Advocacy and the Role of the Advanced Practice Nurse - 1925 Words

Legal / Ethical Issue Focused On Advocacy and the Role of the Advanced Practice Nurse (Coursework Sample) Content: Legal/Ethical Issue Focused On Advocacy and the Role of the Advanced Practice NurseStudents NameInstitutionEthical issues in nursing practice underscore the importance of the nursing profession to express their commitment to provide high quality healthcare as well as maintain and improve community health. From a clinical perspective, nursing ethics encompasses the moral behavior of nurses towards patients that aims at improving health outcomes. Professional ethics define the legitimate norms that govern the professional behavior of both nurses and patients (Dehghani, Mosalanejad Dehghan-Nayeri, 2015). In the recent past, healthcare systems and settings have rapidly changed due to the changing, diverse, and unique health needs of the modern patient. Consequently, the nursing practice continues to be confronted with complex ethical concerns. Using a case study presented in the article When Doctors and Daughters Disagree,  this paper explores and examines the backgro und of the ethical issue of autonomy, its implications in practice, and the role of the advanced practice nursing in observing ethical concerns such when faced with a similar dilemma.Background of the Issues IdentifiedAutonomy is a major ethical aspect in nursing practice. It guides the nurses in acknowledging and understanding the patients rights when making critical healthcare decisions. Although patients have the right to be given an informed consent on the kind of healthcare to receive, they can opt to take part in any treatment (ANA, 2012). It is often challenging for nurses to observe autonomy for incapacitated patients who can no longer request or reject potentially life-sustaining treatment. Thus, a formal attempt to protect individuals right to autonomy when they are no longer autonomous is enhanced through an advanced directive. Based on this point of view, the assumption is that previously expressed wishes are immutable and precise. Many families make decisions together, but individuals may negotiate, compromise, and adjust their genuine preferences at times when new threats arise (Abadir, Finucane McNabney, 2011).Case StudyThe case study presented in the article involves two daughters who overruled a patients genuine reason to refuse a life-sustaining treatment, resulting in burdensome illness prior to her death. Mrs. GF was an 83-year old woman diagnosed with diabetes mellitus, hypertension, heart failure, coronary artery disease, stroke, amputation, renal insufficiency, cholecystostomy, chronic bronchitis, and biliary drain. Having been enrolled in a program of All-Inclusive Care for the Elderly Day Health Center for several years, she regularly expressed her wishes to decline intubation, but attempted and completed cardiopulmonary resuscitation, where she reconfirmed the relevant documents including the legal advance directives. She designated her elder daughter as her health agent, but requested that the discussion remain private without the knowledge of her daughter.Mrs. GF was returned to her primary care clinic with acute illness. She was immediately taken to the emergency department (ED) with her advance directives (Abadir, Finucane McNabney, 2011). Since she appeared septic, the ED personnel requested for the consent from her two daughters to perform intubation, which they agreed despite being aware of the patients initially expressed wishes. Mrs. GF appeared agitated after learning that her daughter and the ED physician were planning for intubation. Despite her efforts to reject the treatment procedure, she was intubated and admitted to the intensive care unit. For 22 days, the primary care physicians, hospital, ethics committee, and ICU staff met with Ms. GFs family regularly. They insisted on continued ventilator support and resuscitation if cardiac arrest occurred. In addition, the family did not refuse hemodialysis when it became medically necessary. Even after 22 days of highly burdensome treatment, the pati ent clearly expressed her desire to be removed from the respirator, which led to her death within an hour (Abadir, Finucane McNabney, 2011).Significance of the IssueAccording to the case study, Mrs. GF understood her daughters needs and showed her willingness to have those needs met, at least in retrospect. Over years, Mrs. GF expressed her wishes not to be extended medical treatment or be put on a ventilator machine due to the painful experiences encountered by her sister. She also requested that her preferences should not be shared with her daughters. Based on these directives, Mrs. GF clearly understood the implications of her