The patient is an 88-year-old man with an extensive cardiac history who has been a resident of a skilled
nursing facility for the past 3 years. Comorbid conditions include type 2 diabetes (15 years) and severe
peripheral vascular disease. For 6 months the patient has suffered from a serious left leg wound that has
not responded to treatment and that has become much worse over the past 2 months. At this point, the leg
is gangrenous to above the ankle, and the normal course of treatment would be to remove the leg above
the circulatory problem. However, the patient is refusing surgery and states that he wants âto die with all
of my limbs intact.â The patient has been assessed with mild to moderate dementia and has named his
daughter as his durable power of attorney. The nurses on the unit, the daughter, and the primary care
physician all realize that amputation is necessary to save the patientâs life.
Dilemma: Several ethical issues are relevant to the resolution of the situation. The obligation to respect
the patientâs autonomy in the decision to refuse an amputation puts his life at risk. However, after hearing
about the need for surgery and the likely outcome without the surgery, he continues to state, âI want to die
with all of my limbs intact.â The daughter and some of the nurses who care for the patient question his
ability to make such a decision.
As a nurse, we want to protect our patientâs rights for autonomy and self-determination, but at the same
time, we want what is in the best interest of the patientâs health. What are the ethical issues in this case
study? Who has the legal right to make this decision? Using the nursing process, define how you would
work through this ethical issue.
Sample Solution
My Background: The thought for this business has been getting arranged out in my psyche since I initially started contemplating Beauty Therapy at James Watt College. My long periods of client care involvement, that I increased past to beginning school, in neighborliness both in an administrative job and a colleague will work well for me and can be adjusted to suit the magnificence and integral treatments industry. When I began I knew my ultimate objective was to set up my very own independent company utilizing the capabilities I was to pick up, I didn’t, anyway acknowledge at the time that I would proceed to seek after corresponding treatments. During the 3 years I have been examining I went from excellence, to spa course and after that onto Complementary Therapies, I have been a committed understudy all through this time and consistently took on any test given to me. I have buckled down all through this time and as a result to the diligent work I have done I was extended to an employment opportunity in the 5 star Blythswood Square Spa where I had done my position, I have been there for right around 2 years now where I have built up my aptitude and learning base, this had enabled me to work with a wide range of individuals and experience the work I need to do. I have likewise had the chance to observe direct numerous astounding working practices, which has given me a lot of thoughts of how I can see my business and medications running. Just as my time in school and the spa I likewise telecommute with customers I have met through dear loved ones. This has given me a chance to fabricate a little customer base with whom I can fall back on at calmer occasions in the start of my new pursuit. I have included a duplicate of my CV in Appendix 2. The Idea: The thought for my business will be a room in the nearby wellbeing focus in which I will offer correlative treatments. Back rub will be the principle center, I will offer restricted fragrance based treatment utilizing pre-mixed oils which have been pre-mixed and marked before I get them. The primary medications I will offer will be Swedish back rub, profound tissue knead, sports/healing back rub, Indian head rub, fragrance based treatment (utilizing pre-mixed oils) and facials. I will work intimately with the social insurance experts in the middle in which the business is based and will take referrals from them to attempt to help the patients in their human services needs. The business will be unique in relation to anyplace in the zone as there are just salons around, which are all considerably more centered around excellence treatment and nails rather than back rub and reciprocal treatments. Business Name: My business name will be “A Tranquil Touch”, serene methods calm, quiet or tranquil and this is the means by which I plan my business to be. I will mean to consistently have a quiet climate, quiet staff should I have to grow or get help and consistently leave my customers feeling peaceful and loose. The touch part alludes to the back rub medications I will offer. Position to Date: The majority of my underlying exploration has been completely assembled and when I have bought the items and hardware required and register that I am independently employed to HMRC I will be in a situation to open. Statement of purpose: “A Tranquil Touch” will be a position of quiet and peacefulness, as the name proposes. I will give the most ideal support of my customers through diligent work, incredible client assistance, elevated expectations and polished skill. I will mean to give a spot and treatment list for which my customers will wish to return over and over to get the correlative treatments they need so as to feel their best. Transient goals: Throughout the following a year I intend to accomplish customary visits from existing customers from the wellbeing focus and of my own, nearby new faces through proposals and with fruitful publicizing through Facebook, through advancement, bundles