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April 17, 2012

Dear Colleague,

How often have patients or family members asked you "What would you do if this was your mother (father, child, spouse, etc.)?" How often have you asked yourself "If this was my loved one, would I do things differently?" Ethical situations arise daily and when it comes to decision-making, there are so many variables that can come into play – living wills, do-not-resuscitate orders, disagreements among families or surrogate decision makers, prior experience, your own moral and ethical beliefs, and so on.

An article in the current issue of the Journal of Hospice and Palliative Care Nursing sheds some light on a particularly interesting consideration regarding decision making. In Why Surrogates Don't Make Decisions the Way We Think They Ought to: Insights From Moral Psychology, we learn about a hierarchy of three ethical standards which should help surrogates to make decisions consistent with a patient's wishes, however research shows that this often is not the case. The three standards in the hierarchy are:

  1. known wishes,
  2. substituted judgment,
  3. and best interests.

In this article, the authors present 5 assumptions that are implicit when using this hierarchy, including a discussion of how can one predict preferences for an unknown circumstance in the future? I encourage you to read this article in its entirety to learn more!

Ethics is a big topic in healthcare – you can also read more by exploring the articles in More Resources and our Focus On: Nursing Ethics resource collection.

Why Surrogates Don't Make Decisions the Way We Think They Ought to: Insights From Moral Psychology

Ethical Issues: Putting the Meds in the Applesauce

Christian Ethics: Ethics and Empathy (Part One)

Christian Ethics: Ethics and Empathy (Part Two)

Use of Digital Health Records Raises Ethics Concerns

Is It Ethical to Do Dialysis But Not Cardiopulmonary Resuscitation?

Lisa Bonsall, MSN, RN, CRNP
Clinical Edito

New on NursingCenter
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New articles and editorials have been added to Focus On: The Future of Nursing.


Free access to journal content and more in Clinical Update: Psoriasis. Learn about the latest news, psychological impact, patch testing, and more.

The current featured article is The Clinical Conundrum of Pruritus. It's a CE article from the current issue of the Journal of the Dermatology Nurses' Association. Review common and uncommon causes of pruritus and recommendations for evaluation and management.

Browse new CE
Increase awareness of emergency contraception, correct common misconceptions about its mechanism of action and potential adverse effects, and facilitate patient access. Don't miss The Underutilization of Emergency Contraception.
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Obstructive sleep apnea is characterized by many apneic and hypopneic periods during the sleeping cycle. These episodes eventually lead to complications of the cardiovascular system. Learn more, including signs and symptoms, diagnosis, and management in Sounding the Alarm for Patients with Obstructive Sleep Apnea.
(2.5 contact hours)

This study examines the evidence supporting the combined use of interventions to prevent pressure ulcers (PrUs) in acute care and long-term-care facilities. Take some time to read Comprehensive Programs for Preventing Pressure Ulcers: A Review of the Literature.
Advances in Skin & Wound Care: The Journal for Prevention and Healing Share:
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Review our Recommended CE list on the many faces of dementia, obstructive sleep apnea, prevention and management of osteoarthritis ...

Read new articles

Brush up on 5 diabetes fundamentals: diagnostic criteria, glycemic goals, pathophysiology of diabetes, carbohydrate basics, and appropriate nutrition messages by reading The Fundamentals of Diabetes Management.
Nutrition Today Share:

Many of us have been exposed to tuberculosis at work and are now PPD positive. What does this mean and what factors can increase progression to active disease? Find out by examining Emerging Infections: Are You 'PPD Positive'?
AJN, American Journal of Nursing

Auscultation of heart sounds should be incorporated into daily cardiac physical assessment and techniques should consist of a routine pattern that focuses on all four valvular points of origin. Learn more by reading Heart Matters: Heart Sounds: Hear the Story.
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Read the articles in the latest Featured Journal online only on NursingCenter. The Featured Journal gives you the opportunity to get acquainted with the kind of coverage and clinical information it has to offer. Get to know our journals. The current Featured Journal is...

Drug news

The FDA has approved Neupro (rotigotine, a nonergoline dopamine agonist) transdermal system for the treatment of the signs and symptoms of advanced-stage idiopathic Parkinson disease and for moderate to severe primary restless legs syndrome.

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