The Aversive Effect of Alcohol

Betty Ford, the wife of former President Gerald Ford, suffered from alcoholism and was addicted to painkillers. She raised public awareness of addiction by confessing her longtime battle with alcoholism in the 1970s. When she recovered, she established the Betty Ford Center to help others overcome substance and alcohol abuse. Perhaps Ford’s greatest legacy was the honesty she brought to the American idea of alcoholism. Alcohol addiction can happen to anyone. There are no stereotypical symptoms of alcoholism. Even being the first lady of the United States does not make you immune to alcoholism. Abuse and addiction are two major issues in America. It affects the mind and bodies of “users” in harsh ways. Substance abuse is a pattern of repeated drug or alcohol use that interferes with health, work, and social relationships. The road to addiction is a long and winding road. Alcohol deeply affects our mentality, the ability to think clearly, and the personality of the people that use it. Numerous treatment options are available to help achieve the goal of ending addiction.

Ethyl alcohol most commonly known as ethanol is the active ingredient in beer, wine, and liquor, also colloquially known as alcohol. The process known as fermentation produces alcohol. When yeast is fermented, sugar breaks down into carbon dioxide and alcohol. Carbon dioxide exits the process through gas bubbles and leaves behind a combination of water and ethanol. Numerous factors can cause or lead to alcoholism.

High levels of stress cause a big impact mainly because people use alcohol to reduce their stress. Experimenting with alcohol at an early age can also lead you to trouble in your later life. While drinking early on can increase the likelihood of alcohol abuse, alcoholism can affect any age group. Mental health issues can increase alcoholism. It is easy for a person feeling depressed or anxious to turn to alcohol, which to them, seems to ease their feelings, while in reality it makes things worse. Another factor that leads to alcoholism may be family history. If a parent or close relative is alcoholic, your risk increases. Part is due to genetics, but the other part has to do with the surrounding environment Research has shown a close link with alcoholism and biological factors, mainly genetics and physiology. For some, alcohol gives off feelings of pleasure, encouraging the brain to repeat the behavior of drinking. Repetitive behavior causes a person to become more vulnerable. (Campus) While the road to addiction is different for every person, there are four common stages of addiction. The first being experimentation which is the voluntary use of a substance without experiencing any consequences. The experimenting usually occurs several times mainly because it is used for the purpose of “fun”. The second stage is regular use, which is when the risk for abuse increases and the start of risky behavior occurs. The third stage is known as the risky use or abuse stage. It is described as continued use of drugs or alcohol despite consequences. The beginning signs of addiction appear. The fourth and final stage is labeled drug addiction and dependency. Withdrawal symptoms occur and the compulsive use of the drug despite any consequences against relationships, physical or mental health, finances, and continuing work. (Palmera) Symptoms of alcoholism include blacking out, dizziness, aggression, compulsive behavior, anxiety, guilt, nausea, fear, problems with coordination, and slurred speech. (AshwoodRecovery)  Frequent risk factors of alcohol use disorder are more than five drinks a day, parent with alcohol use disorder, mental health problems, peer pressure, low self-esteem, and high stress levels.

According to the National Institute on Drug Abuse, addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences. There is no simple cure for addiction. However, effective treatment can help you become and stay sober. Many treatment options are available for alcoholism. The main one being behavioral training, which is changing drinking behavior through counseling. Behavioral training consists of multiple types of therapies. Cognitive-behavioral therapy addresses harmful thought patterns, which helps clients recognize their ability to practice alternative ways of thinking, regulate distressing emotions and harmful behaviors. (AAC) Motivational enhancement therapy helps individuals resolve their ambivalence about their drug use. It aims to evoke rapid and internally motivated change rather than guide the patient through recovery. Motivational enhancement therapy consists of an initial assessment battery session, followed by two to four individual sessions with a therapist. (NIH)