decisions since her wishes were authentic, convincing, thoroughly justified, and consistent over years. Her daughters, on the other hand, did not understand her directives including their implications; hence they thought it was their loving duty to interpret the decisions in the context and on behalf of their mother (Abadir, Finucane McNabney, 2011).For s everal years the primary care team had accomplished their important role to protect Mrs. GF from receiving any treatment against her wishes. The ED physician and her daughters, however, did not respect and acknowledge her wishes to forgo intubation. The decisions made by the ED physician against her preference are a subject of discussion with regards to the ethical issues of advance directive in respect to patient autonomy. While the preferences of family members are likely to be important , it is necessary to acknowledge the possibility of coercion to when incorporating the essence of advance directives during critical and palliative (Abadir, Finucane McNabney, 2011).Ethical Theoretical FrameworkIn Mrs. GFs case, a major ethical issue is the manner in which a life-sustaining treatment was administered to her against her genuine and immutable wishes. The decision by her primary care team to change their approach towards her life-sustaining treatment, including advance directives, i s an issue of ethical concern as far as advanced practice nursing is concerned. Mrs. GFs initially expressed wishes could have imposed psychological suffering to her daughters because they could have witnessed her death without life-sustaining treatment. The fact that her daughters still approved the administration life-sustaining treatment for Mrs. GF contests her right to autonomy by refusing life-sustaining treatment. It is quite a challenge to determine the extent to which the decisions of her daughters contravene the ethical framework of portray the advance directives by patients suffering from terminal illness.The case of Mrs. GF and her daughters show how disagreement can arise between two sides of the family. Mrs. GF preferences were protected and excluded from her daughters knowledge, which shows her desire to avoid confrontation and conflict. Lack of family involvement in planning for the patients advance directives may lead to misunderstanding and non-adherence to the pa tient wishes on life-sustaining treatment (Nursing World, 2015). Therefore, the decision changes and approach by the primary care team during Mrs. GFs end-of-life discussions reveals a greater emphasis and influence of family members in the implementation of patients advance directives. In particular, the several confrontations by her daughters during her terminal hospitalization could have compelled the primary care team to consider their decisions based on the family consensus, recommendations from other professionals, quality of life, and the patients initially expressed wishes.Implications on Nursing PracticeMrs. GF case offers a critical insight about ethical issues of advance directives that can have significant implications towards the nursing practice. First, the primary care physicians (PCPs) consistently protected Mrs. GFs advanced directives from unwanted treatment over years without involving her daughters. Although the PCPs protected Mrs. GFs right to privacy, it was et hically wrong by failing to make efforts t encourage and inform her on the benefits of involving her family members into her routine discussions of advance directives. This may have helped to avoid misunderstanding between Mrs. GF and her daughters, as well as mitigate any non-adherence treatment against her wishes (Nursing World, 2015).During planning and implementation of patients advance directives, a patient-centered collaborative decision making is necessary. It helps to substitute the decision-making with the knowledge of the patients while maintaining the authenticity and autonomy of the patients values and interests. Mrs. GFs case was unethically handled during her end-of-life discussions. When immediate high-stakes decisions were needed, the available information was limited. Therefore, the substitute decisions seemed to have acted prior careful philosophical analysis of whether the daughters devotion intubation was the right thing or not. If the daughters had been involved in planning, a collaborative decision-making would have been developed to avoid unethical interference of the patients. Interference occurs when nursing care procedures are too intrusive to the extent that they affect the patients privacy (LaSala Bjarnason, 2010).Advance care planning is meant to prepare patients and surrogates to participate with clinicians in the making the best possible ongoing medical decisions. However, the physi...

