Introduction
As one ages, the manner the organic structure works and maps alterations. Health jobs that did n’t used to be are present, and the organic structure does non react in the same manner. Mrs. Smith and her scenario is a familiar illustration of the complications and hard determinations that must be made as person ‘s age. From the scenario of Mrs. Smith, many issues and jobs are presented, with many determinations that need to be made. These determinations must take into history the wants of the client, the concerns of her household, safety, what ethically is right to make, and many other facets. In truth, it will be hard to come to a decision that is traveling to do everyone happy and still maintain the client safe and healthy.
Scenario in Relation to Health
Clients wellness jobs and effects
In footings of wellness, it is evident that Mrs. Smith has multiple issues. She has coronary arteria disease, diabetes, degenerative arthritis, spinal stricture, hearing loss, and dry macular devolution. There besides seems to be an addition in confusion, which could propose another wellness issue. CAD and diabetes are two terrible, chronic conditions that consequence her wellness greatly, and the issues of osteoporosis, loss of hearing, spinal stricture, dry macular devolution, and recent evident alterations in cognitive position besides play a big function in her ability to populate independently. These multiple issues affect her in many ways: such as her ability to drive, her ability to read prescription instructions, cook nutrient decently at the right temperature, unfastened pill bottles, walk without falling and farther deteriorating her wellness.
Diabetess
Diabetes entirely can do several jobs that would do it difficult for Mrs. Smith to be wholly independent, and remain healthy. In a longitudinal survey done by Kou, et. all: “ Patients with DM are more likely to describe disablement, have more yearss of restricted activity, and have more physical map restrictions ( 2009 ) . Older grownups with diabetes have an increased hazard of bosom onslaught. Besides, harmonizing to Iliadas: “ caring for an aged individual with type two diabetes is non the same as caring for a younger individual with the disease ” ( Iliadas,2009 ) . Dr. Iliadas continues by explicating that aged with insulin-dependent diabetes frequently have decreased energy degrees, and reduced mobility. This is an of import factor in the wellness of Mrs. Smith, as she lives entirely and needs to be able to acquire to assorted topographic points and travel around her place efficaciously. He besides explains that some conditions are more common in aged than younger people with the disease: such as depression, falling, urinary continency, memory jobs, and hurting. ( Iliadas, 2009 ) . These besides are really of import considerations to take into history sing Mrs. Smith ‘s wellness position. The alterations in her cognitive position may be related to her diabetes, and even if non, the alterations in cognitive map may farther impair her ability to maintain herself healthy.
Coronary Artery Disease
Mrs. Smith suffers from coronary arteria disease, which if non managed, can take to a bosom onslaught. Harmonizing to Dr. Lawrence Young, bosom onslaughts affect aged people much more extensively than younger people, and frequently consequence in longer hospitalizations, and reduced recovery ( Young, 2002 ) . It is truly of import for Mrs. Smith ‘s wellness that she is following her medicine regimen for her CAD, and eating decently. A concern would be that with the alterations in her cognitive position that she is non ever taking her medicine, and this is a major job. Besides, her diabetes increases her hazard of coronary arteria disease, so diabetes direction is critical. With a diminution in cognitive position, every bit good as degenerative arthritis and macular devolution, it needs to be ensured that she is able to read the glucose metre every bit good as draw up, administer and give the right sum of insulin. Her degenerative arthritis, and spinal stricture though non terminal or life-ending diagnosings, can impact her wellness in many ways. , causisng stiffness and impaired sleight in her custodies, doing it hard to open pill bottles, administer oculus beads for macular devolution or pull up right insulin sums. Spinal stricture can do impaired mobility and hurting.
Cognitive alterations
The greatest concern is that Mrs. Smith is sing alterations in her cognitive position ; while holding multiple wellness issues that require attending and most likely medicines that the client must retrieve. It is reasonably important that she is overdrawing her checking history, and has gotten into two accidents in the past six months.From this position, it appears that something must be done, and that this client is no longer able to populate independently.
