Learning Outcomes PPN.docx

Learning Outcomes Week One: Relate the personal and professional self to the nurse’s role. Interpret the nursing process and nursing frameworks. The nursing process is a five-step clinical decision-making approach Assessment: detecting/noticing cues Diagnosis: interpreting the data Planning: resp...

Learning Outcomes Week One: Relate the personal and professional self to the nurse’s role. Interpret the nursing process and nursing frameworks. The nursing process is a five-step clinical decision-making approach Assessment: detecting/noticing cues Diagnosis: interpreting the data Planning: responding and considering the actions Implementation: responding, reflecting and making adjustment Evaluation: reflecting & repeating ADIPIE as indicated Examine the ethical and legal obligations of the nurse. Critique the historical image of nursing. Historical image: nurses are portrayed as heroes, harlots, handmaidens and there are positive images of nurses that are portrayed as positive during times of war. Virtuous Image: label of angel implies image of caring, compassion and comfort and reinforces the idea that nurses as people who will sacrifice themselves for the good of others Moral Depictions: Nurses viewed as sexual object Explore the gendered, political and economic nature of nursing Understand the historical, societal and environmental context of Indigenous health in Canada Week Two: 1. Compare and contrast the two program philosophies. Demonstrate a beginning understanding of critical social theory (CST) and phenomenology and their relationship to nursing and Canadian healthcare. Phenomenology: it is the understanding of the meaning of the client’s lived experiences of health and healing having a nurse-client relationship CST: exposing underlying social relationships that are not shown Discuss CST in relation to social justice. This relates to social justice because social justice works to gain equity within society and fairness in society. This relates to CST because it works to challenge the status quo and unveil inequities within society allowing for human freedom.   2. Discuss Ways of Knowing in nursing. Consider how different ways of knowing can help you reflect on your nursing practice. Ethical: this is the moral aspect and it explores the right from wrong Empirical: evidence based and has to be verified Personal: knowing of self and other and for nursing is nurses connecting with the humanness of the client experience Aesthetic: deeper appreciation of a whole person or situation, past the superficial, this enables nurses to relate to their clients by responding to their more personal information Emancipatory: nurses are teachers and advocate and facilitate social and structural changes that need to be made to right the wrong. This relates to nursing because it allows nurses to be in a better position to advocate for their patients 3. Examine personal and professional values and beliefs in relation to self- awareness and the nursing profession. Personal values are instilled from childhood and these values are part of our self-concept. Professional values are developed as we age and socialize. In some cases our personal values may interfere with our professional values which then for nursing we would have to use our ethical reasoning and decision making to help these challenges. 4. Characterize nursing as a profession. Identify the criteria of a profession. Requires specialized knowledge, skills, scientific methods, values based on research Need to have education that is considered higher Have to advocate for high ethical standards of its members Identify professional behaviours and link them to academic behaviours. Members function autonomously Members committed to advanced study Members motivated by service to society Week Three: Describe the cognitive skills and critical thinking dispositions required for clinical decision making in nursing. Critical thinking requires purposeful and reflective and cognitive skills Nurse’s disposition is to ask questions, be well informed, be honest in facing personal biases and always will to consider and think differently about issues Examine the 3 levels of critical thinking competencies as described by Kataoka-Yahiro (1994) Three Levels of Thinking: Basic: concrete in thinking, cannot think outside the box, trust experts and depend on rules and regulations Complex: thinking less concrete, looking at the bigger picture, able to multitask and alternatives Commitment: no one reaches the pinnacle, question with confidence, more than just consider alternatives and action until a result is given Examine the 5 stages of the Novice to Expert model as described by Benner (1982) Novice: complete beginner no experience Advanced beginner: new graduate with 1-2 years of experience Competent: 2-3 years of experience Proficient: leads to expert with no time limit Expert: no top nurse and people come to you Discuss the relationship between the Kataoka-Yahiro and Benner models. Explain the components of the nursing process. Assessment: detect/ notice any cues from the client Diagnosis: interpreting data based on the assessment Planning: responding and considering the actions and setting priorities, discussing with the family any possible goals or plans Implementation: responding and reflecting on the planning, where the planning is carried out Evaluation: reflecting and determining whether the outcomes have been met Describe the synthesis of critical thinking and the nursing process. Introduction to the Clinical Judgment Model. Same as nursing process, Tanner’s model describes reasoning