Case Study Health Studies

Questions: 1. Give two examples of where the notion of autonomy is a problem for the CPN. where does one person's right to be in charge of their own destiny begin to affect an other's?2. Beneficence vs no-maleficence. How do you think the CPN could reduce any potential for harm while not reducing the benefits for others?3. If bernle is sectioned under the Mental Health Act how will justice be me, or not met? Answer: The community health nurse or particularly in this case study, the community psychiatric nurse (CPN) experiences large number of ethical conflicts and dilemmas in health care delivery system. The CPN has to provide health care services such as consultation or treatment therapies alone and that too at the home of the patient therefore she needs to have enough knowledge of legal issues and implications. The case study discusses three main issues, both ethical and legal, surrounding the family of three, Jim, Edna and Bernie. 1. Autonomy, for a community psychiatric nurse, is an agreement to give regards to anothers person right to determine on his own, a course of action that supports independent decision making (Ivanov and Oden, 2013). It is important for the nurses to respect the patients autonomy where he must be allowed freely to choose between choices of treatment. If a patient is not capable enough to take any treatment related decision for himself and has an advanced directive then another person having durable power of attorney can make decision on his behalf (Ivanov and Oden, 2013). There are two instances in this case study where notion of autonomy is a problem for the family members as well as for the person himself. The first case being the religious inclination of Bernie where he is thinking he is chosen to take holy orders. Also, in order to save self from being bullied and frightened and in debt, he decided to stay at home. In a way, he decided to lock himself. Bernie thinks something else of his psychotic episodes and hallucinations and decides to pursue religious interventions as the priest regularly visit Bernie and this is interfering with the assessment process. Bernie has the freedom to experience religious feelings for his own mental peace and the priest has made him realized that he is not having any psychotic episodes. Also, Bernies past experience is not letting him go for medical interventions as he is afraid of being taken to a mental care institution. Bernies condition is becoming bothersome for his parents, specially his mother who thinks he is becoming like his own father, violent and depressed (Morrison-Valfre, 2012). Another issue is of Jim who is uncommunicative and unforthcoming. He is not ready to take any help too. Here the main issue for the CPN is not only making Jim and Bernie communicative of their problems with their family and care takers but also promoting their capacity to be autonomous. It is important for the CPN to realize the need of medical treatment for treating their mental conditions which are getting more harmful in for self and others. CPN must not make them fill any kind of treatment form to limit their treatment options, particularly in case of chronic depression as Jim has this mental illness (Bockenhauer, Cummings and Hamlin, 2014). 2. CPN chooses the practice of doing benefit for others and this ethical conduct is known as beneficence. CPN has to take such beneficent actions to prevent any harm to this family because of any of the family member or simply by removing damaging situations (Ketefian, 2015). Nonmaleficence on the other hand is the avoidance of hurt or harm which CPN must take into consideration (Ketefian, 2015). This is the ethical dilemma for the CPN what to choose between beneficence and nonmaleficence. The first step towards reducing harm and increasing the benefits is convincing the family members, Jim, Edna and Bernie to take up proper treatment for dealing with depression and anxiety. In case of Bernie and family, the CPN must show loyalty, dedication, fairness, advocacy and truthfulness in bringing out certain issues of each family member in front of them so that everyone understands what the other is going through. The community nurse must not force any treatment on the patients. CPN must us e well tested experimental treatments, especially on Bernie to improve his life. The nurse must show empathy towards the condition of Bernie, Edna and Jim and talk to them to make them vent out their emotions. CPN must put in front of each family member where everyone is suffering from one or the other form of depression and anxiety, keeping into consideration his or her attitude, beliefs and assumptions that is going to shape the course of action (Marrs, 2014). Nurse must encourage Bernie to go out and meet his friends and relatives, watch a movie or do out for dinner with family members so that each of them understand the need of and value their presence. CPN must support Edna to keep her opinion in front of others about what she feels and is afraid of. In other words, CPN in case of depression does not have to treat patients in particular but has to create an environment where the principle of nonmaleficence can be applied. This in turn will not reduce the benefits for others (be neficence) as the whole family will get a supportive environment to live. In extreme case, in order to remove any harm, CPN under the guidance of approved doctors must give orders to section Bernie under Mental Health Act. 3. Bernie shows the signs and symptoms of anxiety as well as bipolar disorder where he is involved in compulsive activities such as locking himself in his room and delusions where he thinks he hears voices and sounds of his grandmother. This means he follows beliefs and experiences that are not at the level of the established facts and realities (Masters, 2014). It is possible that Bernie is sectioned under Mental Health Act if his conducts are hurting himself or the others (Buka, 2014). Being sectioned under MHA implies that Bernie is detained in a psychiatric institution against his own will and is given medication without his consent (Marrs, 2014). Justice is met in case Bernie is given proper treatment with all the legitimate resources of therapies and treatment available for him. Complete fairness should be maintained in order to treat Bernie well so that he becomes mentally healthy and harmless for himself and his family. A proper justice is given to Bernie if CPN discovers mec hanisms to perpetuate much needed help and care for Bernie (Wenyan and ZhengYan, 2013). Reference List Bockenhauer, B. J., Cummings, K., Hamlin, L. (2014) The Ethical Practice of the Psychiatric Advanced Practice Nurse in Public Mental Health Care.Advanced Practice Nursing Contexts of Care, p. 199. Buka, P. (2014) Patients' Rights, Law and Ethics for Nurses. CRC Press. Ivanov, L. L., Oden, T. L. (2013) Public health nursing, ethics and human rights.Public Health Nursing,vol. 30(3), p. 231-238. Ketefian, S. (2015) Ethical considerations in research. Focus on vulnerable groups.Investigacin y Educacin en Enfermera,vol. 33(1), p. 164-172. Marrs, J. A. S. (2014) Ethics in Nursing Administration.Financial Management for Nurse Managers, p. 325. Masters, K. (Ed.). (2014)Role development in professional nursing practice. Jones Bartlett Publishers. Morrison-Valfre, M. (2012)Foundations of Mental Health Care5: Foundations of Mental Health Care. Elsevier Health Sciences. Wenyan, Z., ZhengYan, L. (2013) Application of Nursing Ethics Knowledge in the Community Hospice Care.Journal of Yangtze University (Natural Science Edition),vol. 6, p. 031.