Terminating the Patient-Provider Relationship Essay Example for Free

Terminating the Patient-Provider Relationship EssayIntroductionProblem OverviewWith the advent of 21st speed of light medical technology, health bid surgerys, good and legal considerations and scopes of practice among health cover suppliers have become greatly complex. harmonize to Servellen (1997), one of the most confronting expels of the juvenile provider- enduring kinship is the often misunderstanding of accountability, responsibility and indebtedness of deal out measures towards the persevering (p.334).Legal considerations of providing treat and craft of obligation of the provider towards the longanimouss start when the health criminal maintenance professional enters into a relationship with a enduring. However, the agreement of rush relationship does not only require role of the provider. According to Scott, Ed and Scott (2005), compliance of the enduring throughout the business procedures rendered by the provider is another signifi hind endt component of caring process (p.162). In fact, providers include initial assessments on endurings level of compliance prior to the start of alimony process, and more master(prenominal)ly, health professionals inform the forbearing about the written policy imposing the responsibility of the affected role to comply with the process of health bearing interventions.As considered by Ameri contri moreovere Academy of Nurses, if the diligent becomes noncompliant or initiates actions violating professional rights of provider or the patients rights, the provider possesses the benefit of terminating the working relationships as considered by the appropriate grounds (Scott, Ed and Scott, 2005 p.162). On the other hand, if the provider terminates the relationship, such professional finish now confronts the geld on breaching the pledged role of devoted financial aid and legal duty of service.Termination of patient-provider relationships is confronted by question whether or not conflicts surrou nded by the professional role of the provider and the legal duty to provide c atomic number 18 (Servellen, 1997 p.334). The current implementations of patient care disengagement largely depend on the institutional policy. According to Scott, Ed and Scott (2005), enclosure of the provider-patient relationship is justified when the patient makes a knowing, voluntary election to end the relationship, either unilaterally or jointly with the provider (p.162).Upon signing the consent of care, both participants of the care process obtain their own roles in the entire procedure of care. Mason (2004) emphasizes that the professional relationship with the patient apprize just be terminated due to personal or other improper grounds (p.307). Termination of care is only considered honorable and appropriate when (1) the patient has already reached the maximum benefit of the procedure as supported by clinicians judgment, or (2) when the patient has already achieved cure from the procedure.Howev er, termination of patient-care relationship on the ground of patient non-compliance imposes a conflict issue between duty of care and patients participatory role in the process of care deli very. As supported by Servellen (1997), the providers duties to the patient, involving a breach of duty, relates to the standards of practice for all health care professionals (p.334).According to Mason (2004), termination of patient care may result to a legal accusation of abandonment, which is the discontinuation of an established patient-provider relationship (p.307). According to AMA, a non-compliant patient is considered as a onerous patient and candidate for the reconsideration of patient-provider termination of care. However, termination of care essential follow appropriate procedures without interfering the continuity of patient care.Terminating the patient care somehow conflicts with the element of maintaining the continuity of care. As explained by Carter, Levetown and Foley 2004), noncompliant patients under reconsideration of patient-care termination still possess the rights of continuous care until another health care reliever has been reassigned (p.120). Moscow (2004) proves out that terminating patient care without proper reliever of care is automatically considered a liability against the established patient-provider relationship contract (p.120).According to Servellen (1997), despite the protective and patient-focused approaches of the provider, inevitable times wherein a provider is confronted with situations (e.g. DNR requests can sometimes impede to patients right of autonomy, etc.) that can possibly or actually impinge patients rights can still occur (p.335). According to American Hospital Association (AHA), the four basic consumer rights state that the (1) patient has the right to safety, (2) right to be informed, (3) right to choose, and (4) right to be heard (Servellen, 1997 p.335). Considering these components as part of the reconsiderations i n the honourable discussion of patient-provider care termination, it is indeed inappropriate to terminate the relationship set prior to the start of the process.As mentioned by AMA, provision of care towards non-compliant patients is still under the governance of the elements of (1) health care providers duty to provide continuous care, (2) fulfilling the expectations of care for the patient, and (3) carrying out the obligations of care (Mason, 2004 p.307). Terminating the care relationship set during the formal contract establishment between the provider and patient is automatically considered a breach in the legal nature