Share your feedback re: ethical nursing issues - page 3

Hi! I will graduate from nursing school in May and would like to hear about ethical issues that practicing nurses (or even students in clinical) have experienced, and how you handled the situation.... Read More

  1. by   GrnHonu99
    Quote from janfrn
    ELKMNin06, the answer to the question is in the question, at least ethically. This lady was in full control of her faculties when she was admitted. She indicated that she did not want resuscitation. She is the only one in this case whose wishes, ethically, should be considered. She knew what she was doing and chose the option she was most comfortable with, and that was to allow nature to take its course. She was assaulted each time she was resused and the physician was culpable because he ignored her decision in favor of the family's. He could be held accountable in court, but of course the family would never do anything like that since they were the ones pushing for resuscitation. The nurses and hospital could file complaints with the medical association and he'd likely be sanctioned. I would find it very difficult to go against someone's clearly stated and clearly understood wishes, and would be inclined to do what the nurse in your case study did. I would be inclined to watch the patient "in the hope of a reversal" for a while before initiating any response from the code team, and perhaps discuss each step of the code as it unfolded before acting on anything. This would slow down the pace enough to bring the situation to its logical conclusion.
    I agree. Ethically, I think I would have done the same. My profs were telling us that even though the choice she made was ethical, it wasn't legal...and she could be sued.....I guess that is why they used this example for an ethical dilemma. So sad...I guess I thought that if you were lucid and actively functioning that the MD HAD to abide by your wishes...does this really happen in the field? Are there patients that want a DNR and the MD won't sign off on it or put it on the chart? I surely hope not. Also, I would like to know if anyone knows a nurse that was sued or sanctioned over a case similar to this?

    On a seperate note, how many nurses out there carry malpractice insurance...our teachers say that they reccomend it. I was just wondering how many nurses actually carried it...?
  2. by   ZASHAGALKA
    Unfortunately, the survivors get preference over the dying because the dead can't sue. I had this mental exercise with myself long ago and decided that 'slow codes' were completely unethical.

    If the patient wants everything done, or if the patient can't speak for themselves and left no directive, and the family want everything done, then I break ribs.

    (it's not my fault they left such an important decision to surrogates, but somebody with a 'vested' interest in the patient's wishes has to be a decision maker otherwise, you have to assume full code.

    I don't subscribe to futile care theory (FTC): experts should make decisions in the best interest of society based on life expectancy and quality of life regardless the individual's preference. FTC's premise is that this is a societal issue that shouldn't be in the hands of an individual, so, you're DNR when your doc decides you are and you have no say. Before you dismiss FTC; it's coming. It's already here on the fringes. In 10 yrs, the majority of ethics concerns on this site will involve FTC.)

    If the patient expresses a DNR desire, that's the way it is. Period. Unless it's absolutely imminent and I don't have 15 minutes, if the doc refuses, then I have 3 options:

    1. If it is imminent within 15 minutes, as I'm marshaling resources, I'll argue with the doc. I'm not afraid of raising my voice. I'll threaten ethics and peer review actions if he doesn't relent. I have used this phrase in the past: "You have only 2 choices here doc, answer to these family members RIGHT NOW and do what's right for your patient, or answer to your peers later. And I promise that if you don't act now, I WILL ACT LATER."

    2. If IT IS relatively but not IMMINENT imminent, I go to chain of command. I have informed docs that, if they don't change their mind, then they'll have to justify it to the chief of staff because that's where I'm going, and I'm going there now. At that point, so far, the docs have changed their minds (placating family is the easy way out, but it's not easier that justifying your actions to a peer review committee.)

    If a doc didn't institute a DNR, I'd call the house and start immediately moving towards the chief of staff's involvement.

    3. If IT'S NOT imminent, I ask for an immediate Ethics Committee determination on the issue.

    In an extreme case, which I haven't had, I would refuse to participate. My hospital has provisions for refusing to provide care based on 'conscientious objection'. And that would certainly be one.

    I make my reputation on providing critical care to critical patients. If I only pretended to provide that care, then what makes me any different from the car mechanic that 'pretends' to work on your car?

    Last edit by ZASHAGALKA on Jun 30, '05
  3. by   pricklypear
    Quote from ELKMNin06
    ...I guess I thought that if you were lucid and actively functioning that the MD HAD to abide by your wishes...does this really happen in the field? Are there patients that want a DNR and the MD won't sign off on it or put it on the chart? I surely hope not.
    Yes, it happens. I see it more in the smaller hospital I'm at now than I did at the major center at which I used to work. I've seen probably 3 MAJOR examples of this happening in 3 years. Doesn't seem like a lot, but even 1 is too many. That's one person who suffered against their will and needlessly.