Discussion – Evaluating and Terminating Staff

Discussion – Evaluating and Terminating Staff

Reading Assignment: Chapter 18 & 19 in Sullivan

Assignment 1: What evaluation method has been used at your workplace or clinical site?

Number of patients per a day, less x-ray repeated,

Assignment 2: What component of your job or clinical placement is evaluated? Are they the appropriate ones?

Assignment 3: What types of assessment methods have been used to evaluate you? Were they the best ones to evaluate your performance? What would you suggest?

Assignment 4: Have you ever been coached, confronted, or disciplined in your workplace or clinical site? How well did the intervener handle the situation? How well did you handle the situation? Have you ever had to coach, confront or discipline someone? How did the person respond? How well did you do? What did you learn?

Assignment 5 You are a health care manager and you must terminate a staff member. How would you prepare yourself for the termination?

Assignment 6 – Discussion Board Please read the New York Times article “Prepping for Your Annual Review” by Eilene Zimmerman, December 17, 2011.

UNIT 12 – Decisions at the End of Life Page 252

Reading Assignment: Chapter 9

Assignment 1: Review Question C

Assignment 2: Review question E

Assignment 3: Case Study, page 235

Assignment 4: Case Study, page 237

Assignment 5: Case Study, page 245

Assignment 6: Please read the New York Times article “Italian Poet Dies With Help From His Doctor” by Ian Fisher on December 22, 2006.

Permalink: https://nursingpaperslayers.com/discussion-evalu…erminating-staff/ ‎

Assignment 7: Please read the New York Times article “A Racial Gap in Attitudes Towards Hospice Care” by Sarah Varney, August 21, 2015

Euthanasia

· Passive

· Is the allowance of the dying process to continue without intervention beyond palliative care?

· It is the process of doing nothing to preserve life.

· Passive euthanasia is a generally accepted practice in cases of futility, and where no possibility of patient benefit exists.

· Active

· Where the health care provider takes actions that speeds the process of dying does not have ethical or legal support in the United States.

· You are initiating a process that brings about death.

· Active euthanasia is against the law and is contrary to professional and ethical standards of health care practice.

· It is the intentional killing of the terminally ill such as by injection if a lethal dose of medication.

· Active euthanasia is illegal in all jurisdictions in the United States, with the exception of the State of Oregon and The State of Washington

· The voters in Oregon have twice voted to give terminally ill patients, under carefully limited circumstances, the right to ask for a doctor’s prescription to end their lives.

· The Oregon law requires a second medical opinion and the determination that the patient is in fact terminally ill and not just depressed.

· There has not been a stampede demanding death by prescription in Oregon, however, from 1970-2001 only 70 people in Oregon used this law.

· This law in Oregon is still being challenged and allows physician-assisted suicide (PAS) but not homicide.

· The State of Washington became the second state to legalize active euthanasia in November 2008.

· Patient assisted suicide

· Some physicians have sought to engage a patient-assisted suicide.

· In this case the physician provides a patient with the medical know how or the means (a prescription) to enable a patient to end his or her own life.

· Jack Kevorkian first gained notoriety in June 1990 when he assisted in the suicide of Janet Adkins, a Michigan woman who was in the early stages of Alzheimer’s disease.

· Since that time he has assisted in the suicides of many other patients.

· The State of Michigan enacted a law making assisted suicide a felony punishable by up to four years in prison.

· Jack Kevorkian is presently serving a sentence in a Michigan prison.

· Voluntary

· The Netherlands is the only modern industrial nation that has legalized voluntary active euthanasia.

· Involuntary

· Where the patient has not indicted a desire to be assisted in death is not easily differentiated from murder

Euthanasia Arguments

Arguments in Favor of Euthanasia

· Respect for patient self-determination. Individuals should have the right to determine the outcomes of their lives.

· Euthanasia provides a means for harvesting viable organs.

· It provides relief for the family of a patient with an irreversible condition or terminal disease.

· It provides a means to end a terminally ill person’s suffering.

Arguments in Opposition to Euthanasia

· There is no certainty regarding death. Many terminally ill patients have been known to recover.

· Modern technology may find a cure for a terminal disease.

· Families who are undergoing stress due to the financial burden of a dying relative nay be examining euthanasia just to relieve that burden.

· If euthanasia is allowed, than it might be used indiscriminately.

· It is not good for society to have physicians kill patients or for patients to kill themselves.

· There is value and dignity in every human life.

· When physicians and other healthcare professionals become involved in any form of euthanasia, it erodes the ethical basis of the professions.

· The sick and dying may have a fear of involuntary euthanasia if euthanasia is legalized.

· Only G-d has domination over life.

An Ethic of Euthanasia

1. An individual’s life belongs to that individual to dispose of entirely as he or she wishes such as:

· the dignity that attaches to personhood by reason of the freedom to make choices demands also the freedom to take one’s own life;

· there is such a thing as life not worth living whether the cause be distress, illness, physical/mental handicaps, or even sheer despair for whatever reason;

· What is supreme in value us the human dignity that resides in the human’s rational capacity to choose and control death.