of such relationship. Such action is a considerable ground for the legal liability of abandonment.Despite the issue on termination of care, there are still possible grounds wherein a health cares refusal to care can be considered appropriate. According to Servellen (1997), providers may terminate or refuse care process when (1) the procedure caries physical risks to either the provider or the patient, (2) rendered care violates patients rights to autonomy and self-determinations, and (3) religious or moral issues followed by either of the ii parties (p.335). According to Carter, Levetown and Foley (2004), the actual patient-provider relationship is founded on confidence and relationship, and not merely on legal holds or set contracts (p.120). Considering this as a form of assertion to the later reinforcement principles of patient-provider relationship termination, the issue on role fidelity arises as another essential consideration aside from autonomy and the contractual-based patient-provider relationship.Carter, Levetown and Foley (2004) emphasize the value of adhering to the moral and professional role of the nurse, and not solely limiting the care provision on to the patients level of compliance (p.120). Guided by the principle of patients trump interest and fidelity, Mezey and Berkman (2000) support the idea pointing out on the id ealistic elements of nursing practice wherein professionals should consider their importance in administering care under holistic and worldwide perspective regardless of potentially solvable conflicts (p.502).Despite of the relationship established after the setting of contact, the provider needs to consider the nature of non-equalitarian partnership and not the coequal partnership rather, leading, establishment of rapport and serving the best interests to as the patient as the care provider must all be considered. As supported by Shamus and Stern (2003), patient-provider relationship imposes a duty of unauthorized disclosure of contract care process without appropriate grounds (p.74).The 1996 health Insurance Portability and Accountability Act (HIPAA) indeed protect the patients from such decisions brought by health care providers. However, compliance and sets of patients participatory obligations throughout the procedure count significantly on the entire health care delivery pro cess (Shamus and Stern, 2003 p.74). Insurance of care does not only direct the obligations and tasks towards the provider but also from the patient. According to Earp, French and Gilkey (2007), patient-provider relationship is expected to work as an enhancing strategy for patients trust towards their health care provider. Furthermore, such relationship supports a therapeutic alliance and patient care processes involving high levels of trusts, rapport and patient satisfaction (p.195).By this principle, patients are indeed subjected to participate and cooperate in the process of health care delivery. However, in case the patient declines to participate, health care providers must not immediately terminate the procedure since they are no coequals of the patients and resistance towards care measures are sometimes inevitable. According to Rothestein, Brody and McCullough et al. (2001), health care providers must continuously administer care and interventions necessary for the well- macro cosm of the patient despite of the non-compliant appearance (p.620).In case the patient becomes notoriously incompliant to either selective or general procedures scheduled for administration, AMA suggests a series of assessment for the noncompliant behavior without involving ones professional role outside the scope of care provision (Mason, 2004 p.307). Furthermore, the patients decision to not comply entirely depends on himself or herself although, it is an important protocol consideration to check institutional policy for the proper consent documentation of such patients behavior.Most unexclusive institutions implement waiver signing when the patient refuses to take medicinal drugs for example. According to Earp, French and Gilkey (2007), this is done for the purpose of formality and protection from possible accusations of abandonment or care quality infringements (p.195). On the other hand, when provider-patient relationship is not anymore pursuing its beneficial state or heal th care alliance status, AMA suggests the termination of health care steering. As supported by Rubenfield and Scheffer (2006), the duty of the provider in relation to the physician-patient relationship includes (1) fulfilling the patients expected care, (2) carrying out the health care roles of the provider towards the patient, and (3) delivering care guided by the principles of fidelity and nonmalificence (p.96).If the provider has been lookd to satisfy all these criteria, the duty to treat or provide care to the patient is indeed not violated. However, if the patient pursues his or her state of noncompliance despite of the standards of care being administered and the potential of further causing harm to ones self, terminating the set provider-patient relationship is indeed justified. Nonetheless, as supported by the AMA Code of Ethics in 1998 Doc 1, p.5, physicians cannot withdraw from a case without giving see to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured (cited at Rothestein, Brody and McCullough et al., 2001 p.621).The health care provider is still tasked to service the patient until the reliever of care becomes available. Meanwhile, despite the legal recognitions in terminating the provider-patient relationship, the question still lies if whether or not the