ETHICAL DILEMMA THAT RELATES TO FAMILY INVOLVEMENT

ETHICAL DILEMMA THAT RELATES TO FAMILY INVOLVEMENT

by Ricky Ocampo RN

Introduction

            A nurse is faced with many decisions while executing his or her work responsibilities (Milstead, 2016). Some of these decisions may cause an ethical dilemma since the nurse may be confused with the moral choice to make. Ethical dilemmas can cause moral distress since the decisions that the nurse has to make may conflict with his or her morals (Nickitas et al. 2014). As a nurse at the Kaiser Permanente recovery unit, I have been faced with various ethical dilemmas that caused a moral distress. One such ethical dilemma was a situation where the patient’s family requested that I should not tell the patient his condition since they felt that the patient was not well enough to handle the news.

 The patient was conscious and was of sound mind according to my assessment. The family, however, claimed that the he is not good at receiving bad news and his poor stress coping mechanism could jeopardize his treatment and health care decisions. Such an ethical dilemma needs a proper knowledge of the nursing laws and principles as well as the patient’s rights to ensure good decision-making. State and federal statutes as well as prior rulings on legal cases that involved the ethical dilemma are also to be considered while making a decision. This ethical dilemma can violate ethical principles and laws, and there are ways of solving moral distress caused by the difficulty.

Codes of Conduct that Apply to the Ethical Dilemma

Decision-making in the case where family feels that the patient is not able to handle information about his medical condition is hard. On one hand, the patient deserves to have full knowledge of his medical condition to participate in any health decisions. On the contrary, the patient’s family might have a valid reason to fear the patient’s reaction based on their experiences and interactions. They are also close to the patient and have his best interest at heart. The decision should also protect the nurse and the hospital from any malpractice suit from the family and the patient. Various things including various professional guides and policies direct nurses’ decision-making. The nurses code of ethics that apply to this decision include provision 2 which states that a nurse’s primary commitment is to the patient, whether an individual, population, community, group or family. Therefore, the decision to be made needs to be focused on the patient’s needs and wellbeing. 

Another code of ethics that apply to this scenario is provision 3 that states that a nurse protects advocates and promotes the rights, safety, and health of the patient. This means that the nurse has to ensure that the decision does not infringe upon the patient’s rights. The nurse should also ensure that the patient’s rights are balanced with his safety and health. Provision 9 can also apply in this case. It states that the nursing profession, collectively through its professional organizations, must integrate nursing values, the principle of social justice, and maintain the integrity into health policy. Therefore, the nurse should ensure that the decision made is based on professional ethic laws and the rules that govern healthcare. The nurse should also remain unbiased while coming up with the solution of the problem. The nurses’ code of conduct mostly addresses the patient and nurse relationship and does not mention the rights of the patient’s family in regards to withholding patient information. To make a practical decision, there is need of analysis of other laws that govern the right to medical information. 

Ethical Principle and Law that could be Violated

One ethical principle that could be violated in the decision on the disclosing of information as per the request of the patient’s family is the principle of autonomy (Costello, 2010). This refers to the patient’s right to determine a course of action in regards to his or her health. The nurse, the doctor, or any other staff member should not interfere with the patient’s right to a decision. This principle is governed by the Patient Self-Determination Act, which was passed in 1990 by the Congress (Taylor, 2014). The act also outlines how the patient can appoint a right of an attorney to another person to make the tough decisions if the patient is not able.

The only time the patient’s family is allowed to make action under this principle is when the patient is unconscious and incapable of making a comprehensive judgment. The members of the family, however, need to be accorded the right to an attorney for them to make these decisions. Civil action can be pursued by the patient if they feel that the nurses did not respect their autonomy. They can sue the nurses or the hospital responsible for the malpractice. If someone else has the right to attorney, then they can make the decision instead of the family.

One law that can be violated by the decision is the right to informed consent. Accurate information on the health condition of the patient should be presented to him so that he can make a conclusive decision. The nurses need to inform the patient about the possible dangers of the course of treatment that he may choose. The information should be accurate and unbiased to ensure that the patient’s judgment is not compromised. In cases where the patient is in a coma or is not able to receive information concerning his or her health the person with the right of attorney is allowed to receive the information.

 The person with the right of attorney has to ensure that he or she follows the patient’s instructions or wishes if any was left.  Proof that the patient is not in the right mind frame to receive information, however, can ensure that the family conceals the patient health records. The proof is that the patient is not mentally stable and has a history of mental illness, which can severely affect his reaction and decision-making process. Violation of the patient's right to informed consent can lead to a civil suit against the person responsible for the misconduct (Stoljar, 2011). 

A Decision that Demonstrates Integrity

A decision that shows integrity is one that ensures that the nurse’s code of conduct is adhered to, and that prevents violation of the ethical principle and the law. The decision of availing the information on his condition to the patient is the best decision in this instance. This decision goes against the family wishes. This is because the patient still has full rights to his records and is entitled to react as he pleases from the medical report. The patient’s family has the right to make decisions about the patient’s health only when he is not capable due to unconsciousness or poor mental health (Costello, 2010). The family should be encouraged to monitor and communicate with the hospital staff on the patient’s condition. They should also express their fears to the patient and offer their support for any decision that he makes. 

The counseling services that the hospital offers can be used on the patient to ensure that he accepts his medical state and on the family to ensure that they are ready for any outcome that comes from the patient’s illness.  The family should also learn to respect the patient’s decisions and feelings. This decision also protects the hospital and the nurse from civil suit advanced by the patient, which can be very costly. The family cannot sue the hospital for going against their will since the law does not give them the right to patient information when the patient is competent. The family can, however, seek legal action where they can prove to a court of law that the patient is not in the right mind to receive information (Stoljar, 2011). They can convince the judges by showing previous cases where the patient handled bad news in an unfortunate manner. The hospital and the nurses will be obligated to follow the court’s ruling on the matter.

Legal Principles and Laws

The legal principle that applies to the ethical dilemma is the principle of autonomy. Independence means the right to self-determination. Therefore, the person has the right to determine the course of action of his health. For the person to be able to make a good decision on his health the hospital has to offer him all the necessary information on his health. The principle of autonomy ensures that the physicians, nurses or other hospital staff cannot withhold any health information from the patient.

However, information can be concealed if there is proof that the patient might be a danger to himself or others.  However, there is a need for sufficient evidence that proves that the patient is not in the right mental condition to handle the information or to make decisions. In this case, the person that has the patient’s right to attorney will be entrusted with the information and the decision-making process. According to the Patient Self-Determination Act, which was passed by the Congress in 1991 a competent patient, has the right to decide on his or her own (Taylor, 2014). The legal principle not only applies to medical practitioners but the patient’s family as well. They need to respect the patient’s decision and rights. 

