Ethical Decisions

  1. What are some ethical decisions you were faced with while working in the nursing field?
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  2. 14 Comments

  3. by   TheCommuter
    Slow codes (full codes that were being conducted much more slowly than usual).
  4. by   EricJRN
    Some of the toughtest decisions seem to hinge on whether or not to continue providing aggressive care to desperately ill patients. This can lead to the "slow codes" mentioned above.
  5. by   ktwlpn
    Quote from NC_Gal
    What are some ethical decisions you were faced with while working in the nursing field?
    Back in the 80's my first full blown AIDS patient was married-his wife did not know his diagnosis and he wanted to keep it that way.
    Everyone on the unit was really upset over the situation-I'll never forget it...
  6. by   S.T.A.C.E.Y
    Do Not Resusitate.....alot of people see it as Do Not Treat.

    Old man with CHF exacerbation....Bipap may help push the fluid out of his lungs, but the doc says no because he is DNR. Intubation, Bipap, Antibiotics, ICU admission, etc.
  7. by   NC_Gal
    Given the following situation how would you respond?
    An elderly woman, who's health is clearly quickly diminishing, is in a nursing home. Her dx is breast ca. She repeatedly asks what is wrong with her and keeps reminding you that she wants to go home. She yells for someone to help her, and you go to see what you can help her with. All that she says she needs help with is to know what is going on with her and what's wrong with her. But!!!, (BIG BUTT!! here) the resident's family, has made it VERY clear to everyone interacting with this woman, that she is NOT to know her dx of breast ca. How would you respond to this situation? Would you tell the woman what her dx is? Would you tell the woman that she needs to talk to her MD? Can they legally keep this woman in the dark about her own health an healthcare, since she is clearly askign about it?
  8. by   Diary/Dairy
    Not sure - Does she have family to discuss it with???

    Other ethical issues..... Why are all these 80+++ year old people full codes?? How much more time will we buy them with Vents, CPR and all the rest????
  9. by   NC_Gal
    This lady was also a full code, which just completly blew my mind! With health deteriorating so rapidly, plus the dx of breast ca. Her family would visit her often, but they were very specific about her not knowing her dx.
  10. by   Diary/Dairy
    I really don't know what to tell you - respect their wishes or tell her the truth.....But is knowing going to help her or just stress her out?
  11. by   Diary/Dairy
    Oh, forgot - also the family will be around a lot longer to deal with - a lot of times things are done with that in mind.
  12. by   NC_Gal
    I was just curious what others would have done in this situation. This happened at a place where I used to work as a CNA, before the demands of nursing school. Because I wasn't in a position to educate, or really even tell her about her condition, I never said too much to the woman about her dx, when she would ask what was wrong, I would tell her that was something she needed to speak with the nurse or the MD about when he came to visit.
  13. by   PurrRN
    My thought process is:
    Is this 80-ish year old lady impeded some way with another Dx which undermines her cognitive abilities? If yes, then possible the descision to withhold the information by the family is a prudent one. If no, then highly unethical in my eyes. An A/O patient is always the one in control of their health descisions and information regarding thier care/dx (instead of family) regardless of their advanced age. Just because you are old doesn't mean you don't get the same rights as everyone else.
  14. by   snowfreeze
    Ethical issues are tough, first is facility standard, second is family and patient perspective and then the nurse and physician perspective while following what is legal. Educating the patient and family helps if they are receptive but usually ethics committee consults are due to non-receptive patients and/or the person having medical decision powers.
    Social services can be helpful in offering alternatives to care such as hospice in a facility and home hospice. Hospice also offers a year of post death counseling for family.
    I would ask the social worker to talk to the family about these issues and find out why they don't want this patient to know about their diagnosis and prognosis.
    One difficult decision I made for a terminal ICU patient turned out well. This patient had been in the hospital for over a month, started out with GI problems then developed post op cardiac issues, after multiple debridements after GI surgery and an MI, transferred back and forth from ICU, OR, med-surg, rehab and now late evening septic back in ICU and not strong enough to survive the OR again. As his nurse I made the decision to tell him that he was probably going to die tonight, he could do that in the OR or peacefully here in the ICU. His body had used all its reserves and an infection had ruined his kidneys and heart and he would never be able to digest food due to a dead bowel. He was on multiple pressors to maintain a blood pressure, intubated with pneumonia, no bowel sounds, infection in gut and weeping abdominal wound. HemoDialysis had been initiated due to renal failure. I asked him if he wanted to try the OR one more time and I would call his wife to come in and help with this decision if he would like that. He chose to not go to OR, and to have his wife at his side. I gave him some pain medication and called his wife and asked her to come to the hospital, telling her he had made another turn for the worse. I told her the whole prognosis when she arrived and had this coordinated with the docs. This couple had about a half hour of time privately then the wife asked for care to be withdrawn and pain to be controlled. She stayed with him for the whole time, stepped out for a few minutes for extubation and making him comfortable. She spoke to me later and thanked me, he was of native american heritage and was quite relieved that his soul was finally allowed to go to the next step. We had extended his life here for a little longer than he would have without all the encouragement from surgery etc. When the wife arrived at the hospital she seemed to know it was the end before I started to tell her the medical technical stuff making him so near death. She took hold of my hand and said, "honey, you don't have to justify his dying, it is part of life and he is ready to go"

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