and pricelists. Publications will be in plain view in the wellbeing focus, town corridors, schools and other open structures nearby, value records will be accessible in different areas all through the different areas also. To guarantee a beneficial business later on and build up a sound customer base I will publicize as much as I can before opening and in the first year refreshing and rustling up new business through advancements and promoting as and when is fundamental. Long haul goals: My go for what’s to come is to grow the business into a wellbeing focus, where customers can come to unwind, loosen up, adjust their psyches and bodies and improve any medicinal they are getting from the NHS. I would plan to have an effective business and utilize staff to run a room each at whatever day. I might likewise want to incorporate a stunner room as a feature of the business to enable customers to look on a par with they feel, patterns are quick moving nonetheless and keeping in mind that I will endeavor to proceed with my own learning and that of my staff, I would take over as an overseeing job giving medications as and when conceivable. I will consistently be 100% associated with my business, strong to workers, continually taking a gander at things through the clients eyes while giving the most ideal customer venture for all. Industry Analysis Conveyance Chanel: “A Tranquil Touch”, based inside Port Glasgow Health Center, is an all encompassing salon with an inviting and loosened up ethos where gives an elevated expectation of back rub administrations. The strategy for appropriation is immediate dissemination as the administration is coming legitimately from myself to my customers and they go to the premises. Rivalry: For “A Tranquil Touch” I need to separate myself from different salons in the zone that offer a comparative sort of administration. Subsequent to looking into I found that there are 4 salons in the encompassing zone of Port Glasgow Health Center, who are my immediate rivals. There is a hole in the region for an administration which focuses on correlative treatments, spend significant time in back rub and which isn’t centered around excellence medicines however hopes to improve the wellbeing and prosperity of its customers. Subsequent to having conveyed a poll (incorporated into index 3) and addressing my own customers I have increased through versatile administrations, I discovered that they need a business they can feel sure will give them administrations and medications to supplement and upgrade the human services they are getting from the NHS. A great many people appear to be unconscious of the additional advantages of back rub or don’t imagine that excellence salons are the best spot to get these medicines (a few instances of the returned polls are incorporated into informative supplement 4). Direct Competitors Tres Mar: 5 Church Street, Port Glasgow, PA14 5EH are the salon in my general vicinity I consider to be my most grounded rivals. They offer fragrant healing, reflexology and chiropody just as back rub, facials and sports knead. Right now they are regularly completely reserved yet this generally with nails, waxing and the other magnificence medications they offer. For whatever length of time that I keep my costs low I ought to have the option to focus on my demographic and keep them. I will likewise offer distinctive opening times keeping my room open late when they are not so as to target customers in the wake of working hours (I have incorporated a duplicate of the treatment value list in index 5). Amethyst Hair and Beauty: King Street, Port Glasgow are the nearest salon to the wellbeing focus where I will be based, right now they do offer facials however have no body rub medications on their treatment menu as they offer increasingly shallow medicines, for example, nails, lashes, waxing and hair dressing. This ought to be of incredible advantage to me. I may likewise attempt and cause a connection with the salon where we to can offer referrals to our customers (I have incorporated a duplicate of the treatment value list in reference section 5). The other 2 salons in the region are the Relaxation Room and Brown Street Hair and Beauty. Both of these salons are moderately new and furthermore offer mostly magnificence medicines, as they are not yet entrenched inside the zone and have not done much in the method for promoting I don’t consider them to be a noteworthy risk, as long as my publicizing is done well I am sure I can set up my business in the region without a lot of trouble in the method for rivalry. Operational Plan Administrations: I intend to offer various sorts of back rub which will be Swedish, Aromatherapy (utilizing pre-mixed oils), profound tissue, sports/therapeutic, Indian head, bamboo, hot stones and facials in any case. I will offer full body and have numerous alternatives for part body which will be back, neck and shoulders, facial, scalp neck and shoulders, legs and feet, hand and arm, stomach and chest, neck and shoulders. All back rubs will be altered to address the issues of the customer and will accordingly be bespoke, this is something totally not quite the same as that which is offered in any of the encompassing salons and will be my primary selling point. Cost: The lease for the space for the first 2 months will cost me £600. The room is in stroll in condition and needs no embellishing, because of the specific idea of the business I will require next to no gear which is back rub bed at approx £350, hot stone radiator and stones £100, a hot towel bureau £150 and a determination of towels (enormous and little), face materials and gloves on which I gauge I should go through £100 in the first place. My different costs will be items and consumables, for example, love seat move, spatulas, bowls, emergency treatment pack, grapeseed oil, pre-mixed fragrance based treatment oil, chemical, toner, veil, exfoliator, cotton cushions, tissues, rub cream and lotions all of which I can get for an estimated expense of £200 to kick me off. I can get the majority of this from magnificence express which will downplay my delivery costs. As I plan on paying my protection with my own cash I gauge I will require a rough aggregate of £1500 to kick me off. Lawful Entity: The legitimate element I will exchange under will be as a sole broker as I will work for myself, leasing a room and exclusively in charge of firing it up. In this manner, there are no specific lawful customs to stick to and no arranging consent is required as the bu>
