Culture, End of Life and Evidence Based Practice
Definition of evidence based practice This is a healthcare practice whereby a practioner finds, uses and appraises the most recent valid and current research findings when making clinical decisions. This term sometimes denotes evidence based medicine but it can also include various specialties such as pharmacy, evidence-based nursing, and dentistry. On the other hand, various authors have given different definitions to this term. For instance, Sackett et al (1996) defines it as The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients and practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research (Sackett, et al., 1996). 2.
Discuss the process of how current evidence is used to make clinical decisions. Debate on end-on life issues is not new in the society, and some questions have been debated for a long period of time. The major issues in this case, have been on euthanasia and physician-assisted suicide. The current debate on this issue is framed on the acceptance of withdrawing and withholding life sustaining therapies, decision-making at the end of life, self-determination movement and change in social values. In the past one decade, progress has been made in the legal acknowledgement of rights to end of life by patients.
In this case, patients have been warranted the right to refuse unwanted treatments or even discontinue with it. Notably, patients have been accorded the right to life-sustaining therapies. On the other hand, there is a recognized right to control of pain and intensive palliative care. However, there have been questions regarding on whether or not the society should determine the time a patient should die, according to his/ her own values, as underlined by the euthanasia and physician-assisted issue. The debate on euthanasia and physician assisted suicide has been distorted because of the confusing and ambiguous terms.
Physician-assisted suicide is defined as “aiding or helping to bring about death for compassionate reasons” (Drisko & Grady, 2012). On the other hand, Euthanasia implies to “bring or give death for compassionate reasons (Elwood, 2007). The debate on euthanasia has been about the principle of autonomy, the difference between letting on to die and killing, relief on suffering and the arguments on the arbitrariness of the limits. In this case, the above considerations may be used to oppose or support euthanasia. Euthanasia implies that a patient has the right to be relieved from suffering a pain. Majority of people see this as an extrapolation on the principles of autonomy i.
e choosing the means and moment of one’s death. This debate struggles with the suitability of the limits on autonomy and medical uncertainties. The proponents of euthanasia draw comparisons between withdrawing and withholding treatment, neglecting of the distinction between letting die and killing. This is, however, difficulty to justify. Although, letting die and killing are similar in relation to the end result, their intent is different. The potential for abuse of physician-assisted suicide and euthanasia have been expressed by that not in favor of these practices.
Abuse of euthanasia has been found in different reports. The WHO report confirms that0.8% of the deaths are without explicit requests from the patients. In Asia, the medical reports indicate that 19% of critical care nurses engage in forms of Euthanasia without the supervision of physicians. The desire to legalize physician euthanasia and physician assisted suicide is a clear reflection of the failure by the health care system to treat pain and depression. The society should, therefore be guided against making euthanasia or physician assisted suicide a dissertation from humanness.
Arguably, mastering meaning of life and death is beyond the scope of medicine. The society therefore needs to address on end of –life care issues so as to .improve quality of life among patients. 3. Formulate a clinical question about clinical practice. Whenever we come across a patient, we try to look for some new information about some elements of management, prognosis or diagnosis.
Indeed, the available time for finding this information is limited. As a result, we need to be efficient in our searching. This can be achieved by being well skilled in formulating clinical questions. A good clinical question should be relevant to the care of patients and should help in looking for evidence-based answers. It should be noted that there four components of a good clinical question as shown by the acronym PICO below. P – Population, population or interest of problem I – Intervention – prognostic factor, therapy, or exposure C – Comparison interventionO – Outcome of interest There are two types of clinical questions: foreground and background questions.
Foreground questions are relevant and specific. For instance “In adult patients undergoing surgery, how does guided imagery compared with music therapy affect analgesia use within the first 24 hours post-op” (Dobson, & Craig, 1998). Background questions are broader and provide a general knowledge answers. For example, “What therapies reduce postoperative pain” (Dobson & Craig, 1998). Identify common complementary and alternative therapies used by clients based on culture. Describe special considerations related to complementary and alternative medicine (CAM) usage Alternative and complimentary medicine encompases health care beliefs and practices which doesnot fall under the convection al medical system.
The complimentary and alternative therapies are wide and include practices such as prayer, yoga and acupuncture as well as foods, herbs and supplements. The use of complimentary and alternative medicine has been on the increase in the recent past. It is, however, important for nurses to know the various forms of CAM therapies. They should have information on the advantages and disadvantages of these therapies and the legal risks that patients can pose on the use of it. Well educated nurses can effectively identify and document the use of therapies and ensure that CAM does not affect the traditional medical treatment of the patient. Define culture, cultural diversity, cultural sensitivity, and cultural competence Culture can be defined as a cumulative deposit of experience, knowledge, values, beliefs, meanings, religion, spatial relations and concepts of objects and materials acquired by a group of people in the course of a given generation.
On the other hand, cultural diversity is the quality of different cultures while cultural sensitivity eentails being aware that cultural similarities and differences exist and have impact on learning, values and behavior. Identify specific cultural practices, which should be considered when planning nursing care There are various cultural practices to be considered when planning a nursing care, and they include: Dietary and nutrition practices Beliefs about the causes and cures of a certain illness Religious beliefs about death and illness anatomical characteristics i.e. skin tone, stature and hair texture Disorders which are specific to a certain group. List 5 End of Life considerations for a patient with End Stage Renal disease. Patients can choose to undertake dialysis i.
e. peritoneal or haemodialysis dialysis Kidney transplant One can choose not totreat ESRD A minor surgery might be undertaken in preparation for haemodialysis A patient can be given a chance to make his/her decisions Provide 5 nursing intervention for the patient with End of Life considerations with Congestive Heart Failure Patient and family support and education are important Patients with End of Life considerations with heart failure are more comfortable when the symptoms of this disease is well managed and medications given as long as they are able to tolerate them. The pain experienced by these patients can result from noncardiac and cardiac sources. As a result, opioids are recommended as a way of relieving this pain Fatigue is also common among these patients. Managing fatigue can be a challenging factor hence requires a multidimensional strategy As these patients near death, there is a progressive withdrawal.
In this case, patients become very weak and are not interested in eating or interacting with people. In this case, comfort measures should be provided to the patient and these includes repositioning and mouth and skin care. Identify some differences between a patient who is Catholic, Southern Baptist, Scientologist and Jehovah Witness Health care system has been affected by catholic beliefs since the emergence of this church. One of the church practices of this church is to comfort the sick by giving them a “code of honor”. The church has translated this into the emotional, spiritual and corporeal care of the patients. Catholic patients have always received humanity treatment in social interest and received genuine human interest.
There is no official stand given by the Southern Baptist on health issues and end of life issues. However, they argue that aggressive end-of-life is a “contradictory to the desirability of death under circumstances of intractable pain and incurable illness” (Trinder & Reynolds, 2000). Moreover, refusing treatment is acceptable on moral grounds. On the other hand, the beliefs by scientology towards end -of life are similar to that of Buddhism. Patients believe in re-incantation soon after they have passed away.
Jehovah witnesses have beliefs based on the passages from the Bible. Members of this church are prohibited from consuming blood. As a result, blood-free surgery poses a major challenge on Jehovah’s Witness patients.