Prior Legal Cases

The practice of this law is seen in various court rulings. In the case of Union Pacific R. Co v Botsford, the US Supreme Court ruled against the request by a railway company to perform a surgical procedure on a woman who had sued for a fall. The court argued that only the woman had the right to make the decision. This ruling shows the patient’s right are supreme and though medical personnel are more knowledgeable on health care matters they still have to respect the patient’s wishes.  The New York court of appeals in the ruling of the 1914 case of Schloendorff v. Society of New York Hospital the judge spoke against the action of treatment of the patient without consent (Taylor, 2014).

The judge argued that an adult of sound mind had the right to make a decision on a procedure to be performed on his or her body. This ruling shows that if the patient is not of sound mind then his right to information and decision-making can be taken by someone else mostly the person given the power of attorney.  In Cruzan v. Director, Mo. Dept. of Health in 1990, the US Supreme Court, ruled to terminate artificial nutrition and hydration as per the wishes of the patient as relayed by the family. The Supreme Court ruled that the patient had a right of refusal of treatment (Costello, 2010). This ruling is similar to the case of Harvey v Strickland, 2002; the patient was a Jehovah Witness, who objected blood transfusion during surgery. However, the need arose during surgery, and the patient was unconscious and could not make the decision.

The surgeon sought the mother of the patient who consented to a blood transfusion on the basis that it was an emergency. The patient later on proceeded to court and the ruling made was that the patient’s wishes against a blood transfusion were well known by the surgeon and the mother, and they should not have administered it (Goodwin, 2011). This ruling demonstrates the patient’s wishes should be followed even if the patient is unconscious. The rights of the patient should also be respected even if the patient decision may cause harm or death to him or her. 

In the state of California where the ethical dilemma occurred the statute that governs the law is section 2355. The article says, if the conservatee has been adjudged to lack the capacity to make health care decisions, the conservator has the complete authority to make medical judgments for the conservatee in good faith based on medical guidance determines to be necessary. The conservator shall make medical choices for the conservatee by the conservatee's individual medical wishes and instructions to the extent known to the conservator. Otherwise, the conservator shall make the judgment by the conservator's resolve of the conservatee's best interest.

 In defining the conservatee's best interest, the conservator shall consider the conservatee's  likes and principles to the level known to the conservator. The conservator may need the conservatee to receive the health care, whether or not the conservatee objects. In this case, the medical choice of the conservator alone is enough, and no person is liable because the health care is directed to the conservatee without the conservatee's consent (Goodwin, 2011). Therefore, the only time someone is allowed the patient’s right to information and decision-making is when the patient is not capable either due to unconsciousness or due to mental instability. The person acknowledged the rights should ensure that only the patient’s best interests and wishes are recognized in the choices made.  

Differences between Ethical and Legal Reasoning

The difference between ethical and legal reasoning is that ethical reasoning is an interpretation of events or a subject based on a person views of rights and wrongs (Ulrich et al. 2010). This thinking is based on person’s religious and political ideologies. Legal reasoning, on the other hand, is thinking based on the law. Legal reasoning in nursing is controlled by the state and federal laws, professional standards, and licensure. In a case where legal reasoning is not applied, it might lead to suspension or termination of licenses and or criminal and civil action.

However, professional codes of conduct might prescribe a set of ethical principles that a person should adhere to while performing his or her responsibilities. Deviation from these principles can lead to a disciplinary action from the relevant regulatory body. This happens since ethical reasons are also influenced by the culture and traditions of the community and not only the healthcare worker. A decision may be legal but not ethical or ethical but illegal leading to moral distress.

An ethical-legal decision-making model can be used to assist in coming up with a good decision on the ethical dilemma. A model that applies to the case is principlism theory. This is built on four key principles, which are justice, non-maleficence, beneficence, and autonomy (Halstead, 2012).  Justice refers to equality and fairness while non-maleficence refers to not causing harm to the patient as explained in the Hippocratic Oath. Beneficence refers to the nurse focusing on the patient’s best interest while autonomy refers to the patient’s right to make decisions (Nickitas et al. 2014).This approach focuses on the rights of the patient as opposed to the rights of the family and the hospital staff.  Using this theory the decision to be made has to be fair, should not harm the patient, address the patient best interests and give the patient a right to make decisions.

Resolutions to Resolve Moral Distress

There are ways to resolve moral distress caused by the dilemma of either informing the patient of his condition or to hide the status as per the family’s request. One way is by hospital coming up with proper decision-making and legal framework that addresses ethical dilemmas. Coming up with hospital policies that address the decision-making mechanism on the issue can help solve moral distress since it will make decision making easier (Cerit & Dinç, 2013). The nurse’s code of ethics and other professional policies and laws can also be reviewed to enable easy decision-making.

 A proper decision-making structure and framework will make it easy for nurses to make a decision that affect patients, therefore, avoiding moral distress. The medical worker can also use the hospital use in his or her defense in case of legal issues arising from a decision made. If the worker has followed all the hospital regulations, he or she can gain support from the management. The hospital policies should also outline ways of dealing with patients and family and offer education on legal rights that the nurses have while dealing with ethical matters. Nurses that understand their legal obligations are going to use them in making their decisions.

The second way of solving moral distress caused by the ethical dilemma is the use of interdisciplinary efforts. This is by bringing together nurses, doctors and other staff who have faced the situation and can contribute to coming up with a solution based on their experiences. A support group of people facing an ethical dilemma and moral distress formed by staff members of different disciplines can also help reduce the problem. The staff should also offer moral support and understanding on decisions made by other members even if they are facing civil or disciplinary action. This will reduce the stress caused by the decision that they made. The interdisciplinary efforts should also create and lobby for an environment that allows nurses and other healthcare workers speak up on various ethical issues they face or other matters that affect them and the patients. This will quickly help solve the ethical dilemma and moral distress by ensuring the problem facing the nurses are addressed. Hospital teamwork can also foster unity coexistence, which will ensure that members of different disciplines can quickly consult one another while confronted with tough decisions.

Providing ethics experts to deal all forms of ethical dilemma that affect nurses and other hospital staff can also be instrumental in handling moral distress caused by the ethical dilemma (Burston & Tuckett, 2013). An ethical committee should be formed to address all conflicting decisions. The experts consist of people with experience in solving various ethical dilemmas. This includes people that have knowledge of the federal and state laws. The committee should educate the hospital personnel on the ethical dilemma and ways of avoiding moral distress. The group responsible for the ethical issue in the hospital should also come up with counseling services for nurses affected by ethical dilemmas and moral distress. They should also recommend proper stress coping mechanisms for the healthcare workers while monitoring any employees that abuse drugs or alcohol.