Experience of Holland/Netherlands

· It is the only modern nation to fully sanction the practice of physician–assisted euthanasia.

· Process.

· Patient must request

· Patient must be terminally ill, with no hope of improvement and in severe pain.

· Consultation with second physician and reporting of event.

· Procedural review mechanism.

Oregon Death with Dignity Act

· Criteria

· Capable and competent adult

· Oregon resident

· Have terminal illness with less than six months to live

· Must consult two physicians

· Voluntary request a prescription for lethal drugs

· Request must be both orally and in writing

· Must be able to take the medication by themselves (not injected)

· This law is being challenged in 2005 by John Ashcroft as violating the FDA laws. (Discussion Board)

Right to Die

· The U.S. Supreme Court has found no “right to die” within the U.S. Constitution.

· In the most recent cases, the court has moved the question back to the state courts?

Discussion – Evaluating and Terminating Staff

Choices in Life and Death

Suicide

· Is it morally permissible to allow competent persons to consent to their own deaths?

· Voluntary euthanasia and suicide are considered to be morally different.

· Voluntary euthanasia is also called mercy killing and is the action (or inaction) of a second person to help or hasten the death of a person who wishes to die.

· A health care practitioner, who deliberately hastens the death of a patient under the guise of mercy killing, enters a practice prohibited by homicide laws.

· Common and criminal laws regard life as sacred and inalienable and view any premeditated killing as homicide.

· Consent and humanitarian motive are never a defense for murder.

· The law in regard to mercy killing is unequivocal, personal motivation us not defense in murder.

· The public has been particularly outraged when mercy killing involves those entrusted with health care, especially nurses and allied health practitioners.

· Hans Florian and Bertram Harper cases

· Show consideration for the “spirit of the law?

· “Its Over, Debbie” case

· No real patient/physician relationship

· Unclear communication of desire

· No discussion of options (hospice, etc..)

· No consultation with other providers

· Recent rises in cases involving nursing

· Preclude all future options for patient

· Negative effects on community, patients, practitioners, institutions

· Hard to imagine an ethical justification for the decision and action

The Case of the Cojoined Twins

· A marathon 50 hour operation was done to separate 29 year old Iranian twins joined at the head and resulted in their deaths during a surgical procedure in July 2003.

· The twins made a desperate plea to surgeons to give them a chance at having independent lives.

· The twins knew the operation carried deadly risks but knowingly accepted the risks.

· Ethical question – if the surgeons knew that there was 100% chance the twins would die, they should have not performed the operation.

· By performing the operation were the surgeons akin to participating in an assisted suicide?

Mechanical Heart Recipient

· The first implanted mechanical heart, a grapefruit sized plastic and titanium four pound heart called AbioCor was implanted in a 59 year old man, Robert Tools, in July 2001.

· The patient did well until he suffered a severe stroke from a blood clot that was believed to be caused by the mechanical device.

· Unable to take anticoagulant medications, he spent the final days of his life partially paralyzed and breathing through a ventilator.

· Before the implant he had been on the brink of death with end-stage heart failure and had about 30 days to live.

· He lived 5 months.

Discussion – Evaluating and Terminating Staff

Viatical Settlements

· Allow people with terminal illnesses, such as AIDS, to obtain money from their life insurance policies by selling them.

· In exchange for a 20-50% discount on the face value of the patient’s insurance policy, they can have access to the money.

· The patient names the insurance company as the reciepient of the death benefit.

· Some of the problems involving viatical settlements include:

· Tax liabilities for the patient

· Loss of Medicaid benefits

· Loss of face value of the policy to the insurance company

Hospice

· The hospice movement, by providing relief for the terminally ill patient and addressing many of the patient’s and family’s concerns in regard to the dying process, may lesson the need for legislating physician-assisted suicide or euthanasia.

· The hospice movement, which originated in France, has a commitment to keep patients as pain-free as possible.

· Hospice care us focused on providing comfort measures, emotional support, and a final environment as pain free as possible.

Discussion – Evaluating and Terminating Staff

· Additional services may include:

· Pastoral care and respite care for the family

· The staff consists of specially trained personnel who have experience and an interest in the care for the dying patient.

· Patient’s are usually hospitalized in a hospice unit during the final weeks of life.

· Most care is at the patient’s home.

The Hospice Alternative

· Many feel the genesis for support for euthanasia is based on fear of dying

· In pain

· Separated from friends and family

· Following massive technical interventions that wipe out savings and cause lingering in a protracted state of unconsciousness

· If hospice could change the how of dying, would it change the desire for euthanasia?

Palliative care

· Is the total care of patients whose disease is no longer responsive to curative therapy.

· This type of care, comfort care, is meant to relieve pain and suffering so the patient can die with dignity.

· Palliative care includes:

· Pain control

· Shortness of breath

· Supportive treatment for depression

· Frequent turning of the patient

· Bathing

· Palliative care is NOT euthanasia, nor do the professionals giving this type of care passively allow people to die.

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