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?