Practice Issues Related to Technology

1. Chapter 10 Practice Issues Related to Technology

2. Phenomenological advances Examples: 1)( Scientific advances in the past include medication, surgical techniques, machine and equipments…etc) 2)Saving lives, improved QOL, alleviate suffering, decreased the incidence of some diseases 3)Restart arrested hearts, breath machines, correct deformities, eliminate disease, or to replace malfunctioning vital organs. Dilemmas: Questions of QOL Whether physical existence is synonymous with living. Whether the availability of certain technologies means they should always be used Benefits and Challenges of Technology

3. How and for whom technology should be used???

4. - Some people believe that Biological life must be preserved, regardless of the effect on the person whose body is being kept alive. - Truly alive ↔ only physiological function without awareness Living goes beyond physical existence Quality of life: a subjective appraisal of factors that make life worth living and contribute to a positive experience of living, means different things to different people. Integration concepts QOL: personal perspective Quality of Life

5. It is difficult to find a clear and concise definition of QOL because of multidisciplinary usage and variable cultural understanding of the concept

6. - Conflict between these two concepts - Implementing a particular technology with the intention of doing good may result in much suffering. E.g., pain associated with surgery, chemotherapy side effects. - We are willing to endure the discomfort because there is an expectation of recovery. - In circumstances with little or no expectation of recovery?? Harm induced by technology outweighs the good intended by its use Principles of beneficence & nonmaleficence

7. -Suffering associated with technology may include physical, spiritual, and emotional elements for patient and family -Making decision regarding use of technology may cause pain -There is suffering in living with unknown results of these ongoing decisions

8. -Organ and tissue transplantation -Genetic engineering -Reproduction -Sustaining life -Nurses generally do not make the decisions regarding implementing or withdrawing particular technology (except CPR) Current Technology: Issues and Dilemmas

9. One of the nursing’s primary responsibilities is to help patients and families deal with purposes, benefits, and limitation of a specific technology

10. -Withholding or withdrawing life-sustaining treatments then they are deemed to have poor outcomes or offer no benefit -Medical treatment: physicians in consultation with pt and family (decisions) -In the past: working with natural processes Currently: exercising power over nature; the focus is to cure diseases; QOL and suffering are unrecognized and neglected -Nurses concerns are caring and healing (go beyond the narrow focus of curing) Treating patients: When to Intervene and to What End

11. Ethical dilemmas in health care settings often related toward living and dying • Deliberated questions: • When does life begin? (conception or outside womb) • When does life end? • How can we be sure that someone has died? • Who decides? • How much effort to invest in “saving” a few infants who have a high probability of living only a short time or with significant health problems? • If an infant will die without technology and the technology is withdrawn, do you consider that a natural or unnatural end of life? Why? Life, Death, and Dying Issues

12. Technology makes this discussion more complex -What happen when conception can’t occur naturally and artificial process are employed? -Low birth weight survive with support of machines, surgical procedure….they kept a live only to die after months of expensive treatment

13. +General attitude among health care professionals: failure, unable to deal with death as a possible outcome. +No hope of cure: go home and facilitating the transition/death. +Death view: different cultures +You should be aware of your own attitudes concerning living/dying; as well as the beliefs and expectations of patients, families, and other health care providers Life, Death, and Dying Issues…cont.

14. +Medical futility related to situations in which interventions are judged to have no medical benefit, or the chance for success is low (CPR-DNR) +No distinction between not instituting a treatment and discontinuing treatment already initiated. -Euthanasia: causing the painless death of a person in order to end or prevent suffering -Difficulty: no set definition of the concept, varied suggested guidelines -Futility & expensive treatment/inexpensive treatment -Futility & children/elderly; futility/percent of success Medical Futility (Ineffectiveness)

15. +Principle of justice: if treatment with no effect → it should be discontinued to be available to another person esp. with scarce resources +Under what circumstances do you feel physicians or institutions should be able to limit a patient’s access to expensive treatments? +How might patient care be affected by these decisions? Economics and Medical Futility