Another type of treatment is holding brief interventions. Brief interventions are evidence-based practices designed to motivate individuals at risk of substance abuse and related health problems. It helps change their behavior by guiding them to understand how their abuse puts them at risk and how to reduce or give up their substance use. (SAMHSA) Alcohol and substance use disorders can severely undermine the foundation of healthy relationships. Spousal relationships often are the first to suffer when some is struggling with alcohol or drug dependence. Marital and family counseling is very common in these situations. Marital and family counseling is a type of psychotherapy that helps couples of all types recognize and resolve conflicts and improve their relationships. When your spouse is addicted to a substance, you have to deal with irrational behavior, them getting sick, lies, cheating and other unacceptable behaviors. The majority of the time it is extremely difficult for the non-addicted spouse for the fact that they are legally bound to the other person.  (Dombeck) Two patient treatment options are available. Inpatient treatment programs require the patient to live at the facility for the duration, typically thirty, sixty, or ninety days of treatment. The process begins with detoxification. Withdrawal symptoms are managed in a safe environment by qualified medical staff. Outpatient treatment gives the patient more freedom to work and be home with you family. Though more freedom is granted, a person is at more risk for relapse. Lastly, the most common type of treatment for alcohol dependency is Alcoholics Anonymous (AA). Alcoholics Anonymous is a twelve step, nonprofit organization. It is an international mutual aid fellowship whose stated purpose is to enable its members to “stay sober and help other alcoholics to achieve sobriety”. AA was founded in 1935 by Bill Wilson and Bob Smith in Akron, Ohio. (AlcoholicsAnonymous) Being a member of Alcoholics Anonymous means listening to members share their experiences and to give service or sponsorship. Even though there are many treatment options for all individuals, people with a less serious addiction may attempt to diminish their addiction through everyday activities such as exercising, working out, running, going for walks, meditating, reading, volunteering, or finding a new hobby to take up your time. (AA) Most treatments work for the majority of alcoholics, though some of the time, people may not be ready or able to begin or finish their treatment. There is no exact success rate given but a few common statistics are known. In 2015, only 4.4% of people twelve years and older, agreed to receive treatment for their addiction. Alcoholics Anonymous has more than 115,000 groups worldwide. 32% of those people were introduced by another group member and an additional 32% of people were recommended by a treatment facility. 59% of people who join Alcoholics Anonymous have already received prior treatment and 40% drop out of group within the first year. An article in the New York Times stated that around 75% of people who begin and finish a treatment plan stay abstinent throughout their lifetime. (AmericanAddictionCenters)

If alcohol is not consumed responsibly, there may be some serious consequences. Alcohol can permeate virtually every organ and tissue in the body, resulting in tissue injury and organ dysfunction. Evidence indicates that alcohol abuse results in clinical abnormalities of one of the body’s most important system, the endocrine system. The endocrine system ensures proper communication between various organs, also interfacing with the immune and nervous systems. The system is essential for maintaining a constant internal environment. Along with altering the endocrine system, alcohol also alters the levels of neurotransmitters which transmit behavioral, physical, activity, and emotion signals throughout the body. (Rachdaoui) Addictive substances such as alcohol tend to overstimulate the brain’s reward system by flooding it with excess levels of dopamine. The brain adjusts to the imbalance by reducing brain cells. Because of this, alcoholics could be at risk of dementia, stroke, depression, anxiety, suicidal thoughts, social problems, and many forms of cancer. Suicidal behavior is an extreme medical and social problem with alcoholics. Numerous amounts of evidence suggest that alcohol and drug abuse is associated with suicidal ideation, attempts, and suicides. After depression, alcoholism is the psychiatric condition most associated with suicide attempts and completed suicides. Alcohol and drugs are involved in around fifty percent of attempts. About twenty-five percent of completed suicides occur among individuals with alcoholism. (Vilens) A major study in 2017 by the National Institute on Alcohol Abuse and Alcoholism, reported that the rate of female alcohol dependence in the United States increased drastically between 2002 and 2013. Experts suggest that the drastic rise stems from the high amount of anxiety and stress over balancing work and life situations. (Johnston) Today’s youth seems to have an extremely difficult time dealing with alcohol and other substances. Alcohol is the most common drug choice among young people. Teenagers get hooked on alcohol just for the “fun of it”. Alcohol slows down the brains of young people more quickly than the brains of legal age drinkers. It causes shrinkage in the brain causing numerous brain cells to die.  Children’s brains tend to develop much slower than the average adult because children of ages 12-18 have yet to learn many life and developmental skills.

Countless arguments have been discussed around of people questioning if some parts of consuming alcohol are good for you. Consuming alcohol, without a doubt, is a dangerous path to go on in general. People believe that if done responsibly, alcohol can add a few years onto your life. Although studies have shown that alcohol shortens your life by two or three years. Another claim is that alcohol attacks cancer cells which is untrue. Drinking alcohol can increase the risk of developing cancer due to damages to the body tissue, improper absorption, and failure to produce estrogen. Lastly, another belief is that alcohol lowers cholesterol. Cholesterol is a waxy substance that is found in every substance of the body. Human bodies need cholesterol to produce hormones, vitamin D, and substances that help digest food. Although it is commonly known that irresponsible drinking does damage to the liver, cholesterol is mainly produced in the liver.