provider breaches his or her professional role as the higher component of the alliance considering the noncompliant state of the patient.Statement of the ProblemThe participation of both parties in the patient-provider relationship is an important consideration to the entire success of the health care delivery process. Once the provider accepts the task pf providing care to the patient, it is lawfully and professionally understood that the provider agrees to apparatus a transactional bond with the patient. According to AMA code of ethical motive, the setting of contract between the provider and the patient includes participatory roles from the two parties, and compliance to the higher participant of the alliance, the health care provider, must take the lead of health care management (Rothestein, Brody and McCullough et al., 2001 p.621). Added by Earp, French and Gilkey (2007), patient-provider relationship is even ideally characterized by high levels of provider informativeness, interpersonal sensitivity and partnership building (p.189).However, in some instances, patient may pose as the incompliant participant of the body system, which can greatly via media the delivery of care as well as the role function of the provider. As emphasized by Servellen (1997), if the patient manifests a noncompliant behavior towards the care being provided by the assigned health care professional, the code of ethics should rather consider the termination of the bonded agreement than forcing the two participants to maintain their relationship since this can actually be detrimental to both patie nts health and providers role (p.336).Hence, termination of patient-provider relationship in relation to patients incompliant behavior can be possibly done via appropriate process of separation mandated by the institutional policies. It is important however to consider the administration of the providers claims followed by the written acknowledgement signed by the patient. aft(prenominal) establishing an agreement of termination, the provider is expected to maintain the level of care being provided to the patient until the endorsement of the patients care to the assigned reliever. AMA has obligate significant abandonment liabilities once the provider terminates the established relationship without properly lovable to the set institutional policies. According to Rothestein, Brody and McCullough et al. (2001), terminating the established relationship between the provider and the patient without properly notifying, validating and documenting the said action will immediately hangout to legal liabilities (p.621). Termination of patient-provider relationship must be laid down to the patient for recognition and prevention of legal accusation of abandonment.Despite the valid points and supporting rationales in terminating the patient-provider relationship, the issue still lies questioning the appropriateness of termination in relation to the ideal practice of role fidelity and duty of care. Due to this very reason, we have proposed a descriptive and non-experimental acquire analyzing the legal, ethical and moral nature of terminating the set patient-provider relationship. The objectives of the memorize proposed are as followsTo determine the ethical stand point of terminating patient-provider relationship in relation to the ideal principles of (a) duty of care and (b) role fidelityTo determine the acquaintances of the patients on the potential effects of terminating patient-provider relationship towards the level of trust and health care satisfactionScopes and LimitationsDue to the continuously evolving policies of health care system, changes in the patient-provider relationship have also evolved progressively. Despite the idealistic principles of fidelity and duty of care, health care providers still encounter inevitable instances wherein the client becomes non-compliant towards selective or general interventions implemented as part of the care process. According to Servellen (1997), alternatively compromising the care delivered to these patients, code of ethics have now reconsidered the procedure-based termination of patient-provider relationship to prevent the delivery of reluctant or incompetent care management due to patients incompliance (p.327).However, Carter, Levetown and Foley (2004) and Mezey and Berkman (2000) assert that terminating patient-provider relationship violate the principles of duty of care and role fidelity since it is always the task of the provider to carry-out the needs of the patient as guided by the principle of patients best-interests regardless of the patients response to health care.In this proposed study, the primary goal is to determine whether or not the ideal principles of health care (role fidelity and duty of care) are breached once the provider terminates the established relationship with the patient. At the end of the study, the succeeding(a) questions must be answeredWhat are the supported grounds for terminating patient-provider relations approved by AMA and AAN? Cite the legal, ethical and moral comparisons between the two policies.Does the health care provider breach the established relationship once he/she requested for termination due to incompliant behavior?Significance of the StudyDespite the defined institutional policies supporting the process of termination, the issue on breached principles of health care still remains questionable. Federal health care organizations, such as AMA and AAN, have nice the issue and process involving the termination of patient-provider relationship on the grounds of non-compliance and failure to