Genetic advances: influences on the delivery of health care.
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Biomedical subjects
Publications and source records attributed to C Scanlon.
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PURPOSE/OBJECTIVES: To describe ethical issues determined to be highly important to oncology nurses and to discuss strategies by which the Oncology Nursing Society (ONS) can address these priority concerns. DATA SOURCES: Survey on oncology nurses regarding ethical issues; nursing literature. DATA SYNTHESIS: Nine priority ethical issues of oncology nurses are identified. Past, current, and future ONS activities that address these priority issues are discussed. IMPLICATIONS FOR NURSING PRACTICE: ONS must support activities to increase the knowledge, confidence, and involvement of oncology nurses in discussions and decision making related to the ethical issues. CONCLUSIONS: The top three priority ethical issues for oncology nurses are assisted suicide, end-of-life decisions, and pain management. Efforts should be made to increase ethics expertise among the ONS membership.
Prior studies indicate that the natriuretic effects of atrial natriuretic peptide (ANP) are due, in part, to an inhibition of the passive movement of sodium ions from tubular lumen through apical cation channels into renal tubular epithelium. The present work demonstrates that ANP also exerts a potent inhibitory effect on the active pumping of sodium ions by renal tubular sodium and potassium-activated adenosine triphosphatase (Na, K-ATPase). This action of ANP is relatively long lasting, is due to a change in enzyme Vmax and is specific for ouabain-sensitive activity. Enzyme modulation occurs with an EC50 for ANP of 0.1 nM, is independent of intracellular [Na+] and is associated with an increase in tissue cyclic GMP (cGMP), but not cyclic AMP (cAMP). Modulation of Na, K-ATPase by ANP is mimicked by 8-bromo-cGMP and okadaic acid (OA) and is blocked by KT 5823, a selective inhibitor of cGMP-dependent protein kinase (PKG), but not by KT 5720, a selective inhibitor of cyclic AMP-dependent protein kinase (PKA), which suggests that the action of ANP on the sodium pump involves cGMP-mediated changes in protein phosphorylation. Regulation of renal Na, K-ATPase activity also occurs with nitric oxide-generating compounds, such as nitroglycerin and sodium nitroprusside (SNP). However, the ability of ANP to modulate Na, K-ATPase does not appear to involve this latter pathway because the effects of ANP on the sodium pump cannot be blocked by either N omega-nitro-L-arginine, an inhibitor of NO synthase, or hemoglobin, which blocks NO through binding.(ABSTRACT TRUNCATED AT 250 WORDS)
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As the population ages, nurses will be working with increased numbers of elderly cancer patients. It is imperative that nurses gain an understanding of the aging process and an appreciation of the cancer experience in the older adult. By aggravating or influencing cancer-related symptoms and their treatments, or by inducing non-cancer related symptoms, concurrent health problems may inadvertently be thought to be associated with malignancy progression. An in-depth investigation of a patient's history may reveal a vast number of actual and potential health problems; the areas that pose special concerns for the elderly are nutrition, pain, and psychosocial aspects, such as depression and confusion.
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The patient in the advanced stages of cancer presents many challenges for the nurse caregiver. To care for the patient effectively as the end of life approaches requires a shift in focus from cure or treatment of the disease to the management of the associated symptoms. This is the primary goal of palliative care, a unique approach to meeting the needs of this vulnerable patient group. The clinical issues that are common in the care of the patient with advanced cancer may raise specific ethical concerns for the nurse. Managing the symptoms with the goal of palliative care in mind will help to frame these concerns more clearly. Communicating with patients and families on an ongoing basis in a clear and sensitive manner will help to ensure that patients' decisions are known and respected. Nurses need to be prepared to assist in these difficult situations. A nursing ethics group is one method that has been found to be effective in developing nurses' expertise in this area.
Two surveys were conducted independently to ascertain whether health care institutions in the New York City metropolitan region currently have ethics committees and to gather information related to their functioning and use by nurses. Comparable findings in the overlapping samples suggest that approximately one-third of surveyed institutions do not have interdisciplinary ethics committees. Where the committees do exist, they may not be adequate to address nurses' ethical concerns.
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The authors surveyed 1,137 physicians, nurses, and social workers (overall response = 48%) to characterize the willingness to endorse assisted suicide. Willingness to endorse varied among disciplines and was negatively correlated with level of religious belief (r = -0.35, P < 0.0001), knowledge of symptom management (r = -0.21, P < 0.0001), and time managing symptoms (r = -0.21, P < 0.0001). On multivariate analysis, the significant predictors were lesser religious belief (P < 0.0001), greater concern about analgesic toxicity (P = 0.001), diminished empathy (P = 0.03), lesser knowledge of symptom management (P < 0.04), and the interaction between religious belief and knowledge of symptom management (P = 0.04). Professionals' attitudes toward assisted suicide are influenced by diverse personal attributes, among which may be competence in symptom management and burnout.
However compassionate the motives behind assisted suicide initiatives, the risks and harm for patients, health professionals and the public are too great. The moral and professional challenge should not revolve around assisted suicide but be directed at reversing the dying person's despair and fulfilling the obligation to provide competent and committed care to the dying.
Those who care for persons with AIDS face a number of special issues. They must understand the complex clinical course of the disease, be ready to cope with its devastating effects on patients, know how to address social prejudices against persons with AIDS, and be prepared to deal with the stresses of providing care under difficult circumstances. To be effective, care givers must know how to take care of themselves. Having a philosophy of care is one key component of self-care because it gives care givers a clear sense of direction and helps them enjoy a greater sense of well-being and personal satisfaction. Creating a motivating environment, taking responsibility for the challenges and stresses of the job, building a supportive team, understanding the AIDS experience, and confronting the effects of grief are also important components in the self-care of the AIDS care giver.
Home care for PWAs is now available. This paper addresses some of the treatments and problems that may be a part of care at home. It is intended to be a basic review of principles and procedures associated with the care of PWAs at home.
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