Psychology in Modern Hostage Negotiation - Free Essay Example

Abstract The position of this paper is that psychologists have a role of mental health consultation and bigger consultation role at the situation of the hostage. Over the past few decades, there has been a record of increased hostage incidents involving perpetrators with a variety of motives which include economic and political. According to this paper, psychological knowledge has proven to be of great value considering the way one is supposed to deal with the subject of hostage negotiations. This article explain that psychological knowledge also helps to guide the negotiator on the steps that should be undertaken in order to negotiate with hostage takers and the required steps to go about the negotiation. The incident of hostage can be referred to a case where a perpetrator holds one or more individuals against their desires in places known to police. Around 25 years ago, policies of hostage or crisis negotiations were developed and they are being used continuously in field application. According to this article, there are less than 25% incidents that have been resolved and nobody is killed in cases of law enforcement on serious incidents. This article also explains that the negotiators ought to be in a position to direct the subjects who will express their perspectives into stating clearly the idea of their doubts and difficulties and speaking up their requests and demands to make work easier for the law enforcers to address them. In the United States the negotiator mus t be able to withstand any form of deployment that is extended to complex as well as demanding situations and incidences. The position of this article is therefore, clear that the psychological principles have enabled the police to employ active techniques for listening, maintain an approach that is open minded as well as create a rapport that can influence the counterparts of an individual. Introduction Involvement of psychologists in the police department has increased significantly over the past two decades. This is considering the fact that psychology plays a very important in cases of the hostage in matters of negotiation. Development of psychological negotiation strategies is a key factor that should be considered in regard to the dynamic nature of hostage incidents that have been happening in the world in the past three decades. Understanding motivation and goals of the situation must be put into consideration before developing the required negotiation strategies. Taking a little bit some time is also important in order to give space for the highly emotional states and give time for informed decisions on how to intervene the strategies. This also allows the security departments to obtain adequate resources, and give chance on gathering any background information on the matter. In this case, the most important point is allowing the relationship between the hostage-takers time t o develop. Therefore, development of negotiation strategies in cases of hostage and crisis is very important to the negotiator as the way of protecting the captives. The psychological knowledge has proven to be of great value considering the way one is supposed to deal with the subject of hostage negotiations. It has also been discovered that those individuals who are specialized in these areas are gaining rapid acceptance in most of the hostage cases. Therefore, the role played by the psychologist in hostage negotiation is very clear to all individuals. Researchers have defined that the crucial role of the psychologists is balancing the mental status of the hostage-takers and the best direction to address them in order to ensure that the mission of protecting the hostages is successful Strentz, (2011). However, it is important to understand that there has been no universal agreement between mental health specialists on the importance of consulting the hostage-taker. Their doubts have been considering the fact that psychologists dont have a lot of experience compared to anybody else in situations of hostage and it might be a way of confusion if t hey can be trusted when they claim that hostage negotiation is part of their profession. Moreover, they claim that the role of psychologists in cases of hostage have been ignored despite the fact that there has been the continued training of negotiators more especially in New York. Though it is of great significance to understand that the role psychology is mainly to make the police understand the personalities of the hostage-takers which is very important in cases of hostage and crisis intervention. The position of this paper is that psychologists have a role of mental health consultation and bigger consultation role at the situation of the hostage. According to research, the psychological knowledge not only helps at the time of hostage incident but also they have enough knowledge that can be used to train negotiators in order to deal with cases of hostage and crisis intervention. In addition, it is important to understand that negotiating with hostage takers is all about psychology and those who are in most cases successful in the process are psychologists who are very experienced Lynch, (2012). Considering the scenario of a typical hostage, lives of the captives are at pending chances of violent death at the hands of the hostage taker which normally takes place in the uncontrolled environment. Situations of hostage can take hours, days or weeks of intense negotiation and these cases require skilled negotiators in order to save the captives from the hands of the hostage-takers hence psychology will be great role when considering such situations. In fact, according to studies and records, it is very clear that negotiation yield 90% success in resolving hostage crisis