: nurse should assess the different values associated with Mr. Adam. Mr. Adams personal values regarding life are worth living life. He believes in living life in a productive and positive way. Nurse should assess the cultural values of the patient, what role cultural values play in his life. What his culture says about life and death. Nurse should also keep in view the religious values of the patient. What role does his religion play in his life? If the religion allows for hastening the death process. Professional values play an important role in ethical decision making. Nurse should consider the professional values associated with the removal of life support system. Nurse should assess the values of the family members regarding the decision of hastening death of their family member. Mr. Adams wife is in favor of his decision to remove life support as she does not want to see him suffering. She wants him to die peacefully and painlessly. Consider the ethical principles. Principle of Autonomy: According to this principle patient has the right to decide for himself, here in this case Mr. Adam is autonomous and deciding removal of life support system. He tells the nurse that he does not want to live life like this. Nurse should respect his autonomy towards the life and should consider his decision and wish while taking actions. Principle of non maleficence: According to this principle nurse should do no harm to the patient. In the above case scenario, patient want to stop the life support and continuing the treatment may go against the principle as it is against his wish. Principle of beneficence: According to this principle, nurse should do good for the patient. Here patient is asking for stopping life support system but it does not provide any benefit towards his condition at the same time it works in favor of his wish to die. Principle of justice: According to this principle, all persons should be equally provided with health care services. In this case patient is provided with required health care needs. Consider the social expectations and legal requirements: Nurse should look for any similar history in the hospital. Identify any previous similar case in the institution, so that she/he can look for the policies and steps that can be taken. Nurse should check the hospital policies regarding the hastening of death of the patient. She should assess that what steps can be taken according to the policies. Nurse should ask for any legal documentation of clients decision making authorities. She can ask for any legal will or advance directives. While considering the different aspects of model nurse should assess that what possible range of actions can de done. Considering the information provided, Mr. Adam is a strong social human being, he spent life doing productive, now as he is chronically sick and dependent which for him is not worth living. He is old and the life expectancy is poor also it gives him severe pain. His wife want him die peacefully. And also the financial sources may be limited to continue life support. The ethical principles gives him the right to decide for himself. According to Canadian Nurses association code of ethics for registered nurses, there are seven primary nursing values: 1. Providing safe, compassionate, competent and ethical care 2. Promoting health and well-being 3. Promoting and respecting informed decision-making 4. Preserving dignity 5. Maintaining privacy and confidentiality 6. Promoting justice 7. Being accountable ( CNA code of ethics for registered nurse) Nurse should consider the professional code of ethics while making decision for the patient that whether she is going according to provided professional guidelines. In this case nurse should follow the professional code of ethics while caring And deciding for Mr. Adam. Nurse can consider her own values and beliefs regarding life and death in empathizing and understanding the needs of the patient and family. Nurse should understand the values and beliefs of the persons involved in the decision making for the patient. How the stopping of life support system effect the family members? What they believe about death process? Mr, Adams wife believes in his peaceful death. Nurse should assess if there is any conflict between the values of patient, family members , profession, culture, religion. Action and review: in this case scenario action must be decided according to the various perspectives proposed by the model. Nurse can check what she can provide to the patient, whether the request to hasten dying is made under depression or really in relevant means to patient. If it is due to depression, what nurse can do to promote and facilitate calm and peace to mind of patient. How she can provide compassionate care and peaceful death to the patient. If patient really wants to die, nurse should t check what she can do while regulating the hospital policies. All the perspectives given by the model should be reviewed before taking any actions. Conclusion: In the nutshell, I can say that Storch Model is the best suited model to the above case scenario as it covers all the issues and perspectives related to the decision. The ethical decision making skill can achieved by reading literature and with the practice experience. These decisions play important role in the lives of patients and nurses as well. There is need of ethical relationship between patient and nurse. There should be better understanding of nurses own values, beliefs, patient and his values and beliefs, professional values , institutional policies.

Online Travel Industry :: essays research papers

Online Travel Industry   Ã‚  Ã‚  Ã‚  Ã‚  Internet travel bookings have been very prosperous these past couple of years. During the first three months of 2005, Internet travel bookings grew about 20 percent in the United States from the year earlier. Companies like Expedia, Travelocity, and Orbitz are putting more emphasis on selling to corporations and expanding in foreign markets. Travel has become one of the Web’s most developed categories. According to comScore, â€Å"online leisure travel bookings reached about $51 billion last year, or 44 percent of all online sales. Roughly 30 percent of all travel bookings occur online, which is a far greater share than retailing stores.† Between 2001 and 2003, leisure travel bookings more than tripled,   Ã‚  Ã‚  Ã‚  Ã‚  to $43 billion.   Ã‚  Ã‚  Ã‚  Ã‚  After the September 2001 attacks, the travel supplier industry had to take action in order to stay profitable. The industries tried desperately to reach consumers by offering discounted airfares and hotel prices, but the industry did not have enough money to support the advertising and marketing of these bargains and deals that they offered after the September attacks. The industry then turned to companies like Expedia, Travelocity, Orbitz, and Priceline in order to advertise their bargains. These companies became great allies to the suppliers by selling hotel and airline bookings at hefty prices.   Ã‚  Ã‚  Ã‚  Ã‚  In order to save even more money, the travel industry began to reduce the number of cut-rate rooms and airline seats they offered through travel agencies, while increasing efforts to attract customers directly to their Web sites, where they could sell their products commission-free.

