J Gerontol Nurs
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It is estimated that of the 2.2 million people who turned 65 years of age in 1990, approximately 1 million will be cared for in a SNF at least once before they die (Satterfield, 1993). Under pressure from federal and state governments to reduce costs associated with acute care hospitalization, SNFs are admitting patients who require more complex medical and surgical care than in the past. Until recently, FS-SNF ICPs did not have the motivation to develop and implement complex infection prevention and control programs because their patients required a level of care that assured that their activities of daily living were met. ⋯ However, the person responsible for infection prevention and control for a DP-SNF may be the same individual who is the ICP for the acute care hospital of which it is a part. Persons designated as ICPs for FS-SNFs often function in a much more isolated setting with limited access to resources. It is now time for experienced hospital-based ICPs to reach out to personnel in FS-SNFs to work together to develop and implement effective infection and prevention and control programs that meet the needs of patients cared for across the continuum.
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Although ECT has been the subject of controversy for decades, ECT has brought increased chances for recovery to many people suffering from severe depression. Crossfield (1988) states the evidence is overwhelming that treatment of some depressive clients with ECT is the best treatment available. Other researchers have found that ECT is equal to, and sometimes superior to, other therapies for major depressive disorders (Gomez & Gomez, 1993). ⋯ Sixth, ECT can be contraindicated when certain other medical conditions are present. Persons suffering from severe cardiac or pulmonary disease are frequently disqualified for treatment due to the risk of receiving anesthesia. Last, people usually require a prophylactic treatment with antidepressant medication, even if a complete, acute phase response to ECT is attained (pp. 26-27).
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1. End of life ethical decision-making is complex and involves many key players, each with their individual roles, responsibilities, and ethical concepts. 2. ⋯ Those involved in ethical decision-making are influenced by various ethical theories as well as factors including control, legal issues, failure, coercion, obligation, advocacy, autonomy, respect, and cost. 4. Ethics committees can play a valuable role in assisting patients, families and staff through the decision-making process by providing guidelines based on ethical principles and compatible with facility mission and philosophy.