I had a conversation with a close family member of mine to learn more in depth of his struggles with alcoholism. “I was addicted but did not need alcohol every day, most people do not believe that not needing your substance everyday can still be an addiction. I would start drinking on Fridays after work and typically not stop until around Sunday at midnight. The majority of the time I would drink until I would pass out. It would happen a couple times each day if I had nothing to do that day. Sometimes I woke up covered in vomit, then I would wash up, mix another drink and keep going no matter the time of day. It was such a terrible way to live, but I did not know how to stop. The way I quit was the best yet the worst way to quit. I went to jail and that was the longest time I had been without alcohol since I was eighteen. When I got out of jail, I was arranged to see a court ordered counselor for thirty-two hours’ worth of meetings. Through those meetings, I learned how real my problem was. I knew I needed to change things, or I would fall into the same drinking cycle. The friends I had were not real friends, they were alcoholics just like I was. We enabled each other, made each other think our behavior was normal. Now, being sober, I focus more on what matters most. I try to spend more time with my family and work on my hobbies like hunting, fishing, camping, and working around the yard. Doing all these things helps me spend my time doing better and healthier things while not thinking about drinking. So, even if someone is an alcoholic, they can quit and overcome their substance abuse.”

Substance abuse is a continuous pattern of daily destruction to a person body. Abusing alcohol interferes with work, health, and relationships. A person’s road to addiction is long and winding and takes a toll on your mental health. Substances, like alcohol, deeply affects our mental health, the ability to think clearly, and the personality of the people that use it. Numerous treatment options are known and available to help a person overcome their lengthy battle with addiction.

Works Cited

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Pain management is an important indicator of a patient’s quality of life because pain is the most feared of all the symptoms associated with cancer. Unfortunately, ineffective and inadequate cancer pain management remains a major problem in the clinical setting despite the availability of pain assessment tools, and effective pharmacological and technological advances in pain management.

the beliefs patients have about pain could be the major hindrance in achieving optimal cancer pain control.

Yates, Patsy M. and Edwards, Helen E. and Nash, Robyn E. and Walsh, Anne M. and

Fentiman, Belinda J. and Skerman, Helen M. and McDowell, Jan K. and Najman,

Jake M. (2002) Barriers to Effective Cancer Pain Management: A Survey of

Hospitalized Cancer Patients in Australia. Journal of Pain and Symptom Management

23(5):393-405.

Reluctance to use analgesics and inadequate reporting of pain have been well documented as barriers to optimal cancer pain management

Despite the fact that cancer pain can be controlled in 90% to 95% of patients with effective pharmacologic and nonpharmacologic approaches, unfortunately, unrelieved pain remains highly prevalent

patient beliefs about pain control also are a primary obstacle to effective pain management

Enhancing management of cancer pain: Contribution of the internal working model

Lin, Chia-chin Ph.D., R.N. Cancer Nursing

Issue: Volume 21(2), April 1998, pp 90-96

Assessment of patients’ beliefs or concerns about pain and pain treatment, meanings associated with pain experiences, intentions to follow prescribed treatment, and expectations about relief of pain comprise the crucial first step in successful management of cancer pain. Clinicians are in an important position to assess these components within the patient’s internal working model. However, it may not be correct to assume that patients are the only group in need of assessment. Family caregivers play a crucial role in pain management for patients with cancer.

Patients’ reluctance to report pain and to use analgesics are considered major barriers to pain management.

Despite scientific and medical advances that have provided a better understanding of pain and its treatment, much pain still goes unrelieved

The most frequently mentioned barriers for both patients and professionals were knowledge deficits, inadequate pain assessment and misconceptions regarding pain.

Nurses need to be aware of the barriers, the patient’s fears in particular because nurses are exquisitely trained to address these fears with their patients and often have the most intimate relationships with their patients. They have the insight to be aware of what might be serving as an obstacle to good pain control.

