Do Resuscitate Status: A Legal and Ethical Challenge for Nursing
Shawn Wolkart
Senior Integrative Seminar
Spring A semester, 2010
University of Saint Mary
Abstract
A status of do resuscitate in those critically ill patients may result in a slow code. A slow code is a situation where the nursing staff decides to do less than the standard set forth by advanced life support algorithms and the nurse practice act and allow the patient to die instead of possibly sustaining life. The legal implications include falsification of documents and breaching the standard of care set forth by the nurse practice act. The ethical issues include malfeasance, dishonesty, and taking on the role of deciding who has a chance to live during a life
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Although it has been many years since I rotated through an intensive care, I am sure these issues still arise. As a nurse I worked in the pediatric and neonatal ICU’s and thankfully was not exposed to this type of ethical dilemma. In those instances we did everything we could for those little lives. Today, I would report this to the manager and follow the chain of command. The staff needs education and training on end of life care and issues, legal and ethical dilemmas in relation to code status, and review of the nurse practice act. Reviewing legal cases and outcomes with the staff may also increase awareness of the dangers of practices such as slow codes. Nurses are to be healing, caring, empathetic and supportive of patients and families during critical illness, death and dying. At that time, I was just a student nurse and had yet to realize the consequences of this unethical practice. However, as a manager equipped with the knowledge of the ethical and legal dilemmas of a slow code, my actions today would be different. Involving the ethics committee in these cases would be encouraged. According to Pozgar (2007), “An ethics committee in the health care setting is a multidisciplinary committee that serves as a hospital resource to patients, families, and staff, offering an objective counsel when facing difficult health care issues and decisions.” As a
Thao violated the standard practice and principle of her profession. According to the ANA code of ethics Ms. Thao violated provision 2, 3, and 4. As a nurse Ms. Thao’s primary commitment was Ms. Gant, which she failed to fulfill. Ms. Thao volunteered to work extra eight-hour shift after working sixteen hours (Mason, 2007). She was knowingly taking the risk about of her duty and safety of the patient. Ms. Thao failed to finish the delegation that was given to her due to overwork by which she dishonored provision 4. She violated provision 3 by not reading the warning label on the drug bag and opening the locked cabinet with out the permission of a
Codes of ethics contain a coherent set of normative principles underlying a nurse’s purpose and associated values (Vanlaere and Gastmans, 2007). Two perspectives of ethics are the ethics of justice and the ethics of care (Botes, 2000). The ethics of justice constitutes an ethical perspective in terms of which ethical decisions are made on the basis of universal principles and rules, and in an impartial and verifiable manner with a view to ensuring the fair and equitable treatment of all people (Botes, 2000). The ethics of care, on the other hand, constitutes an ethical approach in terms of which involvement, harmonious relations and the needs of others play an important part in ethical decision making in each ethical situation (Botes, 2000).
There are things that could have been done to solve the ethical issues in Mr. J’s scenario. First, the CNA needs to be educated on what to look for when it comes to pressure areas. A protocol should be in place in which a CNA notifies the nursing staff of any redness. In turn the nursing staff should then follow up with a care for the patient that requires turning every two hours. Second, a local Rabbi should be called in to educate staff on the Jewish culture and the changes in care a patient should need if they are Jewish. Teaching on Kosher diets would be one of the aspects of the education provided to all staff. Thirdly, all staff needs education about communication. Education about communication should be ongoing. Communication between staff is as important as communication between staff and patients and staff and family. The diet issue should have been brought up to management before so that the problem could have been prevented before Mr. J became a patient. The fact that it was not reported reflects a system change that needs to be made in the realm of communication. Lastly, there should be a protocol as to when restraints should be used. As discussed earlier in this paper, the patient would have benefited from a bed
The State of Tennessee Board of Nursing’s Rules and Regulations of Registered Nurses, Rule # 1000-01-.13-1r states that unprofessional conduct is defined in part by "failing to take appropriate action in safeguarding the patient from incompetent health care practices" (State of Tennessee, 2011). There are a number of arguments in this case study that incompetent health care practices are being performed, from the decision to place a patient on a ventilator for an oxygen saturation of 88%, circumventing the patient’s written and verbal advanced directives, utilizing an unauthorized family member to get consent for
In the Code of Ethics for Nurses provision 4 states “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.” This was not done, there was no regard for human life. The patients in the hospital were treated as a burden. A meeting was held where the doctors agreed that
Nurses are faced with ethical dilemmas on a daily basis, each situation being unique and requiring the nurse to set aside their own values and beliefs in order to properly care for their patients. Situations requiring nurses to make an ethical decision are diverse and dynamic; the values set out by the College of Nurses of Ontario code of ethics remains the same. Therefore, all decision based on these vales regardless of the setting and circumstances ensure consistent solutions. The scenario involves a woman who was admitted to the NICU due to complications during her sixth month of pregnancy. The patient indicated that no extraordinary measures should be made to save her baby; she became further detached when the baby developed a bleed
There are several legal and ethical issues relating to FWR. Some of the key legal concerns expressed by healthcare professionals include the potential for litigation, patient confidentiality, and the patient’s right to privacy (Mian et al, 2007; Critchell et al, 2007). Litigation and liability concerns arise from the fact that, in most cases, family members will have little understanding of the procedures used in the code room. The fear is that the staff’s actions could be perceived as detrimental or harmful to the patient in the eyes of the typical lay-person. The reality is that once healthcare providers become educated and experienced with FWR,
Being ethically and legally responsible for another human being, was recognized as an overwhelming and ‘extremely scary’ experience. Specifically, graduate nurses fear the lack of recognising a deteriorating patient as a result of ‘overlooking something’ important (Goh and Watt 2003). Therefore, this stress and uncertainty in their practice may lead to a number of unfortunate events occurring and put patient’s safety at risk, due to the degree of responsibility and
Ethical issues in nursing will always be an ongoing learning process. Nurses are taught in nursing school what should be done and how. Scenarios are given on tests with one right answer. However, there are situations that nurses may encounter that may have multiple answers and it is hard to choose one. “Ethical directives are not always clearly evident and people sometimes disagree about what is right and wrong” (Butts & Rich, 2016). When an ethical decision is made by a nurse, there must be a logical justification and not just emotions.