Conclusion

In conclusion, nurses face various ethical dilemmas that cause moral distress while executing their tasks. An ethical dilemma that I faced was whether to withhold medical information from the patient as per the family’s request. The nurse’s code of ethics applies to this particular case with provision 2, 3, and 9 relating to the decision that should be made. The decision on the ethical dilemma can be affected by the principle of autonomy and the patient’s right to informed consent. Autonomy refers to the freedom of making healthcare decisions that patient enjoys while informed consent refers to the patient’s right to all his or her health information so as to make a good choice. A decision that would not violate the ethical principles and laws is ignoring the family’s wishes and informing the patient of his medical condition. This decision is in line with the nurse’s code of ethics, the principle of autonomy, and the right to informed consent. The legal principle that applies in the case is the principle of autonomy where there are many court rulings to show how this particular law is used.

The difference between ethical reasoning and legal reasoning is that legal reasoning is based on the law, and moral reasoning is based on a person’s principles. A decision-making model that can be used in the case is principlism. There are three ways of solving moral distress caused by the ethical dilemma in the discussion. One is by the hospital coming up with policies that address various decisions that have to be made and guidelines on how to deal with moral distress immediately before it negatively affects the nurses. The second way is the use of interdisciplinary efforts to ensure cohesion and support in the work area. The third one is the use of ethical experts who have vast knowledge of solving ethical distress and moral dilemma.

References

Burston, A. S., & Tuckett, A. G. (2013). Moral distress in nursing: Contributing factors,    outcomes and interventions. Nursing Ethics,20(3), 312-324.            doi:10.1177/0969733012462049

Cerit, B., & Dinç, L. (2013). Ethical decision-making and professional behaviour among   nurses: A correlational study. Nursing Ethics,20(2), 200-212.            doi:10.1177/0969733012455562

Costello, J. (2010, January). Truth telling and the palliative diagnosis. International Journal           of Palliative Nursing. p. 3.

Goodwin, M. B. (2011). 2010–2011 National Health Law Moot Court Competition. Journal        Of Legal Medicine, 32(4), 345-364

Halstead, J. A. (2012). Embracing Ethical Principles for Nursing Education. Nursing         Education Perspectives, 33(1), 5. doi:10.5480/1536-5026-33.1.5

Milstead, J. (2016). Health Policy and Politics-A Nurse's Guide (Milstead, Health Policy and         Politics)(5th ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Nickitas, D., Middaugh, D., & Aries, N. (2014). Policy and Politics for Nurses and Other Health Professionals (2nd ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Taylor, H. (2014). Promoting a patient's right to autonomy: implications for primary           healthcare practitioners. Part 2. Primary Health Care, 24(3), 34-40.

Stoljar, N. (2011). Informed Consent and Relational Conceptions of Autonomy. Journal Of         Medicine & Philosophy, 36(4), 375-384.

Ulrich, C. M., Taylor, C., Soeken, K., O'Donnell, P., Farrar, A., Danis, M., & Grady, C.    (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal Of         Advanced Nursing, 66(11), 2510-2519. doi:10.1111/j.1365-2648.2010.05425.x

EMPLOYER AND EMPLOYEE RIGHTS IN NURSING

EMPLOYER AND EMPLOYEE RIGHTS IN NURSING

by Ricky Ocampo RN

            The constitution places rights that every person is entitled to so that there can be a peaceful coexistence where every person is allowed to thrive. The rights ensure that the law protects people from any form of harm or injustice from other people, governments, and companies. The nurses have various rights that protect their role and their scope as well as their employment (Milstead, 2016). The bill of rights outlines seven rights that every nurse in the country should have. They include the right to practice in a manner that realizes their obligations to those who receive nursing care and the whole society. Nurses need to be fully committed to the society and ensure their profession is to the benefit of the community. Nurses also have the right to practice in environments that permit them to act by legally authorized scopes of practice and professional standards. They also have the right to a work environment that facilitates and supports the ethical practice. The employers need to provide the nurses a suitable environment where nurses can fulfill their roles while meeting various rules of ethics and professional guides (Fitzpatrick et al. 2013).

The bill of rights also gives the nurses the right to openly and freely advocate for their patients and themselves without fear. It also gives the nurses the right to a work environment that is safe for their patients and themselves. The nurses also have the right to negotiate the conditions of their employment either collectively or as individuals (Fitzpatrick et al. 2013). The employers also have rights that protect them such as the right to discipline or terminate the contract of the employee who operates in contrast to the rules agreed on the contract. The employer also has the right to report the nurse involved in misconduct to the relevant licensing board. Understanding the rights of the employer and employee is important since it ensures that the advanced practice nurse does not get into a contract where his or her rights are violated. It also ensures that the advanced practice nurse knows the rights to demand for better employment terms or the improvement of the work environment. The topic is also important since the advanced practice nurse can avoid infringing the rights of the employer (Kangasniemi et al. 2013).

References

Fitzpatrick, T., Anen, T., & Martinez Soto, E. (2013). Nurse Staffing: The Illinois Experience. Nursing Economic$, 31(5), 221-259.

Kangasniemi, M., Stievano, A., & Pietilä, A. (2013). Nurses’ perceptions of their   professional rights. Nursing Ethics, 20(4), 459-469. doi:10.1177/0969733012466001

Milstead, J. (2016). Health Policy and Politics-A Nurse's Guide (Milstead, Health Policy and         Politics)(5th ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Nickitas, D., Middaugh, D., & Aries, N. (2014). Policy and Politics for Nurses and Other Health Professionals (2nd ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Knowing Medicare Options

Knowing Medicare Options

by Ricky Ocampo RN

            It appears the nation's woe for affordable healthcare has led the federal government to take action in educating the country on its options and ensuring accessibility to government enforced and regulated plans, but for skeptics of government competence, no songs of praises will be sung until an extensive assessment of how resourceful, affordable, accessible, and generally effective the options are has been conducted. Medicare.gov is the web-based one-stop information center for all topics and dynamics associated with both signing up for and accessing Medicare services (Medicare, 2015). Instant usability consideration is found in URL address of the website alone; Medicare is all that's needed to be remembered, and aside from this, the .gov domain provides users with confidence that the site is an official government one. The process of shopping for health insurance can be very complex and frustrating if one isn't completely sure of which option one wants beforehand, and it's nearly impossible to be sure of such factor without being aware of what options are available. Luckily Medicare.gov has all of the necessary information collected on site. Admittedly, the many links, pages, and texts available on the website can make the website appear intimidating to some users; it's likely that information of such scale can make healthcare appear more complex than it actually is. On the home page for instance, even something as simple as placing the mouse cursor over the 'Sign Up/Change Plans' tab reveals a scripted display of more links and options. The positive side of the amount of information available on the site is that it would only be more frustration if—at the end of it all—one isn't able to find answers to questions one might have, but this is very unlikely to happen.

