Purchasing Abroad

Organ donation can replaced a failing organ such as a kidney, lung, or heart.  Waiting for a compatible organ can take a lot of time, time which some people may not have.  If the option was available would you decide to purchase an organ if that mean't not having to wait?  In Canada the buying and selling of organs is illegal.  This law however doesn't stop people from purchasing body parts abroad.  If you were put in the position to purchase an organ outside of Canada to save a loved one or even yourself would you do it?

The world health organization stated "Payment for... organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and human trafficking.  Another consideration is that those living in poverty may decide to sell organs in order to support themselves and their families.

According to ER knowledge 93% of exploited commercial living donors sold a kidney to repay a debt and 85% reported no economic improvement in their lives as they were either still in debt or unable to achieve their objective in selling their kidney.

There is considerations that organs coming abroad may be through illegal organ trade by criminals who trick or kill people in order to profit.  There is however medical tourist companies who harvest and sell organs humanely.

For many people who answered this question their decision was based on the circumstances.  People who believed they would be supporting a poor family in need though it would be right.  Others without considering if it was right or wrong said they would if it was for their child or themselves.
Would you be willing to purchase an organ from another country even if you didn't know the history and reason for the donation?

http://er.knowledge.ca/
http://www.who.int/en/

Health Care Coverage

A lot of times when people think about health care coverage they compare Canada against the US.  They consider medications and free health care.  However health care coverage doesn't just address these areas.  It can cover medical devices, treatment therapies, and other home care health services.  The question is who decides what health care is covered and what isn't and why are treatment measures covered but preventative measures aren't?

An example of this shoes for diabetic clients, who are at risk of pressure ulcers and amputations.  A pair of good shoes for a diabetic client can cost between 300-500 hundred dollars, which isn't covered by medical coverage.  This client can't afford to pay for this product themselves and in the future require amputation of the foot since they had improper footwear.  This client receives the operation which health care coverage will cover from 7,000-10,000 dollars.  However this amputation could have been prevented by purchasing good quality diabetic shoes.

In regards to medications the majority of prescription drugs are covered depending on the health care and benefits you receive.  Coverage can depend on what profession you have and the company that you are employeed with.  A lot of people in Canada find it hard to access medications outside of the hospital due to the inflation of prices and little coverage.  The majority of prescription medications are consumed by the geriatric population.  Many must afford their medications through pension and retirement funds.  There is a need for system sustainability in regards to medications, meaning to support continuing research and clinical trials many must pay the high prices on over the counter and prescription medications.  Rare diseases have some of the highest costing treatments due to little consumption and use.  In regards to common medications such as tylenol and gravol they are less expensive since they are more widely purchased.

Another issue is birth control.  Most coverage regarding contraceptives involve the pill depending on the cover you have.  Other forms of birth control including the nuvaring, condoms, and IUD's aren't affordable to teens.  If a woman does get pregnant however, an abortion, which can cause between 400-600 dollars in the United States, is completely covered in Canada.

How come there is more coverage for treatment options, than preventive interventions, which in turn would cost less money in the long run?  Wouldn't spending less money on treatments allow more money in other aspects of health care, such as being able to increase staff in hospitals and invest in new equipment and research.

Pharmaceutical Companies

As nurses we are going to experience a vast variety of medications which will appear on the market due to advancements in technology and developments in research.  Some of these medications may claim to be the “next big thing” or the “miracle cure” however, this may not be so.  Despite media advertisements promoting a new product, the realization is that some drugs are almost identical in composition but have been labeled under a different name.  Due to the advancement in technology, information regarding health care is more readily available to the public.  At times information may be falsified or not completely factual, such as some of the advertisements which Big Pharma used as examples.  With knowledge about diseases and health care treatments at the access of one’s fingertips there may be an increase in individuals that self- diagnosis themselves without thorough understanding and investigation.  In a variety of care settings nurses may be challenged by patients regarding their own health care due to the impact of such media. 

We may experience patients who self-diagnosis themselves by using a search engine such as google, see advertisements on TV or through reading information in magazines, as well as shows such as Dr.Oz.  In Kohli and Buller’s (2013) survey they found the most influential components to “brand name OTCs... were advertisements, duration of the effectiveness, degrees of sickness, preferable form of medication, safety of the OTC, relief of multiple symptoms, and preferred manufacturer.” (158)  As the video mentioned, once consumers watched advertisements on TV they sometimes consulted with their physician wanting to obtain such “miracle” medications.  One physician stated that he struggled to convince his patients that despite the advertisements they had seen there was a drug less expensive but more beneficial that was available to them.  “Although generic and brand name OTC drugs contain the same active ingredients and undergo a rigorous Food and Drug Administration (FDA) approval process, brand name formulations continue to lead the OTC drug market.”  (Kohli & Buller, 155)  I find it hard to believe that media has such a huge influence on the public that they would choose an advertisements word against a studying Doctor with a degree.  

