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The effects of malnutrition continue to effect the adult population with wounds significantly. Nutrition plays an important part in the healing process of wounds (Timms, 2011). Patients with malnutrition typically suffer from delayed wound healing due to inadequate nutrition needed to sustain strong skin integrity (Timms, 2011). Therefore, the phenomenon of interest (POI), Strategies to Improve Malnutrition with Adult Patients with Wounds, is a huge issue that need to be addressed by the Adult Gerontological Nurse Practitioner (ADGNP) working as a Wound Specialist in the Community Living Center (CLC). Often times, the concept of ethics has a vital impact on the POI, effecting decisions made and the way care is performed. Ethical principles and frameworks help to guide the ADGNPs practice. This paper will discuss ethical principles that effect the POI and the ethical framework most relevant to the POI.
Ethical matters can arise in wound care practice when a patient lacks ability to understand the cause of their wound or the suggested management (Beldon, 2014). In turn, patients with malnutrition are subject to the same ethical issues. The following ethical principles, beneficence, non-maleficence, and autonomy are directly related to the POI. Beneficence means the obligation to promote the health and well-being of the patient (Beldon, 2014). For example, the ADGNP taking the time to feed the malnourished patient who cannot feed himself to ensure he has good food intake or writing a specific order for the staff to feed the patient for each meal. Atmosphere and the environment are key during meal time, and eating with patients inspires eating (Moynihan, Macdonald, Teal, Methven, Heaven, & Bamford, 2012). Beneficence will impact the ADGNP practice significantly, it will determine specific actions taken. This can be inferred as respecting the specific patient’s right to make choices concerning his/her own wound care directed by proper information and decisions provided by the ADGNP (Beldon, 2014). Autonomy encourages the ADGNP to allow the patient to be involved in their own care. An example of autonomy would be allowing the patient to select his or her own meals or snacks. Hence, autonomy enables the patient to take an active role in their care. Non-maleficence, which is no harm done to the patient ( Medical Dictionary for the Health Professions and Nursing , 2012), impacts the practice of the ADGNP by forcing her to be self-conscious of actions taken in an effort to protect the patient. For example, the ADGNP washes her hands prior to setting up the patient’s tray to eat or before wound care is implemented to prevent the spread of infection. Overall, the ethical principle will direct ADGNP by stirring her provide care based on the well-being of the patient without causing harm, while also allowing the patient to be involved in care.
Ethical Framework for Practice
The ethical framework, Principlism, is most relevant to the POI. Principlism fits into the POI based on the importance of providing efficient care that is right for the malnourished patient. Hine (2011) describes principlism as a standard of right action based on action-guiding. Action-guiding is referred to as essential and suf?cient circumstances for the appropriateness of the deed but also offers a decision method by which one can recognize the tangibly ethically right action in a real situation, not just hypothetical (Hine, 2011). This ethical framework will direct the ADGNP practice by inspiring her to make appropriate ethical decisions while in practice. The ADGNP will provide proper care to prevent and treat malnutrition based on the standard of evidenced-based practice, as well as it being the ethically right decision. For example, completing a nutritional assessment on admission to screen for malnourishment fits into the principlism framework. Even if the ADGNP does not believe the patient is malnourished, assessing the patient regardless of thoughts is the right action due to inability to always look at an individual and know if (s)he suffers from malnutrition.
Ethics play a critical role in the POI, strategies to improve malnutrition in the adult patient with wounds. Autonomy, non-maleficence, and beneficence impact the POI by guiding the practice of the ADGNP, practicing as a wound specialist, to provide care that will promote the well-being of the patient, allow the patient to have an active role in care, and do no harm to the patient. In addition, the principlism framework encourages the ADGNP to do what is ethically right while performing care of the undernourished patient.