Ethical and Legal issues

[olichi]

I need help with a paper. The paper is about ethical and legal issues in nursing homes. I came up with legal issues in physical restraint use in nursing home. For ethical issue tube feeding to the elderly who refused to eat. please help me. Any information or web site will really help

I need help, I have to write a paper on the ethical issue of tube feeding in nursing home patients who refues to eat. and the legal issues on physical restraint use in nursing homes. please any information and stories will help.

[Nascar nurse, ASN, RN]

Might be able to help. Can you give me specific questions? That is a little vague. But here is a start

Tube feeding in a nursing home. When Dr. or nsg staff notice drastic weight changes and resident is no longer eating, we notify family and as appropriate give them the option of having a G-tube placement (obviously w/ a dr's order if family wishes). Ultimately it is the health care rep/responsible parties decision to make - not our ethical decision at all. In every single circumstance I have seen in the past 20 years, the Dr. will always follow the HCR wishes (after all they will be the ones to sue). We try to provide the education needed to help families in their decision making process; ie: "Mom has lost ** lbs, Mom has such and such end stage disease process, Dr thinks prognosis is poor (Dr discussion w/ family) and Mom has a signed living will on file with us that states she did not want artificial nutrition/hydration. How you would you like us to proceed with Mom's care from here? If at that point they insist Mom needs a tube feeding - that is what they get. I have seen several people w/ several advanced disease processes going on at once been put thru the wringer by a family that just refuses to let Mom die. (I'll haunt my kids if they EVER do this to me!) In my 20 years, I have never had experiences with someone getting a court order to remove feeding tube once inserted.

Restraints: Only used for the safety of residents, only used when other devices have been tried and deemed inappropriate, only used with physicain order and family approval. Have been the big "taboo" for many years, we basically only used in the most extreme of safety issues, but lately I'm hearing reports of surveyors citing for not using restraints more appropriately. Jeez go figure. There is just a very delicate balance of what is and what isn't (a restraint) and when to use and when not to use. All goes on case by case basis.

Does any of this help? Ask away if more is needed.