QUESTION TO ANSWER

Esme12, ASN, BSN, RN · Sep 27, 2013

I am not sure how we can help.....most of us are in the US.....do you have link to the Palestinian code of ethics? How do you think you would/should solve the problem?

nurse nesreen · Sep 28, 2013

can help for question

Esme12, ASN, BSN, RN · Sep 28, 2013

I can't help....I do not know the code of ethics of Palestine nurses

sama alghad · Sep 28, 2013

I can't help....I do not know the code of ethics of Palestine nurses

ok,,

what about your code

how you will do in this condition here according your code

LadyFree28, BSN, LPN, RN · Sep 28, 2013

ok,,
what about your code
how you will do in this condition here according your code

We don't have a code like that in the US; although we are respectful to different cultures, our respect of the patient that may actively dying has a right to know and make decisions based on that; we cannot go along with the family just because they don't want the patient to know. If the patient has an underlying medical cause where they are not able to understand, there may be a different approach, however, the patient has the right to know.

nowim clean · Sep 28, 2013

First off it is the doctor not the nurse who gives this news. Just like giving results of a test we do not do it. As far as the rest you take care of the pt and family as well. Will respecting family wishes harm pt or put them in discomfort? They don't want it told I will not tell , but they better have a DNR signed or we will be discussing DNR and what having vs not having one means.

KelRN215, BSN, RN · Sep 28, 2013

ok,,
what about your code
how you will do in this condition here according your code

Unless the patient has a medical condition which makes him/her unable to comprehend what is going on, there's no way the family would know the prognosis before the patient. And a terminal prognosis would, as others have stated, be shared with the patient by the MD, not the nurse. It would be unethical and illegal to approach the grown child of a cognitively intact adult and say "Sue, your mother's CT shows that she has a terminal cancer. What would you like us to do?"

nurseprnRN, BSN, RN · Sep 28, 2013

If a patient or family member asked us about diagnostic results or prognoses, we would probably also seek further information first. "What has your doctor told you?" "Can you tell me what you think about how you are doing?"

KelRN215, BSN, RN · Sep 28, 2013

If a patient or family member asked us about diagnostic results or prognoses, we would probably also seek further information first. "What has your doctor told you?" "Can you tell me what you think about how you are doing?"

My least favorite position to be in as a hospital nurse was always knowing the (bad) results of a test and having the parents ask over and over "are the results back yet?" before the MD arrived to share them. I was once caring for a child with a long (nearly life long) history of a brain tumor who we thought was just going to have a post-op MRI before we transferred him to rehab... as it turns out this MRI revealed that his tumor was rapidly progressing and had spread throughout his brain and spine, his ventricular system was completely blocked and he had clots in every major vessel in his brain. I read that report and knew that this was the end and the inpatient team didn't want anyone but the child's primary oncologist to share the results with the family. I was in and out of that room probably a dozen times with the parents asking "have the MRI results come back yet?" before the doctor finally arrived.

I hate the prognoses questions too. Currently have a young child with a diagnosis that is nearly 100% fatal. She had an MRI a few months ago that demonstrated several new tumors despite the fact that she'd been on continuous treatment. After learning this, her Mom asked me over and over "do you think there is no hope at all?" That honestly is what I think (and if it were my child, I think I would terminate treatment and take her home/try to enjoy the last few months) but the medical team is offering them clinical trials and experimental treatment and they are choosing to pursue those options so I honor that choice and keep my mouth shut. Clinically the child is well appearing and she is tolerating her current trial. The family has been told the honest truth (less than 10% of children survive this particular type of tumor) but, like any family in this position, they believe that their child will be in that 10%.

CiaoBella_Xo · Sep 29, 2013

Sometimes family members ask physicians and health care professionals to withhold information from patients. Family requests of this kind are usually justified by protective instincts. They believe that disclosure will do more harm than good. Requests like this are difficult to honor.

In the first place, concealing a diagnosis from the patient may be very difficult in the long run, especially if tests and treatments are indicated. The course of medical care itself can reveal a diagnosis even if the specific disease or condition is never mentioned out loud. Physicians should not promise to withhold what is not in their power to conceal. Secondly, it is not always clear that the family is right about their interpretation of the patient’s state. Some patients can absorb information about their illness without exhibiting the devastation predicted by family members.

If physicians receive requests to withhold information, they should understand that they have a duty to the patient first. If a patient is able to make decisions about his or her medical care, the physician has a duty to disclose the information relevant to helping that patient make decisions about exactly what sort of care he or she wants. This does not mean that the physician must disclose the information all at once or in a hurtful way. Sometimes, the information can be disclosed by indirection. For example, the physician might ask “Do you have any idea of what the problem might be?” The physician can then build toward full disclosure on the basis of the answers he or she gets. The physician might also ask the family whether it would be beneficial to have someone in particular in the room during the disclosure (for example, a particular son or daughter or clergyman).

At the very least, physicians should assume that the balance of truth-telling is tilted – well tilted – toward disclosure of diagnoses and treatment. A strong set of reasons is required to withhold information, especially from patients able to make medical decisions for themselves.

Esme12, ASN, BSN, RN · Sep 29, 2013

Sometimes family members ask physicians and health care professionals to withhold information from patients. Family requests of this kind are usually justified by protective instincts. They believe that disclosure will do more harm than good. Requests like this are difficult to honor.
In the first place, concealing a diagnosis from the patient may be very difficult in the long run, especially if tests and treatments are indicated. The course of medical care itself can reveal a diagnosis even if the specific disease or condition is never mentioned out loud. Physicians should not promise to withhold what is not in their power to conceal. Secondly, it is not always clear that the family is right about their interpretation of the patient’s state. Some patients can absorb information about their illness without exhibiting the devastation predicted by family members.
If physicians receive requests to withhold information, they should understand that they have a duty to the patient first. If a patient is able to make decisions about his or her medical care, the physician has a duty to disclose the information relevant to helping that patient make decisions about exactly what sort of care he or she wants. This does not mean that the physician must disclose the information all at once or in a hurtful way. Sometimes, the information can be disclosed by indirection. For example, the physician might ask “Do you have any idea of what the problem might be?” The physician can then build toward full disclosure on the basis of the answers he or she gets. The physician might also ask the family whether it would be beneficial to have someone in particular in the room during the disclosure (for example, a particular son or daughter or clergyman).
At the very least, physicians should assume that the balance of truth-telling is tilted – well tilted – toward disclosure of diagnoses and treatment. A strong set of reasons is required to withhold information, especially from patients able to make medical decisions for themselves.

You found an excellent source for information......Medical Ethics | Truth Telling

For the entire resource/information.......

Standards of Disclosure

Therapeutic Privilege

Requests to Withhold Information

Requests for Medical Information

Case for Discussion : Keeping Secrets from Patients