This cannot be ethical!

[sweetcheekers]

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.

[BadBird, BSN, RN]

If handled in a professional way for the purpose of teaching and improving a skill I don't object. It is not something that anyone would want done to their child but if your child needed intubation wouldn't you want someone with experience?

[mom23RN]

If handled in a professional way for the purpose of teaching and improving a skill I don't object. It is not something that anyone would want done to their child but if your child needed intubation wouldn't you want someone with experience?

Well, my child did need intubation, several times. I also knew we were in a teaching hospital and knew that residents may be doing it for the first time. I also knew that they would be supervised because the nurses in our hospital were looking out for his best interest. I had no problems with them doing it in that situation.

Had they done it after he died WITHOUT my consent, I certainly would have had a very BIG problem with it.

[GermPhobe]

hmm. I don't think its that big of a deal, either. I think that the benefits of this practice far outweigh any potential detriment. If I was in a position where I needed to be ABLE to intubate a baby, I'd certainly want to practice first. There is no substitute for practice on a real person.

I'm guessing this probably needs to be done before rigor sets in--or the practice will not be real/instructional.

As far as asking for permission goes, the parents would be grieving INTENSELY at this point. It seems almost insensitive to ask their permission for something that will not leave marks or alter the baby's body in any way. Do they really need to know that it happened? It's not as if somebody was messing with the body for ignoble reasons. Do people want to be informed of exactly what happens during the embalming process? There are things we don't need to know.

At a time when they are further removed from their grief, most parents would probably be relieved to learn that their baby's death had SOME small, positive consequence, and that it may have helped other babies to have a better outcome.

[mom23RN]

hmm. I don't think its that big of a deal, either. I think that the benefits of this practice far outweigh any potential detriment. If I was in a position where I needed to be ABLE to intubate a baby, I'd certainly want to practice first. There is no substitute for practice on a real person.

I'm guessing this probably needs to be done before rigor sets in--or the practice will not be real/instructional.

As far as asking for permission goes, the parents would be grieving INTENSELY at this point. It seems almost insensitive to ask their permission for something that will not leave marks or alter the baby's body in any way. Do they really need to know that it happened? It's not as if somebody was messing with the body for ignoble reasons. Do people want to be informed of exactly what happens during the embalming process? There are things we don't need to know.

At a time when they are further removed from their grief, most parents would probably be relieved to learn that their baby's death had SOME small, positive consequence, and that it may have helped other babies to have a better outcome.

NOPE! If I want my baby to be a martyr I will make that decision, NO ONE else.

[nurse4theplanet, RN]

hmm. I don't think its that big of a deal, either. I think that the benefits of this practice far outweigh any potential detriment. If I was in a position where I needed to be ABLE to intubate a baby, I'd certainly want to practice first. There is no substitute for practice on a real person.

If you were grieving the immediate death of the child involved, then it may seem inappropriate and disrespectful to you. The effects of the family realizing this has been done without their permission will last a lifetime. They will be guilt-ridden that they entrusted their baby's body with these 'professionals.' They will mistrust future healthcare providers. They may not seek treatment for themselves or their other children out of fear that this may happen again. They will focus more on the final handling of the body, rather than trying to work through the grieving process naturally. Using the knowledge to save another child's life is an incredible benefit, but don't underestimate the powerful emotional toll it will take on the grieving family.

I'm guessing this probably needs to be done before rigor sets in--or the practice will not be real/instructional.

As far as asking for permission goes, the parents would be grieving INTENSELY at this point. It seems almost insensitive to ask their permission for something that will not leave marks or alter the baby's body in any way. Do they really need to know that it happened? It's not as if somebody was messing with the body for ignoble reasons. Do people want to be informed of exactly what happens during the embalming process? There are things we don't need to know.

There are things that some people may want to know so don't place your feelings and interests on others. I am very interested in how my body will be handled once I die. I also would want to know if these procedures were going to be done on my child's body. I have the right to know. That is part of every pt's bill of rights. You explain every procedure to the pt, even if you are performing skills on someone who is comatose....you still talk to them and explain what you are doing before touching them because we don't know how much they can comprehend. When you consult the POA and family of dementia pt's, you explain all the procedures to them even though they are not the patient. It's common courtesy and respect for the family.

At a time when they are further removed from their grief, most parents would probably be relieved to learn that their baby's death had SOME small, positive consequence, and that it may have helped other babies to have a better outcome.

You think? Have you had a lot of experience with this? I am betting that this is just an assumption based on your personal views. I don't think there is any truth to it at all. I think that if a teaching hospital plans to use deceased bodies in anyway that is not what the family would naturally expect to be done then it should be disclosed to them upon admission, its purpose explained, and consent requested. Some may refuse, some may not. But doing it behind their back because they may never find out is unjustifiable.

[sweetcheekers]

hmm. I don't think its that big of a deal, either. I think that the benefits of this practice far outweigh any potential detriment. If I was in a position where I needed to be ABLE to intubate a baby, I'd certainly want to practice first. There is no substitute for practice on a real person.

I'm guessing this probably needs to be done before rigor sets in--or the practice will not be real/instructional.

As far as asking for permission goes, the parents would be grieving INTENSELY at this point. It seems almost insensitive to ask their permission for something that will not leave marks or alter the baby's body in any way. Do they really need to know that it happened? It's not as if somebody was messing with the body for ignoble reasons. Do people want to be informed of exactly what happens during the embalming process? There are things we don't need to know.

At a time when they are further removed from their grief, most parents would probably be relieved to learn that their baby's death had SOME small, positive consequence, and that it may have helped other babies to have a better outcome.