adhere to the providers instructions.According to Servellen (1997), during the times of the HIV epidemic, termination of care is considered professionally inappropriate hence, care provided towards these HIV patients became detrimental to the patients health due to the reluctance and exaggerated care measures implemented by these providers (p.327). The issue involving the termination of such established relationship covers both ethical and legal principles (e.g. role fidelity, duty of care, etc.) governing the pledged role of the provider and the assigned participatory role (e.g. patients rights, patients task of compliance, etc.) of the patient.Clarifying the care issues on the termination of patient-provider relationship is significant due to the following reasonsBy understanding the limitations and defined grounds of terminating the patient-provider relationships, the study can aid in identifying the relationships of e thical principles that shall answer the confronting issue of patient-provider relationshipBy understanding the legal and ethical considerations on patient-provider relationship termination, the study can help in defining policy proposals on the proper procedures for implementing the termination of patient-provider relationship The purposeual framework of the study illustrates the proposed program of implementation addressing the issue on termination of patient-provider relationship. The conceptual framework is based from the primary goal of the study to determine the base of the termination of patient-provider relationship. By ascertain the subjective responses from two types of savours, patients and nurses (selected provider population), the procedure should be able to reveal the ethical justifications and oppositions on the subject of terminating patient-provider relationship due to noncompliance. After determining the collation of responses, the procedure analyzes the data i n ordain to obtain significant relationships pertaining to the issue on breaching the principles of role fidelity and duty of care upon termination of such care contracts. course of instruction Proposalf.1. Research Design The study proposes a non-experimental and descriptively designed survey methodology as the program for analyzing the issue on termination of patient-provider relationship. exploitation the perception-based methodology, the study explores the different insights of the two parties involved patients and nurses/ providers in the issue targeted by the study. The proposed program utilizes open-ended questions depicting the different possible perspectives of the samples approval, opposition, suggestive towards the issue imposed. The design of the study relates to the patterns illustrated on the conceptual framework. The emphasis of the survey questions is derived from the primary goal of the study to determine if whether or not the termination of patient-provider breaches the concept of role fidelity and duty of care. The collated responses obtained from the survey are compared to the ethics analysis conducted in the literary reviews.f.2. Samples and Sampling Technique Used The study aims to achieve the keep down target population of 100 patients and 100 nurses proportionately divided into two different sample hospital locales. Using a simple random have method, selection of patient respondents is guided by the following criteria (1) 18 and above, (2) patients must be admitted deep down the hospital premises for at least two days, and (3) must be conscious and coherent. On the other hand, sampling criteria among nurses are as follows (1) must be licensed professional, (2) must be employed and working within the hospital premises, (3) must have at least 2 years of nursing experience from the surveyed hospital locale or other institution.f.2. Data pull together Procedure Data gathering procedures shall be composed of two different methodol ogies (a) ethics analysis conducted in the literary reviews and (2) survey methodology implemented on two groups of samples. Ethics analysis from the literature reviews comprise of the different ideas answering the ethical disputes on termination of patient-provider relationship. In the process of ethics analysis, the principles of role fidelity and duty of care involved in the issue are the emphasis of the analysis.The main objective of this procedure is to answer the ethical standpoints of the issue based on whether the termination violates the principles of role fidelity and duty of care. On the other hand, the second methodology deals with the perceptions answering the issue on breached principles of role fidelity and duty of care through the termination of patient-provider relationship. After gathering the results of the two data sources, the consolidation of data is conducted aiming to answer the primary goal of then proposed study.f.3. Instrumentation Survey questionnaires a re the primary instrument used for the gathering of data and responses from the qualified samples. The questions used have been derived from three categories inclined to the different possible responses of the respondents. Categories used include (1) approval, (2) opposition, and (3) suggestive. Using open ended-questions jibe to the four categories, the respondent must select their preferred side among the four categories. Approval selection depicts their positive response over the termination of patient-provider relationship, opposition is the reverse, and suggestive implicates the possible changes they want. The results of the survey are collated for the purpose of analysis and implications of data.f.4. Program Implementations