Fundamental caring skills

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fundamental caring skills

For my assessment brief I have chosen to use the ethical principle of Beneficence.

Beneficence being the principle that expresses the concept that professionals have a

duty to act for the benefit of others. I have chosen to use Roper, Logan and Tierney’s

The Elements of Nursing (1980). I have chosen to discuss Assessing the need for

Nursing intervention in the elderly. The ward that I am on is a short stay observation

ward for the Elderly. I will be discussing the case of a patient I will refer to as Mr

Jones as to protect patient confidentiality. Mr Jones is 80 years old and

has arrived on our ward for assessment. Mr Jones lives on his own and has no family

and it is a neighbour who regularly checks on him that has contacted Mr Jones’s GP

as they have become concerned about his welfare as he has not been seen for a few

days and has not attended his usual weekly meetings. The neighbours regularly visit

Mr Jones and have reported that he appears to be becoming slightly confused,

bathing at unusual times of day and repeating activities that he has only just

completed. The General Practitioner has contacted Social Services who have then

arranged for him to be admitted onto the ward. Mr Jones appears physically well, he

has bathed and is wearing clean clothes although once arriving on the ward has

become agitated and attempts are made to leave the ward. The wards objective is to

establish whether or not the patient is able to stay at home or if they need to be placed

in accommodation that will be able to accommodate their care needs.

     It has been agreed that it would be advisable to observe Mr Jones on the ward

for a short period of time to make relevant observations on his behaviour in order to

establish the appropriate care that Mr Jones requires. Firstly it was a matter of

looking through Mr Jones’s past notes and from them being able to establish what his

life had been like for the past ten years or so. Mr Jones’s had been married but had

no children. His wife had died five years previously. Mr Jones has appeared to have

coped well since the death of his wife and had maintained a reasonable social life

including visits to the library and social club. Mr Jones rarely went to the doctors and

appeared in good health.

Whilst speaking to Mr Jones and asking him what would he prefer, it is clear his

preference would be to go home. Whilst his assessments are being carried out it does

become obvious that although he manages most tasks well, his forgetfulness is a

concern. Therefore the problem that is now faced is that Mr Jones wants to go home,

he thinks he can manage and is becoming withdrawn and agitated as he is unable to

leave the ward.

The ethical issue now is Beneficence. Mr Jones wants to go home the medical

profession thinks that it would be to dangerous as he is becoming increasingly

forgetful and therefore unsafe to himself and to people around him. There are no next

of kin to assist in this decision so it is between Mr Jones and the medical profession

to come to an arrangement that will keep Mr Jones and ultimately the people around

him safe. Autonomy is the connecting principle to this case, Mr Jones has to be able

to exercise his Human Rights although the decision maybe have to be taken out of his

hands on the grounds that he is not fit to make the decision.

The Medical Staff’s primary obligation is service to the patient and the public at

large. The most important aspect of this obligation is the competent and timely

delivery of medical care within the bounds of clinical circumstances presented by the

patient, with due consideration being given to the needs, desires and values of the

patient. Part of the assessment will be to use tools that can be used to measure all

aspects of physical, mental and social functioning. Many are reviewed by Burnside

(1988), Ebersole and Hess (1990), Hogstel (1990), Norman (1991b), Yurick et al.

(1989) and Kane and Bayer (1991); there is no single measurement that will

universally be appropriate to every patient. Although some assessment can be made

based on the history of the patient a accurate assessment can only be made by full

observation whilst in hospital or in a Nursing care setting.

The medical staff on the ward were there to establish the best possible way in which

to provide Mr Jones with the care that he would require whether this be in a nursing

home on a ward or in a residential care home. There is also the possibility that Mr

Jones may be able to live in sheltered accommodation.

In reference to Frankena (1963), the principle of beneficence could be summarized as


1, One aught not to inflict evil or harm (what is bad); 2,

One ought to prevent evil or harm; 3, One ought to remove evil; and 4, One ought to

do or promise good.

These four things are different, but they may appropriately be regarded as

Parts of the principle of beneficence.