without any one among the hostages being injured by the hostage takers and this is a remarkable condition considering life-saving intervention of crisis strategy. Psychological knowledge also helps to guide the negotiator on the steps that should be undertaken in order to negotiate with hostage takers and the required steps to go about the negotiation. This steps include reducing background distractions to ensure clarity of the communication, introducing yourself clearly and tell them the reason why you are calling, address them using sir or madam since in most cases you will not be aware of their names and most important monitor your tone to set a mature conversation between yourself and them. This is very important in hostage situations since the main goal of hostage negotiation is to maintain verbal strategies and utilize time in order to control the emotions of the hostage takers and make ensure that there is increased rationality. The intention is to make sure the hostages are saved without any injuries and if possible the hostage takers are arrested in a non-violent way, this situation will only work if psychological knowledge is applied in such cases. According to the studies that have been conducted, it is clear that negotiation is among the best channels that can be used to resolve hostage. Research has confirmed that less than 5% such cases will result in death if there if good negotiation skills are employed. Since negotiation relies on the knowledge of psychology, therefore, psychology is very important in modern hostage negotiation. According to Miller (2005), there are less than 25% incidents that have been resolved and nobody is killed in cases of law enforcement on serious incidents. This condition has been improved with good negotiation strategies Miller (2005). Although every hostage situation appears different, they all have general similarities on how they are carried out and reasons of the practice. In some cases, hostage takers will uses hostages to attempt robbery and sometimes it is impossible for them to get away without the assurance of the hostages. Sometimes if law enforcement acts lethal towards such cases, the robbers might decide to kill the hostages before they are caught or before they kill themselves. Therefore, psychological knowledge will be very important in dealing with such situation to ensure that hostages lives are saved and if possible the hostage takers are arrested in a non-violent manner. Consequently, the psychological knowledge on hostage negotiation has been used for quite some period of time and there is a positive response in regard to its use. Considering such cases it is, therefore, important to ensure that more negotiator is trained with psychological knowledge since there are many cases of the hostage that are being experienced every day. The knowledge is also used in order to prolong the negotiation so as to give the chance of other tactical options to be used. On the other side, it is important to note that in most cases the negotiators are used to buy time for alternative options to be considered and this has been regarded to be very important considering a number of such cases. For hostage negotiations to take place modern psychology must be applied. A psychological study conducted by Greenstone in 2013 revealed that, in any hostage situation, the lives of people are at a violent risk of death due to a homicidal, cold blooded, suicidal or even a depressed, drug controlled hostage taker. This happens in a chaotic family or a work place environment that is uncontrolled. As per Greenstone (2013), resolving the hostage situations and crises often take a lot of hours or even multiple days of intense negotiations and need the psychological principles to enable skilled communication. Notably, the use of the principles of modern psychology has changed the manner in which the police negotiate in hostage situations in various ways. First, it has enabled the police negotiator to work hand in hand with the individual involved in the crisis or the hostage situation towards a solution that is peaceful, and that which was viewed as impossible previously. This implies that psychological principles have enhanced the reconciliation of a counterpart issues with an aim of maintaining peace for a whole community. Secondly, the psychological principles have enabled the police to employ active techniques for listening, maintain an approach that is open minded as well as create a rapport that can influence the counterparts of an individual. The principles have also changed the manner in which police negotiate to putting a lot of determination on the nature of the dynamic activities, negotiation skills and communication tools to use for the response of the hostage situations. By practicing this, a rapport and trust is built by the police negotiators with the takers of the hostages thus enabling the police negotiators to put together a lot of information that is useful concerning the hostage takers (Greenstone, 2013). This information gathered will, in turn, enable the determination of appropriate decision methods, communication, and negotiations. Apart from that, through the use of modern psychological principles, the police negotiators have come up with important skills of negotiations to be use d in the hostage situations. These skills include the motto that says ‘talk to me’ to emphasize the essence of communication as an essential technique in the police negotiation in hostage situations. This creates a rapport to help the situation. The second skill is patience which aids in limiting the police negotiator from rushing to conclusions as well as jumping into resolutions. There is also the active listening that employs both the effective as well as the affective skills to build trust with the police negotiators and the negotiating counterparts and establish rapports. With the use of modern psychological principles, police negotiations changed to being respectful to enable the counterpart feel that the negotiator is there to listen and address her concerns (Greenstone, 2013).   