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I was recently told during NRP training that a nurse was instructed at some point to always use the opportunity to practice intubation if a stillborn babe was available. I said, "Are you kidding me?" She said no and that she had the opportunity three times but just was unable to do it. I said that I felt that was extremely unethical and that using a patient's body (dead or alive) for learning purposes without proper consent was just plain WRONG! I don't care how great the learning opportunity, I would NEVER use another human to further my education without knowledge and consent of the patient or parents. Am I overreacting! This does not seem like a gray area to me.
So is it unethical for a nurse to assist a physician in an abortion?
I am the one that originally posted this thread, and after further thought on the matter I have finally found the words that sum up in a very brief way why this is so wrong. Patient advocate. That is who we are suppose to be, right? That pretty well covers it. Doing anything to a patient, alive or dead, without considering the patient and the family is not being a patient advocate, it is being self-serving. That is not the nurse I want to be, and I'm pretty sure it is not the nurse that most patients want me to be.
So is it unethical for a nurse to assist a physician in an abortion?
This has nothing to do with the topic at hand. Why would you even bring this up. The person having the abortion has signed a consent form and the nurse assisting the physician is employed at her own free will. Please, this has nothing to do with what we are discussing.
I myself have mixed views in teaching hospitals this practice is used as a way to learn but on the other hand if the family has not given permission it should not be done. We as health professionals should not assume that we have a blanket to do what ever we care to because someone has said yes even if it is our instructors. I would still want permission a baby even if stillborn was at one point a "living thing" and like all living things should receive respect.
I myself have gone to the extent of donating my body to science MD School of Medicine when I die so that the students may learn. But there is the agreement I have agreeded to having my body used for such purposes.
20 years ago, this was the norm in my unit, but it isn't now. Our residents go to NRP classes and use cats (Okay, this is a whole nother fight waiting to happpen, but I'd rather they use the kitty than my kid, IMHO). In a teaching hospital, unfortunately, someone's kid/family member is going to be some residents first for whatever...intubation, IV, sutures, etc, but in my unit we are really forward about saying...eh, you need to find someone else.
And intubating something that is already dead is nothing like something alive and wiggling. You can learn landmarks by looking when someone is intubating.
20 years ago, this was the norm in my unit, but it isn't now. Our residents go to NRP classes and use cats (Okay, this is a whole nother fight waiting to happpen, but I'd rather they use the kitty than my kid, IMHO). In a teaching hospital, unfortunately, someone's kid/family member is going to be some residents first for whatever...intubation, IV, sutures, etc, but in my unit we are really forward about saying...eh, you need to find someone else.And intubating something that is already dead is nothing like something alive and wiggling. You can learn landmarks by looking when someone is intubating.
I have had the same experience in the >30 years I worked in a teaching hospital. This was done 20 or so years ago. It is not done now. And I can honestly say that the change came from the top. The attendings made the decision (they may have had some nursing input.) The baby doesn't belong to us. They conduct "kitten labs". The kittens are anesthetized, and usually have adoptive parents (among the participants) before the lab is over.
I now work in a smaller community hospital. We have ALS-trained nurses that go to risk deliveries. When there is a kitten lab (~once a year), they are allowed to go. It is critical that this teaching takes place. There is often no neonatologist in the delivery.
20 years ago, this was the norm in my unit, but it isn't now. Our residents go to NRP classes and use cats (Okay, this is a whole nother fight waiting to happpen, but I'd rather they use the kitty than my kid, IMHO). In a teaching hospital, unfortunately, someone's kid/family member is going to be some residents first for whatever...intubation, IV, sutures, etc, but in my unit we are really forward about saying...eh, you need to find someone else.And intubating something that is already dead is nothing like something alive and wiggling. You can learn landmarks by looking when someone is intubating.
Exactly.
I also work at a teaching hospital. You have to decide what is more ethical - a first-year resident trying to intubate a sick baby, and perhaps the intubation will not go very well because of their inexperience. Or you can have them trying to intubate a dead baby without the parents' permission. In my hospital, we will always go with the live baby, because it's a necessary procedure and we are responsible for that doctor's education and training. They've practiced on dolls, and often on kittens as well. Honestly, if I had a choice between letting a first-year resident intubate my sick 24-weeker or my stillborn infant...I'd pick the preemie. I mean, come on, don't we all remember our first IV stick? First arterial puncture? Gotta learn sometime, and at least it should be a case where the procedure is necessary, so it's not just for "practice" you know?
I just can't imagine being a part of this, I'm totally disgusted. When we lose a baby, we take such care of their bodies. We slowly and gently remove all the tubes, lines, and tape. We bathe the baby's body, and we always ask the parents if they wish to be a part of this process. It's almost like a ritual - we feel like we're washing away all the pain and suffering the baby endured. We even turn the warmer on high so the baby stays warm as long as possible. Then we'll dress them and wrap them up, and when it's time to go the morgue, I don't think there's a single nurse on the unit who can zip up that body bag without crying. We just treat their bodies with such respect, whether or not the parents are around. We've even had some very sad cases of parental abandonment, where the docs would not have needed to get permission on "practice" on the baby's body - but they never even mentioned it. We're almost more protective of these poor babies because they have no parents to be their advocates.
Clearly there are some who have justified this in their mind. Thankfully they are the minority. Like any other issue, peolpe have different views and beliefs. This is exactly why the parents should be consulted. Just because the nurse thinks it is ethical does not mean the parents would agree. To make the decision without consulting the family is overstepping the boundary line. It is not the medical staff's decision to make.
sweetcheekers
75 Posts
I am the one that originally posted this thread, and after further thought on the matter I have finally found the words that sum up in a very brief way why this is so wrong. Patient advocate. That is who we are suppose to be, right? That pretty well covers it. Doing anything to a patient, alive or dead, without considering the patient and the family is not being a patient advocate, it is being self-serving. That is not the nurse I want to be, and I'm pretty sure it is not the nurse that most patients want me to be.