Safety
Safety related to vision alterations
Another manner to look at Mrs. Smith ‘s state of affairs is from a safety point of view. There evidently are some issues if she is burying the range was one, and is acquiring into auto accidents. Her safety is a precedence, because without being safe, and guaranting safety, there is no manner she can independently populate on her ain. One concern is her drive. She has several hazard factors related to her drive, and added to that her freshly developing confusion may do it excessively unsafe for her to drive. Macular degeration is the loss of cardinal vision, and the taking cause of sightlessness in people over 50 ( Touhy, 2010 ) . The disease progresss, so it is possible that it is acquiring worse in Mrs. Smith ‘s instance and this could be partly to fault for her auto accidents.
Safety and Diabetess
Another issue would be her diabetes, and the alterations in vision that this can do, particularly if she is allowing her blood glucose degrees get high and is burying to administrate insulin, or due to arthritis holding a difficult clip administrating her insulin. Dr. Iliades explains that research done on aged diabetics shows that they have twice the rate of disablement as non-diabetic aged. The disablements can run from trouble walking, dressing, bathing, utilizing the bathroom and the phone, cookery, shopping, and pull offing money. Besides, jobs with seeing can besides take to a deficiency of self-care ( Iliades, 2009 ) .Insulin-dependent diabetes can take to diabetic retinopathy, and harmonizing to the National Eye Institute, 40-45 % of Americans who have diabetes will develop diabetic retinopathy, and this another taking cause of sightlessness.
Arthritis
Mrs. Smith besides suffers from arthritis ; which can besides do some jobs with her safety and life independently. Harmonizing to the U.S. section of Health and human services, “ Osteoarthritis of the articulatio genus and hip articulations causes the most trouble for the aged because it significantly impacts their ability to carry on their normal activities of day-to-day life, such as walking, cookery, bathing, dressing, utilizing the lavatory, and executing family jobs ” ( ahrq.gov, 2002 ) . It goes on to state that due to this disablement they frequently do non utilize the musculuss every bit much as they should ; which can take to failing and do them more prone to falling, which would be a important hazard for her safety. Besides her important hearing loss will set her at hazard for safety impairment..
Socioeconomic factors
Another manner to discourse Mrs. Smith ‘s state of affairs is through a socioeconomic point of view. Mrs. Smith lives on a fixed income. She ne’er had a occupation, so likely lives off Medicare and anything her hubby left her. This will show some jobs because now on top of her usual disbursals, she is paying for her house fixs, and her infirmary stay. If she receives Medicare, it may assist her wage for some medical disbursals, medicine, insulin, things like that. If it would stop up that the best solution is assisted life, Mrs. Smith would most probably have to pay for it independently. This, depending on her fiscal state of affairs, could take a immense toll on her bank history, and may non be executable from a fiscal point of view. Another economic issue Mrs. Smith may confront is paying for a nurse and other wellness suppliers to come in to her place and cheque on her. Because she suffered some terrible Burnss and this will necessitate close monitoring, every bit good as some rehabilitation, she may be able under her Medicare to measure up for Home Health. This would let a nurse to come into her place and cheque on her: guarantee she is acquiring about O.K. , taking her medicine, supervising her blood glucose degrees, etc. Mrs. Smith is profoundly opposed to this, but possibly through account and stressing her independency, an understanding can be made. Home Health nursing does non hold to be improbably expensive, and many times takes in the functions of assorted other wellness professions: such as rehabilitation therapy, physical therapy, and occupational therapy. This besides would forestall Mrs. Smith from holding to drive so frequently to her physicians assignments, since the physician ‘s assignments now would come to her. Financially, it will be of import for Mrs. Smith and her kids to look at how much money Mrs. Smith has, how much will be needed for the assorted thoughts for her life alterations that will hold to take topographic point. Depending on which Medicare program Mrs. Smith is on, Home Health may be covered for her.