Despite that, the police negotiations have adapted to being calm, a technique that is so quick to master by the hostage negotiator. By use of an understanding, calm or even a respectful tone, the subject realizes that an alternative way exists. Self-awareness is also a skill that enables the police negotiators to create and up bring a healthy relationship with a person he or she has never met while maintaining a strategic communication that its nature is purposeful. Lastly, in matters relating to the adaptability of the police negotiator, police negotiator adapts to the varyin g circumstances and reacts to those circumstances accordingly. The respond should not only ensure that the trustworthy relationship built with the negotiating counterparts is preserved but also bring the negotiating goals closer to them. Generally, on the arrival of the negotiators at a scene of a crisis so as to begin the negotiations, they have to put in mind that the subject is in the middle of an internal turmoil that is considerable (McMains Mullins, 2014). In order to get rid of the crisis, the negotiators should first appreciate the aspects that might have brought the situation. Among the practical psychologist, the most skilled are the crisis negotiators who have had a successful trend. A negotiator has to enforce the law by creating a conversation with the suicidal people, the takers of the hostages and any other individual who is barricaded. These psychologists have a role of participating in training, development and personnel selection as well as operational assistance in the course of a crisis intervention. They also monitor the progress of negotiation and memory of the people at the hostage situation. The negotiators put into use the primary technique of negotiation. This technique depends on the issues constructing and affecting the hostage resolutions for negotiation. (Spence Millott, 2016). In addition, the negotiators put emphasis on the criminal as well as on the behavioral of the hostage takers who are involved in the scenes so as to decide if they can be taken as expressive or rather instruments. A negotiator fits in the field of crisis intervention within the United States in the following ways. First, the negotiator must be able to withstand any form of deployment that is extended to complex as well as demanding situations and incidences. This is a specification training that is challenging, however, the public and even the service administrators in the United States, expect that the trained and the deployed negotiators are useful and purposefully fit. They, therefore, provide negotiators who have the skills necessary to eventually minimize serious injuries, life loses and be successful. This is the fulfillment of their primary objective that is to preserve life. The other aspects such as subject confinement and arrest are important secondarily. (Spence Millott, 2016). Secondly, to fit in the field of crisis intervention in the United States, the negotiator must be of a high standard with developed skills after going through training. Apart from that, the negotiator needs to be able to integrate in order to deliver of their skills and their knowledge as well especially in critical outcomes where the environments require pre-evidencing. This is reinforced particularly by the amount of money and time I invested in training including the consequences of the unexpected and poor performance. On the other hand, the negotiator should be able to determine and implement the decision making and negotiation strategies in a different manner depending on the nature of the situation they are dealing with. This is in order to be able to fit in the crisis intervention in the states. The situation of the hostages can be expressive or even instrumental (McMains Mullins, 2014). Furthermore, the negotiators ought to be in a position to direct the subjects who will express their perspectives into stating clearly the idea of their doubts and difficulties and speaking up their requests and demands to make work easier for the law enforcers to address them. Also, they have to adopt a technique in negotiation that is designed to elicit information and provide a skill that can be useful in helping the communicative subjects sort out the doubts and their scattered feelings and thoughts as well. The negotiators ought to be in a position to use an active skill of listening to alter the negotiat ion tone. To employ the listening skills in a successful manner, it is mandatory for the negotiator to understand the situation at hand first. Conclusion From the above discussion, it is clear that modern psychology should be applied in every hostage negotiations. The psychological principles are important, as they have enabled the police to employ active techniques for listening, maintain an approach that is open minded as well as create a rapport that can influence the counterparts of an individual. It has also enabled the police negotiator to work hand in hand with the individual involved in the crisis or the hostage situation towards a solution that is peaceful. Additionally, the use of the principles has enabled the police negotiators have come up with important skills of negotiations to be used in the hostage situations. It is also clear that, for a negotiator to fit in the field of crisis intervention, he/she must be highly skilled, able to withstand any form of deployment and lastly, should be able to determine and implement the decision making and negotiation strategies.