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Raden Ahmad Dedy Mardani, MNS
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OtonomiKemurahan hatiKeadilanNonmaleficen
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1. Penjelasan danpersetujuan
erahasiaanKompetensi
!e!erapa hu!un"an!iaya
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!e!erapa masalah persetujuan eti a !e erjaden"an oran" de#asa yan" le!ih tua mun" intermasu memasti an apasitas de#asa yan"le!ih tua $untu memahami formulir persetujuan
dan mem!uat pilihan dan layanan pen"o!ataneputusan eprihatinan independenKeya inan% elompo ter ait tentan" $ esehatanmental$ dan psi oterapi dapat san"atmempen"aruhi oran" de#asa yan" le!ih tua
eya inan tentan" layanan ini, sehin""aesadaran eya inan ohort mem!antu dalammemahami am!i&alensi !e!erapa de#asa yan"le!ih tua atau een""anan untu menerimalayanan psi olo"is.
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'su%isu tentan" erahasiaan yan" le!ih umumdi antara oran" de#asa yan" le!ih tua
termasu masalah penyalah"unaan tua,mem!ahaya an diri, dan pelepasan informasiepada an""ota eluar"a dan profesional
lainnya
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(e erja den"an oran" de#asa yan" le!ih tua!isa san"at !ermanfaat dan menantan"
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Dilema umum men"enai !e!erapa hu!un"andan oran" de#asa yan" le!ih tua mun" intermasu $pere"an"an$ !atas%!atasprofesional ji a jasa profesional yan"disedia an di rumah lien seserin" dapatterjadi eti a mo!ilitas dan a sesi!ilitasmun" in ham!atan untu unjun"an antor
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pen"etahuan tentan" Medicare elaya an,prosedur, dan opini tentan" apa ah atautida untu menerima pem!ayaran Medicareadalah isu%isu profesional pentin" untudipertim!an" an
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1. Ne"ati&e Attitudes). Prioriti*ation of resources+. Professional disa"reement
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here is a #idespread cultural !elief thatolder people ha&e li&ed their li&es and do notconstitute a "roup of patients that should !eprioriti*ed in the allocation of health careresources.
he lac of no#led"e of "erontolo"y #ithinother professional specialties, made themfeel frustrated.
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e nolo"i dan sum!er daya manusiaPandan"an manusia dan ilmu pen"etahuandalam profesi medis cenderun" men"an""appenya it umum dan oran"%oran" yan" tidamenari .-al ini terhu!un" e hirar i medis danprestise, dimana te nolo"i edo teranter"antun" di atas.Pen"a uan dan pen"halan" pilihan yan"!er aitan den"an e!erhasilan se!a"aipeneliti dan eahlian linis diremeh an
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A "ood #or in" climate concernin" treatmentand non%treatment.
'n some cases, the decision to stop
treatment #as inconse uent in that somesymptoms and dia"noses #ere treated andnot others
he lac of conse uent decision%ma in" and
lac of communication #ith physicians madeit dif/cult to esta!lish "ood communication#ith patients and their relati&es.
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1. Feeling powerless). 0eelin" moral outra"e+. rustin" oneself
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he nurses e pressed feelin" emotionalstrain due to the ethical challen"es #ith#hich they #ere faced.
Patients and relati&es had demands ande pectations of the nurses that needed to !efollo#ed up.
he nurses emphasi*ed that they #ere doin"their outmost to satisfy the needs of the
patients. 2ooperation and communication #ith other
professionals #as not al#ays satisfactory andthis led to a sense of feelin" po#erless.
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he nurses found it painful that there #ereinade uate resources to care for the olderpatients in a proper #ay.
he nurses felt "uilty to#ards the patients asa result.
he ne"ati&e attitudes to#ards the olderpeople in society and amon" collea"ues inother specialties added to their feelin" of
"uilt. hey emphasi*ed that feelin" frustrated and
!urnout had ne"ati&e impacts on their self%esteem and the respect for their profession
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he nurses felt that it #as dif/cult to "ainprofessional reco"nition from physicians andsometimes they disa"reed #ith thephysicians a!out the treatment of thepatients
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1. Meetin" the patient). (ein" responsi!le
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hey emphasi*ed that patients are differentand that it #as important to attend to theirindi&iduality
hey emphasi*ed the importance of ta in"the older patients seriously and relatin" tothem respectfully
he older people represent a richness and
specter of people #ho are #ise, e periencedand e citin" to listen to.
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he nurses felt responsi!le for pro&idin" "oodcare for older patients, as they #ere &ulnera!leand often #ea , especially the patientssufferin" from dementia.
he nurses #ere frustrated #hen they had touse coercion or restrain patients sufferin" fromdementia
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1. Professional a#areness of o#n moralreasonin" and decision%ma in" presupposesdiscussions of moral dilemmas and couldincrease the readiness to act in similarsituations.
). 3thical decision ma in" in nursin" is "enuinelyin4uenced !y other professionals, collea"uesand the or"ani*ation.
+. hus, interdisciplinary participation indifferent forums for ethical discussion isstron"ly recommended.
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