Nursing-Geriatric/Adult Nurse Practitioner, Essay Example

Ethical issues in healthcare for elderly patients affect practitioners and the way in which healthcare delivery is handled. The morals and ethics used in geriatric care regarding end-of-life and the patient’s wishes and instructions are very important. A current moral and ethical issue concerning society today is the principal of justice which is the notion of an allocation system of healthcare resources and a patient’s autonomy. Ethical issues in healthcare particularly affect the elderly; older people are sick more often than younger people and suffer more in the end stages of various chronic progressive diseases (Knowlton, 2002). Additionally, there is the dilemma of elderly patients not being able to make critical decisions in most cases. If the patient has not signed over a power of attorney to a family member, any decision making can become a legal and family member struggle.

The principle of justice and allocation of healthcare resources deals with the cost-benefit ratio and determining when healthcare should be given or withheld. The utilitarian ethical viewpoint dictates healthcare should be allocated to do the most good for the largest number of people (Knowlton, 2002). While this concept on the surface appears to be positive, the components associated with this create ethical and moral issues. It will impact negatively the elderly as well as women over men. Successful intervention in healthcare for the elderly is less than for younger individuals. Statistically above the age of 65 there are 68 men and 100 women and over the age of 85, there are 48 males for every 100 females (Kowlton, 2002).

The idealistic approach to the concept of healthcare rationing states that resources should be allocated purely determined on where it is needed the most.  This means that help should be given to the individuals who are the sickest and need it more than someone not as sick; regardless of age. This also means the geriatric population is going to benefit from this concept since the elderly generally need more healthcare delivery. So the healthcare dollars would be spent on the elderly.

These two differing approaches to the same concept create problems for practitioners and society in general. The problem of limited healthcare creates a debate over how to handle the situation. If a patient over the age of 80 needs surgery with an unfavorable prognosis, it is still up to the patient and family whether to proceed with the needed intervention. If healthcare rationing were legalized the decision would be taken out of the patient’s hands and the physician and most certainly committee approval for his/her recommendation would be the deciding factors.  The physician would be placed in an ethical and moral dilemma with state and government interference.

Professional Career Goals

I am applying to the field of geriatric medicine due to the experiences I have had in my work with the elderly. I have worked for approximately two years in a critical care unit in a hospital setting prior to my decision to return to graduate school. As I work on my Master’s degree I am currently working as a personal nurse aid inside a hospital. The type of care is multifold but most of the patients are elderly. After working with the geriatric population I began to see that my career path should focus on furthering my education to better serve this age group.

The dynamics of nursing care regarding the geriatric population is diverse and specific in the needs for care. As individuals get older, not only does the body change but there are psychological changes also. It requires specific skills with knowledge that cannot be learned in the classroom but rather by working hands on with patients. I began to realize this as I have worked with this age population. The treatments and response to treatments are different in the geriatric population. Many of the past approaches to care used in gerontology are no longer appropriate and research has shown that evidence-based practices should be routinely employed to provide the safest and highest quality care possible (Kany, 2009).

The healthcare status is often a product of the patient’s income level. This determines the living arrangements. For the most part the elderly have a specific need for physical support; but the need for psycho/social support is also an important component (Williams & Mezey, 2000). The geriatric nursing population is relatively small as this specialty is often not attractive to the majority of nurses. The reason for this is multifold and includes the complexity of the problems, the high maintenance requirements of the needs of this group and for the most part the patients die and this creates a loss for the nurses. Also nurses tend to cluster in urban areas and few advanced practice geriatric nurses are available to care for older persons living in rural areas (Williams & Mezey, 2000).

I am pursing my graduate degree at this time in order to further my current knowledge and abilities to be able to care for the geriatric population in a proficient and efficient manner.  Furthering my education will help me grow in knowledge, skills and understanding of the dynamics of caring for the elderly. It will help me in analyzing the effectiveness of community resources. I hope to grow in communication effectiveness with older adults and families and learn how to be more sensitive in my perception of this population and the physical, cognitive and psychological challenges they face in dealing with health issues.

Another incentive for pursuing my degree at this level is to further my skills and ability to apply evidence-based standards to how patients are treated, screened and immunized against illnesses. The complexity of acute and chronic co-morbid conditions in the elderly takes more than just theory and I feel my current work environment with this degree will able me the abilities to recognize the needs of geriatric patients. Complementary health care practices and management of symptoms for the elderly requires high quality of care. I feel this is the perfect time for my endeavors in working on a high level of degree to promote and involve myself in becoming a high performing and care-giving geriatric nurse.

Motivation

Motivation is goal-oriented behavior undertaken to achieve a goal or mission. Pursing a university graduate degree requires motivation, dedication and perseverance. Having a desire is not enough to create the motivation needed to undertake the pursuit of a higher educational degree.  Personal causation is comprised of cognition, skills, and motivations or intents (McClellend, 1987). Each person has within him or herself certain desires and aspirations. Motivation can be formed by materialistic endeavors or status acquisition. However, to me true motivation comes from the heart.