            One thing to naturally expect is that the process will consist of filling out a lot of forms and completing various assessments and surveys. Initially, one has to first determine eligibility. Right away upon entering one's age, the criteria are simple. As the site blatantly warns, “Medicare is for people age 65 and older and those who have special condition or disability” (Medicare, 2015); anyone short of meeting this requirement will not be able to move on the next step. Medicare plans are generally divided into two main options: Part A and Part B. Part A is explained to cover hospital care, skilled nursing facility care, hospice, nursing home care, and home health services. It's explained that “Medicare Part A (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies”, elaborating that “this includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care” (Medicare, 2015). Things like private duty nursing, unneeded private rooms, television/phone in the patients' room, and personal care items like slippers and socks aren't covered. For skilled nursing facility coverage, Part A covers the typical provisions like a semi-private room, meals, skilled nursing care, physical and occupational therapy, speech-language pathology services, medical social services, medications, ambulatory services, dietary counseling, and more (Medicare, 2015). Part A also covers long-term care hospital (LTCH). The website explains that “generally, you won't pay more for care in a long-term care hospital than in an acute care hospital. Under Medicare, you're only responsible for one deductible for any benefit period. This applies whether you're in an acute care hospital or a long-term care hospital (LTCH)” (Medicare, 2015). Part A also covers hospice care and home health services. Generally, Part A is likely to cover all that an elderly patient would need, unless such patient has multiple illnesses that require very specific and exclusive attention and treatment. Upon assessing the coverage of Part A, it's perhaps a bit more practical to press on towards viewing the provisions of Part B, as opposed to just settling for Part A.

            Part B of Medicare is immediately explained to cover medically necessary services and preventive services. Clinical research, ambulance services, durable medical equipment, mental health, inpatient, outpatient, partial hospitalization, obtaining a second opinion prior to surgery, and more, are all listed as services covered under Part B. Part B covers and Part A cover clinical research, “which help doctors and researchers see if a new treatment works and it's safe” (Medicare, 2015). The ambulance service coverage is rather extensive, as it includes aircraft transportation, given the condition that the patient's location can't be easily reached by land vehicles, and/or the patient's condition is too critical to and obstacles found in land travel—heavy traffic and distance—can take away from crucial time the patient might not have. A third option is Part C, which is also referred to as Medicare Advantage (MA), includes both Part A and Part B, and is covered by private insurance companies that have been approved by Medicare. Most programs require the use of doctors provided by MA, otherwise one would have to pay some or all of the costs out of pocket. Most people pay 104$—the Plan B premium—a month for MA but usually pay additional monthly premiums to get MA. Medicare also warns that one may “pay a copayment or coinsurance for covered services. Costs, extra coverage, and rules vary by plan” (Medicare, 2015). MA plans costs would appear worthwhile due to the factor that—as Medicare boldly declares—they cover all Medicare services. Lastly, Part D simply covers medical prescription drug costs. Admittedly the Part D appears a bit more complex than what just drug costs coverage would initially appear to involve. For instance, prior authorization might be required, meaning—as Medicare explains—that one's prescriber must contact the drug plan before you can fill certain prescriptions, as the prescriber “may need to show that the drug is medically necessary for the plan to cover it” (Medicare, 2015). There are also limits on how much medication a patient can get at a time, and for sleep therapy, the patient must try a similar drug of lower costs before the plan will cover any further prescriptions. After having learned the provisions and limits of each option, one central factor that might be an important part of the decision making process is that of costs. A Part A cost is set at a monthly premium of $407, and Part B is $104.90/month for most people. Part D costs are a bit more complex as they're codependent on the amount of annual income the customer makes. People who make under $85K get the Part D coverage as part of their regular coverage (Part A or B), and people who make over $85K pay a $12.30/month premium, in addition to the costs of their regular coverage; people who earn between $107K pay $31.80 in addition to their regular Medicare premium, people between $160K and $214K pay $51.30 in addition to their regular premium. Lastly, people who earn above $214K pay $70.80.

           

            Upon a close assessment of the costs/coverage of each option, it would appear that Part B is perhaps the most practical option. Part A, while being adequate for covering a basic patient with no chronic illness, it doesn't appear to be ideal for patients who are likely to fall ill; such patients can be hung out dry upon realizing the treatment needed by their sudden illness isn't fully covered by Part A. Part B, on the other hand, appears to provide nearly as much coverage as Plan C, but leaves room for incidences where the patient isn't ill enough to need all of the coverage provided by Plan C, where he/she would have to pay a higher premium and be possibly left to cover part of the overall costs. Part D is obviously not ideally meant for being the only form of coverage any patient would have. Part D should generally be ignored as it's not needed if one has any of the other three options.  From all of the information provided, Plan B is perhaps the best way to go, for the preceding premises established.

           

            To conclude, generally, the decision making process isn't necessarily complex, but is rather intimidating, as all of the content on the website can be seen as overwhelming to people shopping for coverage. The contexts within the site are made for people over the age of 65, but it's very likely that people of such age would need the assistance of a younger professional to guide them through the process. In the long run, it's all there—everything that needs to be known. The website takes on a simple and clean presentation focused solely on providing clear and direct information, in contrast of flash and attention retention. Medicare can perhaps benefit from simplifying and/or reducing the amount of links and sub links and texts available on each page, so older adults who are less computer-savvy won't find the site to be confusing and not resourceful.

References

Medicare. (2015, January 1). Medicare.gov. Retrieved March 5, 2015, from            http://www.medicare.gov/

Substance Abuse

Substance Abuse

by Ricky Ocampo

            A strong factor that attracts extra criticism and scrutiny to nurses associated with drug abuse, dependence, and addiction is that naturally, within the premises of the occupation, they're expected to know better, as they're expected to know the consequences of such actions (Sullivan, 1994). Generally, my standpoint towards such cases is that I try to be objective without being indifferent, and what I mean by that is that I acknowledge that such behavior shouldn't be condoned, but generally, my disapproval isn't of the person participating in the action, but of the action itself. I think a nursing professional is expected to, and should, have the ability to hold his/herself accountable and to take responsibility and control of his/her own personal issues. In order to remain objective, it's not my place to judge how someone chooses to address their problems, but in order to not be indifferent, I do acknowledge and appreciate that nursing—and any medical job in general—is a stressful and troublesome position, and there are plenty of room for people who aren't careful to realize they're taking on more than they can handle. I'm uninterested in sticking up a snobby nose and pointing judgmental fingers and pretending to be saintly.