patters: noticing, interpreting, responding and reflection Introduction to critical thinking and ethical reasoning. To apply critical thinking to situation requires nurses to examine their own personal value and values of profession 9. Identify barriers to critical thinking and ethical reasoning. Attitudes & habits Cognitive dissonance Personal vs professional values Week Four: Describe and discuss paradigms, paradigm shifts and metaparadigms. Paradigm: example of pattern of something like a model, pattern of shared understanding: world view and theories are often based on these Paradigm shift: fundamental change in approach or underlying assumptions: disease-focused to health promotion focus Metaparadigms: area of interest or concern to a discipline 2. Discuss the meta-paradigm of nursing and its contribution to nursing knowledge and scholarship. Person: includes groups of people, communities and families and it subject to dynamic changes in understanding over time – each person has distinct characteristics Health: determined by each person or community, more than the absence of disease/injury and well-being Environment: totality of all things (external and internal) includes both social and physical environments Nursing: partnership with clients and families where therapeutic and comfort caring occur, actions taken by nurse 3. Discuss in detail the four concepts of the meta-paradigm in relation to practice. ● Discuss the four concepts in relation to theories developed by Nightingale, Roy and Watson. Nightingale: promoted environment conductive to healing Roy: viewed the person as biopsychological being in constant interaction with a changing environment Watson: viewed nursing as caring enacted between a nurse and another with boundaries and space 4. Discuss the relationship between social justice, nursing and health. ● Discuss the O’Mahoney-Paquin article in relation to social justice and the upstream approach. 5. Discuss the meaning of the art and science of nursing within a health care setting. Week Five: Discuss the history, purpose and importance of theory development in nursing Theory and practice = extricably linked b/c inform one another Nursing theories use partners that guide the thinking, being and doing of nursing and are like lenses because they colour and shape what is seen • Describe the perspectives of the following nurse theorists: Nightingale Roy Watson, Nightingale: believed that the nurse and patient relationship is important and the linked health with the environmental factors that influence the client’s environment to help the client heal. She believes the environmental cleanliness and hand washing were and are major factors to preventing infection in clinical settings. Roy: she viewed the person in constant interaction with a changing environment. The Roy Adaption Model explores the psychological needs, self-concept, role-function, and interdependence. Overall, the goal is to promote adaption in individuals or group (person) in order to help them achieve health. Watson: believed the nurse treat the body, mind and spirit of a person through the establishing of caring and relationship. Additionally, she says a human art and science is directed towards the protection, enhancement and preservation of human dignity. 2. Describe evidence informed practice and its relevance to nursing theories, models, and frameworks. Features that go into a single framework or everything that goes into being a nurse. For example, a nurse may use Watson’s theoretical approach (Nurse) when caring for a palliative patient and apply Roy (person, environment) when caring for a rehabilitation patient. 3. Define meta, grand, midrange and practice theories. Grand theory: provides perspective on nursing practice, education & research and can be applied in most nursing situations. Sometimes called paradigm b/c they represent world views and provide structural framework in which narrower theories can be developed and tested. Middle- Range Theory: more limited in scope less abstract than grand theory. An example is that stress theory can be useful in ANY stressful situation (grand theory) whereas chronic pain can be viewed as a stressor on family relationship (mid-range theory). Practice Theory: very specific; limited to specific situations and identifies desired goals and actions to achieve goals Metaparadigm: of nursing offers a holistic approach care. It represents the most abstract form of nursing abstract form of nursing knowledge. It is a set of concepts and propositions that sets forth the phenomena with which a discipline is concerned of. It considers all things that care for a patient 4. Describe scholarliness in nursing. ● Focus of nursing knowledge metaparadigm concepts( ). Metaparadigm: of nursing offers a holistic approach care. It represents the most abstract form of nursing abstract form of nursing knowledge. It is a set of concepts and propositions that sets forth the phenomena with which a discipline is concerned of. It considers all things that care for a patient ● Development of nursing knowledge. Hallmark of nursing practice is a unique body of knowledge. It is a combined set of principles that guide of systematic application of that knowledge in an expanding array of contexts. ● Role of theory as essential to the nursing profession and nursing practice. ● Relationship between theory practice and research, . ● Linking theory to practice. Theory guides assessments, nursing diagnoses & nursing actions and it is linked because it’s reciprocal and in turn these areas help develop and inform new theories. Week Six: Compare and contrast the