The point is that it is not up to you to decide if its a big deal, it is not your decision. It is up to the family. We are taking it upon ourselves to make decisions that are not ours to make. Another point I'd like to make is that regardless of wether or not "marks" could be left on the babe (there could be bruising by the way) that is beside the point. Think of various cultures and the different beliefs that they have about care of a body after death. These beliefs vary widely and should be respected. Just because this is not an unusual "cultural" situation we are specifically addressing (though that should always be considered) does not make the feelings and desires of the family for the care of their loved one following death any less critical and requires no less of us than to abide completely. What if you had a patient who died who had cultural beliefs that required the family to care for the body after death. What if they spent large amounts of time with the body following death? Is it appropriate then that we ask them to put aside their beliefs/desires because God forbid we are missing out on a learning opportunity? That's what classes are for. I know that classes are not the real deal, but neither is intubating someone who is deceased. Reality will always be different and regardless of your training it may or may not suffice. We simply cannot go around doing whatever it takes to get experience at the expense of our patients/families trust. I would rather be an ignorant and inexperienced nurse than compromise what is ethical.

[nurse_wannabe]

And I can honestly say in the number of times I have done this or seen it done not once did the patient complain.

Hey, it cracked me up.

:rotfl:

I see you are a nursing student. I suggest you quit now and find another field of work. One that does not involve even a modicum of empathy or caring would be perfect for you.

[DapperRN]

(quote)"I see you are a nursing student. I suggest you quit now and find another field of work. One that does not involve even a modicum of empathy or caring would be perfect for you."

I think that comment may be a little too far. Working in critical care I have found many nurses (including myself) that rely on black humour to cope with many situations. I also noticed that you yourself are a nursing student, keep in mind the best evaluation is self evaluation, don't assume this person would not be empathetic (they may suprise you, and maybe they wont)

As far as this discussion goes, I think it has had soo many responses because it is a very ethical dilemma. I am not sure where I stand with this issue. Someone previously made a comment that it could help other neonates in the future. This I believe to be true. Many residents need to practice skills to become competent, do I say this should be a reason to go ahead and continue with this, no, but it is something to consider. At the hospital I work at students perform various skills on deceased patients (I wouldn't call them a cadaver at this point) and it is vital to learning. Do they have a right, I can't answer that. Great thread, hence the heated discussion.

[rambisisking]

PERMISSION-PERMISSION-PERMISSION--------There are no other issues here. That is the only one. It may be benificial, It may save a life, It may make you look good later, It doesn't matter what doing it will do. I doesn't matter...YOU MUST HAVE PERMISSION. Without PERMISSION you have no RIGHT.

[pugmum]

I am not at all sure about your laws, or if they vary from state to state. Does informed consent end with the death of a patient? If it does not, then the parents must be informed before any potential "practicing" takes place. It becomes more than an ethical issue when you include a legal element. Furthermore, do you have laws relating to "commiting an indignity upon a human body"? If so, I would be making darned sure that I had parental permission before attempting any procedure on their child.

Leaving the legal issues aside, in my opinion it is unethical to perform such procedures on anyone without permission. This goes for pediatric intubation, adult intubation, or practicing line insertion on anyone without permission of next of kin (or unless permission granted by the person before death). When we go ahead and perform these procedures under the guise of obtaining skills for the future, we do nothing to honour the patient or his family ...

[gustercc]

Blah blah blah,

everyone here has their own agenda as to why this is ethical or that is unethical. In nursing, we are blessed with the ability to go into a WIDE variety of specialties. Be it, L&D, Forensic, or Research. The need for someone to practice so that others may benefit is there people. It has always happened and always will happen. Regardless of your personal beliefs and personal morals.

I know the idea of attempting to intubate a baby seems very wrong, but think about the otherwise. What if your child died because a paramedic couldn't get the intubation because he'd never had the opportunity to attempt it? Medicine started out this way, we just never talk about it. You know, I know, and now everyone else knows it.

Would I want it done to my two-month old? Probably not. I would probably not want to be told about it either.

If you wanna preach ethics, tell it to the mountain. Our profession has tons of questionable practices that are done because they can be done, not necessarily because they should be done. (ex: genetic modification or "Hey New Grad, wanna practice starting IV's on this tubed and sedated pt.?" --- I know who you guilty ones are!!!) I'm sure if you asked a group of med students what they thought, you might get a different answer.

I hope this provokes some thought and intelligent HEALTHY debate.

cheers,

gustercc

p.s. keep your bible chatter at bay

[Midwest4me]

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.[/quote

Patient advocates are EXACTLY what we are called to be. Engaging in such "practice to better one's knowledge" ( as those who support this would say) is NOT considering the patient OR the family. I too lost a child---a very precious grandchild at age 3----if I'd known any such "practice" was ever done to her, I'd have obtained the names of everyone involved, spread their names to the media, and made their lives hell. :angryfire No one who loses a child EVER gets over it (and if he/she does, the child never meant anything in the first place IMO). To COMPOUND the grief with the knowledge (or even the suspicion)that there was practice on the infant for educational purposes proclaims lack of a conscience and ...more importantly...ABUSE in my opinion!!!

Is there REALLY such a thing as "giving consent" for such practices anyway? How exactly does something like that READ? Does anyone out there know????? Is it something like this: "for educational purposes or provision of care in future similar cases"?????? And if there really IS a chance to obtain such consent, what nurse in his/her right mind would ever be a part of that?? Wouldn't such a nurse feel shame in approaching a family member with such a form? AND what kind of a family member would actually AGREE to sign such a form?