Socialization
Assisted life could besides supply Mrs. Smith with a societal system of friends and people similar to her life nearby. Presently, Mrs. Smith lives entirely and a reasonably far distance from her kids, and she is reasonably stray. Although she enjoys her independency and populating entirely, there are some benefits to see aided life that possibly she has ne’er thought approximately. Mrs. Smith may non believe so now, but her deficiency of a support system is non healthy. A survey done by Yeh ( 2003 ) , on the relationship between societal support and cognitive map showed that higher cognitive map was associated with increased societal support. Harmonizing to an article entitled “ Healthy Ripening: what function does Socialization Play ” , it states: “ Research has shown that those older grownups, who have strong societal webs, seem to hold a higher quality of life, unrecorded longer and are healthier compared to those with small societal support ” ( Moore, 2010 ) .A The article besides goes on to province that societal support is of import to keep cognitive map and cut down disablement and provinces: “ The ‘use-it or lose it ‘ theory seems to be true-social battle may excite multiple organic structure systems including the cognitive, cardiovascular, and neuromuscular systems ” ( Moore, 2010 ) . Having socialisation can besides assist people get by and cover with emphasis ( Moore, 2010 ) . It is of import to hold other people and friends to back up one in sad times, or when things get disputing. It si really likely that with the loss of her hubby, her kids being so far off, and the recent emphasis and cognitive alterations in her life are doing Mrs. Smith some anxiousness or depression. Social support and comfort can be important in bettering how she feels. Another possible consideration would be culturally similar/ ethnically similar societal support. Mrs. Smith is an African American, and this contributes significantly to who she is today. She may experience safe and more comfy in an ambiance of people with similar backgrounds to herself. This may be of import to see if a place wellness adjutant were to be used ; possibly an African American female nurse or physical healer would do Mrs. Smith non every bit opposed to the thought.
Ethical Issues
Another issue to see in Mrs. Smith ‘s instance is the ethical issue. In Fundamentalss of nursing, every bit good as Code of Ethics for nurses ( 2006 ) , there are five ethical issues related to pattern in nursing: nonmaleficence, beneficence, liberty, justness, and privacy/confidentiality. Nonmalficence is the basic rule of making no injury, and non doing hurt to patients. This besides goes along with the ethical issue of beneficence, which is to make good, non to harm other people. Harmonizing to the Code of Ethics for Nurses: “ Often the construct of weighing possible benefit to the patient against possible injury is used in doing these hard determinations, along with the patient ‘s ain stated wants ” ( 2006 ) . This is clearly the issue with Mrs. Smith. She wants to populate at place ; her place, where she lived with her hubby and raised her kids. In an ideal state of affairs, she would be able to make so ; but as an ethical rule it besides must be taken into history the dangers of leting this. She has several wellness jobs and is presently worsening in cognitive position. As a nurse, there is a responsibility to protect the patients, and to non do injury. Allowing Mrs. Smith to populate at place wholly entirely and unsupervised could do injury to her. It is hard to burden the benefits with the hazards of the picks, and sometimes the right determination is non ever made on the first attempt, but nurses are expected to make their best with the information they have, and the observations they make to come to a solution. Another ethical rule is Justice, which harmonizing to the Code of Ethics for Nurses is the duty to be just to all people ( 2006 ) . It frequently is used in respect to fiscal state of affairss. In Mrs. Smith ‘s instance, she may non hold the economic resources to pay for a place wellness adjutant or rehabilitation healer in her place if it is non covered by Medicare. Besides, looking at what is just, it is of import that the nurse return into history what Mrs. Smith wants. She does non desire to go forth her place, she besides does non desire anyone coming into her place. In a perfect state of affairs, these wants could be guaranteed, but in this state of affairs, Mrs. Smith is confronting issues that may necessitate her to non needfully be one hundred per centum satisfied, but possibly suit her wants. Besides, educating the patient, and supplying her with clip and resources to assist with these hard picks. Giving Mrs. Smith the maximal sum of independency is traveling to be cardinal, as this is what she desires most. Another ethical issue is autonomy, which harmonizing to the Code of Ethics for Nurses is giving persons the right to help in their ain determination devising. In Mrs. Smith ‘s instance, this is really of import. Her wants must be taken into history, or she will non follow. Although her kids take a firm stand she be moved to an assisted life installation, she has made it clear that she will non travel. Alternatively of coercing her into it, doing her to lose all independency and ability to do her ain determinations it would be ideal to come up with a solution that still attempts to keep Mrs. Smith ‘s wants. This does non intend that Mrs. Smith should be allowed to do any determination she wants and that she knows absolute best. But she does hold the right to be listened to and for her wants to be taken into history. Ethically, it is really of import for the nurse to try to maintain Mrs. Smith ‘s desires in head, and to seek to suit her. But, she besides has the duty to non let injury to come to Mrs. Smith, and to advance her wellbeing. This may intend that the nurse is unable to wholly carry through Mrs. Smith ‘s wants, which would be populating entirely at her place, with non even a place wellness visit.