The NMC (2015) are the providers of the Nursing Code of Conduct. The code contains the professional standards to which all nurses must uphold, allowing for accountability of patients that come into their care. As well as the code of conduct, all nursing professionals have a responsibility to develop their knowledge in relation to law within clinical practice, and furthermore, ethical frameworks that are linked to judgment and decision making when providing care (Savage & Moore, 2006). In light of this, the overall aim of this essay is to elaborate on issues surrounding law and ethics in nursing. To do so, a case study has been chosen from a previous clinical experience. The focus of the case study will be on the decision of withdrawal from life sustaining treatment. Emphasis will be largely on the law and ethics concerning the issue of withdrawal from treatment. Moreover, the ethics and law involved in the palliative/advanced end of life care planning and decision making. In order to protect the identity and uphold the confidentiality of the case study, a pseudonym will be used throughout. Hendrick (2005) portrays confidentiality as being ‘one of the most important and well established moral obligations of health-care ethics’.
As the nursing profession progresses throughout the years, its nature becomes more complex in meeting the professional standards and codes of ethics that are required by all nurses. The American Nurses Association has a specific code of ethics that each nurse should follow and adopt as their own beliefs. The public and the patients should be the priority when providing care in the healthcare setting. The knowledge and education that nurses’ gain is valuable and allows them to encourage health, avoid illness, restore health, and aid in coping for those who are all ill. (LeMone, pp.192) Given that the code of ethics is put into place, there are many registered nurses who violate these codes in various situations. The following will discuss
Healthcare professionals will be faced with ethical dilemmas throughout their career, particularly in the hospital environment. Having an education regarding professional healthcare ethics will provide some direction in how to best address these dilemmas at a time when either the patient or their family is in need of making decisions for themselves or their family member. It can be difficult for healthcare professionals to weigh professional protocol against their own personal beliefs and ethical understandings when determining critical care for their patient.
Most cultures value life and bringing persons back from the dead is a popular subject of many fictional books. However, as technology evolves and the story of Frankenstein reborn with a bolt of lighting has come true with the external or implanted defibrillators, the natural process of death slows as much of society gains the knowledge to live longer than nature intended. The Red Cross Association taught many organizations like the girl and boy scouts the methods of mouth-to-mouth resuscitation and Cardiopulmonary resuscitation or CPR, a manual manipulation of the heart, as life saving methods for drowning, electrocution or heart attacks. First aid for laypersons to save lives as well as
Ethical principals are the seed of which nursing flourishes from. Many ethical principals were involved and dishonored in this case such as, justice, autonomy, beneficence, non-maleficence, confidentiality and fidelity (Burkhardt et al., 2014). I believe justice was the main principal involved as the entire ethical predicament was revolved around unjust behavior and treatment of the residents. The residents were treated poorly and given unequal rights as a causation of their illnesses. Autonomy, an essential piece of human rights was also being violated in this ethical dilemma. The residents did not have any choice or independence in their care or how they were being treated. Beneficence and non-maleficence are significant dynamics of this ethical situation, as the health care providers needed to reflect on how they can have the maximum benefit while diminishing possible damage to the residents (Burkhardt et al., 2014). Our actions as nurses should always be beneficent and non maleficent, continuously being kind, compassionate and doing what is in their best interest as well a removing and preventing harm. Confidentiality is a key component of nursing and it was blatantly being violated as the health care
The nursing code of ethics has a very standard definition. It is the base on how nurses should guide themselves in conduct by making the right decision regarding ethical issues. According to the National Student Nurses Association “students of nursing have a responsibility to society in learning the academic theory and clinical skills needed to provide nursing care” (2003). In the clinical setting nurses have a lot of responsibilities while caring for an ill patient, they have the obligation to practice their profession with compassion, love, and respect the uniqueness of each patient, as nurses we are not supposed to deny care to a patient because of their economic status, their skin color, race, or the nature of health problems, we are