            The relationships between drugs and users typically vary based on several factors such as extents, how important they are to the user, why they're used, and more, and this leads to the need for having different labels and definitions to differentiate these factors from one another, as the difference are certainly important. Drug use is simply the regular use of prescribed or over-the-counter drugs for the usage they were designed and intended to be used for. Drug abuse is the  usage of excessive dosage of a drug, or the usage of a drug for enhancement of one's physical or psychological—and perhaps neurological—state, or usage towards effects other than what the drug was manufactured and sold for. Dependence occurs after a drug has been used for its purpose to the extent that the body has practically shifted to needing the drug to perform a specific function it should naturally be able to perform independently (Stanhope & Lancaster, 2013), and lastly, addiction occurs when the body is unable to carry out practically all of its natural, psychology and/or neurological functions without having consumed a drug (O'Brien, 2005); addiction is typically the worst extent and consequence of substance abuse.

Reference

Sullivan, E. J. "Impaired nursing practice: ethical, legal and policy perspectives." Bioethics             forum. Vol. 10. No. 1. 1994.

O’Brien, Charles P. "Benzodiazepine use, abuse, and dependence." J Clin Psychiatry 66.Suppl 2 (2005): 28-33.

Stanhope, Marcia, and Jeanette Lancaster. Public Health Nursing-Revised Reprint: Population-     Centered Health Care in the Community. Elsevier Health Sciences, 2013.

Assessing Mental Health of Geriatric Patient

Assessing Mental Health of Geriatric Patient

by Ricky Ocampo RN

Geriatric patients undergo a distinct change by the way they interpret things. Old age means weakened immune systems and lower cognitive responses (Cockrell & Folstein, 2002). As a result, it is important to treat geriatric patients with another means of examination. The discussing point would be to use the Mini-Mental State Examination or MMSE to test five areas of an elderly patient’s cognitive responses. Interpretations of the test would be utilized to understand the cognitive condition of the patient. Interventions would then be derived from these interpretations to enhance the treatment process of the geriatric patient. Additionally, an important discussing point would be the cognitive impairment presence in the patient, which will be analyzed after the results of the interview and examination are presented.

Geriatric Patient Information

The patient, whose identity is to remain confidential as per request, is a 68-year-old male, of Caucasian descent, and who has been recovering from depression. His wife died 15 years ago and he has recently recovered from his depression because of medication and family support. He has three children who are all professionals now, and he remarked on how happy he was to see that they were doing well. He used to work at the police force, so his cognitive abilities are above average. He has been a chain smoker until well into his 40s where bronchitis prompted him to stop. He did not drink much, only on occasions. The patient, with old age, has experienced his motor skills waning, but he could cope because of his police training. He feels that his body is not the same, but he is able to manage because of the fact that he jogs every day to keep up his energy levels and to promote metabolism. 

Upon the administration of the MMSE to the patient, the following points had been attained: he received 4 on Orientation to Time, 5 on Orientation to Place, 2 on Registration, 4 on Attention and Calculation, 3 on Recall, 2 on Language, 1 on Repetition, and 4 on Complex Commands. The possible points for each score had been based on the MMSE guidelines by Cockrell and Folstein (2002) as: 5 for Orientation to Time, 5 for Orientation to Place, 3 for Registration, 5 for Attention and Calculation, 3 for Recall, 2 for Language, 1 for Repetition, and 6 for Complex Commands. The total possible score would be 30.

MMSE Interpretation

Based on the results of the patient, he got a score of 25, which is slightly lower than the mean score of 27 as stated in Muir, Gopaul, and Odasso (2012). He manages to score high on specific portions such as Orientation to Place, Recall, Language, and Repetition due to his line of work as a police officer. He scored lowest on Complex Commands due to his degraded level of cognitive motor skills. 

Upon assessment, Orientation to Time had been the element of how a person perceives the arbitrary elements of past, present, and future. Cockrell and Folstein (2002) studied that the correlation effectiveness decreases as a person ages. The patient scored 4, which is only a subtle decrease.

Orientation to Place via deductive testing is presented by data from the broadest perspectives such as nations to the narrowest such as streets (Cockrell & Folstein, 2002). The patient scored a 5, the perfect score. It is very evident that the geographic element of being a police officer has strengthened his resolve to memorize and retain information on locations.

For Registration, the patient scored a 2. Registration is the repetition of prompts (Cockrell, & Folstein, 2002). The patient may have had a subtle decrease of registration due to the abundance of prompts he had to listen to throughout the years as a police officer. 

For Attention and Calculation, he scored a 4. Attention and Calculation would entail the ability to maintain a keen detail on a set of words or prompts (Cockrell & Folstein, 2002). One of the merits of police work is investigative work, so the patient has engraved such experience to memory.

Recall is the repetitive assessment of Registration, which the patient received a score of 3, which is the perfect score for this category. He also received perfect scores of 2 and 1 on Language and Repetition, respectively. The patient’s justification of the result is due to his experience as police officer in procedural analysis, which requires recall.

Lastly, the patient received a 4 out of 6 for Complex Commands. Because of cognitive performance decrease due to old age, the patient was not able to easily comprehend and execute the complex commands presented.

Having that interpretation, the patient receiving a score of 25 is just below the benchmark of 27 as normal cognition. Cockrell and Folstein (2002) stated that anything below 24 is mild cognitive impairment. So, the patient functions at normal cognition levels.

Cognitive Impairment Analysis and Conclusion

If the patient were to have cognitive impairment, the results of the MMSE would be very different. For instance, he would score low on Orientation to Time and Orientation to Place since these require a deep understanding of correlation. Moreover, he would also fail in Registration, Recall, Repetition, and Complex Commands, which require high cognitive abilities as well. According to Muir, Gopaul, and Odasso (2012), the MMSE is a good indicator of the cognitive levels of a patient. Cognitive impairment will produce a very different result because the patient would not be able to manage the tasks as easily as intended. As a result, the patient would have different treatment goals, especially those focused on intervention and cognitive stabilization.

