Patient decisions in a domiciliary setting
Nurses working in the community frequently begin their professional relationship with a patient based on the reason for which their services were initially sought; but, as the relationship develops, community nurses can find that their strictly clinical expertise is not the only factor in the relationship which the patient seeks. This article looks at some aspects of the relationship between practitioner and patient which go beyond the strictly clinical and which attract further legal and ethical considerations. These further responsibilities may not have been examined in detail during training and can be learned only by experience.
There are numerous reasons why a patient may want, or require, a practitioner's help in making a decision while receiving treatment and care at home. The most obvious need is for information and support in deciding whether or not to accept something proposed by their nurse; and, if there is a choice between alternatives, which one to choose and why. Every decision bears on the patient' s future in the shorter or longer term and one of the most vital decisions is whether all the patient's surrounding circumstances indicate that care and treatment in their home can sensibly continue or whether it would be better pursued in a care home, in hospital or in a hospice. Such a decision places a particular burden on the treating nurse because their training and experience may well favour the maintenance of domiciliary care.
The fundamental principle guiding a patient's decision in their home is autonomy. Autonomy means that patients either decide on a course of action for themselves or at least feel free to decide which proposal or alternative from their nurse to adopt. Autonomy underpins the element which is always of the essence of treatment, namely consent.
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