Ethical Dilemma - page 2

I need some advice about a patient that I admitted last night. I know we've all debated about these situations in nursing school but I've never had this happen to me in real life before. The pt... Read More

  1. by   sixes
    Hello since when does anybody else family or no have the right to not tell this client his Dx or prognosis?? I would run to anyone in the position of authoriy. And Document document document. I hope someone advocates for this client. Maybe the US way is not always the best, but I have yet to hear of any religion that says you should not know what your health is, or that you are not allowed to make an informed decsion. Even the Jehovah witness people who refuse blood products etc. or the jewish religion that refuses autopsyies etc. or any other religion I can think still make there decsions on an informed bases
  2. by   Dr. Kate
    Probably the most important piece of information is the one that is missing, what is the ethnicity of the patient and family.
    We are obliged to provide culturally competent and sensitive care. There might well be times when to provide such care, some of the HIPPA mandates may have to be stretched a bit. Confronted with such a situation, it is necessary to find out what are the cultural issues regarding disclosure of information, decision making, etc. Then, the family decision maker (and that may not be the person we expect it to be) needs to be made aware of the obligations of information disclosure. It is at this point that you will want to get social services, chaplaincy, and your supervisor involved. These will not be easy situations. And there are probably no "one size fits all" decisions.
  3. by   Disablednurse
    I have been involved in a situation like this in LTC. Everyone felt so uncomfortable about this, but could do nothing. Have no suggestions. Just hang in there.
  4. by   canoehead
    Get a translater, other than a family member. The patient is bound to ask questions about diagnosis and prognosis and the MD has to answer the patient's questions, right? Then you have abided by the family's wishes up until the point that the patient expresses his/her wish to know more. Makes everyone relatively happy, and patient is informed.
  5. by   Helori
    Thanks for all the great advice. I did contact my nurse manager the next day and she was up-to date on the whole situation. It was decided between her and the docs that before going after the family aggressively we would arrange a family meeting and discuss everyone's concerns. Social work and palliative care were also brought in on the mtg basically for emotional support at this point. The family said that their main concern was that if the pt knew the diagnosis he would simply give up and die and they didn't want to see that. They were also under the impression (from a family friend in no way involved with health care) that if the CA wan inoperable there was nothing that could be done. So, once the docs and palliative care were able to explain in detail what options they still had and what tests and procedures could still be done they were a little more receptive.
    It was explained that inorder for any decisions and consents the pt had to have all the information and so a translator was brought in to explain the situation and get consent for a CT (to relieve the pneumo) and a bx. Mass was shown to be CA and inoperable, probably terminal. The family and the pt were understandbly very upset but palliative care a social work were able to provide support. The family is very supportive to the pt, still not too happy with us but are starting to come around.

    I think in my first post I was maybe a little too judgmental, it was a long and busy shift. They are really very nice people who were given a 'heck of a lot' of bad news in a very short period of time and just needed time to come to terms with the situation. I'm glad it turned out well, frankly I don't know what would have if they had continued to be very insistant that the pt. not know anything.

    Thanks agains for all they replies.
  6. by   sunnygirl272
    Originally posted by Jay Levan
    ...Have you not been oriented to the HIPAA regs.?? ....
    my thoughts exactly!!!!!!!!!!
  7. by   NsgTiger
    Patient's Rights! The hospital is required to provide a translator. This is unethical treatment. HIPAA HIPAA! HIPAA!
  8. by   hoolahan
    Originally posted by Dr. Kate
    Probably the most important piece of information is the one that is missing, what is the ethnicity of the patient and family.
    We are obliged to provide culturally competent and sensitive care. There might well be times when to provide such care, some of the HIPPA mandates may have to be stretched a bit. Confronted with such a situation, it is necessary to find out what are the cultural issues regarding disclosure of information, decision making, etc. Then, the family decision maker (and that may not be the person we expect it to be) needs to be made aware of the obligations of information disclosure. It is at this point that you will want to get social services, chaplaincy, and your supervisor involved. These will not be easy situations. And there are probably no "one size fits all" decisions.

    I completely agree with everything in this statement. Excellent words of wisdom, as usual, Dr. Kate!!

    I think maybe w HIPPA and the earlier push for cultural sensitivity, we may be finding that we have overly politically-corrected ourselves.

    For the record HLR, I did not think you sounded too judgemental, you sounded like a nurse who was watching someone suffer and was powerless to change it, at least at that moment.
  9. by   psychonurse
    Sure glad that things are starting to straighten out with that....I was apalled about them not telling the patient that he had cancer, that use to happen in the dark ages but I didn't think that it happened anymore. What happened to Advance directives????Anyone over 18 has to sign them anymore when they enter the hospital I thought. It is much better that the patient knows before it is too late and he might be able to make some decisions on his own.

close