Fulminant hepatic failure in acute acetaminophen overdose.

Fulminant hepatic failure is a serious complication of acetaminophen overdose. The cascade of complications starts with an alert patient that can quickly result in hepatic coma and even death. The nurse completes a poisoning history, provides an antidote, and assesses the extent of hepatic failure from an overdose. This article uses a case study to describe the problems and nursing care for the patient with hepatic failure from acetaminophen overdose. Advanced assessment skills by the critical care nurse enable prompt recognition of postoverdose complications for early intervention and treatment. Acute care nurse practitioners, utilizing the same techniques, can develop protocols for emergency or intensive care units where these patients may be admitted and subsequently cared for.

Informed consent in the elderly: assessing decisional capacity.

Informed consent is a process involving both patient rights and professional responsibilities. A nurses discomfort with an elderly person's ability to make a fully informed choice can be a source of ethical conflict. Assessing mental capacity in this vulnerable patient population is a necessary function of respecting patient autonomy.

Choosing a framework for ethical analysis in advanced practice settings: the case for casuistry.

The need for advanced practice nurses to incorporate ethical analysis into case management is becoming more apparent -- particularly for the increasingly independent practice settings of psychiatric and mental health nursing. The nursing literature contains many articles dealing with the more abstract treatment of clinical ethics, but for the practitioner there is unfortunately little information available that uses ethical principles in a practical framework, which addresses the concrete reality of daily, difficult clinical decision making. This article applies a model of reasoned analysis to an actual case study using the concepts of casuistry or case-based reasoning. This method offers an alternative to the more popular paradigm of principilism. Complicated by the existence of violence and abuse, the case examines several ethical issues including patient privacy and legitimate breaches of patient confidentiality.

A comparison of principle-based and case-based approaches to ethical analysis.

Illness is not just something that persons have or get--it is something that they experience. They live this experience fully with their entire being--emotionally, psychologically, spiritually, and physiologically. Any method of ethical analysis must take care to not simplify the process of dealing with morally troubling cases. The multidimensional nature of human life is so complex that the decisions made in these situations are seldom if ever strictly medical decisions--they are also social, emotional, religious, and moral ones. Ethical dilemmas present in today's health care settings compel members of HECs to engage in and contribute toward meaningful dialogue in ethics that is collaborative, multidisciplinary, and mutually respectful. The inevitability of change in the way in which the health needs of people are going to be handled in the future demands this proactive approach. Individuals who accept this responsibility must equip themselves for ethical analysis that deals effectively with the inevitably complex questions that will arise.

Cases of conscience: casuistic analysis of ethical dilemmas in expanded role settings.

In the absence of a well articulated conceptual framework for nursing ethics, this article argues for a theory of applied ethics--casuistics--used within a clinical reasoning model, to analyse the complicated issues presented in three cases involving adolescents receiving treatment for abuse through a rural alternative learning centre. The clinical nurse specialist, as an independent practitioner within the community, is presented with many ethical challenges arising from cultural diversity. The inherent independent nature of such practice environments combined with the pluralism which exists in today's multicultural society demands that professional nurses working in these circumstances develop and utilize an ethical framework for the analysis of patient care in situations that involve moral conflict.