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Ethical Principles and LTC Ombudsman Program

Introduction and State Residence

The case scenario is of an elderly patient in skilled nursing facilities where she is treated with dementia. The patient was placed in SNF for competent services from skillful workers to help manage dementia. The patient is placed in a locked unit to protect themselves and access skillful services to manage her psychological issues. However, the recent event has been of concern after the resident became verbally and physically abusive, especially when he was close to other patients in the commonplace dining room, which has worsened the situation of other dementia residents. In one situation, a dementia resident helped staff from a combative resident, resulting in one of them falling, though no injury was witnessed. Despite the facilities’ management effort to address the situation, the residents’ aggressive behavior has continued. Thus, the professionals are more concerned with the patients’ and staff’s safety. The research will be applied to Hawaii. Hawaii has numerous long-term skillful nursing facilities to help patients with chronic mental disorders. Despite the patients’ aggressiveness, there is a need for the facility to institute a long-term ombudsman program to ensure ethical management of patients’ behavior and facilitate access to quality healthcare services.

Ethical Principle and LTC Ombudsman Program

The American code of ethics encourages nurses to uphold the four ethical principles: beneficence, autonomy, maleficence, and justice. The healthcare professionals in the LTF should embrace a high level of professionalism when engaging with patients to facilitate maximum outcomes. The first ethical concept is autonomy, in which medical care practitioners must respect the patients’ autonomy and their judgment. This involves collaborating with them and their families to ensure optimum services. The ethical code allows patients to determine their operations. In this case, the nurse professionals must guide the residents to understand the care needed by collaborating to establish care quality. The second ethical value is the beneficence principle which encourages medical professionals to do what is good for the patients. Although the patient has proven to be a danger to themself and others, the care provider needs to determine what is good for her. This can include showing her kindness and professionalism and avoiding discrimination because of her medical condition or other cultural factors. Beneficence promotes patient satisfaction and enhances care quality (Hawk et al., 2017). The beneficence factor would enable the hospital to foster interpersonal relations and lower anxiety and tension within the facility that affect the resident and other patients. The third ethical principle is malfeasance is the principle that encourages medical professionals to ensure utter care and reduce patients’ exposure to medical risks. The ethical complaisance principle ensures medical practitioners treat patients with high diligence to reduce their exposure to health hazards and risks. The principle discourages malfeasance from medical practitioners’ negligence and stereotypes that compromise objective thinking. The justice aspect ensures that the medical professionals offer fair treatment to their patients to guide them through the treatment process. Justice ensures medical professionals do not treat patients with biases but prioritize their wellbeing.

Different medical providers in the SNF ensure patients access high-quality care services. The primary care providers include nurses and general doctors. The responsibilities of general doctors are to diagnose and prescribe treatment for the patients. the nurse professional provides care to dementia residents, ensure they manage their drugs on time, respond to healthcare emergency, and offer counseling and therapy services to the patients. There are different nursing practitioners in the institution, including RN, LPN, AP. Other medical practitioners include psychiatrists and psychologists who offer cognitive-based therapy to enable patients to achieve better wellbeing.

The long-term care facilities provide medical and non-medical services to enable the patients to access quality care for an extended period. The SNF facility allows patients to interact with medical practitioners within a short period. The SNF and LTC facilitate emergency response, especially when patients experience extreme psychotic situations. The facility is ideal for patients with chronic illnesses which require constant attention. The LTC also enables patients to live for longer periods and achieve better well-being due to constant access to quality services. Another stakeholder is the LTC ombudsman, who develops programs to resolve situations relating to patients’ health, safety, welfare, and rights (American Medical Association, 2001). the ombudsman works with individuals and groups to enable them to manage and resolve conflict and problematic issues affecting the institution. The ombudsman, for instance, would help address the institution’s safety concerns following the dementia resident’s aggression.

The residents have the right to protect themselves from extreme aggression from dementia residents. The institution must develop a safety program that would enable patients to cope with the tense environment and reduce the dementia residents’ aggressive behavior. The institution’s professionals should not compromise their quality of care due to the violence witnessed but strive to create a qualitative institution.

