moskeetus

Surprisingly..... I had exactly the same scenario for an assignment on Law and Ethics subject in my nursing school, except the patient's name (you may be doing the same course which I have done!). The details of the law may vary according to where you work, but in Australia, general consensus seems to be that there should be a correct Advanced Directives form filled by the patient (for NFR), and a NFR order by a treating medical officer should also be written up on the chart. With the presence of legally valid Advanced Directives for NFR, resuscitation cannot be done since NFR is what the patient has consented for, and the attempt to resuscitate will be considered to be an assault or battery to the patient. The key is "legally valid" Advanced Directives. If there is no Advanced Directives filled out and the patient has arrested (again, depending on which state/country you're working in, but generally) the healthcare provider has to resuscitate the patient according to "the doctrine of necessity/ doctrine of emergency" otherwise not resuscitating the patient can be against the duty of care. It means that under the circumstance of no clear NFR directives from the patient, the healthcare team would have to proceed in the best interests of the patient with the assumption that the saving life is his best interest. Also, if there is no Advance Directives filed, and the patient suddenly loses his capacity to make his own decision (e.g. falls unconscious), a surrogate decision maker will be appointed (usually the patient's next of kin - in this case, it would be the wife), to make healthcare decisions for the patient. Or, an Advanced Directive can be prepared to appoint a surrogate decision maker in advance. The healthcare providers have to resuscitate the patient if the surrogate decision maker decides that it is in the best interest of the patient. This is as far as I know about the answers for my assignment.

Hello Pancake, Since no-one has replied to your question, I thought of sharing what I experienced before.... First of all, congratulations for getting a position at the CCU. If that is the area that you're interested, I think you will enjoy it as you get used to it. I understand your concerns and apprehension towards the unknown.... you are a new grad, so I suppose that you haven't had any nursing experience before (except during the clinical prac)? I don't know if this helps, but let me share the experience I had at a CCU when I was a new grad. I used to nurse in one of the Asian countries, and when I started I was thrown into a CCU all of a sudden, as a new grad (initially, I got a position in a general ward and then I was transferred to the CCU after a week or so). It was very fortunate that the unit was very prepared to work with new grads, they understood that we knew NOTHING. Our training at a nursing college was very much theory based, so we weren't even able to prepare an IV line or mix up antibiotics.... Also no-one knew how to read ECGs... We couldn't do anything practical at all, to start. The unit had this 3-month structured orientation program. We had a preceptor for each new grad, and we worked one-on-one for 1 month. Most of the time, the pair had to look after 1 or 2 patients with various levels of dependency to start, and at the end of the month, I think we started looking after up to 3 patients. In the second month, the new grads started becoming a bit more independent, having 1 or 2 patients on our own, but there were always the preceptors in the same shift (so that we could ask questions to our own preceptor). The third month was designed so that the new grads took a bit heavier responsibilities and become independent, so I think we started looking after more severe patients i.e. IABP or ventilators, or getting involved in cath lab duties etc. At our CCU, the nurse in charge (a nurse leader?) did handovers, so we didn't need to do it for another 3 months (6 months from the start)..... I think the induction program that we had was very thorough and it couldn't be any longer! But still we didn't think we were prepared even after spending 6 or 7 months in the unit. This wasn't in the US (and also a long time ago), and what I went through may not be relevant over there. I know the nursing education at an undergaduate level would be a bit different there, so I am not sure how much you're actually prepared to nurse the patients at a very acute stage. At CCT, in many occasions, I think speed is really the key in the end (I mean, how fast and accurate you can respond to the situation e.g. arrhythmia, chest pain, shock.... etc). If you're like me when I started nursing as a new grad, like "knew absolutely nothing practical", you would need a lot of education and training to assess and respond to patients' conditions as quickly as possible, in many different critical situations.... moreover, all those highly sophisticated machines.... (they gave me headaches!). I think it is normal that it takes time for new grads to become fully competent, and up until then they always need constant attention and support - this is my opinion. I hope this helps .... but I wish someone else would give you advice on this - I'm not sure if my case is relevant to your situation! Anyway, all the best and good luck. PS: English is not my native language, my apologies if there is anything that is not clear.... please let me know if any, and I'll try to clarify it as much as possible.