Sigmund Freud said “I had become a physician quite reluctantly, but was at that time impelled by a strong motive to help nervous patients, or at least to learn to understand something of their conditions” (McClelland, 1987, quoted p. 5). Often our motivation comes from so deep within ourselves that we may not recognize the reasons or causes.  This to me summarizes how I feel about obtaining my degree; there is always financial and time commitment risks involved but the rewards are numerous.

Another motivational factor in attending a university graduate program is the increase in knowledge which can be obtained in my field of interest. Although money should not be a motivating factor, it nevertheless plays a small role in the possibility of greater financial earning opportunities. Overall, attending university graduate programs will foster creativity and tangible thinking processes to better define avenues for quality patient care and the specific needs of a geriatric population.

With the ever changing and undetermined health care reimbursement processes of today, most may not be motivated to enter this field. However, I believe motivation itself is the key to changing how health care reimbursement is handled. The bottom line is always the care of the patient and reimbursement often takes away from the quality of care. Attending a program to learn the skills and techniques needed for an effective nurse practitioner role allows me the opportunity to be involved in how health care delivery is conducted in my area. This is a motivating factor for my career goals.

Working with physicians have also motivated me as I have watched and learned how to order, perform and interpret diagnostic tests to include lab work and x-rays. To be able to work along-side physicians in more independent role with diagnosing, prescribing medication and managing overall care allows me to help patients learn how their lifestyle behavior affects their health and well-being. This is also a high motivation factor. Although I am pursing geriatric nursing, the elderly also need to understand how past actions and further actions affect their health.

More patients are choosing Nurse Practitioners since they have a reputation for taking more time with patients and provide personalized health education and counseling. My desire is to be able to help patients accurately and dependably. It is motivating to me to be able to accurately and dependably provide this service through the practical working knowledge I have coupled with a formal education through attending a university program.

Career Progress

My career progress and goals to date have been consistent with my motivation and desires for the end result.  I have been working as a Registered Nurse and have been productive and steady in my contribution to health care delivery. My early career in the hospital began my foundation for working with all ages and types of individuals. I learned a tremendous amount through these formative years.

My current work in affords me the opportunity to work directly with elderly patients as this is the highest portion of my patient population. While my work is rewarding and I feel my contributions are helpful and meaningful to my patients, further progression through my education will allow me to continue to grow in my knowledge and career goals. Entering this university program will allow me to enhance my talents and skills to better serve my patient population. Once I have completed my studies my desire is to focus on the geriatric population and work to help these individuals with their complex and threatening ailments.

Although work experience through the years would allow me to learn hands-on, attending a formalized program will better equipment me to better deal with the nature of geriatric care. A well rounded program which encompasses all the dynamics of learning to include classroom, textbook and practical experience will develop what I have learned to date in my undergraduate program and working experience.

Nurse practitioners have a reputation for distinguishing their profession from the various other health care professions by attention to the patient as a whole person and understanding how the systems of the human body affect each other. I believe by providing this type of care to patients it helps in the overall health care cost, reducing physician charges and fewer emergency room visits. As nurse practitioners have become more commonplace in the health care industry, they are learning to lower these costs, resulting in lower prescription and medicine costs along with shortening hospital stays.

Summary

Moral and ethical health care is vital to the community and to health care delivery. Understanding the dynamics of how health care is delivered to maintain high morals and ethics is a goal and desire I feel strongly is needed by all health care personnel. Attending a university program to become a nurse practitioner will be a rewarding and challenging endeavor for which my motivation remains at high levels. I believe my work experience and current career progression supports my aspiration to attend and graduate from a program; earning my graduate degree as a nurse practitioner in the field of geriatric nursing.

References

Karyn, Katherine. “Nursing Care of Older Adults.” Lippincott’s Nursing Center.com. 2009. Retrieved March 8, 2010 from http://www.nursingcenter.com/library/static.asp?pageid=730388

Knowlton, Leslie. “Ethical Issues in the Care of the Elderly.” Geriatric Times.  March/April, 2002, 111(2). Retrieved March 9, 2010 from http://www.cmellc.com/geriatrictimes/g020301.html

McClelland, David C.  Human Emotion. Press Syndicate of the University of Cambridge: New York, 1987.  Retrieved March 12, 2010 from http://books.google.com/books?id=vic4AAAAIAAJ&printsec=frontcover&dq=motivation&source=bll&ots=Ap0Y4JZ-e2&sig=I8ebXlTyY4beW_zdMkIWs8qEGEE&hl=en&ei=4KeaS9z6IcKB8gac54WNDg&sa=X&oi=book_result&ct=result&resnum=11&ved=0CDcQ6AEwCg#v=onepage&q=&f=false

Williams, Carolyn, and Mezey, Mathy. “Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care.”  2000. Retrieved March 12, 2010 from http://www.aacn.nche.edu/Education/pdf/Gercomp.pdf