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NRS 434 Topic 5 DQ 2 






Topic 5 DQ 2 




Topic 5 DQ 2 

A majority of older adults do not die in their homes despite it being their preference, and they prefer home care. However, about 25% of patients having terminal illnesses have a home death, while 50% die in hospitals, 20% in nursing homes, and 4% in palliative care facilities (Wheatley & Baker, 2007). A majority of patients, even those who are discharged following admission, are not able to stay at home and instead die in inpatient units. Besides, a large percentage of patients get an emergency admission before their death due to a change in their health condition in which discharge at this point is usually impossible (Morris et al., 2013). In a case where a patient’s relatives would experience burdens and risks by providing home care, the choice of dying at home is usually inappropriate (Loh et al., 2016). Furthermore, in situations where there are limited resources and community providers cannot provide care at the household level, home care is often impossible, and patients end up dying at nursing homes. 

The duty of a nurse should be to uphold the four ethical principles of respect for autonomy, beneficence, non-maleficence, and justice. The four principles provide a framework when facing ethical dilemmas that enables effective decision-making on the emotional issues involved and ensures that crucial factors are not disregarded (Wheatley & Baker, 2007). Decisions on the place of care in patients with terminal illnesses are usually ethically challenging. Ethical considerations of non-maleficence and beneficence should be balanced against the respect to autonomy and justice (Grand Canyon University, 2018). As a nurse, I would support my clients regarding end-of-life care per their wishes by upholding the moral principle of respect for autonomy (Loh et al., 2016). I would respect patients’ choices on their lives and bodies and allow them to exercise the freedom to make decisions that concern them. Besides, I would enable clients to have adequate time and experience to make decisions regarding end-of-life care to promote better patient outcomes and decrease the occurrence of adverse events (Price, 2016). I will empower patients and caregivers to make healthcare decisions that avoid hospitalizations at the very end of life. 





Grand Canyon University. (Ed.). (2018). Health assessment: Foundations for effective practice. Retrieved from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php 

Loh, A. Z. H., Tan, J. S. Y., Jinxuan, T., Lyn, T. Y., Krishna, L. K. R., & Goh, C. R. (2016). Place of care at end of life: what factors are associated with patients’ and their family members’ preferences? American Journal of Hospice and Palliative Medicine®, 33(7), 669-677. 

Morris, Z. S., Fyfe, M., Momen, N., Hoare, S., & Barclay, S. (2013). Understanding hospital admissions close to the end of life (ACE) study. BMC health services research, 13(1), 89. 

Price, J. (2016). Informed shared decision-making in planning for the end of life. British Journal of Nursing, 25(7), 378-383. 

Wheatley, V. J., & Baker, J. I. (2007). “Please, I want to go home”: ethical issues raised when considering choice of place of care in palliative care. Postgraduate medical journal, 83(984), 643–648. doi:10.1136/pgmj.2007.058487 


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