concepts of cultural competence, cultural humility and cultural safety. Cultural competence: ongoing process, whereby nurses strive to work within the client’s cultural context. Try to work with the clients cultural needs and make them comfortable rather than against. Cultural Safety: three ways: cultural awareness (understand the difference that require self-assessment and reflection about your own personal biases and feelings--- best to learn from the individual), cultural sensitivity ( recognize that there are differences between cultures and reflect that different groups communicate and relate to one another) Cultural safety (challenges unequal power relations) Cultural Humility: life-long learning and challenging power imbalances. To say that you do not know when you truly do not know Define and describe the concepts of colonialism, race, racism and antiracism and how they relate to nursing practice. Race: socially constructed category. It is used as a basis for discrimination and domination. Racism: complex system of racial hierarchy and inequities. It is an ideology that either directly or indirectly asserts that one group is inherently superior to other. Antiracism: no one is born racist or antiracist. These result from choices we make. Not about what you are but about what you do. Colonialism: foreign power rules over nation imposing their values and beliefs on people. It is the takeover of minority by another nation resulting in unequal relationships. Discuss the multiple contexts of culture in relation to health and illness. Treat problems as practice problems; not individual problems Review and examine the equity, diversity and inclusion (EDI) statement in the Student Handbook. Discuss the importance of EDI in nursing. Equity: situation where everyone is treated fairly according to their needs and no group of people is given special treatment. Diversity: people of many different groups in society Inclusion: allowing many different types of people to do something; fair and equally From Handbook: The environment reflects evolving equality through the fostering of interactive relationships, and the attributes of trust, self-awareness and dialogue. Strong collaborative relationships between nursing education and nursing practice also foster a rich learning environment Week Seven: Define the Calls to Action for health in the Truth and Reconciliation Commission of Canada report. Child welfare Education Language and culture Health Justice Define structural racism and how it can be manifested in the health care system. Structural Racism: legitimized and normalized spectrum of attitude, practices and policies that consistently results in chronic and continuous substandard outcomes for indigenous peoples Funding & delivery of health care: Jordan’s Principles Child welfare system: removing children from their families Poverty: low in rom and related issues, such as poor housing conditions Racist assumptions about indigenous patients the store of Brian Sinclair Understand the history of Residential Schools and the impact on survivors today. Expand on the concept of cultural safety and its relevance for Indigenous people in Canadian healthcare. Describe fundamental aspects of nursing practice related to Indigenous people’s values, health and well-being. Discuss the relevance of two-eyed seeing for nursing care in Canada. Describe the UNDRIP and its relevance to nursing practice. Week Nine Explore the goals of client centered education. Engaging clients as active participants in the learning process Ensuring that health teaching interventions are supportive of the client's preferences and values in order to achieve positive clinical outcomes. Introduce participatory strategies, which build on client's personal strengths Collaborative learning environments allows nurses to offer sufficient information, specific instruction and emotional support to clients The teacher must start where the learner is, while supporting the learners natural desire to learn. Discuss client centered learning and L.E.A.R.N.S (RNAO) Client centered learning: interactive, holistic and social process that guides healthcare providers to support clients to become active, responsible partners in their health care; identify previous knowledge; plan intentional learning sessions; and assess and document client learning L- Listen to client needs E- Establish therapeutic partnership relationships A- Adopt intentional approach to every learning encounter (negotiated, tailored, planned/structured, multimodal/media) R- Reinforce health literacy N- Name new knowledge via teach-back S- Strengthen self- management via links to community resources Describe the 3 learning domains Cognitive: understanding the content is a prerequisite for changing attitudes and developing the mastery of psychomotor skills Affective: changing attitudes and promoting acceptance Psychomotor: hand on skill development, tactile Most are combination of all but affective is seen in ALL. It is the WILL to do it Examine the Transtheoretical Model of Change. Pre-contemplation: does not think there is a problem Contemplation: thinks there may be a problem Preparation: recognizes problem and willing to change Action: engages in concrete action to change Maintenance: preserves with positive behavioural change Describe the role of the nurse in health teaching. Guide coach: on action to improve overall health Information providers: how patients can learn to better care for themselves Resource support: connect clients to appropriate community supports Knowledge emotional support: help clients minimize the impact of