Truth-telling versus hope: a dilemma in practice

This paper presents a brief outline of the attributes and therapeutic nature of hope in the context of truth-telling. It is suggested that, in some circumstances, withholding the truth to protect hope can be considered a morally acceptable option when truth-telling has the potential to destroy hope's therapeutic effects. A clinical vignette that highlights how the practitioner can be confronted with a clash of principles is presented. The possible consequences of both truth-telling and the withholding of truth are discussed and the moral positions of the health-care professionals involved are examined. This article is intended to provide a framework for discussion/group work, particularly at undergraduate level.     

Dementia diagnosis and disclosure: a dilemma in practice

Background. Providing the individual with the correct information about their diagnosis can help maximize the patient's autonomy, however empirical evidence identifies inconsistencies in the practice of diagnosis disclosure in dementia. Within health care, ethical problems arise frequently and these present a challenge for health care professionals. This challenge can also give rise to conflict when professionals are torn between respecting autonomy, doing good and avoiding paternalism. Aim. The aim of this paper is to highlight the need for interprofessional collaboration when faced with ethical dilemmas such as diagnosis disclosure in the care of adults with dementia. The use of a dialogue and supplementary notes are used to explore crucial ethical points raised by health care professionals. Relevance to clinical practice. The increasing rate of dementia and the need for patients to have access to timely and appropriate information about their diagnosis has prompted much debate about disclosing the diagnosis with the individual who has dementia. This paper may also be useful for educational purposes when used as a framework for discussion/debate in student nurse education. Conclusion. Ethical theories are of benefit in assisting the members of the multidisciplinary team to reach a morally defensible decision. Making ethical decisions in practice can cause the nurse concern. While there is no complete set of ‘rules’ that can provide an answer to each ethical dilemma, it is of immense value to nurses working within the multidisciplinary team to possess a sound knowledge of ethical positions in order to analyse the many complex situations that nurses encounter. The pivotal role of the health care professional is to work in collaboration and engage in sharing the diagnosis with the patient. It is hoped that this paper will stimulate and encourage further debate and study regarding the individual with dementia and diagnosis disclosure. Recommendations for practice, education, policy and research will also be highlighted.     

Collaborative practice: a nursing perspective of the psychiatric interdisciplinary treatment team

The article describes the evolution of collaborative practice across the continuum of care of nurse members of two psychiatric interdisciplinary treatment teams in an inpatient mental health care unit and a psychiatric partial hospital program. The benefits and difficulties of the process are examined in the context of Bowen's family systems theory and a patient case study. There is evidence that patients on these two units have benefited from the improved communication and coordinated care arising from collaborative practice. The sharing of expertise, insights, and knowledge has led to individual professional and personal growth for members of the treatment teams.     

Nurse versus technician: the dilemma of intensive care nursing

A definition of technology and technician is offered, relating this to nursing in the intensive care unit. It is evident that technicians are focused upon the goal of providing care to the machinery. Intensive care nurses possess attributes of the technician, but also take into account the wider issues surrounding the patient. A conclusion that technology is a means to aid the nurse during his/her nursing practice is drawn.     

Caring and nursing: a dilemma

The history of caring is intertwined with the history of women and thus with nursing Although nurses have a professional mandate to provide care, the significance, meaning and function of care and caring remains undefined and intangible within nursing Many factors contribute to a dilemma that requires the professional responsibility to care while withholding recognition from those who provide such care Caring is often hailed as the hallmark of nursing This paper considers some of the questions and permutations related to the concept of caring in nursing     

A nursing diagnosis based model: guiding nursing practice

Fiscal uncertainty, anxiety about nursing retention, and public scrutiny characterize the hospital milieu. During times such as these, introducing a conceptual model may appear inpractical and untimely. However, the conceptual model at Robert Wood Johnson University Hospital has demonstrated many practical applications. It guides nursing practice and provides a framework for quality assurance, documentation of nursing care, and education of nurses in the hospital. Future plans include using the model as a basis for developing a computerized care planning system and a method for cost accounting for nursing. The authors describe how the model serves to unify, give direction, simplify, and improve nursing practice.     

Caring versus empowerment: considerations for nursing practice

The authors argue that there is a tension between the concepts of caring and empowerment. This tension appears in political and managerial debates over how best to run a health service, and it reappears in the clinical situation in nursing dilemmas over the presentation of information to patients. The authors review the major contributions to theory from health care literature, and use case studies to explore some of the clinical implications of these theories for nursing practice.     

Differential diagnosis in advanced nursing practice

Differential diagnosis has become a key element of advanced nursing roles that are incorporating history taking and physical assessment into their remit of professional responsibilities. The aim of this article is to review the relevant definitions of different types of diagnoses, to describe the process of formulating a differential diagnosis including using clinical reasoning skills, and to use a case study as an example of differential diagnosis in advanced clinical practice.     

New quality regulations versus established nursing home practice: a qualitative study

Background

Western governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents?? rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations.

Methods

For this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study.

Results

Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity.

Conclusion

New regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.     

The nursing dilemma of restraints

This study provides a data base for developing intervention strategies aimed at helping staff cope with concerns regarding restraints. Most respondents believe patients should be restrained for safety even if it means loss of dignity, and that a caring manner should be conveyed to restrained patients. A large percentage felt that family members did not have the right to refuse the use of restraints, but that they should have that right if they were patients, suggesting negative attitudes toward restraints, of which they are unaware. Personal and professional characteristics, such as knowledge about restraints, years in geriatrics, and experience with elderly family members, showed no significant relationship to attitudes.     

The diagnosis of cor triatriatum sinistrum in children: a continuing dilemma

Cor triatriatum (CT) is a rare congenital cardiac anomaly. The salient clinical, roentgenographic, electrocardiographic, echocardiographic, and hemodynamic findings are presented in two asymptomatic children and one with nonspecific dyspnea on exertion. Two male children had a classical form of cor triatriatum with normal physical and inconsequential roentgenographic and electrocardiographic findings. One of the male patients had surgery for a large atrial septal defect ostium secundum (ASD 2 degrees) and pulmonary hypertension in infancy. The female patient had CT with a communicating accessory chamber to right atrium and a rare patent foramen ovale. Her clinical findings confirmed an atrial level shunt. All patients had excision of the fibromuscular membrane from the right and left atrial transseptal approach with excellent results and with no recurrence during 2 to 4 year follow-up. We report the dilemma encountered in the clinical diagnosis of CT in children and the pivotal role played by echocardiography in the diagnosis of this anomaly.