Legal point of view
Another position of the issue is from a legal point of view. Harmonizing to the Centers for American nurses, there are several evidences on which legal action can take topographic point. These include unprofessionalism in pattern, substance/drug maltreatment, insecure or unethical pattern and condemnable strong beliefs ( Smith, 2009 ) . In respects to Mrs. Smith and her state of affairs, the lone legal issue could perchance be insecure or unethical pattern. It is truly of import to maintain this client safe, particularly as she is aging, and cognitively may non be able to care for herself. Or, if it is determined at this point that she is safe plenty to return place, appraisals for alterations in that position must be made. It is truly of import that she remains safe, particularly with the auto accidents she has had, and now the first and second- grade Burnss from go forthing a pan on the range. The nurse must be an advocator for Mrs. Smith, and guarantee that whatever determination is made is traveling to supply her with maximal safety. Another legal issues are her power of lawyer. Harmonizing to ” Legal Services for the Elderly, power of lawyer is “ a papers in which you province that you give person else ( normally a comparative or friend ) the authorization to do certain determinations and act on your behalf ” ( 2005 ) . It is of import to cognize that this will non take away Mrs. Smith ‘s ability to do determinations, but it appoints person who besides can move for her. This could be important if she of all time becomes sick, or if she needs person else to pull off her fiscal history, which it appears she may. If one of her kids takes over as the accountant of her fundss, Mrs. Smith may hold a better opportunity of being able to populate at place. She can non go on to overdraw her bank history.
Options for Future Care
Possible solutions
Through the analysis of Mrs. Smith ‘s scenario based on wellness, safety, socioeconomic, societal, ethical and legal, there is a batch traveling on. Besides to take into history the alterations in her ability to populate entirely, the clients wants, her kids ‘s wants, and the ideas of the wellness attention squad make this a hard instance for the nurse to take on, while still maintaining the client and her household satisfied. Looking at the scenario, it appears that there are three possible solutions ; none of which are traveling to fulfill everyone, and each holding certain benefits. The three options are for Mrs. Smith to independently populate on her ain, in her place. This option is what Mrs. Smith desires. She would be wholly independent and life in her ain place, making whatever she wants. A 2nd option would be to hold place wellness attention: have a nurse, and other members of the interdisciplinary squad semen to Mrs. Smith ‘s place, and do certain that everything is being done: medicine is being taken, blood glucose is under control, ADLs are able to be performed, healthy nutrients are being consumed, and any aid that may be needed can be supplied. A 3rd option would be for Mrs. Smith to travel to an assisted life installation. Here she would keep her maximal sum of independency, but still be with a nurse who can give medicines, and guarantee that she is safe.
Independent life
Issues with Independent Populating
The first option: holding Mrs. Smith live at place wholly independent is the most coveted result. This is Mrs. Smith ‘s desire, this is what she has ever done, but as of late some jobs have been happening. She is acquiring into auto accidents, her kids are get downing to detect some cognitive diminution, and she late left a pan on the range, where it caught fire and burned her pretty extensively. Equally perfect as it would be if she was able to populate on her ain, it is clear that there are some issues with wellness and safety. Mrs. Smith has multiple wellness issues that require a batch of work and rigorous attachment to her primary attention supplier ‘s instructions. Her alterations in cognitive damage may propose that she is non able to maintain up with this. This may non be the instance though, and Mrs. Smith may still be cognately working good plenty to administrate her medicines on a regular basis, decently attention for herself and her organic structure, feed herself, clothe decently for the elements and other things. Even so, there are some safety issues of concern with her life in her ain house. Her osteoporosis makes it hard for her to acquire around, she is holding trouble drive, which could be related to her worsening vision and hearing, and she caused a fire by go forthing the range on.