temporary setback Discuss factors affecting a client’s readiness and ability to learn. Level of anxiety (emotional capability) Ability to learn (intellectual capability) Physical: pain, nausea comorbid health problems Crisis and life transitions can improve learning Level of social support Health literacy Development level Culture, language Self-awareness Examine the characteristics of different learning styles according to developmental stage and in terms of cultural diversity. Visual: learns best by seeing Likes to watch demonstrations, looks around; examines situations Organizes thoughts by writing them down, needs detail Auditory: learns best with verbal instructions, likes to talk things through Details not as important Talks about situation and pros and cons Kinetic: learns best by doing, hands-on involvement, needs action and likes to touch and feel Loses interest with detailed instructions Tries things out Relate the teaching process to the nursing process and clinical Judgement model. NURSING PROCESS (P&P, 333) Tanner’s Clinical Judgement Model (2006) (Alfaro-LeFevre, p.82, P&P p.296) TEACHING PROCESSES (P&P, p.333-40) ASSESSMENT Collects Data Detecting/Noticing Clues Gather data about Preferred learning style Learning Readiness Ability to learn Health literacy NURSING DIAGNOSIS Identifies appropriate nursing diagnosis based on assessment Analyzing, synthesizing and Interpreting data Identify client’s needs based on 3 domains of learning PLANNING Develop individualized care plans through collaboration Responding, considering actions and setting priorities Family involvement Consider Learning needs Create a plan (SMART) Collaborate IMPLEMENTATION Perform Nursing care Involve client Responding, reflecting and making adjustments Building logical information flow Involve client and family EVALUATION Identify success in meeting outcomes/goals Reflecting and repeating ADPIE as indicated Determine outcomes: Were they achieved? Analyze health literacy and its impact on health Health literacy is defined by The Centers for Disease Control and Prevention as: "The degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions". Impacts on health - It includes knowing how to describe symptoms, where to find help for health issues, how to understand medical information and how to safely manage the use of medication Week Ten Discuss the history of the Canadian Health Care system, and how it evolved. What was the role of Tommy Douglas? Early Health Care pre1867 Emphasis was on local communities and essential services Responsive to crisis Centralized care to local churches and families Problems Poor-sanitation Infectious disease British North America Act, 1867 Birth of Canada Act gave certain powers to the federal and provincial governments (only 4 provinces at a time) Responsibility for health, education & social services given to the provinces Federal government has some health responsibilities: health care for Indigenous persons, Canadian Forces, veterans; pharmaceutical safety Late 19th – Early 20th Century Industrial revolution led to urbanization Substandard living conditions and sanitation = increased disease Patients who could not pay for health care depended on charity Growth of charitable and voluntary health agencies 1916: federal government gives municipalities ability to use tax dollars to pay for physicians (municipality act) 1930s: Great Depression 1940s: Provinces inspired to create a prepaid medical and hospitalization insurance plan Events of the 1940s and 50s Establishment of the first universal social programs in Canada Post-war economic growth and stability with positive effects on determinants of health of population Health care continued towards institutional shift Immunizations programs initiated Tommy Douglas: father of Medicare in Canada Envisioned, built and tirelessly promoted our national system of healthcare Proposal in 1959 for a universal, pre-paid and publicly administered health care system in Saskatchewan introduced the first program of its kind in North America Federal government has some health responsibilities: health care for indigenous persons, Canadian forces, veterans Describe key principles and implications of the Canada Health Act (1984). Public Administration: refers to the insurance, not the actual delivery of care. A public authority administers and operates the health insurance plan of a province or territory on a non-profit basis. Comprehensiveness: the health care insurance plan of a province or territory must cover all insured health services provided by hospitals and physicians Universality: entitles all insured residents of a province or territory to be insured by the provincial or territorial health care insurance plan Portability: residents are entitled to a certain level of coverage when they are in another province or territory within Canada or when they travel within Canada or abroad Accessibility: residents have reasonable access to insured services and additional charges for insured services are not permitted with no discrimination based on age, health status or financial circumstances. Discuss the current healthcare system/issues Canada’s Healthcare System is facing at the provincial and national level. -relate these issues to the nursing profession Sustainability/cost Halfway medicine Wait times Indigenous health LTC/acute beds Mental health Equity/accessibility Pharma care Staffing shortage Aging population Other Information: Canada Health Transfer (CHT): -discuss the crucial issues that require urgent action Discuss the Canadian Health Care System in terms of social justice. Identify the role