References

Cockrell, J. R., & Folstein, M. F. (2002). Mini-mental state examination. Principles and practice of geriatric psychiatry, 140-141.

Muir, S. W., Gopaul, K., & Odasso, M. M. M. (2012). The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and ageing, 41(3), 299-308.

IMPLEMENTATION OF A HEALTHCARE SYSTEM PRACTICE GUIDELINE

IMPLEMENTATION OF A HEALTHCARE SYSTEM PRACTICE GUIDELINE

by Ricky Ocampo

Introduction

            The healthcare system involves various professions who have the same goal of ensuring a healthy population. They include physicians, nurses, pharmacists, administrators, and many other workers. The professional diversity is brought about by the need for different approaches to treatment and prevention of diseases. It is also necessitated by the wide range of information about human anatomy, which leads to people specializing in a particular field. Healthcare involves much research, which leads to the discovery of different ways that can improve the practice. Implementation of new guidelines found from research can be efficiently through the collaboration of various disciplines (Melnyk&Fineout-Overholt 2011). The guidelines adopted in the hospital affect different professions, and they need thorough research to define them.

Healthcare System Practice Guideline

In my current job at Kaiser Permanente, there are various employees who work together to ensure patients are fully healthy and out of danger. As a critical care nurse, I have to work hand in hand with workers of different disciplines. Patients in need of critical care are delicate, and caution and professionalism need to be exercised at every given moment to avoid fatal mistakes. Various guidelines are used to provide a framework for patient care and intervention. The guidelines have to be adhered to by all workers in the ICU to ensure proper coordination of care and intervention procedures (Reardon et al. 2013).

One such guideline is the management of delirium, agitation, and pain in adult patients in the intensive care unit. It offers practical approaches to handling patients in ICU who is waiting for, or has undergone a surgical procedure, or for any patient with a severe medical condition. The guideline’s target population is adult patients over 18 years old. The instruction was made to propose best practices for preventing, treating, and assessing pain, agitation, and delirium (PAD) to in adult patients (ICU)(Barr et al. 2013).

The guideline recommends strategies for managing delirium, agitation, and pain to improve ICU outcomes. This can be done with an interdisciplinary ICU team approach that includes provider education, preprinted and/or computerized protocols, and order forms. ICU rounds checklists to monitor the use of pain, agitation, and delirium management guidelines or protocols in adult ICUscan also be used.Promoting sleep in adult ICU patients by using strategies to control noise and light, decreasing stimuli at night, clustering patient care activities, and to protect patients' sleep cycles is also recommended by the guideline. A target light level of sedation or daily sedation interruption to be routinely used in mechanically ventilated adult ICU patients is also part of the recommendations. The guideline also mentions that in mechanically ventilated adult ICU patients analgesia-first sedation should be used. Using specific modes of mechanical ventilation to enhance sleep in mechanically ventilated ICU patients is not advised since there is insufficient evidence to prove the efficacy of these interventions (Barr et al. 2013).

How Different Professions in the Healthcare System are Held to the Guideline

            The various jobs in the system that have to follow the guideline are nurses, pharmacists, physicians, and respiratory care practitioners. The nurses in the ICU handle care of the critical patients, which include administering fluids, and drugs that are prescribed by the physician. They are also in responsible for cleaning the patient, conducting, and recording various tests on the patient such as blood test and blood pressure and temperature (Shorter &Stayt 2010). The guideline offers recommendations on patient care in the ICU therefore binding the critical care nurses. The directive mentions various ways of ensuring patient avoids pain such as by ensuring there is mobility, which falls directly on the work of the nurses. There are also recommendations on drug administration of drugs, monitoring, and recording the patient’s delirium, agitation, and pain levels to ensure that appropriate intervention strategies are utilized which are also roles of the critical care nurse (Warlan & Howland, 2015).There is also a framework for the education of the recommendations and monitoring progress among other staff, which also falls the duty of the nurse. The guideline also provides a way of cooperation between workers of different disciplines in the ICU including nurses (Hsiang-Ling & Yun-Fang 2010).

            The physicians in the ICU are also impacted by the guideline since they assess the patients and prescribe treatment methods. A framework on measuring, treating, and preventing the pain, agitation and delirium is provided which affects the work of the physician.  There also recommendations on the monitoring of the status of the patient in the ICU, which can also be done by the doctors. The doctors can also participate in education and decision making on various recommended issues (Luetz et al. 2014). The guideline also affects the respiratory care practitioners since they are in charge of establishing and maintaining airway during intensive care (Norman, 2010). They also work with life support and mechanical ventilation machines where there are various recommendations on the use of this equipment on the guideline (Luetz et al. 2014). 

            The pharmacists handle medicine in the hospital, which includes processing medication orders, expediting the arrival of medication, and monitoring the drug administration and effects. The guideline mentions drugs that should be offered to patients experiencing delirium, agitation, and pain in the ICU, which falls in the line of work of the pharmacists. There are also recommendations on the titration of some medication, which is part of the work of the pharmacist. The pharmacists are also represented in the multidisciplinary team that is also responsible for education and deliberating on crucial decisions on the implementation of the recommendations (Hsiang-Ling & Yun-Fang 2010). The professions in the system ensure that they follow the guideline clearly. An interdisciplinary team is charged with educating and monitoring the implementation of the directive.

Evidence used to define the Guideline

      Research was done to support the implementation of the directive was done using various online libraries, which included CINAHL, PubMed, and EBSCOhost. The primary evidence utilized in the directive is the 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.This guideline is contained in the National Guideline Clearinghouse (NGC). These guidelines were put to replace “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult” published in Critical Care Medicine in 2002(Barr et al. 2013).

These guidelines were formed by the American College of Critical Care Medicine where a multi-institutional and multidisciplinary task force of 20 people divided into four subcommittees with expertise in guideline development, delirium, agitation and sedation, and pain management and associated outcomes in adult critically ill patients. The task force collaborated over six years in person via electronic communication and teleconferences. The subcommittees developed relevant clinical questions, reviewed, evaluated, and summarized the literature to develop clinical recommendations and statements (Barr et al. 2013).

The methods used to collect evidence for the guideline is by a search through electronic databases which include the International Pharmaceutical Abstracts, PubMed, ISI Web of Science, Scopus, CINAHL, Cochrane Database of Systematic Reviews and MEDLINE. The researchers developed an extensive list of related keywords and a professional librarian organized and expanded this key word list. The librarian also created a corresponding medical subject heading (MeSH) terms, searched relevant databases, and with RefWorks software he created a Web-based database. The search parameters included published English-only manuscripts on adult humans from December 1999 to December 2010. Letters to the editor, case reports, editorials, studies with less than 30 patients as well as narrative reviews were excluded (Barr et al. 2013).