Driving and Cooking
Mrs. Smith ‘s drive and cookery are two countries that must be assessed before leting her to populate at place. Cooking and fixing hot repasts would be a concern, and the societal worker may be able to look up plans like Meals on Wheels, that could supply Mrs. Smith with warm repasts without the danger that she could fire something once more. Another concern with this would be her driving. A batch of treatment with the patient and her household would be of import because it looks like driving will necessitate to be monitored really closely, and likely at least non at dark, and non far distances. This will be an issue with respects to her physicians assignments, and person would necessitate to be able to take her. This could be a job, because all of her kids live far off. A vision appraisal and cognitive appraisal would be truly of import before allowing Mrs. Smith thrust once more. This suggests that although Mrs. Smith ‘s desire is to stay at place, that possibly this is no longer executable.
Benefits
Populating at place is esteeming Mrs. Smith ‘s liberty ; but in other moralss it could be go againsting Nonmalficence, which is the rule of making no injury. Leting Mrs. Smith live at place, wholly alone all of the clip, cognizing that she has had jobs in the yesteryear, and after her kids have stated a diminution in her cognitive position, could be seen as making injury, or non what is genuinely the best for the client. Her household does non desire her traveling back to populate entirely. Looking at this from a multidisciplinary position, if she were to travel place to populate entirely, a thorough physical and occupational therapy rating would necessitate to happen to do certain she is even capable. Both of these professions would be cardinal in the procedure of cognizing if Mrs. Smith is safe plenty to return place, and the point of views of these professions is important. Although this option is the best because it respects the wants of the client, there are many dangers to it that brings up the thought that there may be something better.
Home Health Aide
Benefits
Another option for Mrs. Smith is to hold a Home Health Aide, or sing nurse come into the place and assist Mrs. Smith. The figure of hours the adjutant or nurse spends can change ; and in Mrs. Smith ‘s instance maximal independency is cardinal, so every bit few as possible while still guaranting safety and good wellness would be of import. A place wellness adjutant could come into the place and look into up on Mrs. Smith, make certain she is safe, taking medicine, able to travel approximately and make her things. This option, although non good received by Mrs. Smith, may be a good option for this clip. This would supply some peace of head to her concerned kids, because their ma would non ever be entirely, and yet Mrs. Smith would possibly be more receptive to this thought because at least she is in her ain place. It respects the ethical rules of Nonmalficence and beneficence.
Problems
The jobs with it would be from an economic point of view. Mrs. Smith may non be able to pay for the place wellness aide, although Medicare does cover it for some people and some state of affairss ( medicare.gov ) . Depending on her insurance and what she receives through Medicare, she could be eligible for the system to cover the cost. Another issue would be societal, as she still will be rather stray, no one her age to speak to. This besides does non take into history her drive, or her seeking to cook on her ain. Similar to before, plans to convey her repasts, and person to drive her topographic points likely will be necessary. Before returning place, it would be necessary for Mrs. Smith to hold a comprehensive physical rating. Particularly with her recent stay in the infirmary ; her pace needs to be assessed, her bosom, lungs, labs like haemoglobin A1C and BUN/creatinine. Besides she truly needs a good cognitive appraisal. Her kids are the 1s describing the alteration and that is of import, but it needs to be decently evaluated to do certain she even can populate entirely. Another concern with this option is that her cognitive position appears to hold been worsening for the past six months. Even if she is capable of life on her ain for now, there is no stating if her cognitive map, seeing, or physical mobility will go on to worsen, and if how that will be assessed. She may merely be able to remain in her place a few more months until she declines so much that she can non be place entirely at all. Some benefits to the thought of holding place wellness nurses come in and attention for Mrs. Smith are that she will non be all entirely all the clip and person will be at that place to do certain she is making O.K. , taking medical specialties, making therapy, advancing wellness and health. If she has person to convey her repasts, and person to drive her to sophisticate ‘s assignments, and her cognitive position is integral plenty, this is ideal. It will particularly be ideal if one of her kids can take over fundss for her. Hopefully she will be able to take her medicine as prescribed, and take attention of her organic structure.