Busy Busy Barcelona

It is said that Barcelona is one of the most exciting cities in the world. On first arrival there were only hints of this, but as the coach further into the city its true colours were shining gloriously. I couldn't be sure if it was the fast street entertainment or the immense amount of shoppers and traffic, but either way my pulse was pumping because of this electrifying city. My excuse for being in this exhilarating environment is a day trip to the big city everyone talks about. My accommodation was situated in a coastal town named Salou, roughly one hours drive from Barcelona. My hotel was called hotel â€Å"Cleopatra†, a nice but relatively insignificant next to this manic metropolis. As my accommodation was over an hour away I was anticipating a good day out and so far things looked set to be going that way. Approaching the city centre now, I notice two extremes of Barcelona's busy life. The first are apparent to be the wealthy, designer labelled snobs who frown upon and grace no pity towards the other forgotten race that that are the remorseful tramps. It seemed that the rest of the city was moving forward so blindingly fast that that these endless vagabonds are left in a sea of no hope. However, in an action so hypocritical to whom I just accused, we deliberately admire a crumbling sculpture to move on swiftly past the swarm of homeless Spaniards. Our first objective of the trip is to get a topless bus around the city. We vaguely made out the attempt at English from the operator, which did seem to be a recurrence throughout the day, demanding of us, â€Å"four people, 68 Euros!† You've got to be joking!! However at this point we didn't really have much choice as this was the only real way we could ever get a good old gander at the sites of the city. So despite the outrage, me, my Girlfriend, her Mum and her Dad decide to give it a go. The bus was certainly filled with most British, yet the navigator on the microphone never thought to attempt a spot of English, no, strictly Spanish. Nevertheless we could still view the sites and scenery, if of course we hadn't of taken poor advice in which we asked for the route which takes us past the illustrious Barcelona Cathedral, but never did we actually see the magnificent building. At least, not from closer than half a mile away viewed on a hilltop. The one truly satisfying thing about this exhilarating experience was that from inside the topless bus the sun came beaming down on us in which I believe I turned about 5 different shades from white to brown within a matter of two and half hours. On departure of our trip that proved a somewhat anti climax situation, I felt a large overpowering sigh of relief come across me, and a look around made an impact and my original feelings of the day that was the anticipation of the new city ahead of me. Fresh air? No block buildings? No traffic and insane amounts of shoppers We had reached a completely different part of Barcelona which we had looped around the city to get to it in the bus, but we had ended up perhaps ten minutes from the city centre. We couldn't even feel that it was Barcelona, it felt like Spain, which seemed like so much different. This was certainly more the family side of the city as it had many more family shops and attractions, and not to mention families. Yes, this part of the city was giving me the holiday feeling that the closed up, claustrophobic busy mainstream of the city wasn't. This new side of Barcelona creates a new feeling of ease and I finally find why this so highly rated city gets the praise that it does, and is so renowned worldwide as a hotspot for any age or type. It was almost as if there were two separate cities mixed in together to make the ultimate holiday destination, with a family attraction to the city being just a 10 minute drive from a busy and unpredictable centre, its bound to be that. Such a huge variation in tourist attraction is no doubt how this city rakes in millions upon millions of pounds through the tourism industry, making it Barcelona's key and its largest impact on the cities economy. My favourite attraction from the whole experience was stumbled upon at about mid afternoon and was a stones throw away from where we departed with the bus. I stared at first, mesmerised at the colossal once used Olympic Stadium. From the outside I witnessed it to be a enormous display of architectural genius used subtlety to emphasise the home of the flame once held within. As I leave the magnificent Stadium in which we were not allowed to enter, I felt like I could spend all afternoon with the satisfaction that I am butterflied with at the moment. No sooner said than done we ended up in that very place where we started off originally, but somehow I managed to appreciate it a lot more than I did as a first impression. It now occurs to me that these two parts of the cities are maybe simply complimenting the other to combine creating a worldwide holiday destination. However there are many reasons I would tell a holiday maker contemplating where to go to not travel to this big city, but there are so many reasons more why I would tell them to book it for Barcelona. After a hectic day we made it back to Salou at around nine thirty when I came to my conclusion on my day. I felt that as busy and difficult as Barcelona was, it was worth every minute and is not a day to miss out on, whoever you are.