If the situation is not resolved, the level of violence within the institution will increase exponentially. Dementia patients may become more aggressive and pose a danger to themselves and others. Failure to address the situation may also threaten the staff security, making it harder for professionals to administer required drugs on time, which may compromise the business operations. The tense environment may also affect the progress made to enhance the patients’ well-being. Increased conflict and violence expose the patients to a more vulnerable complex condition (Jongen et al., 2018). Thus, the institution must uphold the ethical principle of beneficence, justice, and autonomy.

LTC Ombudsman Program

The LTCO can adopt different programs to ensure the safety of the dementia residents in the facility is addressed. The LTC can visit the care facility and residents to identify and analyze the situation before advising the ideal course of action. The LTCO can advise the relevant agencies to either train professionals on handling violent patients, increase security surveillance, create a culture that promotes patients’ autonomy or encourage the transfer of the patient to another facility. The second program that the LTCO can adopt is discharging the resident from the psychiatric unit and returning to the nursing facility where he was before the event. These would allow the professionals in the nursing facility to understand the reason for aggressive behavior. The LTCO mat also collaborates with medical professionals to communicate with residents to scaritine their claims about the culture and treatment environment (Hawaii LTCO, 2020).

The LTCO may also encourage the professionals to adopt education and outreach programs within the facilities amongst the residents and medical; practitioners to create a conducive treatment environment. The ombudsman can advocate for emotional intelligence training for medical practitioners to increase their skills in managing violent patients. Lastly, the ombudsman can undertake personal and confidential consultation with the patients to find the root course of the violent engagement amongst the residents and the role of professionals in advancing the culture. The consultation will allow the stakeholders to find a satisfactory resolution to all concerns, issues, and complaints.

The barriers that can exist during the programs include poor communication between the ombudsman and the dementia patients. the patients may fail to recall the situation leading to biased information (Ahmed et al., 2020). There is also a high probability of interpersonal conflict, especially amongst patients, that may compromise the consultation quality. The team may also face low support from the medical professional leadership. The leadership may conceal some information. The potential resources that LTCO can provide are training manuals on handling tense environments, recommended training, or further funding to improve the facility.

Aspect C: FTC regulation

The regulation that applies in the situation is the Federal Older American Act (OAA). The OAA was established to protect older patients receive protection from elder abuse, job opportunity, health service and home assistance, and family caregiver support. The OAA is significant to the situation because older adults are the most vulnerable to dementia disorder. The Act requires the facility to ensure constant access to caregiver services and quality meals to enhance their wellbeing. The facility administrator must initiate a process to ensure patients feel safe and secure. The administrator can also train the staff to deal with aggressive patients to foster tranquillity (Jongen et al., 2018). The administrator can also establish an internal program that ensures residents access high-quality care services.

Training and development programs are one resource that the administrator can provide to help the staff comply with the regulation. The administrator can develop- training programs focusing on cultural competencies, emotional intelligence, and conflict management to enhance the staff competencies in confronting workplace issues that expose patients to greater risks.


The greatest threat that institutions face is a tense environment due to residents’ violence. The organization’s leadership must create a sustainable culture that facilitates objective interaction between medical practitioners and patients. The LTCO will help the facility achieve an ideal environment by resolving complaints, giving feedback to management after collecting information from patients and staff, and engaging in educational and outreach programs. The hospital administrator can establish training programs to enhance the staff competencies in dealing with the situation. The institution must adopt and apply ethical principles to create a conducive care environment.


Ahmed, A., Ali, H. S., & Mahmoud, M. A. (2020). Prioritizing Well-being of Patients through Consideration of Ethical Principles in Healthcare Settings: Concepts and Practices. Systematic Reviews in Pharmacy11(5), 643-648.

American Medical Association. (2001). AMA Principles of Medical Ethics. Code of Medical Ethics. Retrieved from:

Hawaii LTCO. (2022). Be a Voice for Hawaii’s Kupuna Residing in a Long-Term Care Home. Retrieved from:

Hawk, M., Coulter, R. W., Egan, J. E., Fisk, S., Friedman, M. R., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm reduction journal14(1), 1-9.

Jongen, C., McCalman, J., Bainbridge, R., & Clifford, A. (2018). Health Workforce Development Interventions to Improve Cultural Competence. In Cultural Competence in Health (pp. 49-64). Springer, Singapore.


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