Disadvantages
The disadvantages are that it is non want Mrs. Smith wants. She desires to stay wholly independent. Besides, it is non precisely what her kids want, as they think assisted life would be best. Possibly with some instruction though, they would come to hold that this may be a good option. Depending on what other wellness attention suppliers find, this may be a good thought for Mrs. Smith, or it may be bad. If physical therapy, and occupational therapy for illustration find Mrs. Smith able to travel about good on her ain, and holding no jobs with finishing ADL ‘s they may hold that this is a good determination. If her cognitive appraisal reveals merely little damage, but non so much that she is insecure to populate entirely, this would farther stress the benefits of allowing Mrs. Smith live at place, and have AIDSs who come in to look into on her.
Assisted Populating
Benefits
The 3rd option for Mrs. Smith would be to travel to an assisted life installation. This attack has several benefits and drawbacks. The benefits would be that a nurse is ever available for Mrs. Smith. Her medicines can be administered by the nurse, she can travel to therapy and exert right at that place at the installation, and a physician can ever be reached. She is safer in this state of affairs, and wellness publicity is optimum. She besides gets the socialisation facet, which is really of import and may assist her stay cognitively integral and promote better wellness. This besides would wholly extinguish concerns about her drive, and her cookery. She would hold healthy repasts supplied that best suit her bosom jobs, and her diabetes. Person would be able to take her anywhere she needs to travel ; frequently there are coachs, or other ways of suiting seniors in aided life to where they need to travel.
Drawbacks
Although there are these benefits, there are some important drawbacks. There are surely some ethical issues ; such as a complete deficiency of liberty. Any manner it is presented, it is most likely that Mrs. Smith is traveling to decline holding to populate in an aided life installation. She is against it and refuses to travel. If she will non travel ; there is non a whole batch that can be done. Economically, traveling Mrs. Smith to an assisted life installation may non be executable. She lives on a fixed income, and the mean cost of populating for one month is 2,969 dollars ( Touhy, 2010 ) . Although this option is safe, and likely would, in the long term, be good to the client, it may be difficult to acquire her to accept. The emphasis and toll this would take on her at least at first could be something of concern, and it is disturbing to believe of taking off all the things she has of all time known. Traveling to assisted life takes off the house she lived in most of her life, takes off her ability to be a housewife and attention for that house, her yard, and her garden. This option is ideal for her kids though, who are concerned about her life entirely. It besides would be of benefit to the wellness attention squad, who now can supervise Mrs. Smith, and cognize she is safe and taken attention of.
Soultions/Resolution
It is hard to state for certain which result would be of most benefit to Mrs. Smith, or to cognize what will go on in her hereafter. Some other possible options would be to hold her move in with her kids, but it is impossible to cognize if they have the agencies to make this, or if it would even be possible ; plus once more, Mrs. Smith ‘s desire is to stay at place. Looking at the state of affairs, the best intercession would be to foremost give Mrs. Smith a to the full comprehensive rating. It must be really clear and well-established as to what her true position is. If consequences come back that she is able, the best solution would be to hold Mrs. Smith return place and have a place wellness adjutant come in for at least an hr or so each twenty-four hours to do certain she is acquiring her medicine, and to drive her any topographic point she may necessitate to acquire. The biggest concerns are that Mrs. Smith says she does non desire that, and that financially, it may be really hard. Her insurance and Medicare would necessitate to be to the full assessed to see if it is executable, but most likely leting her to populate at place would be less expensive than traveling her to assisted life. With some instruction and the right attack, Mrs. Smith will come to understand the necessity of holding person merely to look into up on her. All of her repasts will be supplied through repasts on wheels, driving will be provided through the place wellness, and fundss will be controlled by whichever kid is lasting power of lawyer. It is taking some liberty off from Mrs. Smith, but besides is maintaining her healthy and safe. If this works, hopefully Mrs. Smith can go on for at least another twelvemonth or so ; and if the cognitive diminutions continue, new attacks such as assistive life will necessitate to be assessed.