Share your feedback re: ethical nursing issues

mattsmom81 · Mar 20, 2005

A recent one was a patient in my ICU who had symtoms of neuromuscular collapse of unknown origin. Several times he decompensated, required intubation, and was having varying and changing degrees of paralysis. This went on for a week and the docs were 'observing' without definitive diagnoses or prognosis, which greatly frustrated the patient and family.

During this rollercoaster his daughter began a questioning conversation with me about whether this was the best place for her father; should she move him to a bigger facility, etc. I had to be cautious with my responses but finally she asked me 'If this was your father would you move him to _____? (a huge hospital affiliated with the med school) I reluctantly admitted I would definitely consider it. Later her father was at a point where he could communicate his wishes, and indicated he would like to transfer to the bigger facility, so they asked for my help.

I had to reach a conclusion that my ultimate role was as patient advocate, so I called my supervisor who agreed with me...and we initiated conversations with the doctors to follow patient/family wishes. I did worry a bit about repercussions from the doctors and possibly administration, but got none thankfully.

UnewmeB4 · Mar 23, 2005

KUDOS!

I think the hospital was probably grateful, as they won't face a lawsuit over this pt...lol.

Seriously, it was the best thing to do. These are the things that should make us very proud of our fellow nurses.

I once worked in PEDS, where a little boy had a serious lung problem. This was a small hospital. The Resp therapist expressed his concern to me that the boy will eventually need tubed, and we agreed that it was better that he be transferred before that happened. Fortunately, the Dr. agreed, and the boy was transferred. We were all relieved he received the proper care. Just remember...He had Goodpasteurs Syndrome. The best part was, he survived.

It is so nice when the departments can work together for the pts best interest.

Tweety, BSN, RN · Mar 23, 2005

End of life and treatment options are forever a delimema for us. I was in charge one night and a nurse at the beginning of the shift came to me and said "I refuse to participate in the starvation of a patient". Pt. was 80, had a stroke, failed a swallow study, was aphasic, but definately alert, was obeying commands, but the family instituted her living will which stated no artificial feeding.

I called the doctor and asked him to at least hydrate with IV fluids until there could be a family conference. The family agreed to hydration that night. I'm not sure what happened because after that I was off a few days and then she was discharged to a nursing home.

LPNer · Mar 23, 2005

I've seen this a couple of times when floated to the tele unit. I am not a current cardiac nurse, so I never get anyone compromised assigned to me when I am pulled there. So, I get things like DNR-CC on tele!

I don't know if this would actually qualify as an ethical delima as much as a "what's that Doc thinking?" issue, but really, where does that put the nursing staff when/if they do arrest or convert to an "impending" rhythm. Do we just sit and watch cardiac arrest develop? They are CC only, how much care is too much care when the pt/family has decided on comfort care only?

If they are DNR-Code, sure, we can treat abnormal rhythms which could lead to arrest but not code the pt if/when if progressed that far, and tele would help us to do that, but CC only? What's the purpose of tele?

TheCommuter, BSN, RN · Mar 23, 2005

A doctor may ask you to give a placebo. What if the patient needs relief from pain and/or discomfort? I would feel uncomfortable giving a placebo. To me, this is an ethical issue. :uhoh3:

LPNer · Mar 23, 2005

A doctor may ask you to give a placebo. What if the patient needs relief from pain and/or discomfort? I would feel uncomfortable giving a placebo. To me, this is an ethical issue.

Ya know, when I was in my 20s, way back when, we gave pacebos all the time. Didn't think a thing of it. "They can't possibly be having THAT much pain." is what the Doc would say and order a placebo.

Well now I am 50, have a lot of chronic pain myself (and feel really bad about those folks all those years ago, that I did not perform as the pt advocate).

At the same time, things have changed, pain is now known to be very personal and that which one person calls annoying or uncomfortable another comes to tears for, and it is not "being a baby" as was once thought.

I would be very warry of any Doc who wanted to prescribe a placebo for pain these days.

I could just imaging how I would feel if I was told, your vertibrae are never going to line themselves back up and LL is only, at best, 50% effective, you might as well just get used to it.

I am ashamed for having so easily given those placebos so many years ago, but in my own defense, we just didn't know that yet.

TheCommuter, BSN, RN · Mar 23, 2005

How would you truthfully feel about administering a placebo tomorrow? It's an ethical issue. :crying2:

Ya know, when I was in my 20s, way back when, we gave pacebos all the time. Didn't think a thing of it. "They can't possibly be having THAT much pain." is what the Doc would say and order a placebo.
Well now I am 50, have a lot of chronic pain myself (and feel really bad about those folks all those years ago, that I did not perform as the pt advocate).
At the same time, things have changed, pain is now known to be very personal and that which one person calls annoying or uncomfortable another comes to tears for, and it is not "being a baby" as was once thought.
I would be very warry of any Doc who wanted to prescribe a placebo for pain these days.
I could just imaging how I would feel if I was told, your vertibrae are never going to line themselves back up and LL is only, at best, 50% effective, you might as well just get used to it.
I am ashamed for having so easily given those placebos so many years ago, but in my own defense, we just didn't know that yet.

LPNer · Mar 23, 2005

How would you truthfully feel about administering a placebo tomorrow? It's an ethical issue.

Maybe you didn't read my entire post. I did agree it's an ethical issue and I also said I would not do it and I would act as the pt advocate and would definately "corner" the Doc and get an order for real meds. (Using different words this time because I think you misunderstood my last post). However, I have not run into that in a long time.

I also mentioned that years ago we gave placebos without thinking about it. There was a different belief then about pain.

newnurse2005 · Mar 24, 2005

Has anyone ever had to deal with an RN coworker who was using drugs? I couldn't imagine! I'd love to hear about more examples, if anyone else can share?!!

UnewmeB4 · Mar 25, 2005

I've seen this a couple of times when floated to the tele unit. I am not a current cardiac nurse, so I never get anyone compromised assigned to me when I am pulled there. So, I get things like DNR-CC on tele!
I don't know if this would actually qualify as an ethical delima as much as a "what's that Doc thinking?" issue, but really, where does that put the nursing staff when/if they do arrest or convert to an "impending" rhythm. Do we just sit and watch cardiac arrest develop? They are CC only, how much care is too much care when the pt/family has decided on comfort care only?
If they are DNR-Code, sure, we can treat abnormal rhythms which could lead to arrest but not code the pt if/when if progressed that far, and tele would help us to do that, but CC only? What's the purpose of tele?

We have that problem as well...or, LOC II(meaning no code) Meds only...what a crock, or, CPR, without intubation. Where are the meds going to go if there is no circulation to get them there.

I think part of the public's(and Drs.) misconception is that we will "let people go". DNR just means they will not be coded. They still receives all meds and treatments.

The really sad thing is, some people get BETTER care when nurses and Aids know they will not have to attempt the futile, thumping on someone's body just to say..."we did everything we could". When people are DNR, I have seen both aids and nurses spend more time with them, providing more care and comfort.

TheCommuter, BSN, RN · Mar 25, 2005

I did read both of your posts in their entirety and understood them the first time they were read. Perhaps I have a bad habit of repeating things or reiterating points. :)

Maybe you didn't read my entire post. I did agree it's an ethical issue and I also said I would not do it and I would act as the pt advocate and would definately "corner" the Doc and get an order for real meds. (Using different words this time because I think you misunderstood my last post). However, I have not run into that in a long time.
I also mentioned that years ago we gave placebos without thinking about it. There was a different belief then about pain.