Please respond to the discussion  and answer the question

Is the patients autonomy being respected by involving her in the decision-

making process?

No the patients Autonomy is being violated. The principle of autonomy asserts that individuals have the right to determine their own actions and the freedom to make their own decisions. Respect for individual is the cornerstone of this principle (Black, 2017).The patient diagnosis requires her to have the strong pain medication to relieve the pain and since she is at the care facility under the supervision of the staff instead the physician and the family are against it. The physician does not ask the patient her opinion violating her rights. I see this happening a lot at my facility where family members want what they want to be done to the patient and not what the patient wants. If a patient is capable of making decisions they should be involved in the cares not unless they are not able, then the power of attorney should consulted and will make the decisions in behalf of the patient
How could a meeting of all parties involved have been more effective and/or ethical than piecemeal decision making?
The meeting could have helped to plan for and collaborate in the care and management of the patient. When all clinical and non clinical staff collaborates effectively, healthcare teams can improve patient outcomes, prevent medication errors and improve efficiency and increase patient satisfaction (Bhatt &Swick, 2017).The family should also be incorporated instead of them being negative about the whole issue.
What ethical principles do you see of concern with this case study?
Autonomy: The patient is not given the right to participate in her treatment she ends up not having relief from pain of which staff feels she is demanding. If the staff were able to carry out assessment they would have notified the doctor and would have involved the patient in determining the right medication to relieve the pain.
No maleficence: The doctor is not harming the patient in determining the right medication for the patient. But in this case he is only dwelling much on the family and not involving the patient. During my practice l have across the doctors who write orders or prescribe treatment to the patient according to the family wants and not what the patient wants.
Justice: The principle of justice is that equals should be treated the same and that unequal should be treated differently (Black, 2017). Justice is not exercised in this case the patient is in a lot of pain with no proper pain control.
Does the nurse have a moral responsibility to be more assertive in advocating for the patients relief?
Nurse should establish the therapeutic relationship with the patient and showing emphathy.The nurse should assess the pain level and find out the past medication history then notify the doctor. As a nurse being there and listening to the patient will calm the patient. The nurse can use non pharmacological interventions like cool packs and positioning the patient to help relieve the pain.
Given that the doctor is likely to see the resident only every two months, what role should the doctor take in assessing and monitoring the pain and its treatment?
It is such a long time for the patient to wait and be seen by the doctor .Pain assessments should be done every four hours and the nurse should notify the physician with severity. As a nurse would notify the director of nursing of the situation and she may collaborate with medical director of the care center to see the patient.
Explain the ANA Code of Ethics provision(s) you think is violated in the case study and why was it violated?  Describe how you could apply the ANA Code of Ethics in the case to uphold the provisions.
Provision1-The nurse should ensure that the patients dignity is respected during patient stay at the care centre and be supportive to keep the patient comfortable.
Provision 2: There was no commitment to this family or patient to help the cope with the pain the patient was having.
Provision 3: The nurse did not advocate for the patient. By careful documentation and assessment would have helped the doctor to come up with the right treatment for this patient.
Provision 4: Nurse did not exercise judgment and decision making in the care and management of this patient
Provision 5: Duties to others-Nowhere in the case study was shown where the nurse was dedicated to serving this patient.
Provision 6: The environment and ethical obligation-Not setting the environment that is conducive for the care of this patient. Is seen when staff states that the patient is very demanding
Provision 7: Collaboration with other health professionals-If the nurse would have collaborated with doctor with proper assessment and documentation the patient could have received the right treatment to help ease the pain. This was violated (ANA, 2015).
List one assumption pertinent to this case that you would like to check and why. The patient is capable of making decisions towards her treatment and care.
What other issues do you think this case explores?
How close the family is to this patient and how often do they visit her. Does the family know the pain medication? Does the sister understand about hippa?
Question: A100 year patient is admitted to your facility after sustaining a left sided stroke.
The patient is to undergo rehabilitation at your facility. You are the nurse who has been taking care of this patient and you have developed a nurse patient relationship. One day as you go to do morning cares the patient tells you that she doesnt want to do therapy and she want to die. When the family members come to visit you tell them about the patients wishes. They become so angry with you and that they go in the patients room to confront her and would like to talk to the director of nursing. How are the rights of the nurse and the patient violated? If you were the nurse how would you have handled the situation? 

References

American Nurses Association. (2015). Code of ethics for nurses: with interpretative statements. MD: silver Spring
Black, B. P. (n.d.). Professional nursing-concepts and challenges (8th ed.). St Louis, Missouri: Elsevier.
Bhatt, J., & Swick, M. (n.d.). American Hospital Association: Advancing health in America. Focusing on Teamwork and Communication to Improve Patient Safety. Retrieved from: https://www.aha.org/news/blog/2017-03-15-focusing-teamwork-and-communication-improve-patient-safety