Ethical issue?

[nursesmatter]

Hello. I have a question to ask because I have been reading about ethical issues and moral distress. I recently experienced an event on my unit which caused multiple staff including myself to feel frustrated and somewhat angry. I cared for one member of an elderly couple that were involved in an accident. Unfortunately, the woman's husband passed during the accident. She survived and I cared for her for 2 days immediately after the event. Her adult children were present at her bedside throughout her hospitalization for her emotional well-being. Upon arrival to my unit, one of her family members pulled me aside and told me (not asked) not to disclose her husband's death because they wanted her to get well first, then eventually tell her. Family members also told each staff that provided her care the same thing. During the 2 days I cared for her, multiple times she asked me about the condition of her husband. Whenever she asked me this, I looked at her family members and they would glare at me. So I ended-up distracting her or would tell her to focus on her healing first. Not telling her what happened to her husband ate me inside. If that were my significant other, I would want to know right away. Finally, the family told her about her husband's death on her 5th day of hospitalization.

I'm not sure but I feel as though this type of situation may be more common than I think. But my question is: Do you think this is an ethical issue that could have initiated an ethics consult??? Thanks for your input!

[Kooky Korky, BSN, RN]

not.done.yet said:

This is tricky. Sometimes it is cultural....some cultures never disclose bad news when someone is ill. Sometimes it is just that particular family's culture, based on what they know about the individual. If a family is making a request like this, I am going to get the chaplain and/or social worker involved to help them work through their fears and concerns and to come up with a plan that the whole team, family included, can abide by. I will also inform the physician and let him/her have heavy weight in whether to tell the patient.

It is not the same as a spouse, but people who love their pets REALLY love their pets. I had a young individual in a very horrific car accident. This patient's two dogs were in the vehicle at the time of the accident and were unrestrained. Both were thrown from the car. Both were able to get up and run. Both ran into traffic and were killed in their confusion and panic. My patient had a potential spinal cord injury and a head injury and there were instructions to keep the patient calm and still until all studies could be completed and the potential for trauma related injuries ruled out. The girlfriend came in and immediately blurted out that this patient's fur babies were now dead. Keeping my patient calm and still was next to impossible after that and it lead to a LOT of suffering, distress and ultimately pharmacological intervention that could have been avoided if that bit of information had been withheld for a day or two. I was very unhappy with the girlfriend. The patient's grief was acute and dangerous for the patient at that point in time.

So you see, there is no firm answer. It is, like many ethical issues, different shades of gray.

As much as I love fur babies, a human spouse is different.

[Kooky Korky, BSN, RN]

missmollie said:

I work in neurosurgery. For my patients it is a matter of what the family believes is best, the extent of their injuries, and their ability to comprehend the information. For the majority of my patients, it absolutely IS up to the family and it is ultimately their decision.

Family understand their loved one better than you or I will after a mere 12, 24, or 36 hours with the patient. Why would you believe you know more about the patient than the family, if everyone in the family is saying not to tell him/her. Granted, every nurse must make the decision based on the situation on hand, but if every family member believes it is best, then I will do what I can to ensure they are making an educated decision. You do what is right for the patient based on all information, not just based on your own personal beliefs.

Not all family members are close to a patient, so I'm not at all sure that they understand the patient just by virtue of being family.

And OP never said she thought she knew better than family. She expressed concern about ethics.

[Anna Flaxis, BSN, RN]

Castiela said:

On ine hand, it really isn't your position to tell her that her husband died..

What??? Why not? It is completely within your scope of practice as a professional R.N. to provide this information.

Granted, I might advise taking the family members aside and gathering more information about why they feel the need to deceive their loved one, but I would also inform them that as a competent adult, she has a right to know, and that as a professional R.N., your duty is to your patient.

[FNPTOB2018]

This is definitely a tough situation to be in. Im sorry you had to experience this

[Been there,done that, ASN, RN]

No time to take it to the ethics .

Your patient asked you a question. She was competent and deserved the answer. You needed to discuss the family's issue with her physician. It should be the provider's decision to divulge the information. The family has no choice in the matter. Your patient retains her legal rights.

[MunoRN, RN]

Anna Flaxis said:

What??? Why not? It is completely within your scope of practice as a professional R.N. to provide this information.

Granted, I might advise taking the family members aside and gathering more information about why they feel the need to deceive their loved one, but I would also inform them that as a competent adult, she has a right to know, and that as a professional R.N., your duty is to your patient.

I'm with you, and I find it sad that there are a number of nurses who would only advocate for their patient if the MD said it was OK. The Physician's role is basically to diagnose and treat a particular medical condition, the nurses job is to advocate for and protect the basic rights of their patient. Nurse's shouldn't be waiting for a doctor to be the patient's nurse before the nurse will.

[Tenebrae, BSN, RN]

I would have been very upfront and advised the family that if the patient asks I'm not going to lie to them. But then again I work in a healthcare system where people dont threaten litigation based on being looked at funny

I would have consulted with the patients doctor and perhaps looked at bringing in the social worker or chaplain to ensure the news was delivered to the patient in the most gentle way possible.

[JKL33]

Julius Seizure said:

I've seen a few comments saying that this should be handled by the MD rather than the nurse. Can anyone give me a reason as to why they think this would be outside of the nurses role? I can't think of any other solid reasons.

I don't think it's outside of the nurse's role at all. With a family that acts this way though, it can (in some places especially, depending on overall culture) be helpful to have a show of "multidisciplinary agreement" when a family is so opposed to something. Look at the number of (what I believe are) misguided responses to this straightforward ethics situation - No reason to get hung out to dry by a misguided manager or supervisor or patient relations guru for "upsetting the family" when it's as simple as showing a united front, so-to-speak.

The physician and nurse can both confirm (both display agreement) that "doing the right thing" isn't expected to lead to any physical deterioration in condition.

My idea was more that medical staff would join the "front" along with nursing, social work, clergy, etc. I don't see this (and many other things) as nurse-vs.-physician.

[Been there,done that, ASN, RN]

MunoRN said:

I'm with you, and I find it sad that there are a number of nurses who would only advocate for their patient if the MD said it was OK. The Physician's role is basically to diagnose and treat a particular medical condition, the nurses job is to advocate for and protect the basic rights of their patient. Nurse's shouldn't be waiting for a doctor to be the patient's nurse before the nurse will.

They don't pay me enough to advocate in this situation. The family was trying to call the shots. In a situation this volatile.... the doc takes the hit.