Top ethical concerns to RNs

Libby1987 · Nov 12, 2015

A lot of the points above are so valid.
I worked ICU and keeping a pt alive for months on a vent, trached, pegged with family who would visit once a week or so and continue on insisting care. One time, I had this absolute ridiculous family and I made sure to turn them while they were there to see the bedsores. We were turning per protocol but this patients entire body was just breaking down no matter what we did. They were terminal. The family got to hear this persons moans. I grabbed a very good intensivist who was great about talking to families regarding end of life and thankfully after many tears they allowed us to make this person comfortable and disconnect the vent.
i feel that nurses encounter ethical delimmas daily and that's one of the things that makes us all amazing. We push through and we keep fighting for what's right for the patient.

Your last statement, exactly. I don't so much resent the positions we are sometimes put in, I try to look at it as being a safety net. Thank goodness I'm there to assess and intervene appropriately. This has included upping my abilities to manage sicker patients at home as well as sending them back as appropriate.

It's part rising to the challenge and part drawing a line.

And it also underscores the need for experienced nurses in home health.

nurseactivist · Nov 12, 2015

After retiring from 40 years of nursing, there are two that stick in my mind. Once was a critical patient, post-op bilateral amputee, heart failure, eventually required a trache. She used to mouth the words, "let me die." Her husband a physician, would not let go. We had her for months in ICU before he decided to let go. The whole thing made me sad.

The other was a terminal, elderly patient with Ca. In the days of paper charting, all the previous shifts had charted "C" for comatose. Well, I turned him and he moaned loudly. I knew if I medicated him, it would probably result in his death. I called his wife to inform her in case she wanted to come see him (she declined) and then medicated him. It infuriated me that I suspect he had not been comatose for days. I had to remind myself, he moaned LOUDLY.

Wrench Party · Nov 12, 2015

1) Quality of life once we discharge patients into the community.

2) Access to affordable care, especially to my patient populations (older cardiac and adolescent-25 yo women and men)

3) Transplant suitability

4) the lack of experienced bedside nurses and creating an atmosphere for veteran nurses to thrive (i.e. stay at the bedside if they wish)

bloatedputti, MSN, RN · Nov 12, 2015

Massive waste of healthcare dollars for terminally ill patients, usually related to family members who cant accept death. Guarantee that if they had to pony up the money, they'd pull the plug.

WKShadowNP, DNP, APRN · Nov 12, 2015

Allocation of scarce resources, especially in populations that continually squander them.
Lack of discussion in the lay population on what exactly a code consists of, and what that will do to a 94 y/o terminal COPDer or FTT.
Broken multi-payer system that has more cracks than the streets of Detroit and is incentivised to deny needed care to maintain obscene profits.
The treatment of Native Americans by both staff and the IHS.

I think I could have written most of this.

Getting care to those who need it, e.g. allocation of resources is a big thing for me. In this great grand ole country how is there such a disparity in what services can be accessed and how.

Also, the press ganey/hcahps reimbursement thing. What makes the patient/family happy may not be what they need. But if you want them to select "always/everytime/excellent" you better fluff their pillow and answer their call lights toute suite.

WKShadowNP, DNP, APRN · Nov 12, 2015

A lot of the points above are so valid.
I worked ICU and keeping a pt alive for months on a vent, trached, pegged with family who would visit once a week or so and continue on insisting care. One time, I had this absolute ridiculous family and I made sure to turn them while they were there to see the bedsores. We were turning per protocol but this patients entire body was just breaking down no matter what we did. They were terminal. The family got to hear this persons moans. I grabbed a very good intensivist who was great about talking to families regarding end of life and thankfully after many tears they allowed us to make this person comfortable and disconnect the vent.
i feel that nurses encounter ethical delimmas daily and that's one of the things that makes us all amazing. We push through and we keep fighting for what's right for the patient.

Kennedy terminal ulcers?

wallum · Nov 13, 2015

Hello I was wondering what nurses do and how they react when they personally care for women who are victims of domestic violence

WKShadowNP, DNP, APRN · Nov 13, 2015

Treat the patient for the physical and emotional injuries, refer to help. Remain as professional as possible, try to not get too attached or let your emotions cloud your professional judgement. Be kind.

LDAthleteNurse, BSN, RN · Nov 13, 2015

Hello I was wondering what nurses do and how they react when they personally care for women who are victims of domestic violence

Hello:) This is a great topic! You might get a much better response if you start a new thread asking this question.

allnurses Guide · Nov 13, 2015

Hello I was wondering what nurses do and how they react when they personally care for women who are victims of domestic violence

https://allnurses.com/general-nursing-discussion/domestic-violence-the-1019827.html

https://allnurses.com/general-nursing-discussion/domestic-violence-what-1020700.html

https://allnurses.com/general-nursing-discussion/domestic-violence-rebuilding-1020723.html

KelRN215, BSN, RN · Nov 13, 2015

I believe this played an active role in accelerating the death of my baby cousin. She was 3 and had been suffering from a myriad of congenital birth defects. After she lost the ability to swallow at 2 years old and required a mickey tube, the doctors informed us that she would eventually lose the ability to breathe on her own. A year later the doctor was right. She caught a really bad cause of pneumonia and the doctor gave her two options: tracheostomy with mechanical ventilation for the rest of her painful life or hospice/palliative care. Thank God her mother chose to provide palliative care and comfort measures. She had been depending on a bipap machine for adequate ventilation, within 45 minutes of its removal she began experiencing agonal respirations. The nurses gave her morphine to ease her breathing efforts. Within 4 hours, she was gone. I believe she was "medicated to death" but this was a kind service to her and our family. We were so happy to see her finally be at peace.

Death four hours after a dose of morphine is not death caused or hastened by the morphine. Morphine has a very short half life, it's gone by 4 hours later. I think of this kid every time something like this comes up but the most morphine I ever gave to a patient was 100 mg PER HOUR to a kid who weighed 24 kg. (For reference, the normal pediatric dose of morphine is 0.05-0.1 mg/kg q 2-4hrs.) This kid was getting four times his daily dose in an hour and it didn't kill him. He lived for days on this and was getting 10 mg boluses PRN on top of it. He was also on high doses of ativan (6 mg/dose) and continuous ketamine. Having seen the way he screamed in pain because of a rapidly progressing brain tumor the day we started him on the PCA (he started at 1 mg/hr), I felt zero qualms about how we were managing his symptoms.

LDAthleteNurse, BSN, RN · Nov 13, 2015

Death four hours after a dose of morphine is not death caused or hastened by the morphine. Morphine has a very short half life, it's gone by 4 hours later. I think of this kid every time something like this comes up but the most morphine I ever gave to a patient was 100 mg PER HOUR to a kid who weighed 24 kg. (For reference, the normal pediatric dose of morphine is 0.05-0.1 mg/kg q 2-4hrs.) This kid was getting four times his daily dose in an hour and it didn't kill him. He lived for days on this and was getting 10 mg boluses PRN on top of it. He was also on high doses of ativan (6 mg/dose) and continuous ketamine. Having seen the way he screamed in pain because of a rapidly progressing brain tumor the day we started him on the PCA (he started at 1 mg/hr), I felt zero qualms about how we were managing his symptoms.

I mis-typed. She was gone within 45 minutes of her first morphine dose. I think the morphine kindly pushed her over the edge. We all were grateful for this.