Discuss the ethical principles of autonomy and beneficence as they might arise in a long-term care setting.

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Bruns posted Jul 8, 2020 8:09 PM
Discussion 12/13

6) Discuss the ethical principles of autonomy and beneficence as they might arise in a long-term care setting.

Many times, when there is a decline in health or mental status most often in the elderly, they will need to transition into a long-term care facility. Chronic health conditions such as diabetes, heart diseases, strokes, arthritis, lung diseases, and cancers in addition to decreased functioning increases the need for extra help. Long-term care facilities are set up to assist individuals to maintain their independence as long as possible, and to aid in their activities of daily living.

The foundation of medical ethics is the concept of Autonomy (Racine, & Dubljević, 2016). Autonomy can be defined as self-determination, or the right to decide what choices are best for yourself. There is a close relationship between autonomy and dignity for individuals transitioning to a new level of care (Heggestad, Hoy, Saeteren, Slettebo, Lillesto, Rehnsfeldt, Lindwall, Lohne, Raholm, Aasgaard, Caspari, & Naden, 2015). Another important ethical principal is the belief that healthcare providers must act in a way that promotes the well-being of their clients, which is known as beneficence.

In the long-term care setting, it is fundamental for the residents to have autonomy in order for the them to feel like the have charge of their own life. Autonomy promotes independence within this population. Often times, the need for additional support because of health issues, causes these residents to lose some of their decision-making abilities. In some institutions, the lack of time and staffing issues also can make some residents become more dependent on others. If a resident is too weak or cannot walk well, they may be required to wait for assistance to use the restroom instead of just getting up and going like they normally would. The actions and attitudes of caregivers in the long-term care setting, can show dignity and respect or can infringe on their rights and make an individual feel vulnerable (Heggestad et al., 2015). These individuals may not have any choice in what time the get up in the morning or go to bed at night, or any choices in the meals they are fed. When there is a loss in functioning, or an individual needs assistance with their cares, sometimes there is the misunderstanding that they are incapable of making their own choices (Larson, 2019). Many long-term care facilities do not offer meals when resident’s desire them, they are served at set times. Nursing home resident also may feel like they are trapped, or have lost their freedom, because they can no longer come and go as they please. Multiple residents may have to share a bathroom in some long-term care facilities, unlike in their home setting. As a nurse, we should respect the choices of our clients unless they are risky or unhealthy behaviors, then we must encourage changes.

There may be health changes in an individual’s condition that may render them unable to make their own decisions. In cases such as dementia, other family members may have to make these decisions for their loved one. When there is no family, or the family is not available, this is when it is necessary for caregivers to use beneficence and perform in a way that helps preserve the resident’s well-being, and safety. Using beneficence in long-term care would involve giving preference to our client’s wishes. Sometime in nursing we act on what we believe is best for an individual instead of asking them their choices and needs. Caregivers who place restrictions for someone who has fallen, may be causing the client grief or anxiety from all their new rules, or being watched much of the time.

Older people have better outcomes when they are allowed to have their independence, autonomy, and dignity (Heggestad et al., 2015). Nurses have an obligation to respect each individual’s autonomy and help them live within their desires and beliefs in the long-term care setting (Heggestad et al., 2015). Making a transition from what many consider a normal life to moving into nursing care facility represents a huge change in an individual’s life. Nurses must give individuals all the information necessary to make appropriate decisions, and respect their judgements, because these are the essential morals of autonomy and beneficence.

Question: Have you ever witnessed a caregiver disregarding an individual’s autonomy?

Reference

Heggestad, A. K. T., Hoy, B., Saeteren, B., Slettebo, A., Lillesto, B., Rehnsfeldt, A., Lindwall,

L., Lohne, V., Raholm, M., Aasgaard, T., Caspari, S., & Naden, D. (2015). Dignity, dependence, and relational autonomy for older people living in nursing homes. International Journal for Human Caring, 19(3), 42–46. https://doi-org.ssuproxy.mnpals.net/10.20467/1091-5710-19.3.42

Larson, P.A. (2019). Lubkin’s chronic illness: Impact and intervention. (10th ed.).

Burlington, MA: Jones and Bartlett Learning.

Racine, E., & Dubljević, V. (2016). Porous or contextualized autonomy? Knowledge

can empower autonomous moral agents. American Journal of Bioethics, 16(2), 48–50. https://doi-org.ssuproxy.mnpals.net/10.1080/15265161.2015.1120800

 

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