of the various levels of Canadian government in funding and delivery of health services. Health promotion (federal) Disease and injury prevention Diagnosis and treatment: primary, secondary, tertiary Rehabilitation Supportive care Explain the layers of coverage in the Canadian Health Care system: Layer one: public services (medicare) all public funding Layer two: mixed services combination of public and private funding Layer three: private services almost all private funding Services Layer 1: hospitals, physicians, diagnostics Layer 2: prescription drugs, home care, long-term care, mental health care Layer 3: dental care, vision care, complementary medicine, outpatient physiotherapy Funding Layer 1: public taxation Layer 2: public taxation, private insurance, out-of-pocket payments Layer 3: primarily private insurance, out-of-pocket payments with some public taxation Administration Layer 1: universal single-payer systems, private self-regulating, professions Layer 2: public coverage is targeted, public regulation of public services Layer 3: private ownership, private professions, limited public regulation Delivery Layer 1: private profession for profit and not-for-profit facilities and public arm’s length facilities Layer 2: private profession for profit and not-for-profit facilities and public arm’s length facilities Layer 3: private professional for profit facilities Week Eleven Part 1 Examine your own personal, professional, and socio-cultural values and belief systems. How would these values Influence patient care? Discuss professional accountability and CNO Code of Conduct. Professional Accountability: Keeping up with professional standards, law and regulations Ensuring competence to provide these practice Maintaining fitness to practice, ensuring have necessary physical, mental and emotional capacity to practice safety and competency Sharing their knowledge other nurses, nursing students and other health care providers through mentorship and giving feedback Advocating for comprehensive and equitable mental health care services Discuss the major roles and responsibilities of nursing organizations legal requirement versus voluntary membership College of Nurses of Ontario (CNO): responsible for governing the profession of nursing in Ontario in the public interest Ontario Nurses Association (ONA): union that develops and ensured that labour laws are being followed – protects labour rights and laws for the nurses Canadian Nurses Association (CNA): voices of registered nurses, trying to strengthen leaderships Canadian Association of Schools of Nursing (CASN):voices for nursing education and scholarship International Council of Nurses (ICN) Registered: its all over the world, representative for all nurses globally Nurses Association of Ontario (RNAO): they give you protection liability when you do not have a union as a nurse – support you Sigma Theta Tau International (STTI): international community of nurses dedicated to advancement of knowledge, teaching, learning and service through cultivation of communication of practice, education and research Discuss entry to practice competencies for Registered Nurses and NCLEX exam for professional licensing. Entry to practice competencies: ability to achieve entry-level proficiency Employer knows what to expect from a new grad nurse Licensure: granted by provincial or territorial body (CNO) exclusive legal right to practice a profession --- can’t be a nurse without doing your licensure Registration: list of members in good standing of an organization. Must meet practice requirements and show no evidence of unsafe practice Discuss Personal Health Information Protection Act (PHIPA) and Personal Information Protection and Electronic Documents Act (PIPEDA). Discuss how these acts affect nursing practice. PHIPA Governs health care information privacy in Ontario Privacy as the client’s right to control how personal health information is collected, used and disclosed Permits sharing of personal health information among health care team members, regardless of whether they are employed by the same organization Do not keep charts open PIPEDA Obtain an individual’s consent when they collect, use and disclose that individual’s personal information People have the right to access their personal information held by an organization Right to challenge its accuracy If organization is going to use it for another purpose, must obtain consent again Personal information must be protected by appropriate safeguards Explore the concepts of negligence and duty of care. Unintentional tort: Negligence No intent is needed for negligence to occur Nurses can be found liable for negligence if following 4 criteria are established: Nurse owed a duty of care to a patient Nurse did not carry out that duty That patient was injured Nurse’s failed to carry out the duty caused the injury Duty to report: any healthcare provider if they witness these things must report: Child neglect/abuse Elder abuse in people who reside in long-term care (must be hurt by themselves or professional themselves) Gunshot or stab wounds police must be notified Briefly discuss key components of Canada’s legal system and their effects on nursing practice. Regulatory Law: Established to protect the public and govern standards Public Law: Relations between individuals and state Constitutional, tax, administrative, human rights, criminal law Private Law: Disputes between individuals Contracts, marriage and divorce, civil wrongs (including negligence) Legal Issues in Nursing: Consumer and patient’s rights movements Scope of practice and responsibility growing Attention