The references of the 2002 guideline were also included in the database. Ultimately, over 19,000 references were listed in the RefWorks database. The methods used to assess the quality of evidence for the study include weighting according to a rating scheme and expert consensus method. The evidence was analyzed through systematic review with evidence table; review of published meta-analysis and by meta-analysis. The methods used to formulate recommendations were expert consensus (Delphi) and expert consensus (nominal group technique) (Barr et al. 2013).

The guideline was validated by internal and external peer review. The guideline was also reviewed and endorsed by the New Zealand Intensive Care Society, American Association for Respiratory Care and the American College of Chest Physicians. The benefits of implementing the guideline are that it provides suitable methods of management of critically ill adults in the ICU with delirium, agitation, and pain. The potential harms of the implementation are the side effects from the medication used to manage delirium, agitation, and pain (Barr et al. 2013).

The assessment methods that were reviewed by the guideline are detecting and monitoring delirium, assessment of delirium risk factors, assessment of quality and depth of sedation, and pain assessment. The treatment and management methods that were examined were treatment of pain with Thoracic epidural anesthesia/analgesia, Enterally administered gabapentin, Intravenous (IV) opioids, Nonopioid analgesics to decrease opioid use and side effects and Preemptive analgesia and/or non-pharmacologic interventions (e.g., relaxation).The treatment of agitation and sedation include sedation strategies using nonbenzodiazepine sedatives, Electroencephalogram monitoring (EEG), Objective measures of brain function, Monitoring depth of sedation and brain function (Barr et al. 2013).

The treatment of delirium studied in the guidelines is through IV dexmedetomidine, if sedation is required, routine monitoring of delirium, consideration of delirium risk factors and early mobilization of adult intensive care unit (ICU) patients. The strategies for managing delirium, agitation and pain that were examined include interdisciplinary ICU team approach where they provide education, preprinted computerized and/or preprinted protocols and order forms, and quality ICU rounds checklists. Another management method studied is promoting sleep in ICU patients by controlling noise and light and by decreasing stimuli at night (Barr et al. 2013).

Pain management methods reviewed by the guideline include analgesia-first sedation and a target light level of sedation in mechanically ventilated adult ICU patients or a routine daily sedation interruption or the prevention methods examined include prevention of delirium that includes restart baseline psychiatric medications, if needed, sleep promotion and by identifying delirium risk factors.Prevention of agitation was also studied. Methods reviewed include EEG monitoring for patients at risk for seizures, early mobility, and exercise when at goal sedation level and daily spontaneous breathing trials (SBT). Pain prevention methods studied include treatment of pain before sedation and non-pharmacologic interventions and or pre-procedure analgesia (Barr et al. 2013).

The second evidence document that was used to support the implementation of the guideline is Pain, Agitation, and Delirium Guidelines: Nurses' Involvement in Development and Implementation. Which was authored by Judy Davidson, Chris Winkelman, Celine Gélinas, and Anna Dermenchyan. The article includes the experiences of nurses that served in the guideline-making panel for the 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.This study explores the main responsibilities that nurses have during generation and execution of new practice guidelines (Davidson et al. 2015).

The study also describes the influence of the guidelines to the nursing profession. The nurses in the guideline-writing panel were given equal treatment with other professions represented. According to this article, there are various roles that nurses can have in the implementation of guidelines such as the nurse leader. These are the people charged with the responsibility of translating the recommendation of the new guidelines into practice. The nurse leaders may be staff nurses serving as project leaders, educators, nurse practitioners, clinical nurse specialists, directors, managers, supervisors, and charge nurses. The nurse leader should be involved in an inter-professional committee where various decisions are made on areas where the guidelines recommended two or more methods such as the selection of assessment tools of delirium, agitation,and pain(Davidson et al. 2015).

The nurse leaders are also instrumental in implementing mobility in the ICU since immobility has been noted as one of the chief causes of complication during critical illness. Complications caused include skeletal muscle weakness and wasting, contractures, thrombotic events and pressure ulcer formation. The nurse leader should also measure the impact of change on implementing the guidelines using selected quality metrics. The nurse leader can ensure that change is achieved by making frequent rounds and by educating, coaching, and communicating with the nursing staff ( Davidson et al. 2015).

Nurse informaticist is also a role that the nurses can have in the implementation of guidelines. Nurses in this role use their clinical knowledge to create the documentation in the electronic medical record (EMR) for use by clinicians. Nurse informaticists ensure that professional and regulatory standards are registered in the EMR. They are a critical part of the implementation of guidelines since the hospital might need to change the contents of the EMR to meet the new recommendations. Another role that nurses can play is a staff nurse as a change leader and personnel nurse as change recipient (Davidson et al. 2015).

Conclusion

            The healthcare system consists of a collaboration of various people of different disciplines. In my career as a critical care nurse at the Kaiser Permanente,  I have to work hand in hand with various people. A guideline that affects different workers at my employment place is the management of delirium, agitation, and pain in adult patients in the intensive care unit. The guidance offers practical approaches to handling patients in ICU, who is waiting for, or has undergone a surgical procedure, or for any patient with a severe medical condition. The different medical care disciplines that have to follow the guideline are nurses, physicians, pharmacists, and respiratory care practitioners. The evidence used in the research and implementation of the guideline includes is the 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Pain, Agitation, and Delirium Guidelines: Nurses' Involvement in Development and Implementation was also examined for the implementation of the guideline.

References

Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., & ... Skrobik, Y.   (2013). Clinical practice guidelines for the management of pain, agitation, and           delirium in adult patients in the intensive care unit: Executive summary. American           Journal of Health-System Pharmacy, 70(1), 53-58.

Davidson, J. E., Winkelman, C., Gélinas, C., &Dermenchyan, A. (2015).Pain, Agitation,   and      Delirium Guidelines: Nurses' Involvement in Development and          Implementation. Critical Care Nurse, 35(3), 17-32. doi:10.4037/ccn2015824

Hsiang-Ling, W., & Yun-Fang, T. (2010).Nurses' knowledge and barriers regarding pain   management in intensive care units.Journal Of Clinical Nursing, 19(21/22), 3188-       3196. doi:10.1111/j.1365-2702.2010.03226.x

Luetz, A., Balzer, F., Radtke, F. M., Jones, C., Citerio, G., Walder, B., & ... Spies, C. (2014).       Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-     Part Survey among Intensivists. Plos ONE, 9(11), 1-6.         doi:10.1371/journal.pone.0110935

Melnyk, B., &Fineout-Overholt, E. (2011).Evidence-Based Practice in Nursing and           Healthcare (2nd ed.). Philadelphia, Pennsylvania: Wolters Kluwer Health/Lippincott        Williams & Wilkins.

