Ethical issue?

Nurses General Nursing

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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! :geek:

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

It probably would have helped if the doctor had come on board and explained to the family why it was in the patient's best interests to have her questions answered honestly. Obviously the family believed their mother's healing would have been impeded by knowledge of her husband's death. It would have been helpful if a family meeting could have been arranged with the doctor and the hospital chaplain to hear the family's concerns and present some alternative viewpoints.

I'm sure the lady figured it out when no one answered her questions. The uncertainly was probably just as bad (or worse) than receiving the news.

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Specializes in Neuroscience.

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.

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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.

Are you saying these are situations in which it has been determined that the patient doesn't have the legal competency or capacity for decision making/self-determination?

missmollie said:
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.

Wrong argument. This isn't an issue of ego regarding "who knows the patient better." Of course the family does. You aren't acknowledging that all parties - including family members, are prone to their own "opinions" and prone to the ethical pitfall of focusing on what they think they would want, and then trying to apply it to someone else. The family is absolutely subject to this, too! Which is why breaching patient autonomy is a serious ethical matter that should never be a "default" position, where we just let others (no matter how well meaning) declare that it can/should be breached.

What part of becoming hospitalized takes away a person's "right" to know about the well-being of his/her spouse? In some of these cases, the patient from whom everyone wants to hide information is actually the legal next-of-kin!

Is a patient's "right" to know that his/her spouse/life partner has died different than a patient's right to know something about his/her own medical care? I mean, in terms of ethics are those two things that fundamentally different?

For the purpose of this discussion, we shouldn't muddy it with situations where people literally are unable to make their own wishes known. The OP presents a scenario where the patient is alert and oriented enough to ask (repeatedly) about the status of her own spouse.

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Specializes in Critical Care; Cardiac; Professional Development.

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.

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nursesmatter said:
Just wondering... Is telling the patient allowable in our professional practice or should this be more of a responsibility for the attending MD? I was surprised that the physician got bullied by the family and didn't say anything either. I know through our education we learn ethical concepts, but I feel as though the multiple ethical concepts sometimes contradict themselves and offer a gray area sometimes. Damned if you do, damned if you don't??? At the time, I wasn't sure if I could be putting my job (and personal safety from an angry grieving family) in jeopardy if the family or MD reported me, so I just kept my mouth shut.

Thanks again for the feedback!

In your situation I would not have blurted anything out, but would have done what I could to bring the issue to a head through the involvement of other parties/resources, yes, including the physician.

Your internal discomfort and gut feelings can compel you to reach out to your resources around you. You are definitely not expected to make these decisions in isolation, nor should you when there is such contention about it. In the immediate moment, while you're waiting for team members to arrange a family meeting, you can reach out to your manager or supervisor for suggestions about handling the bedside interactions. I'm sorry you were placed in this position but I believe you will learn a lot from it and will never forget it.

If you sincerely felt physically threatened by this family's determination about this matter, that almost is an entire separate issue that should be handled by security.

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Is it legal for an LPN who has completed the RN program, but has failed the NCLEX, to sign off on company property paperwork as an RN?

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lauren1515 said:
Is it legal for an LPN who has completed the RN program, but has failed the NCLEX, to sign off on company property paperwork as an RN?

Off-topic, but no it is clearly not legal, since that person is not a Registered Nurse.

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nursesmatter said:
Just wondering... Is telling the patient allowable in our professional practice or should this be more of a responsibility for the attending MD? I was surprised that the physician got bullied by the family and didn't say anything either. I know through our education we learn ethical concepts, but I feel as though the multiple ethical concepts sometimes contradict themselves and offer a gray area sometimes. Damned if you do, damned if you don't??? At the time, I wasn't sure if I could be putting my job (and personal safety from an angry grieving family) in jeopardy if the family or MD reported me, so I just kept my mouth shut.

Thanks again for the feedback!

I would have asked my nurse manager for guidance. And I was wondering the same thing regarding if it is in our scope of practice, basically giving a death notification. But that was a tight spot to be put in, especially when the doctor caved to their request.

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lauren1515 said:
Is it legal for an LPN who has completed the RN program, but has failed the NCLEX, to sign off on company property paperwork as an RN?

As you are not yet an RN, no, you cannot sign RN. Only once your name goes up on the BON can you sign as RN.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
nursesmatter said:
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! :geek:

This poor lady -- she probably knew (or strongly suspected) that her long time partner had died and was just looking for confirmation. Because of the family's need to control, she didn't get the answers she was looking for and wasn't able to start grieving his loss until five days after the loss. I'm truly sorry for her.

I suspect that I would have put a call in to the chaplain and (without consulting the family in the first place) had him or her come to the unit to see the patient. Chaplains are good at delivering bad news in good ways, and if you couldn't pry the family loose from the room for the chaplain to have a private visit, perhaps you could have benefitted from a chance to talk to the chaplain about the delivery of the news and the ethics involved.

A Social Work consult (or an ethics consult) would have been good ideas as well, but generally it's quicker to get the chaplain and it doesn't require a formal consult.

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Specializes in Palliative, Onc, Med-Surg, Home Hospice.
lauren1515 said:
Is it legal for an LPN who has completed the RN program, but has failed the NCLEX, to sign off on company property paperwork as an RN?

Yes, the LPN is not an RN.

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Specializes in Critical care.
nursesmatter said:
Just wondering... Is telling the patient allowable in our professional practice or should this be more of a responsibility for the attending MD? I was surprised that the physician got bullied by the family and didn't say anything either. I know through our education we learn ethical concepts, but I feel as though the multiple ethical concepts sometimes contradict themselves and offer a gray area sometimes. Damned if you do, damned if you don't??? At the time, I wasn't sure if I could be putting my job (and personal safety from an angry grieving family) in jeopardy if the family or MD reported me, so I just kept my mouth shut.

Thanks again for the feedback!

Definitely within our scope, most likely could get fired for it. Not that you are doing anything wrong, but when the family goes to admin in horror admin will need a scapegoat. I would have the attending and SW address the issue with the family and turn it on them, would they (the patient's child) like to know if THEIR spouse had died? Would they be upset at their kids for withholding this? Not telling them is worse in my opinion.

Cheers

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