Rudolfo Anayas Bless Me Ultima - 879 Words

Antonio, from Bless Me, Ultima, lives stuck in a world of in-betweens, a world of borders. He must navigate this world and find his place within it, all while trying to please his parents. Tony’s surroundings and cultural background lead to this in between world and force him to pick a side before he has even began to grow up. In Rudolfo Anaya’s Bless Me Ultima, Antonio is constantly searching for answers about his future and the world around him; he finds these answers through his family, environment, religion, and family friend, Ultima. The binary opposition of Antonio’s mother and father are one of the major central conflicts. Antonio resides between the Lunas and the Mà ¡rez tradition, two families that see no common ground. His passage†¦show more content†¦This even translates to his home life because his father followed his mother; he is the outsider in their life and has to live with the choices he made to please his wife. This opposition is unavoidable for Antonio; it is even seen in where his home dwells. His home resides on a hill outside of town; it is not in the fertile valley, but also skirts the Llano. His house represents his parent’s battle between their two origins, a battle that Antonio’s every choice revolves around (Novoa 3). Antonio can see only two structures above the village: the church tower and the schoolhouse (Novoa 5). These structures represent the two forces that will soon become his main conflicts. Antonio will soon begin school, and later he will have his First Communion; two extremely important and defining moments in his life. The first day that Antonio attends school, the kids in his class shunn him and he finds solace with George and Willy: â€Å"We banded together and in our union found strength† (Anaya 62). Everywhere that Antonio goes, he has a specific role to play, somebody to portray. He loses the opportunity to really choose for himself. Antonio’s mother believes that his destiny is to become a priest, and pushes him to become a devout, unquestioning Catholic. Tony tries to follow his mother’s ideals and attends church, and communion, yet remains unsatisfied. He does notShow MoreRelatedRudolfo Anayas Bless Me Ultima1373 Words   |  6 Pages Bless Me, Ultima Rudolfo Anaya Topic #1 Stephanie Chevez Mr. Amoroso AP Literature Pd: 3 The ocean of life is a constant routine to not only reconcile with certain circumstances, but to learn, to understand, and to accept them. With every new obstacle we face, this process is repeated absentmindedly, but the way we choose to react and what we absorb from these events is what ultimately makes us grow. As humans, we tend to find a suitable comfort spaceRead MoreEssay about Rudolfo Anaya’s Bless Me, Ultima1271 Words   |  6 PagesRudolfo Anaya’s Bless Me, Ultima In Rudolfo Anaya’s Bless Me, Ultima, the author uses Tony’s dreams as a way of displaying various symbols. 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I believe that Anaya uses the previously mentioned elements of literature in order to provoke his readers’ thinking and help embody a struggle of understanding the world we live in. Motifs in this novel include: family, dreams, religion, education, and the list continues. For examples of dichotomy, the idea of good versus evil isRead MoreBless Me, Ultima Literary Analysis Essay714 Words   |  3 PagestSam Ennis Period #4 20 September 2012 â€Å"Bless Me, Ultima† by Rudolfo Anaya Literary Analysis Throughout the context of â€Å"Bless Me Ultima,† it is evident that there are many motifs and examples of dichotomy. I believe that Anaya uses the previously mentioned elements of literature in order to provoke his readers’ thinking and help embody a struggle of understanding the world we live in. Motifs in this novel include: family, dreams, religion, education, and the list continues. For examplesRead More A Comparison of Bless Me Ultima and The House on Mango Street2154 Words   |  9 PagesExploring Syncretism in Bless Me Ultima and The House on Mango Street      Ã‚  Ã‚  Ã‚  Ã‚   Syncretism is the fine line between Christianity and Native American Religions because it is the ambivalent, simultaneous attraction of choice and identification to the influences of two or more religious belief systems. Syncretism is most common among minority groups such as Hispanics. The definition applied to their unique position of culture is brought about by the Native American and Spanish ancestry. AmbivalenceRead More Comparing One Hundred Years of Solitude and Bless Me Ultima Essay1675 Words   |  7 PagesMagic or Reality in One Hundred Years of Solitude and Bless Me Ultima  Ã‚     Ã‚   In the South American storytelling tradition it is said that humans are possessed of a hearing that goes beyond the ordinary. This special form is the soul’s way of paying attention and learning. 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People enjoy the book a lot, but there are also some people who want the book to be banned for good. For example, in 1992 Bless Me Ultima, was banned at Porterville high school for â€Å"many profane and obscene references, vulgar Spanish words, and glorifies witchcraft and death(banned library). Bless Me Ultima, is a story of a boy named Antonio who lives in a