Norman, M. A. (2010). Ventilator Management in the Surgical Intensive Care Unit. Texas            Heart Institute Journal, 37(6), 681-682.

Reardon, D. P., Anger, K. E., Adams, C. D., & Szumita, P. M. (2013). Role of      dexmedetomidine in adults in the intensive care unit: An update. American Journal of Health-System Pharmacy, 70(9), 767-777. doi:10.2146/ajhp120211

THE SCREENING OF PROSTATE CANCER

THE SCREENING OF PROSTATE CANCER

by Ricky Ocampo RN

            Many people across the globe or the world die to various diseases. In many cases, the conditions that they suffer from can be contained or treated with proper and early diagnosis (Amin, Lin, Gore, Srigley, Samaratunga, Egevad, & Berney, 2014). One of the diseases that can be controlled if detected early is cancer. Cancer is a disease involving abnormal cell growth that can spread to other body parts. In 2012, this ailment led to 14.6% of total world deaths, which translated to about 8.2 million people (Amin et Al. 2014). Various treatment methods can be used to control the disease. However, their effectiveness is determined by the stage of advancement that the illness has reached (Amin et Al. 2014). Consequently, an early diagnosis of the disease is crucial or necessary. In this case, I will identify and evaluate a screening methodology for prostate cancer, which is relevant to the National Clearinghouse Guidelines. I will proceed to apply the technique to a specific population.

            Prostate cancer is a type of cancer that affects the man’s prostate gland. This particular type of cancer may spread to other parts of the body such as lymph nodes and bones. This disease may not have any symptoms at the initial phase but in later stages, it may cause pain in the back and the pelvis while urinating, and traces of blood in the urine. The disease is most common in elderly people since many of the people suffering from it are above 45yrs old. A person who has a first-degree relative with the disease is also 2 to 3 times more likely to catch the ailment. In America, the disease is more prevalent in African Americans than persons from the other racial groups (Amin et Al. 2014).

My chosen methodology for screening a patient is the Prostate-Specific Antigen (PSA) method. This screening technique measures the level of PSA in a man’s blood.  The prostate glands produce PSA, which is protein in nature. The persons suffering from prostate cancer have a higher level of PSA than ordinary people do. The Food and Drug Agency (FDA) approved the use of the PSA test in 1986 to monitor the progress of prostate cancer in individuals who had already been diagnosed with it (Hayes & Barry, 2014). I have chosen the method of PSA screening since it helps detect prostate cancer in its embryonic stages.  

            PSA, levels of over 4.0 mg/ml are considered high and doctors recommend a prostate biopsy for patients with those levels to check the presence of prostate cancer (Hayes & Barry, 2014). There are other complications that may cause high PSA levels and they include urinary tract infection or prostatitis (Ubel, 2015). PSA screening also has limitations such as cases where early detection of prostate cancer may not reduce the chances of a patient dying of prostate cancer in a process called overdiagnosis. This happens since tumors found through the test may be harmless or may grow at a very slow rate, which cannot affect the man.  Treatment of these tumors is called overtreatment since the patient may be exposed to side effects associated with the remedy such as erectile dysfunction, urinary incontinence while being exposed to numerous infections (Hayes & Barry, 2014).

            Another limitation of the test is that it may give false-negative or false-positive results. False-positive results occur when the person has high levels of PSA yet he does not have prostate cancer while false-negative results occur when a man has low PSA levels yet he has prostate cancer. The use of the PSA method is also helpful while monitoring a treated patient. This is done where tests will confirm rising PSA levels in those patients that will mean the prostate cancer is recurring (Amin et Al. 2014). The population that this screening method can be applied to is those that are at a higher risk of prostate cancer, which are older men above 50 years. This is because the test may be harmful and administering it to people at low risks of cancer may expose them to various undesirable effects.

Various studies have been advanced to find out and to dismiss the PSA test for screening prostate cancer in men. The National Clearing House guidelines contain various directives that have an in-depth analysis of the method where they evaluate if the benefits outweigh the harm. A guideline that offers an insight into the cancer screening method is titled; The Early Detection of Prostate Cancer: AUA Guideline. The objective of the guideline is to offer recommendations for the detection of prostate cancer that are analysis-based (Hayes & Barry, 2014).

            Another objective is to provide a principle to help address prostate cancer’s early detection, which will reduce the mortality rates resulting from the ailment. The guideline recommends shared decision-making in PSA screening of men in the ages between 55 and 69. For this age group, it also recommends that screening intervals should be in two years or more against annual screening.  The guideline does not recommend PSA tests to men under the age of 40 or routine screening of men in the ages between 40 to 54 years. The guideline also does not recommend the PSA screening of men above 70 years old or the ones who have between 5 to 10years to live (Hayes & Barry, 2014).

            In conclusion, early detection of disease is essential for ensuring that the treatment is effective. Cancer is a disease where early detection can reduce the number of deaths reported. Prostate cancer is a type of cancer that affects the prostate area in a man. Screening of this type of cancer can be done by PSA tests. This is a test that is conducted to check the levels of PSA in the blood. Other diseases such as urinary tract infection or prostatitis may cause high PSA levels. There are various limitations to the PSA screening method that include overdiagnosis whereby it may give a false-negative or false-positive result. The target population for this screening strategy is men above 50 years of age.

References

Amin, M. B., Lin, D. W., Gore, J. L., Srigley, J. R., Samaratunga, H., Egevad, L., & Berney, D.                  (2014). The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as        a Management Option in Patients with Prostate Cancer. Archives of Pathology & Laboratory              Medicine, 138(10), 1387-1405. doi:10.5858/arpa.2014-0219-SA

Edelman, C., Kudzma, E., & Mandle, C. (2013). Health Promotion Throughout the Lifespan                       (8th edition ed.). Philadelphia, Pennsylvania: Elsevier.

Hayes, J. H., & Barry, M. J. (2014). Screening for Prostate Cancer with the Prostate-Specific                      Antigen Test. JAMA: Journal of the American Medical Association, 311(11), 1143-  1149.                  doi:10.1001/jama.2014.2085

Ubel, P. A. (2015). Medical Facts versus Value Judgments -- Toward Preference-Sensitive                          Guidelines. New England Journal of Medicine, 372(26), 2475-2477.                                                      doi:10.1056/NEJMp1504245