My Background: The thought for this business has been getting arranged out in my psyche since I initially started contemplating Beauty Therapy at James Watt College. My long periods of client care involvement, that I increased past to beginning school, in neighborliness both in an administrative job and a colleague will work well for me and can be adjusted to suit the magnificence and integral treatments industry. When I began I knew my ultimate objective was to set up my very own independent company utilizing the capabilities I was to pick up, I didn’t, anyway acknowledge at the time that I would proceed to seek after corresponding treatments. During the 3 years I have been examining I went from excellence, to spa course and after that onto Complementary Therapies, I have been a committed understudy all through this time and consistently took on any test given to me. I have buckled down all through this time and as a result to the diligent work I have done I was extended to an employment opportunity in the 5 star Blythswood Square Spa where I had done my position, I have been there for right around 2 years now where I have built up my aptitude and learning base, this had enabled me to work with a wide range of individuals and experience the work I need to do. I have likewise had the chance to observe direct numerous astounding working practices, which has given me a lot of thoughts of how I can see my business and medications running. Just as my time in school and the spa I likewise telecommute with customers I have met through dear loved ones. This has given me a chance to fabricate a little customer base with whom I can fall back on at calmer occasions in the start of my new pursuit. I have included a duplicate of my CV in Appendix 2. The Idea: The thought for my business will be a room in the nearby wellbeing focus in which I will offer correlative treatments. Back rub will be the principle center, I will offer restricted fragrance based treatment utilizing pre-mixed oils which have been pre-mixed and marked before I get them. The primary medications I will offer will be Swedish back rub, profound tissue knead, sports/healing back rub, Indian head rub, fragrance based treatment (utilizing pre-mixed oils) and facials. I will work intimately with the social insurance experts in the middle in which the business is based and will take referrals from them to attempt to help the patients in their human services needs. The business will be unique in relation to anyplace in the zone as there are just salons around, which are all considerably more centered around excellence treatment and nails rather than back rub and reciprocal treatments. Business Name: My business name will be “A Tranquil Touch”, serene methods calm, quiet or tranquil and this is the means by which I plan my business to be. I will mean to consistently have a quiet climate, quiet staff should I have to grow or get help and consistently leave my customers feeling peaceful and loose. The touch part alludes to the back rub medications I will offer. Position to Date: The majority of my underlying exploration has been completely assembled and when I have bought the items and hardware required and register that I am independently employed to HMRC I will be in a situation to open. Statement of purpose: “A Tranquil Touch” will be a position of quiet and peacefulness, as the name proposes. I will give the most ideal support of my customers through diligent work, incredible client assistance, elevated expectations and polished skill. I will mean to give a spot and treatment list for which my customers will wish to return over and over to get the correlative treatments they need so as to feel their best. Transient goals: Throughout the following a year I intend to accomplish customary visits from existing customers from the wellbeing focus and of my own, nearby new faces through proposals and with fruitful publicizing through Facebook, through advancement, bundles and pricelists. Publications will be in plain view in the wellbeing focus, town corridors, schools and other open structures nearby, value records will be accessible in different areas all through the different areas also. To guarantee a beneficial business later on and build up a sound customer base I will publicize as much as I can before opening and in the first year refreshing and rustling up new business through advancements and promoting as and when is fundamental. Long haul goals: My go for what’s to come is to grow the business into a wellbeing focus, where customers can come to unwind, loosen up, adjust their psyches and bodies and improve any medicinal they are getting from the NHS. I would plan to have an effective business and utilize staff to run a room each at whatever day. I might likewise want to incorporate a stunner room as a feature of the business to enable customers