to issues of professional negligence Discuss Statute Law (RHPSLAA) and Tort Law (intentional/unintentional). RHPSLAA Expanding the services of regulated health care professionals Improving patient safety and strengthening in the health care system Torts (Tort law): Civil wrong committed against a person or a property are classified as intentional or unintentional Intentional Assault Battery Invasion of privacy Unintentional Nurses found liable if the following 4 criteria are established Nurse owed a duty of care to the patient Nurse did not carry out that duty That patient was injured Nurse failed to carry out the duty caused the injured Discuss the importance of informed consent in the patient care settings and identify the nurses’ role Informed consent Consent for a treatment is informed if Person received information that a reasonable person is in the same circumstances would need to make a decision Person received responses to any requests to any additional information Getting permission from client or from their families Information about the treatment must include: Nature of the treatment Expected benefits Risks and side effects Alternative courses Likely consequences of not having the treatments Nursing Responsibilities: Informed Consent Always explain to client the treatment or procedure they are performing DO NOT provide treatment if there is any doubt about whether client understands and is capable of consenting (does not apply if SDM has consented) Advocate for client’s and SDM’s access to information about care and treatment Informed consent does not always need to be written, can be oral or implied Week Twelve Part 2 Discuss the foundational principles and values found in the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses. Ethical nursing practice involved endeavouring address broad aspects of social justice associated with health and well-being Defined by the profession Bound to code ethics to serve and protect public Provides guidance Informs professionals about expectations around ethical issues Informs public of underlying values of profession Discuss the Regulated Health Professions Act (RHPA) its intent and key issues: Scope of Practice: general way of what a profession does, the methods it may use and how the professionals practice Controlled Act: something that only a qualified professional can do. Could be dangerous or result in harm if a non-qualified professional performs this Health Regulatory Colleges: responsible for ensuring health professionals provide health services in a safe, professional and ethical manner Discuss the roles of the nursing profession and other health care professions within the RHPA. Better protect, serve the public interest Be more open and accountable system of self governance; Provide more modern framework for work of health professionals Provide consumers with freedom of choice Provide mechanisms improve quality of care Analyze patient safety, accountability and advocacy in relation to being a regulated health professional. Discuss the (4) ethical principles of autonomy, beneficence, nonmaleficence and justice. Autonomy: Right to freely choose for oneself Choices should be based full understanding, free of controlling influences Patients needs to be included in all aspects of decision making regarding their care Patient’s right to choose between options may conflict with what health care providers recommend Beneficence: Doing or promoting good for others Acting with beneficence requires that the best interest of patient remains more important than self-interest Obligation of health care provider to do good, promote welfare of clients through advocacy Nonmaleficence: Avoiding harm or hurt NOT same as “doing good’ Health care provider tries to balance the risks and benefits of treatment while trying to cause the least possible harm for the patient Justice: Fairness When competition for scarce resource. Justice mandates that decisions be fair and unbiased (to greatest extend possible) Social Justice Fair distribution of society’s benefits, responsibilities and their consequences Focuses on relative position of one social group to other in society and root causes of disparities and what can be done to eliminate them Explore the relationship between ethics and professional practice, focusing on responsibility, accountability, advocacy and moral agency. Responsibility: Reliability, dependability Ability to distinguish right from wrong Accountability: Grounded moral principles of fidelity and respect for the dignity, worth and self-determination of patients and other whom nurses work Advocacy: Acting on behalf of others Recognizing need for change Informed consent Awareness of constrained moral agency Moral Agency: Someone who has capacity to direct their actions to some ethical end Ex: good outcomes for patients Discuss the principles of ethical decision making and the concept of “moral distress” in nursing. Moral Distress: recognizes a problem exists, two or more ethically justifiable but mutually opposing action can be taken Phenomenon in which one knows the right action to take but is constrained from taking it Knowing right thing to do, not doing to respect client Identify ethical dilemmas and/or problems nurses may encounter in clinical practice. A client wants to die at home in piece and comfort. The family knowns that the presence of the client at home will create intolerable stress for other family members. The nurse is being pressured by other members of the health care team to talk the family into taking the client home. Discuss possible strategies to resolve these problems.