Overcoming Patient-related Barriers to Cancer Pain Management for Home Care Patients: A Pilot Study

Chang, Ming-Chuan MS, RN; Chang, Yue-Cune PhD; Chiou, Jeng-Fong MD, MS; Tsou, Tsung-Shan PhD; Lin, Chia-Chin PhD, RN

Cancer Nursing

Issue: Volume 25(6), December 2002, pp 470-476

Studies have demonstrated that patients don’t want to talk about symptoms with their oncologist, because they are afraid to distract the oncologist from the cancer care and are concerned that if they report symptoms they won’t be a candidate for clinical trials. Through their skills and education, nurses can address these concerns with patients and family members. Pain management really needs to be directed not just to the patient but also to the family. You could have done the best education for the patient, but if the spouse is very anxious about opioids, he or she will send messages to the patient to withhold the drug.

Morphine is the most commonly used opioid agent for moderate-to-severe pain because it’s widely available in a variety of doses and forms,

Physical and psychosocial methods can also be used with drugs or alone to help control pain in cancer patients.

Several studies have documented that cancer pain is often undertreated.4 Unrelieved pain can have profound consequences for the patient and his or her family. It can lead to depression, loss of sleep, and poor appetite; prevent the dying patient from experiencing enjoyment; and create a sense of hopelessness. It has frequently been cited as a major justification for those who seek legalization of physician-assisted suicide and euthanasia. Yet, most pain at the end of life can be treated with simple measures.4 The physician needs to be not only skillful in effective pain management at the end of life but must also appreciate the special approaches to pain management and drug prescribing in the older patient.5

Whereas pharmacologic interventions are the mainstay for chronic pain management, nonpharmacologic approaches may be very beneficial and synergistic to drug treatments

Neurosensory stimulation techniques such as acupuncture and transcutaneous electrical nerve stimulation (TENS) can be helpful. Massage, exercise, heat and cold, and other interventions administered by a physical therapist can offer pain relief. Psychological approaches, such as counseling, music therapy, and biofeedback, as well as spiritual interventions, can be an aid to relieve pain.9,21 Osteopathic manipulative therapy offers an additional effective strategy to pain management.24 Effective pain management is truly interdisciplinary. It is important that the physician recognize the role that multiple health care professionals have in the management of pain at the end of life.5,7,17

Morphine is the opioid drug of choice; it is versatile, affordable and readily available.

It is administered orally and has a half-life of about 2 – 2.5 hours. Except in

patients in renal failure, it has no danger of accumulation.

As per WHO recommendation, [6] oral route is the preferred route of administration for cancer pain.

Identifying patient barriers to analgesic use is an important nursing consideration. Patient barriers influence pain reporting of pain, adherence to analgesic therapy, and quality of life. Early assessment and intervention for these barriers are essential, and may be effective in ensuring adequate analgesic use and in identifying appropriate nonpharmacologic pain therapies.

Recent research supports some of the older methods of nonpharmacological pain control such as distraction, especially humor; relaxation using the patient’s own memory of peaceful events; and cutaneous stimulation, especially use of cold. Cutaneous stimulation may even be effectively used at sites other than the site of pain

The role of non-pharmacological approaches to pain management is evolving, and it is likely that some non-pharmacological and complementary therapies may have an important contribution to make to holistic patient care. However there is no strong evidence to support their analgesic effectiveness, particularly in cancer pain.

Hypnotic relaxation is the most frequently cited form of non-pharmacologic cognitive pain control. Hypnotic relaxation may be defined as a deeply relaxed state involving mental imagery (Woody et al, 1992; Hammond and Elkins, 1994; Elkins, 1997). Hypnotic relaxation in the treatment of cancer patients involves the use of relaxation and mental imagery to induce relaxation, reduce anxiety and distress, and help patients detach themselves from obsessional thoughts (Araoz, 1983). Hypnotic relaxation has been found to be of significant benefit in reducing anxiety (Wadden and Anderton, 1982; Elkins, 1986). Furthermore, patients who develop anxiety disorders may be more hypnotizable than others (Frankel, 1974).

In the use of hypnotic relaxation for pain management, the focus is on instructing the patient in relaxation and mental imagery. The patient learns a cognitive method of pain management which is utilized at the discretion of the patient and within the patient’s own control. The successful effect is to introduce a non‑pharmacologic method of pain control that may decrease unnecessary dependency on analgesics for pain. Hypnotic relaxation is a safe method, which, when properly used, has no harmful side effects.

Cancer patients frequently experience anxiety due to anticipation about the illness, anticipation of potential treatment-related side effects such as nausea and vomiting, or anticipation of entering the final stages of life (Roberts et al, 1997). Kraft studied hypnotic relaxation in the management of 12 terminally ill cancer patients and reported a reduction in anxiety and depression (Kraft, 1990). Our experience has indicated that hypnotherapy is well accepted by cancer patients and is a powerful adjunct to the usual standard of oncology care (Marcus et al, 2003 a, b, c, d; 2004 a, b, c).