The question is how do nurses prepare to interact with those individuals while preserving dignity and providing holistic care, especially when research and critical information is being withheld from the health profession?  Not only should nurses consult with one another but with other professionals, such as pharmacists, physicians, and other specialized health care workers.  This level of diversity should allow one to determine what medications have the most therapeutic affect regarding a certain health condition or disease.  Nurses should continually research and maintain the most current and up to date information available. When new medications come on the market it is ones responsibility to learn and rationally analyze the drug.  When interacting with the patients, information should be concise and straight forward.  It is important to provide factual information such as statistics and reasoning, along with benefits and risk factors.  Nurses should provide all of the information they possibly can so that the patient can weigh both the pros and cons of the medication.  Despite all reasoning and information some clients may still choose medications which they believe beneficial due to media and public influence.  We must respect the decisions of these individuals while knowing that we have provided all the information that we are capable of.  

Despite the fact as nurses we would be prescribing medications we still have the responsibility to understand and feel comfortable administering such medications to patients.  If we don't feel comfortable with a medication or its affects that it can have on a client, we have the right to refuse under sustainable grounds.   In the Registered Nurses Code of Ethics by CNA “Nurses question and intervene to address unsafe, non-compassionate, unethical or incompetent practice or conditions that interfere with their ability to provide safe, compassionate, competent and ethical care to those to whom they are providing care, and they support those who do the same.”(p.9)  Under the CRNBC Standards of Practice (2012), “nurses may withdraw from care provision or refuse to provide care if they believe that providing care would place them or their clients at an unacceptable level of risk.”  Refusal to administer or suggest medications due to a lack of information by physicians and nurses might encourage pharmaceutical companies to provide all research and data.   

This suggestion might not be the most ideal since some physicians and health care providers are working in coordination with big pharmaceutical companies in order to get a bigger pay cut.  However, I don’t believe large industrial companies will be affected by a small decrease in profit by only a select few health care professionals refusing to promote or administer medications to their patients.  With knowledge and more information, such as videos like Big Pharma hopefully there will be more awareness which can help set forth regulations, which can further protect the public.  

References

Code of ethics for registered nurses. (2008).  Canadian nurses association.  http://www.cna-aiic.ca/~/media/cna/files/en/codeofethics.pdf

 Practice standards for registered nurses and nurse practitioners.  (2012). College of registered nurses. https://www.crnbc.ca/Standards/Lists/StandardResources/398DutytoProvideCarePracStd.pdf References

Kohli, E., & Buller, A.  (2013).  Factors influencing consumer purchasing patterns generic versus brand name over-the-counter drugs.  Southern medical journal,  106(2), 155-160.  

Addictions

Nature and nurture.  In combination they determine an individual.  So when the question is asked is an addiction a choice or disease I believe the answer is both.

Addictions are defined as a chronic diseases affecting brain function.  It is characterized by compulsion, loss of control, negative consequences, denial, and relapse.  It is believed that 33,000 people are addicted to illicit drugs, 120,000 may be alcohol dependent, and 224,000 have indications of alcohol dependence (BCMA 2009)  There is a variety of different factors, which can contribute to addictions whether it be drugs, alcohol, and gambling.

It is show that addictions can be predisposition, meaning that they are passed down through genetics.  Biology and genetic endowment are in a combination with external factors.  These external factors include stress from personal life and work, pleasure seeking, and dysfunction in life.  Social determinants of health factor into additions, such as income and social status, healthy child development, culture, physical environments, and employment and working conditions.

Addictions don't just affect those who have low economic and educational levels, despite this being the perceived stigma.  Those who are influential and successful can have addictions as well.

Reference: Stepping forwards: Improving addiction care in British Columbia.

Feeding Tubes

A feeding tube is used when individuals can no longer swallow safely, are lacking essential nutrients, or needs supplements to maintain a completely balanced diet.  However, there has been much controversial discussion about whether this is just prolonging the natural course of ones life, if it is a humane way of keeping one alive, and if it is invasive towards an individual.

For those who have the ability to give consent they can choose whether they want to be on a feeding tube or not.  But is it appropriate for those who aren’t able to voice their own decision.  Usually a next of kin or advance directive is written in order to accommodate wishes an individual has in the future, however how does one decide what is right when there isn’t those orders.  

Before making this decision one must consider the benefits and burdens of a feeding device.  Tubes can prolong death in otherwise healthy individuals.  Many consider it satisyfing knowing that they are providing their loved one with all possible essentials to maintain life with the advancements of technology.  Tubing feeding can be safer for someone who has increasing difficulties with dysphasia

Being feed through a tube can be uncomfortable when insertion is performed and diarrhea often occurs.  This can increase skin break down and infections.  Those individuals who are no longer able to eat anymore pass usually very quickly and painlessly.  If there is an underlying disease tubing feeding can prolong the dying process and cause the patient to feel more discomfort and pain.  It can also quicken heart failure due to an increase in fluid around the heart.