to look on a par with they feel, patterns are quick moving nonetheless and keeping in mind that I will endeavor to proceed with my own learning and that of my staff, I would take over as an overseeing job giving medications as and when conceivable. I will consistently be 100% associated with my business, strong to workers, continually taking a gander at things through the clients eyes while giving the most ideal customer venture for all. Industry Analysis Conveyance Chanel: “A Tranquil Touch”, based inside Port Glasgow Health Center, is an all encompassing salon with an inviting and loosened up ethos where gives an elevated expectation of back rub administrations. The strategy for appropriation is immediate dissemination as the administration is coming legitimately from myself to my customers and they go to the premises. Rivalry: For “A Tranquil Touch” I need to separate myself from different salons in the zone that offer a comparative sort of administration. Subsequent to looking into I found that there are 4 salons in the encompassing zone of Port Glasgow Health Center, who are my immediate rivals. There is a hole in the region for an administration which focuses on correlative treatments, spend significant time in back rub and which isn’t centered around excellence medicines however hopes to improve the wellbeing and prosperity of its customers. Subsequent to having conveyed a poll (incorporated into index 3) and addressing my own customers I have increased through versatile administrations, I discovered that they need a business they can feel sure will give them administrations and medications to supplement and upgrade the human services they are getting from the NHS. A great many people appear to be unconscious of the additional advantages of back rub or don’t imagine that excellence salons are the best spot to get these medicines (a few instances of the returned polls are incorporated into informative supplement 4). Direct Competitors Tres Mar: 5 Church Street, Port Glasgow, PA14 5EH are the salon in my general vicinity I consider to be my most grounded rivals. They offer fragrant healing, reflexology and chiropody just as back rub, facials and sports knead. Right now they are regularly completely reserved yet this generally with nails, waxing and the other magnificence medications they offer. For whatever length of time that I keep my costs low I ought to have the option to focus on my demographic and keep them. I will likewise offer distinctive opening times keeping my room open late when they are not so as to target customers in the wake of working hours (I have incorporated a duplicate of the treatment value list in index 5). Amethyst Hair and Beauty: King Street, Port Glasgow are the nearest salon to the wellbeing focus where I will be based, right now they do offer facials however have no body rub medications on their treatment menu as they offer increasingly shallow medicines, for example, nails, lashes, waxing and hair dressing. This ought to be of incredible advantage to me. I may likewise attempt and cause a connection with the salon where we to can offer referrals to our customers (I have incorporated a duplicate of the treatment value list in reference section 5). The other 2 salons in the region are the Relaxation Room and Brown Street Hair and Beauty. Both of these salons are moderately new and furthermore offer mostly magnificence medicines, as they are not yet entrenched inside the zone and have not done much in the method for promoting I don’t consider them to be a noteworthy risk, as long as my publicizing is done well I am sure I can set up my business in the region without a lot of trouble in the method for rivalry. Operational Plan Administrations: I intend to offer various sorts of back rub which will be Swedish, Aromatherapy (utilizing pre-mixed oils), profound tissue, sports/therapeutic, Indian head, bamboo, hot stones and facials in any case. I will offer full body and have numerous alternatives for part body which will be back, neck and shoulders, facial, scalp neck and shoulders, legs and feet, hand and arm, stomach and chest, neck and shoulders. All back rubs will be altered to address the issues of the customer and will accordingly be bespoke, this is something totally not quite the same as that which is offered in any of the encompassing salons and will be my primary selling point. Cost: The lease for the space for the first 2 months will cost me £600. The room is in stroll in condition and needs no embellishing, because of the specific idea of the business I will require next to no gear which is back rub bed at approx £350, hot stone radiator and stones £100, a hot towel bureau £150 and a determination of towels (enormous and little), face materials and gloves on which I gauge I should go through £100 in the first place. My different costs will be items and consumables, for example, love seat move, spatulas, bowls, emergency treatment pack, grapeseed oil, pre-mixed fragrance based treatment oil, chemical, toner, veil, exfoliator, cotton cushions, tissues, rub cream and lotions all of which I can get for an estimated expense of £200 to kick me off. I can get the majority of this from magnificence express which will downplay my delivery costs. As I plan on paying my protection with my own cash I gauge I will require a rough aggregate of £1500 to kick me off. Lawful Entity: The legitimate element I will exchange under will be as a sole broker as I will work for myself, leasing a room and exclusively in charge of firing it up. In this manner, there are no specific lawful customs to stick to and no arranging consent is required as the bu>
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