Pain should be considered in its totality of impact. Pain must also be considered in its temporal existence. Every patient will be able remember a time prior to the advent of the cancer and its attendant pain. Pain exists in the moment, and that is generally the patient’s primary concern. The clinician needs to keep in mind that the pain should be treated in a prophylactic manner. When pain is present, a certain amount of anxiety must be considered to be in evidence. The anxiety may be overtly visible or it may be covertly in evidence by its conspicuous absence. Anxiety may manifest itself in the family. Understanding and awareness of the patient’s anxiety about impending pain and the clinician’s role in preventive management needs to be conveyed to the patient to allay this anxiety.

Interventions such as hypnosis can increase the patient’s feeling of self-efficacy and mastery of their internal and external environments. As the patient becomes less anxious and increasingly competent in their use of self-hypnosis to manage their pain, their attendant anxiety frequently is diminished. This may have a similar effect on the family system as family members see their loved ones coping better with the pain.

Introduction

When a patient enters the healthcare system, we assume that the person will be treated with sound judgement and treatment will be based on objective, evidence-based practice parameters set by reliable research. We rarely, if ever, anticipate that the clinical decision making may be influenced by the patient’s attributes such as religion or socioeconomic status or any other feature that is not relevant to their treatment. The United States’ citizens pride themselves in our democratic form of government and equal opportunity for all. Some may take for granted that the healthcare system provides equally. But does it? What if there are some facets of healthcare that favor one portion of the population while hindering another? What if that hindrance was affecting virtually half of the adult population—adult women. There is evidence to support that women do not receive equal care not only in the United States, but internationally as well. To understand this topic fully, we must clarify a few related terms.

The Cambridge Dictionary defines gender bias as “unfair difference in the way women and men are treated” (“Gender Bias,” n.d.). Literature related to gender bias in healthcare primarily focuses on situations in which women are examined, diagnosed, referred, and treated differently and at a lower quality than men with comparable health concerns. As a result, women may have higher complication rates, higher morbidity, and increased mortality. Bias, whether conscious or subconscious, can come about from assuming uniformity between male and female patients where there are substantial differences in physiology and overall response to treatment or assuming differences where none occur. Either assumption can cause flawed, stereotypical assessments about women and men that may impact how healthcare providers practice and deliver care. One example is minimizing a woman patient’s complaints of symptoms of pain, attributing them to emotional causes rather than physical (Unruh, 1996, p. 129).

To clarify, this review is not equating the problematic of gender bias in healthcare with the issue of gender disparity. Several clinically substantial differences exist between women and men related to prevalence, clinical presentation, therapy management, and outcomes of CVD. An example is that women who present several cardiovascular risk factors including diabetes are less likely to be prescribed lipid-lowering agents than men (Jarvie & Foody, 2010, p. 493). Differences between women and men are quite common and deserve recognition. However, when differences in healthcare and treatment are due to gender bias, a more pressing concern calls for our attention owing to the potential to harm patients.

Not everyone agrees that gender bias exists in healthcare. Kadar (1994) said that one physician stated “It is commonly believed that American healthcare delivery and research benefit men at the expense of women, the truth appears to be exactly the opposite” and continued to cite women’s higher life expectancy as evidence that women receive better medical care. Many recent reviews continue to uphold research evidence of gender bias in healthcare internationally, which includes a wide spectrum of clinical areas ranging from pain management, surgery, and orthopedics to behavioral and mental health. This review will examine that literature, cite research targeted to critical care, and consider some implications of this information.

Evidence of Gender Bias

Behavioral Health

A study aimed to detect gender-sensitive signs of mental health in economically diverse areas that used data from the national databases in Columbia, Peru, and Canada in a multidisciplinary context proposed by the World Health Organization. The study showed that the most significant inequalities for women were depression, anxiety, suicide attempts, use of mental health services, and alcohol dependence, and female-to-male prevalence ratios for mental illness ranged from 0.1 to 2.3 (Diaz-Granados et al., 2011). The authors hope for a reduction in gender inequalities in all three nations.

