The medical literature presents conflicting messages and nonspecific guidelines regarding the DNR decision. Ethical principles address the questions: who should decide and for whom? Most sources acknowledge the competent patient's right to refuse treatment, but there is less agreement about resuscitating patients unlikely to recover from the underlying illness. The principles of nonmaleficence and paternalism come into play when the physician's professional duties to prevent suffering and to provide "death with dignity" begins to conflict with the patient's autonomy. Competent adults have the right to participate in decisions regarding their care. Whether this right includes the right to demand as well as refuse certain treatments is not clear. For physicians who institute DNR status without the patient's or family's consent, paternalism and professionalism have overridden patient autonomy. In that case, nonmaleficence is the basis of the physician's view of CPR as a harmful burden.(ABSTRACT TRUNCATED AT 250 WORDS)
{"title":"The DNR decision--Part II. Ethical principles and application.","authors":"J A Headley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The medical literature presents conflicting messages and nonspecific guidelines regarding the DNR decision. Ethical principles address the questions: who should decide and for whom? Most sources acknowledge the competent patient's right to refuse treatment, but there is less agreement about resuscitating patients unlikely to recover from the underlying illness. The principles of nonmaleficence and paternalism come into play when the physician's professional duties to prevent suffering and to provide \"death with dignity\" begins to conflict with the patient's autonomy. Competent adults have the right to participate in decisions regarding their care. Whether this right includes the right to demand as well as refuse certain treatments is not clear. For physicians who institute DNR status without the patient's or family's consent, paternalism and professionalism have overridden patient autonomy. In that case, nonmaleficence is the basis of the physician's view of CPR as a harmful burden.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"5 2","pages":"34-7"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13004645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perioperative nursing in the new decade: what does the future hold?","authors":"K Falkenhagen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"5 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13090699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ambulatory care: an evolving health care delivery system.","authors":"B Moreland","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 1","pages":"4-6"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13510055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Camp Star Trails.","authors":"J Johnson","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 3","pages":"33-5"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13233475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cancer prevention and early detection in the occupational setting.","authors":"N Akwari","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 3","pages":"12-6"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13233587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The insulin-dependent diabetic as a model for pain management.","authors":"D M Thorpe","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 2","pages":"36-8"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13358005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Learned helplessness in elderly hospitalized patients.","authors":"S Morrison","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 2","pages":"13-5"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13358099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Marketing concepts revisited.","authors":"W B Boutwell","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 3","pages":"36-7"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13233476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cost-effective pain management.","authors":"D M Thorpe","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 4","pages":"28-9"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13286948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
No course or book will be of value in nursing patients from other cultures unless the nurse uses the knowledge about these cultures provided therein along with his or her own skills of observation, to assess the cultural factors involved in the health care of each individual. Madeline M. Leininger has said that in making a cultural assessment, "We talk to the members of the family as well as the patient about their health values, beliefs, and practices. Some of the many things we explore are how they keep well, who helps them when they're sick, and what folk remedies they use". Leininger further notes (1980) that "like a flowing river, culture is the underlying force that guides people's preferences and their thinking and action patterns." Many cultures have large networks of people who help out in times of illness and stress. Dr. Leininger says, "They are expected to be caring persons; it's a culturally defined role". To understand the process of how the cultural milieu affects responses to an illness like cancer, the patient must be viewed as a member of a family. This family, in turn, is influenced by its membership in an ethnic or minority group, which defines for the family members the culturally prescribed beliefs and behaviors that are acceptable. These beliefs and behaviors form the foundation upon which these individuals view illness, as well as outline how they respond to the diagnosis and the disease itself. As nurses, we must be interested in learning about and understanding the influence that culture has on our patient care. It is hoped that the information in this article will increase your knowledge base and give you greater insight into your patients because the "need to know" will continue to grow as health care clients increasingly demand and expect both respect and the effective application of their cultural beliefs and values to their health care.
{"title":"Cultural expressions affecting patient care.","authors":"J Scholz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No course or book will be of value in nursing patients from other cultures unless the nurse uses the knowledge about these cultures provided therein along with his or her own skills of observation, to assess the cultural factors involved in the health care of each individual. Madeline M. Leininger has said that in making a cultural assessment, \"We talk to the members of the family as well as the patient about their health values, beliefs, and practices. Some of the many things we explore are how they keep well, who helps them when they're sick, and what folk remedies they use\". Leininger further notes (1980) that \"like a flowing river, culture is the underlying force that guides people's preferences and their thinking and action patterns.\" Many cultures have large networks of people who help out in times of illness and stress. Dr. Leininger says, \"They are expected to be caring persons; it's a culturally defined role\". To understand the process of how the cultural milieu affects responses to an illness like cancer, the patient must be viewed as a member of a family. This family, in turn, is influenced by its membership in an ethnic or minority group, which defines for the family members the culturally prescribed beliefs and behaviors that are acceptable. These beliefs and behaviors form the foundation upon which these individuals view illness, as well as outline how they respond to the diagnosis and the disease itself. As nurses, we must be interested in learning about and understanding the influence that culture has on our patient care. It is hoped that the information in this article will increase your knowledge base and give you greater insight into your patients because the \"need to know\" will continue to grow as health care clients increasingly demand and expect both respect and the effective application of their cultural beliefs and values to their health care.</p>","PeriodicalId":77528,"journal":{"name":"Dimensions in oncology nursing : journal of the Division of Nursing","volume":"4 1","pages":"16-26"},"PeriodicalIF":0.0,"publicationDate":"1990-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13346860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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