Business Sustainability

Description of dilemma

To comply with the study, I have change the name of person involves for privacy and confidential purpose. This situation has happened when I was a part time paramedical staff assistant in a Government hospital as volunteer to help community in my home town 1 year ago located in city of Aden, Yamen where community casualties were normal due to low profile civil war between different powerful political and religious groups. This reflection is regarding the patient whose name is referred as to as Mr. Ali Imran.

Mr. Ali Imran, 69, was one of the patients referred to the Wound Care Team under myself as assistant Wound Care Nurse. . He was a private farmer in the village far from the Aden city. He lived alone in the house after the death of his wife a few years ago and he had no children. Mr Ali Imran referred for reasons of severe venous ulcers on the legs right up to the growing spread throughout her ankle. He suffered with the condition because of severe pain he experienced every time they touched the wounds and sores that do not heal the situation that lasted more than 10 years.

            Over the past 10 years, he just went to a nearby clinic (the lack of facilities and medical equipment) for the treatment of wounds. Due to his health history that also has diabetes, hypertension and acute heart disease complicate the healing process. Due to the less fortunate, he often did not attend an appointment for cleaning wounds or seek treatment for medication. Sometimes, he uses traditional treatment methods to clean the wound and do it yourself. The situation does not heal his wounds and grows so much that he had to be referred to hospital.

            After getting treatment for a month with modern treatment methods cleaning and dressing wounds (modern dressing), the satisfactory progress of his wound, he was given further treatment. The doctor suggested surgery to mend the skin (skin grafting) to help speed up the healing process of the wound. Before the surgery done, verbal and written consent was to be taken. However, after the description and recommendations were given, the patient refused this proposal and wants to dry the wound continued until his wounds heal. He refused on the grounds of financial problems and no one can take care of and accompany him during his stay in hospital later.

            As nurse responsible in helping to heal the wounds of Mr. Ali Imran, the dilemma faced by me is to determining what is the best for the patient and whether the obligation exists to provide appropriate care to older patients. The dilemma faced here is, meet the requirements of the autonomy of patients who were refused treatment recommendations thereon. By continuing dry wound, the patient may experience severe pain if the wound is in touch. With the large wound, and open, the risk of infection may also occur. In the meantime, patients also need to commute to get treatment within a relatively long time. This will burden the patients because of the cost to return to the clinic or hospital and treatment costs should be taken into account. The issue will exist when he refused treatment that has been proposed due to financial burden. Does the wound can be healed with only dry wound treatment alone? Is it possible the patient will comply with any treatment to be performed upon a present given by appointment? Where were Government healthcare programs for ageing citizens with financial assistance? His inventions can buy modern equipments for cleaning and dressing her wounds later? Could he wound will worsen if the patient back to their original treatment. However, if he agrees to do the surgery, the conflict also exists where another problem that will arise. Does the surgery will be successful or not? Can patients pay for her care costs later? Who will help him and accompany him later?