So as to give a definition of beneficence, the principle of it is about doing good. The

question then is, Is what is doing the best for the patient always justice? Justice might

not be achieved through following this principle although what is thought to be the

best for patient and the public may not be what the patent wants and this needs to be

established. Does the patient then loose his rights because other parties involved

know better? Does one principle get outweighed by another? Although it could be

argued that in this case the medical profession is acting in Mr Jones’s best interests

although morally this may not be right. Mr Jones has made a decision that he would

like to go home. He feels he will be able to cope, the only reason for him to go into a

care environment would be because of the possible dangers his forgetfulness may

subject him to. Then there has to be the issue that if Mr Jones was to go into a care

environment would he then loose what capabilities he has left? Will he then loose his

independence that he has fought to keep and would this be morally right?
Mr Jones is now thought to be unable to make an informed decision as he is not

thinking of the possible implications of returning home to care for himself. In

accordance with the Hippocratic Oath the Medical Profession has become

responsible for the well being of the patient and it is now their responsibility to

provide the best care and to act in his best interests. Whilst Mr Jones has been on the

ward his basic needs have been attended to by the nursing staff, his meals are being

prepared for him and he has become accustomed to the wards daily routine. He has

made friends with some of the other patients, and although he continually asks when

he will be able to go home, he appears to be settling into the daily routine. The

principle has influenced his care in the sense that in the long term the overall

outcome will be beneficial to Mr Jones and to the public. Although the moral

argument could still be argued, the greater good would be to place Mr Jones in an

environment where he will be safe, and still able to maintain his independence. The

outcome of the time spent on the ward has established that a ward setting is not

suitable, but a residential care setting with supervision would be. He will be able to

maintain his independence with minimal assistance from cares, until it becomes

necessary to intervene further. It would be wrong to say that every case will be the

same. This is why the guidelines are set and adaptations are made to suit each

individual case. The decision is then made by the Medical team responsible for Mr

Jones’s well being. They have decided that it would not be suitable to return home

because of Mr Jones’s forgetfulness and the dangers in which he may put himself in.

Mr Jones is invited into the room to discuss the decision and to be asked his opinion.

Mr Jones is content with the decision although reluctant to leave his house he is

aware that the reason for this is to accommodate his increased need for supervision,

whilst still being able to maintain his own activities.

Mr Jones has no family, he has managed well by himself but is now needing a little

help. He is still able to maintain functions relevant to Roper et al. Mr Jones is 80

years old and is only now needing assistance in order to continue leading his own

independent life. Mr Jones was not able to recognise that his forgetfulness was

becoming a danger. Once Mr Jones had be deemed a possible risk to himself and the

people around him an intervention needed to be made. In this instance it has proven

to be a positive outcome. Mr Jones has been able to maintain his rights, in respect to

being able to live independently. It is important that Mr Jones is able to make

informed choices as much as the Medical profession has the responsibility to do what

is best for both the patient and the public. An informed decision was made by the

patient in this case. Not all cases are the same sometimes the decisions have to be

taken out of the patients hands as they are unable to make informed choices or they

would not be in a position to consider the well being of others or the possible

outcome. The Medical Profession has to follow very accurate and appropriate

procedures, the Belmont Report is a very detailed report in which all of the principles

are incorporated together in order to cover all the aspects possibly involved in each

individual case.

     As part of the Medical Profession we as Nurses will be expected to follow the

guidelines set. This is because every patient and every person has the right to be

treated with the same consideration and care. We are also responsible to establish the

best care available to those patients who are unable to make informed choices

themselves. It is our responsibility to act in the interest of the patient whilst making

sure that the people around the patient will be safe from harm. In some cases where

the patient is determined to do something that is not compliant with Beneficence the

choice will be taken out of there hands as this will protect the rights of the people

around them. It can sometimes be a difficult and confusing situation as you have two

parties two consider, both have Human Rights and should be able to act in

accordance with them. It appears easier in some situations such as if the patient has a

mental or physical disability, or if they are medically unwell. These situations allow

the decisions to then become the responsibility of someone else or a higher body.

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