Peripheral Arterial Disease

With many cardiovascular disorders, intensive risk-factor modification is imperative in peripheral arterial disease (PAD) to reduce the risk of problematic events. The American College of Cardiology and American Heart association have set forth guidelines for the use of aspirin, statins, and angiotensin-converting enzyme for peripheral arterial disease inhibitors after a patient is discharged for peripheral arterial surgery. Despite those guidelines, however, those therapies are irregularly prescribed to both women and men. Women are far less likely to receive beta blockers, antiplatelet, or lipid-lowering treatments and/or medications for either PAD or cardiovascular disease (Smith et al., 2011, p. 2458). Additionally, treatments for PAD are comparable for men and women. However, women are less often given the option of surgical revascularization. Reasons for this include women’s age at disease onset which is typically higher than men’s, worse post-surgical outcomes, as well as psychosocial factors. A recent discovery that women are offered surgery less in every age group researched for carotid endarterectomy implies that factors outside of age and risk may impact the decision to offer this surgical option to women (Poisson, Claiborne Johnston, Sidney, Klingman, & Nguyen-Huynh, 2010, p. 1892). These results are more alarming given that the female gender is a recognized and negative risk factor for cardiovascular interventions in peripheral arterial disorders.

Critical Care

Beery (1995) noted nearly twenty-five years ago thirty different aspects of gender bias that have been acknowledged in transfers or referrals of female patients with coronary artery disease for diagnostic and therapeutic treatment such as angioplasty, coronary revascularization, implantable cardioverter defibrillators (ICDs), and heart transplants. This partially explains why women who are older and have worse symptoms suffer from more complications and comorbidities by the time they do get treatment and why their results and outcomes are worse than those of men. The results in a summary published by the European Institute of Women’s Health in collaboration with the World Health Organization also support this notion. Women with heart disease tend to be older than their male counterparts when first hospitalized, more prone to risk, and receive substandard care in China, India, and western Asia (“Gender Bias Continues in Heart Health”). Clearly, the issue of women not receiving equal and adequate medical treatment for heart disease has not progressed in more than two decades.

Abuful el al (2006) designed a 2-part study to compare medical professionals and physicians’ attitudes with their practice in preventative care for CAD in Israel. This “attitude study” assessed the attitudes of 172 physicians toward treatment and care of two hypothetical patients, a 58 year old male and a 58 year old postmenopausal female, with identical clinical and laboratory data and mild coronary atherosclerosis on angiography. In the “actual clinical practice study,” researchers examined lipoprotein levels and prescriptions for lipid-lowering medications from the medical records of 344 male and female patients with angiographic evidence of CAD. The “attitude study” discovered that “physicians in general considered the male patient to be at higher risk and prescribed aspirin (91 vs. 77%, p < 0.01) and lipid‐lowering medications (67 vs. 54%, p < 0.07) more often for the male patient.” Assessment and evaluation of the medical charts of patients with CAD revealed that patients with baseline low‐density lipoprotein cholesterol > 110 mg/dl, 77% of the males received a lipid‐lowering medication, compared with only 47% of the female patients (p < 0.001). The researchers concluded that they revealed clear evidence of gender bias in both attitude and actual clinical practice of secondary therapies for patients with CAD.

Reasons for Gender Disparities/Bias

There are a variety of reasons that have been offered to explain the inequalities among men and women in healthcare that seem to imply prejudice related to the patient’s gender. Some of the potential reasons include the following:

• Misunderstanding a woman’s risk for health problems or complications (Jarvie & Foody, 2010)
• Differences in the way women experience cardiac symptoms (Beery, 1995).
• Differences in the way women perceive themselves and their illness (Beery, 1995).
• Patients may have misperceptions of indications, risks, or benefits of surgery. Women are less likely to discuss medical concerns with physicians(Borkhoff, Hawker, & Wright, 2011).
• Differences in communication methods that women and men use to describe their symptoms or injuries to the physician. (Birdwell, Herbers, & Kroenke, 1993).
• Unconscious prejudices among physicians—social stereotyping (Borkhoff et al, 2008).
• Blatant discrimination based on sex in that some physicians do not take women’s symptoms seriously (Borkhoff et al, 2008).
• Cultural biases, especially among older male physicians (Laino, 2006).
• Women thinking of stroke and heart disease as men’s diseases (Laino, 2006).

There is no knowing for certain which factor or combination of factors that lead to gender biased situations in healthcare. Various scenarios may be influenced by various factors. Additionally, no medical professional has suggested that this evidence or clear bias against women is intentional. It is crucial, however, to keep in mind that gender bias doesn’t need to be intentional to be harmful. In fact, gender bias can enter and influence healthcare in the most subtle and undetected ways.

