personal vs. professional

deespoohbear · Oct 1, 2002

i will never alter documentation. if needed, i will add an addenum to the notes if i forgot to chart something that is significant to the pt's care or something the family/pt said, did. otherwise it stays just like i wrote it. i once had a doctor scratch out my charting (i had charted that a pt had refused a bronchial aspirate-which they did on their own accord). i charted "pt declines to have bronchial aspirate done." this doctor actually had the nerve to scratch out in the nurses's notes my documentation and write above it "pt denies refusing bronchial aspirate." fortunately, respiratory heard the pt refuse too but man was i pi$$ed off! i showed the altered chart to the don and of course it was just blown off. i was told "he is going to retire in a few months." :devil: you could find yourself in hot water for rewriting documentation!!

i have also been involved in pt's care that i felt was futile. the one that really gets me is when the patient has an advance directive that states they do not want a feeding tube, don't want intubated, don't want cpr, etc.. and the family does it anyway!! and you are basically screwed at that point if the family member has durable healthcare poa. tv shows do not do us any favors either by having every patient that suffers a cardiac arrest survive the ordeal, and walk out of the hospital 2 days later like nothing happened.

TheLionessRN, RN · Oct 1, 2002

I have cared for a relatively young patient (late 40s) who had extended illness due to cancer. She was healthy one week and the next week she was in a terminal coma. Her husband and a sister that came in for the final days kept asking us when the time was, and really wanted to know how much morphine we could give her to keep her comfortable and hopefully to speed up the end, because the sister had to get back home and work.

We gave that case to the ethics committee. I was not comfortable with the amount of morphine I was asked to give. I asked to stop being her nurse after the last day and the last morphine IV push I gave her and wondered if that was the one that would kill her. I was not comfortable with it at all.

I don't know if that is the direction of the question, but I don't seem to be alone in my idea that doing something for the patient who is terminal is the greatest moral dilemma we face.

I can't count the number of patients who SHOULD be let go who have been extended. The family can't seem to grasp that it is extending their death, not their life, when they do all this to a loved one. It is one of the hardest things I face as a nurse.

OBNURSEHEATHER · Oct 1, 2002

Originally posted by deespoohbear
I once had a doctor scratch out my charting (I had charted that a pt had refused a bronchial aspirate-which they did on their own accord). I charted "pt declines to have bronchial aspirate done." This doctor actually had the nerve to scratch out in the NURSES'S notes my documentation and write above it "pt denies refusing bronchial aspirate." Fortunately, respiratory heard the pt refuse too but man was I pi$$ed off! I showed the altered chart to the DON and of course it was just blown off. I was told "he is going to retire in a few months."

:eek: :eek:

Heather

Agnus · Oct 1, 2002

I wish that advanced directives were leagally binding. That is they over ride family wishes not the other way around.

I think we need an national education campange to educate the public. When they are at the bedside of some one they love who is dying they cannot get past their emoations to hear what is being said. Often when we suggest a discussion about these things and the patient is terminal they think we just want permission to kill or not give care to thier loved one.

They should be well educated before they ever face this. Unfortunately they are well educated before hand with completely false notions fed to them by so called "realistic" medical shows.

A couple of months ago I had a patient who was very unstable and did not want to be intubated, or vented he had been previously and "it hurt" He did not want bipap because the RT had the strap too tight and "it hurt" I said that could be fixed.

But "of course I want CPR"

DUH! no vent, no tube, not even bipap because they hurt, but "of course CPR" Wifey concurred with him. Some information is difinately missing in these brain cells.

Audreyfay · Oct 1, 2002

I've had so many ethical judgments that I quit counting. We all do our best as a patient's advocate. Example: A patient stated he just found out he had diabetes. In examining his HgbA1c, his results 2 years ago were almost 7. Would it make any difference if he knew or not? The doctor he had obviously made a mistake. In diabetes, many do not treat diabetes seriously. Should the pt. be told that he had diabetes for 2 years? It would seriously jeopardize his trust in his MD, who I thought was an "ok" MD. Some things just would not make anything better by saying something.

However, there are other new type 1 diabetics who are young and the MD starts them on a 70/30 insulin, and doesn't want to adjust for almost 10 days. Blood sugars in the a.m. are high, with the p.m., being low. Again, being a patient advocate, the best one can do is to give the information to the pt.

It can be hard. Sometimes I hate to say anything, but I do, and let the MD know that I did it. As always, keep your supervisor informed of problems, and give them a "heads up" just in case. It's worked for me. :stone

arm1077 · Oct 3, 2002

Is it hard to put up with patients that act stupid? I'm a csr right now for a major retail company.I put up with alot now.I can't imagine how bad it's going to be when I have to deal with patients that wanna act stupid.I would hope the money makes up for it.

ohbet · Oct 8, 2002

Ethics is an integral part of the foundation of nursing.

I think the controversy lies in which moral code we follow,a personal one?,whether it be altruistic or selfish, a religious one? a secular one? etc.

This problem has been resolved by the Code of Ethics for Nurses,which serves the purpose of stating the ethical obligations and duties of every individual who enters the nursing profession.It is the professions nonnegotiable ethical standard.

OBNURSEHEATHER · Oct 8, 2002

Originally posted by arm1077
I can't imagine how bad it's going to be when I have to deal with patients that wanna act stupid.I would hope the money makes up for it.

LMAO!!! :rotfl: :rotfl:

Um... ya right!

Heather