ethical dilemma - page 2

I work in LTC. I have a senior citizen living in that LTC who is ordered NPO by his physician and receives GT feeding 24 hours a day. Everyday during meal times, he asks for food and becomes agitated... Read More

  1. by   HikingNinja
    Be careful here. You could get into some serious trouble with your facility if they think you are overstepping your bounds. But there are ways to remedy this situation without your facility even knowing you are involved. I am guessing that this person is either Medicaid funded or private pay. If he is Medicaid funded then you should be able to anonymously contact the appropriate agency (in my state it is called the Division of Aging Services) and report this to his caseworker who must by law investigate. If it is private pay he must have someone who has power of attorney over his affairs if he has been deemed incompetent. That would be the person to contact (this person is probably listed as the emergency contact on his chart). And you can also contact licensing agency who licenses your LTC and lodge a complaint. In my state you can also do that anonymously.

    Dee
  2. by   starbin
    I think I will give up. I am thinking about chaging my job. I had even given a thought on calling the Department of health and senior services but decided not to. I guess the best thing for me is to quit.
  3. by   TazziRN
    Quit if you dislike it and are that frustrated, but please don't leave the poor man in the lurch like that. Make the phone call. If you don't you just leave him at the mercy of other nurses who probably won't do anything. He needs another doctor with a more compassionate attitude.
  4. by   NURSE1987
    This man is lucky to have a nurse that feels so strongly about his rights, you are doing the right thing. If you decide to discuss this problem with a higher power, remind them about Maslow's hierarchy of needs.. 1.Physiological needs 2.Safety needs 3.Social needs 4.Esteem needs 5.Self-actualization needs. If this man's physiological needs (i.e. food, elimination) are not met, there is no way he can attain self-actualization ore any of the prior categories. The doctor needs to examine this situation more closely, I know it's hard for an MD in LTC w/ MANY residents. The right thing to do is at least have the tests ran, so that there can be some type of reasoning for denying the poor man's request.
  5. by   TrudyRN
    DO NOT DISOBEY DOCTOR'S ORDERS. Even if nothing happens, you are setting a bad precedent for yourself. YOU will suffer any negative consequences.

    DO get everyone involved. The social worker, administrator, nursing bosses, speech therapish, et. The doc should at least get the video swallowing study.

    IF HE DOES NOT RELENT: Just forget about it. I know the patient is unhappy but his problem is not worth you risking your license.

    Try prayer.
  6. by   TrudyRN
    Quote from starbin
    I think I will give up. I am thinking about chaging my job. I had even given a thought on calling the Department of health and senior services but decided not to. I guess the best thing for me is to quit.
    It's not worth quitting. Are you going to quit evey job that has a problem come up?

    Fight the good fight where you are but know when to give up and accept the doctor's orders.
  7. by   TrudyRN
    Quote from deefromlv
    Be careful here. You could get into some serious trouble with your facility if they think you are overstepping your bounds. But there are ways to remedy this situation without your facility even knowing you are involved. I am guessing that this person is either Medicaid funded or private pay. If he is Medicaid funded then you should be able to anonymously contact the appropriate agency (in my state it is called the Division of Aging Services) and report this to his caseworker who must by law investigate. If it is private pay he must have someone who has power of attorney over his affairs if he has been deemed incompetent. That would be the person to contact (this person is probably listed as the emergency contact on his chart). And you can also contact licensing agency who licenses your LTC and lodge a complaint. In my state you can also do that anonymously.

    Dee
    I think it's too late for her to be anonymous. She has already been talking to the doc and the speech therapist.
  8. by   Hoozdo
    I would question this doctor carefully. If speech therapy has evaluated the pt and said he can swallow pureed food; why is the doctor so opposed to letting the pt eat? Can he be reasoned with at all?

    If it came to the point where I would want to quit over it, I would question him aggresively. Is he on a power trip or what? If speech therapy said he can swallow, then he can swallow :trout: Why torture this poor patient?
  9. by   RNinSoCal
    Code status and Advance directives are the major differences in these cases. If the family and/or the patient insists on full code status then the MD has no choice but to order NPO for patients who are aspirating and my die from complications related to aspiration. Legally the MD is responsible for the pt's illnesses and/or death if a diet is ordered when aspiration is a known problem. If the family will agree to comfort care then the patient may eat and aspirate to their heart's content. I have documented on the behalf of MD and RNs alike many times when the family insists on feeding a pt with known aspiration. It is a sad and unfortunate problem that we as nurses have to witness and assist in when patients can no longer safely eat/swallow. I am sorry for all of us who witness our patients suffering from swallow difficulties at the end of life.
  10. by   withasmilelpn
    We refer some of our residents to social services, who if their poa or court appointed guardian agree, a dietary waiver is obtained that absolves the facility and physician from liability should they aspirate. It might be a way you can go. A lot of the ones who chose to go that route did well. However, I have had some patients I dreaded meal times with because they would choke and cough and gag their way thrrough the whole meal and we would stand ready to do the heimlich/ suction thing again. So, all things considered, it's a hard decision either way. Good Luck!
  11. by   starbin
    Quote from TrudyRN
    It's not worth quitting. Are you going to quit evey job that has a problem come up?

    Fight the good fight where you are but know when to give up and accept the doctor's orders.
    I definetely will fight the good fight. I have to quit because I have no support that will help me fight. Everybody is so overwhelmed with their own stuff that they do not even want to be bothered with such things. Few people even answered me like this- What is your problem girl? If the doctor says no... why are you making big deal out of it? Forget about it.
    This is not the only reason I am quitting. I just can't digest a lot of things. I will be better off somewhere else. LTC is not for me.

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