Related:


Implicit Bias in Women’s Healthcare

Conclusion

The abundant discrepancies between the care that men and women receive deserve more than notice. Diagnostic procedures are not performed, therapeutic drugs are not prescribed, and referrals are not made and these discrepancies are hindering the life and well-being of women internationally. As healthcare professionals, we can initiate an approach to the problem of gender bias in three ways: identification, recognition, and modification. Acknowledging that not only does gender bias exist, but that it may influence several aspects of healthcare decision making and monitoring from the physician to the patient may be a starting place of eradicating gender bias and its influence. Utilizing tools that can assist in ensuring equal opportunity for healthcare are contained in various sets of evidence-based protocols and guidelines. When cases of gender bias occur, and are confirmed, they will need to be communicated to those responsible for patient care so that all investigations can be swiftly and promptly performed to reveal the causes and develop appropriate solutions to correct patient care.

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Introduction: This assignment illuminates the use of ethical decision making model in taking decisions while managing patients in their best interest. Ethical decision making is very challenging for the health care professionals while working for the benefits and the interests of the patients.

While caring for the dying or the terminally ill patients, health care providers address various issues of pain and suffering in relation to the psychological, spiritual, mental and physical complexities of the person having the terminal illness.

The ethical decision making models act as guide to make decisions in different complex situations addressing various issues which includes ethical principles, person’s own values and beliefs, institutional policies, legal considerations and social values

Nurses can improve results of ethical decisions by:

• preferring client wishes.

• encouraging the importance of ethical issues in care of patient.

• obtaining necessary consultation on ethical concerns

• becoming involved in the development of policy on ethical issues

• advocating for safe and competent nursing care within Alberta communities

• encouraging and facilitating cooperation and collaboration between professionals and

between agencies to effect improvements within health care

• participating in the development of practice standards, issues statements and position

papers on professional issues

• working with colleagues to identify crucial ethical issues for the profession,

including:

− the implementation of evidence-based practice

− shaping the direction of health-care reform

• linking of resource allocation decisions to client outcomes

In this assignment i am going to use STORCH Model for ethical decision making.

This model was developed by Jan Storch for use in health policy decision making, but later it was adapted for use in ethical decision making.

Dr. Storch suggested the use of this circular model as a way of reminding us that it is important to return to each consideration as we move towards decision making. This model involves three major steps:

Information and identification

Concern

People/population

Ethical components.

Clarification and evaluation.

Ethical principles— Autonomy

Nonmaleficence

Beneficence

Justice

Social expectations and Legal requirements

Range of actions/ anticipated consequences

Professional code of ethics

One’s values’ beliefs, values of others and value conflict

3. Actions and Review.

Case study: Eighty four years old Mr. Adam, was admitted to the ICU. He has been suffering from throat malignancy for 18 months. Now his disease condition has become worsen. His life expectancy is about 3 months. He has difficulty in breathing, difficulty in swallowing and cries with pain. He is on mechanical support and has nasogastric tube in place. He lives with his 82 years old wife.

He was a active social worker. His wife tells that he believes in living life in a productive way. He used to drive cancer patients to the rehabilitation centre voluntarily. He has two daughters who live in Ontario, but now they are here to visit their father. He requested the nurse to remove the nasogastric tube and mechanical ventilation as he does not want to live life in this way. His wife agreed to his decision as she does not want to see him suffering anymore. She want him to die peacefully and painlessly.

According to Storch Model of ethical decision making, in this case scenario,

Information and identification: Nurse Need to gather all the information regarding Mr. Adam.

Nurse can arrange a family conference including his wife and the daughters also the family physician can be involved. She should listen to the views and concerns of all the family members related to the request of the patient.

Nurse should consider the medical condition of the patient, Mr. Adam is terminally ill and now as his condition has become worsen he has become totally dependent on life support system. He has severe pain which he cannot tolerate.

His life expectancy is very short and the prognosis is really poor.

Mr. Adam is suffering from throat cancer and is on the last stage but his decision making capacity can be intact, so nurse should assess the reason for his decision. Nurse should assess if there is depression, as it may effect the decision of the patient.

Mr. Adam is staying alone with his wife, so the financial resources may be limited to bear his stay in hospital.

He was an active social worker. Mr. Adam used to drive cancer patients to the rehabilitation centre. He may have strong social connections and a positive quality of life.

Mr. Adam believes in active living of life not in this dependent manner and he spends his life living for others and helping others in their time of need. He had very positive attitude towards life. He believes in life worth living rather living.