Ultimately I believe it depends on the individual, the circumstances such as the health of the individual, age, and the family members wishes.  An advanced directive and next of kin can ease the decision and allow one to feel at peace that their loved one's preferences are being followed.

  http://cbhd.org/content/feeding-tube-dilemma-key-questions

Perspective of Death in the Elderly and Youth

Death is a part of working in the medical field.  One can feel a variety of emotions, such as guilt, frustration, and mourning.  One question that I have been asked as a student is how you deal with it and how does it get easier?  The answer however depends on the situation, the health care professional, and the connection that the individual had.

An example is having a 20 year old female who has flat lined due to hemorrhaging from a gun wound and a 92 year old man who passes due to organ failure.  People may find it to be a harder experience having the female pass rather than the elderly man for a variety of reasons.  Many nurses find age to be a major factor in how death affects them.  They feel an older patient passing way is easier than someone young since it is nature taking its course and they have gotten to experience a lot of life.  However, someone younger may be missing out on many opportunities such as getting married, buying their first house, and having a family.

Depending on the relationship having someone pass may be extremely difficult.  An example of such is having a resident at a care home which you have cared for for seven years compared to someone who you had meet only moments ago.

Guilt can come into play when a professional is required to perform CPR or needs to take other life saving measures.  For instance a victim that has drown and passed from unsuccessful resuscitation may be more harder to accept than letting someone pass on their own from natural causes.  One may feel that they could have done something different or if only they had tried another technique could they have changed the outcome.

Mixed feelings of emotions are normal but one must be able to move on and work through them.  Talking with other nurses might help or writing a journal in order to relieve feelings can make it easier to put ones mind at ease.  Depending on the facility their may be support groups or social workers who will come around and talking with staff after a devastating loss.  It is important that one can express their feelings and emotions in a healthy and beneficial way.

http://news.nurse.com/article/20110221/NATIONAL01/102210041/-1/frontpage#.UuCbBCittok

Humor in the Workplace

In all fairness you must have a sense of humor in all aspects of life, however you must consider how your humor may come across to others and if it is appropriate for the situation.  Working in the health care profession there may be a great deal of stress and pressure at times whether this be working in the emergency room or palliative care.  There is a great deal of responsibility that a nurse has when caring for a client and at times this can feel like a burden which weighs one down.

Laughter and smiling have all been considered therapeutic ways to keep one both happy and healthy.  However, some individuals may laugh when they feel uncomfortable or are in a situation that is unfamiliar to them.  As professionals one must be conscious of their mannerisms and how they present themselves.

I have experienced some inappropriate senses of humor as well as humor which has been used to heal and enlighten.  For instance I overheard a staff member asking a resident who was a tube feed whether they would like a snack than proceeded to laugh as the individual walked by.  At times before one speaks I think it is essential that they put themselves in that persons shoes to consider how hurtful and demeaning such statements can be.

At times of grief or despair laughter can be the best medicine.  It can keep one sane and prevent them from feeling as if they are stepping over the edge.  During the passing of a resident I got the privilege of sitting down with the family and conversing about their loved one.  We brought up memories about times when the resident could be mischievous and caused mischief.  The family joked and laughed about happy memories of their passing family member, which I believe helped them through the grieving process.  I also believe this helped the resident to pass more peacefully since they heard their family members rejoicing over her life rather than grieving over her death.

I think that it is essential to take everything with a grain of salt in such a stressful environment but there however it a time and place to do so.  Depending on the situation and the person they may appreciate humor well as others may not.  As a nurse one must consider and critically think about whether such would be appropriate before speaking.

Assisted Suicide

There is a stigma behind the elderly population in the sense that they aren't able to make rational and justifiable decisions in their life.  It is believed that through old age their body along with their mind begins to deteriorate.  I myself was guilty for developing this stereotype until I became a care aide and started working with the geriatric population.  I have witnessed first hand, how despite age one can still have dependable mental function.
At the facility I work for I have encountered such individuals, which have the majority of their mental capability.  For example there is an individual in his 90's who still does all his own taxes as well as another who completes the daily crossword in a matter of minutes.  They are able to understand, comprehend, and remember information and material that is presented to them.  Despite this many still blame the though of suicide in geriatrics to be from a declining mental state.  In cases of dementia and Alzheimer's this may be the cause, however their are seniors who wish to take their life with coherent mental function.  
There have been instances where client's starve themselves in order to pass away quicker than their body originally planned.  In one client's case she decided that she wanted to pass away so she remains bed ridden, eats little to nothing, and asked her doctor to given her sub q morphine three times a day.  Morphine is used to suppress pain as well as slowly stop the function of major organs.  Morphine has been used to quicken the dying process and allow for patients to pass with as little discomfort as possible.  This patient was previously a nurse herself and understood the implications of her actions and requests.
My belief is that if a geriatric patient wishes to pass than they should have the right to do so.  Rather than starving themselves, which could take a matter of months, or having injections of morphine there should be a quicker alternative to relieve pain and suffering.  Another issue that should be addressed is whether morphine should be used at the end of life.  If assisted suicide is illegal shouldn't morphine be considered as well since it increases mortality?