In the process of implementing the proposed program for evaluation and assessment of the issue, methodologies shall comprise (a) ethics analysis via records review and (b) the qualitatively designed survey of the chosen sample population. Implementation pr ocess shall begin with the gathering of records and reviews on issues and bioethical discussions on termination of patient-provider relationship. In the process of analyzing the obtained data, the study shall document (a) the ethical principles associated to the termination issue, (b) the conflicting ethical principles, and (c) the violated ethical principles upon implementation of the issue. After gathering these three components, the data shall be analyzed drawing appropriate implications from the documentation acquired. With the acquired results from ethics analysis, we shall now relate these to the two principles role fidelity and duty of care that are hypothetically breached upon terminating patient-provider relationship. After the application of the second procedure, the survey methodology shall now begin its pilot study with a smaller sample population of at least 10 qualified respondents from the chosen research locales. During the process of pilot testing, the research pr ocesses involving the survey questions, respondent interaction, collation of data, analysis and interpretation of data shall be tested for proof and revision in case necessary. After the pilot study, the actual survey procedure shall commence targeting a population of 100 qualified respondents from each of the two hospitals chosen. Furthermore, 100 target samples from each institution shall be divided into two comprising of 50 qualified nurses and another 50 qualified patient respondents. The total sample population shall therefore be 200 qualified respondents. After gathering the survey results using open-ended questions and simple random sampling technique, the results shall be collated according to the three categories of the questions used -(1) approval, (2) opposition, and (3) suggestive. The results shall be analyzed according to the data obtained from the records review. Implications associated to the ethical issue proposed (termination of patient-provider relationship) shal l be drawn from the results of the interview. With the implications and analysis of the survey results, the next procedure integrates the study results from the records review and survey results to draw the general relationship between the perceptive study and theoretical ethical discussion on the issue proposed. Finally, the results drawn from the integration should answer the primary goal of the study. 1.5. PICO AnalysisTable 1 P.I.C.O AnalysisPopulationThe main subjects concerning the research topic are the patients and associated providers, such as nurses and physicians. Program implementations involve similar sample groups as well (patients and nurses).InterventionEthics analysis on patient-provider relationship utilizes the general overview of nursing and clinical care procedures (e.g. medication administration, wound care, etc.). On the other hand, the program implementation utilizes two interventions, specifically (a) Survey with corresponding questionnaires and (b) records analysis.ComparisonVariable comparisons involve (a) patient perception versus (b) nurses perception on whether or not termination of patient-provider relationship violates the principles of duty to care and role fidelity.OutcomesExpected results of the study differentiate among the two parties involved. Nurses perceive the termination an ethical consideration under the basis of noncompliance and breach in the contract of relationship set prior to care delivery. Meanwhile, patients perceive the termination as an ethical breach since the tasks of the nurses must always comply with the duty to care and role fidelity.ConclusionIn summary of this research proposal, we aim to determine the ethical standpoint of terminating patient-provider relationship on the grounds of patient incompliance despite the set agreement and principles governing the role of the health care provider.Since termination of patient-provider relationship has already been adjudge by federal organizations (e.g. AMA, AAN, etc.), we determine if such termination of accounts on the basis of patients incompliance breaches the ethical principles of role fidelity and duty of care. In order to strengthen the ethics analysis of the issue, we have incorporated a descriptively designed survey method to obtain the perceptive response of both patients and nurses towards the imposed issue. After collating the results of the survey, the next step is to integrate the results obtained from the records review and from the survey conducted.ReferencesCarter, B. S., Levetown, M., Foley, K. M. (2004). Palliative do by for Infants, Children, and Adolescents A Practical Handbook. London, newborn York JHU Press.Earp, J., French, E. A., Gilkey, M. B. (2007). Patient Advocacy for Health Care Quality Strategies for Achieving Patient-centered Care. New York, U.S.A Jones Bartlett Publishers.Mason, J. (2004). Concepts in Dental Public Health. New York, U.S.A Lippincott Williams Wilkin.Mezey, M., Berkman, B. J. (2000) . The Encyclopedia of Elder Care The Comprehensive Resource on Geriatric and societal Care. London, New York Springer Publishing Company.Rothstein, M. A., Brody, B. A., McCullough et al., L. B. (2001). Medical Ethics Analysis of the Issues Raised by the Codes, Opinions, and Statements. London, New York BNA Books.Rubenfield, M., Scheffer, B. K. (2006). 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