16. -Nurses have active role in initiating or withholding life-sustaining treatment -Principles utilized to justify decisions regarding resuscitation include autonomy, self-determination, nonmaleficence, and respect for persons -General practice, perform CPR unless: 1)It is clearly that CPR is futile 2)The physician has specific instructions not to do so -Written advanced directives placed in records Do Not Resuscitate(DNR) Orders

17. What to document in patient record?: 1.DNR order 2.The reason for the order 3.Who gave consent? 4.Who was involved in the discussion? 5.Patient competency to give consent 6.Who was authorized to do so? 7.time frame for the DNR order DNR decisions required open communication Do Not Resuscitate(DNR) Orders…cont

18. -The presence of DNR orders requires nurses to become more focused on providing supportive care. -No reduction in the level of care -Nursing considerations R/t DNR order: Identify pt, document this, periodically review it as condition change, if no order but a request, document the request in chart Do Not Resuscitate(DNR) Orders…cont

19. +Dilemma: feeding or medical treatments? +Withholding food: starvation and death +Withholding artificial sources of nutrition is more complex than withdrawing medical interventions +Should consider the wishes of the patient +QOL is an important factor (nonmaleficence) Artificial Sources of Nutrition

20. Decisions about artificial source must be made when person has difficulty with function associated with nutrition: -chewing or swallowing -not conscious

21. Artificial Nutrition +QOL perception of patient is important +Ethical dilemmas arise concerning whether to classify such intervention as feeding or medical treatment +Dilemmas in situation with vegetative state

22. Advance directive are instructions indicating one’s wishes regarding health care interventions or designating someone to act as a surrogate in making such decision Legal Issues Related to Technology

23. +Focus on the best QOL for the patient +Two primary obligations: comfort and company +A comprehensive, total, supportive care for patient who is not responding to curative treatment +Back bone of PC is a good nursing care that support pt’s dignity, & self-respect of pt & family Palliative Care

24. 1)Control of pain and other symptoms 2)Spiritual and psychosocial care TEAM------nurse, physician, spiritual support, pharmacist, social services and mentalist Benefits

25. +Which is usually done within an in vitro fertilization (IVF) program, involves a process of biopsy of embryos to determine the presence of genetic flaws and gender prior to implementation +Examination of DNA Genetic Diagnoses

26. For couples who have a high risk of conceiving a child with serious genetic disorder, only embryos that are free of genetic flaws are would be implemented

27. Is the ability to alter organisms genetically for a variety of purposes such as developing more disease –resistant fruits and vegetables Genetic Engineering

28. It is possible to determine if person predisposed to certain disease and weather couples have the possibility of giving birth to genetically impaired infant Genetic Screening

29. +Elimination of serious diseases +Correction of embryos defects +Produce more nourished, healthier, siblings Implications of Reproductive Technology

30. +“Good birth”----promote traits that proponents felt were desirable for society +Genetically superior (encouraging) Genetically inferior+ Eugenics

31. -In population control, such as deciding that some people are unfit to have children because of their biology or socioeconomic status -Suggesting that reproduction is the cause of social problem -Racial disparity in reproductive policies and practices Danger of Eugenics

32. It gives hope to many people Questions related to this issue Expectation of survival post-transplant Payment ability for the procedure Power & prestige Transplantation may involve organs from dead or living human donors Organ Transplantation

33. Moment Of Death, When? -Irreversible cessation of cardiopulmonary function -If CPR is initiated, organ to be donated may be damaged How to deal with this issue -Brain death

34. Living donors concerns Voluntary informed consent Selling & buying of organs Sudden Death Family Decision

35. +Focus of caring for pt and families +Being attentive to the needs of persons whose lives are affected by technology +Integrating caring and technology and juggling the demands of each present challenges for nurses in any area of practice Nursing Practice in The Midst of Technology

36. Importance of self awareness related to values, beliefs, and reaction when dealing with technology Attitude and Values

37. +Nurses need to determine who is involved in making decision and how the nurse fits into the scenario? Caring+the human focus +Responsibility for helping pt and families benefit from what technology offers Communication: Who decide?

38. The End