Nurse should assess the expectations of his family regarding the condition of the patient. Mr. Adam’s wife and daughter should be asked about their expectations for Mr. Adam’s health status and prognosis. His daughters live far away from him so they may not have as much familiar with his condition as Mrs. Adam do.

Nurse can consult the doctor regarding the condition of the patient and also about the outcome of the decision.

Identify the surrogate decision makers for Mr. Adam.

According to the second step:

Clarification and evaluation: nurse should assess the different values associated with Mr. Adam.

Mr. Adam’s personal values regarding life are worth living life. He believes in living life in a productive and positive way.

Nurse should assess the cultural values of the patient, what role cultural values play in his life. What his culture says about life and death.

Nurse should also keep in view the religious values of the patient. What role does his religion play in his life? If the religion allows for hastening the death process.

Professional values

play an important role in ethical decision making. Nurse should consider the professional values associated with the removal of life support system.

Nurse should assess the values of the family members regarding the decision of hastening death of their family member.

Mr. Adam’s wife is in favor of his decision to remove life support as she does not want to see him suffering. She wants him to die peacefully and painlessly.

Consider the ethical principles.

Principle of Autonomy: According to this principle patient has the right to decide for himself, here in this case Mr. Adam is autonomous and deciding removal of life support system. He tells the nurse that he does not want to live life like this.

Nurse should respect his autonomy towards the life and should consider his decision and wish while taking actions.

Principle of non maleficence: According to this principle nurse should do no harm to the patient. In the above case scenario,

patient want to stop the life support and continuing the treatment may go against the principle as it is against his wish.

Principle of beneficence: According to this principle, nurse should do good for the patient. Here patient is asking for stopping life support system but it does not provide any benefit towards his condition at the same time it works in favor of his wish to die.

Principle of justice: According to this principle, all persons should be equally provided with health care services. In this case patient is provided with required health care needs.

Consider the social expectations and legal requirements:

Nurse should look for any similar history in the hospital. Identify any previous similar case in the institution, so that she/he can look for the policies and steps that can be taken.

Nurse should check the hospital policies regarding the hastening of death of the patient. She should assess that what steps can be taken according to the policies.

Nurse should ask for any legal documentation of client’s decision making authorities. She can ask for any legal will or advance directives.

While considering the different aspects of model nurse should assess that what possible range of actions can de done.

Considering the information provided, Mr. Adam is a strong social human being, he spent life doing productive, now as he is chronically sick and dependent which for him is not worth living. He is old and the life expectancy is poor also it gives him severe pain. His wife want him die peacefully. And also the financial sources may be limited to continue life support.

The ethical principles gives him the right to decide for himself.

According to Canadian Nurses association code of ethics for registered nurses, there are seven primary nursing values:

1. Providing safe, compassionate, competent and ethical care

2. Promoting health and well-being

3. Promoting and respecting informed decision-making

4. Preserving dignity

5. Maintaining privacy and confidentiality

.

6. Promoting justice

7. Being accountable

( CNA code of ethics for registered nurse)

Nurse should consider the professional code of ethics while making decision for the patient that whether she is going according to provided professional guidelines.

In this case nurse should follow the professional code of ethics while caring

And deciding for Mr. Adam.

Nurse can consider her own values and beliefs regarding life and death in empathizing and understanding the needs of the patient and family.

Nurse should understand the values and beliefs of the persons involved in the decision making for the patient. How the stopping of life support system effect the family members? What they believe about death process?

Mr, Adam’s wife believes in his peaceful death.

Nurse should assess if there is any conflict between the values of patient, family members , profession, culture, religion.

Action and review: in this case scenario action must be decided according to the various perspectives proposed by the model.

Nurse can check what she can provide to the patient, whether the request to hasten dying is made under depression or really in relevant means to patient.

If it is due to depression, what nurse can do to promote and facilitate calm and peace to mind of patient.

How she can provide compassionate care and peaceful death to the patient.

If patient really wants to die, nurse should t check what she can do while regulating the hospital policies.

All the perspectives given by the model should be reviewed before taking any actions.

Conclusion: In the nutshell, I can say that Storch Model is the best suited model to the above case scenario as it covers all the issues and perspectives related to the decision. The ethical decision making skill can achieved by reading literature and with the practice experience. These decisions play important role in the lives of patients and nurses as well. There is need of ethical relationship between patient and nurse. There should be better understanding of nurses own values, beliefs, patient and his values and beliefs, professional values , institutional policies.