Work Place Ethical Dilemma

The nurses did not act as sentries towards the patient or the family. They did not protect the patient’s choice to die in peace, instead they just let the doctor jump in into the situation and try to resuscitate her even though she did not want that.The nurses should have stepped in and asked the frazzled husband what he wants the nurses and doctor to do. Not let the doctor yell at him until he is forced to allow it.

For this study patient families were randomly assigned to the intervention or control group. In the control group the interactions between the family and ICU staff, including the end-of-life conference, occurred according to the usual practices and policies in the hospital; whereas in the intervention group, the research study was conducted according to specific guidelines. A bereavement information leaflet was given to each surrogate decision maker. In this research, the independent variable can be the type of family conference received by the surrogates and the dependent variables were the level of stress, anxiety, and depression levels indicated in the 90-day follow-up interview.

There has to be shared decision making between the family members and educate them about treatment of the patient since they will be helping take care of the patient.

Discussion of family presence during invasive procedures has been ongoing for many years. Some healthcare organizations have instituted policies to allow family members to be present during invasive procedures, which they would previously forbid during these procedures. Attitudes of healthcare provider’s differ drastically. (MacLean et al., 2003) This paper will illustrate the important benefits of having a family member present during these procedures. Terms used in this search includes: Pro family at bedside, Importance of family at bedside invasive procedure, Family centered car in the operating room and position statement on Family presence. The following articles were deemed appropriate for this paper.

The title clearly represents the main topic and population of the study – the changes that occur in medical care when a person is placed on a Do-Not-Resuscitate order and pediatric oncology patients. The abstract capably depicts the problem that is being addressed, the results from the study, and the implications of the study. The methods for gathering data are also included in the abstract. The abstract may benefit from including the limitations of this research study, specifically that this study focused on one hospital; therefore, the results may not be able to be generalized to other populations. Overall, the abstract is written well.

Giving the patient the option to accept or decline will demonstrate an understanding of the need for patient and family-centered care. To overcome barriers of concern expressed throughout the studies analyzed, it is essential to address, and modify practice as well as policies to reduce the likelihood of potential problems. Modifying elements of practice, such as handoff report, and talking in front of, or near family members can help decrease the breaching of patient confidentiality. Finding a small room away from patients and their families can provide them with privacy, and can provide staff with privacy when speaking about other patients. Unfortunately, depending on the structure of each PACU, limitations in space will always exist (Holthaus, Davis, Filla & Cooper, 2015). Managing the number of family members involved in the visit can help utilize the space available. Finding an appropriate time for visitation is also important. A suggested time for visitation is when the patient is awake from anesthesia, their pain and vital signs are under control and importantly, the patient is consenting to a visit with their family. Giving families some time alone with their loved one without staff continuously interrupting can give them that one-on-one time they

Many health care providers view family-involvement as a foundation of pediatric care. However, the ethical decision to allow family members to be present in pediatric resuscitation processes and invasive procedures can be challenging for many. Despite the evidenced based support of family presence within resuscitations and invasive procedures by the Emergency Nursing Association (2007) as well as the American Association of Critical-Care Nurses (2010), compliance with this practice often fluctuates substantially. A systematic review, Family Presence During Resuscitation and Invasive Procedures in Pediatric Critical Care: A Systematic Review, conducted by McAlvin and Carew-Lyons (2014), examined the positive affects associated with family presence at the bed-side, in an aim to encourage health care providers to implement this patient-centered practice.

Most people believe that it is their right to be present during a loved-one’s resuscitation, should they so desire. Contrary to the fears of the medical community, family members who have been present during a resuscitation report that the experience was not traumatic for them and would in fact opt to witness it again. Also, being present seems to provide a sense of closure and security in knowing that everything possible was done to save their loved one’s life (Critchell et al 2007).

Data was collected over two years in a level one trauma center with trauma patients that had one family member present and were admitted to the surgical intensive care unit after resuscitation. The family member was interviewed two days later for an average of ten to thirty minutes in a quiet room away from the patient. The sample size of the study was twenty eight and the majority of the sample was female. The results showed that the majority of family members that were present felt that there role was to be supportive and protect the patient during the trauma. They felt that being present was comforting to them and the patient, regardless of the outcome. Another common theme was that the family felt comforted knowing that everything possible was done for their family member.

Having a family member unexpectedly in ICU can be a painful and difficult time. Evidence based practice demonstrates that when a member of their social system is compromised, the entire family is disrupted. The unfamiliar environment leaves family members in severe stress and in a state of shock. Family members also require attention and needs to help cope with the stress of a family member in intensive care unit. These needs are grouped into five categories: receiving assurance, remaining near the patient, receiving information, being comfortable, and having support available. There should be

It can be very frustrating at times dealing with the family members of the older patient that I see in the emergency room. I have such limited time to take care of everyone’s needs before the next patient comes in by ambulance that I often forget how the family feels seeing their parent on an emergency room cart in pain and confused. My definition of the comfort I can provide in the emergency room are often very different from the family’s expectations. According to Gerontological Nursing (Tabloski, 2014), the attending nurse needs to understand the patient and family’s goals, wishes and values to attend to their

Healthcare professionals tend to shy away from having families present because they believe that the process may be considered offensive, there would be added pressure and stress on employees, there would be distractions and interferences with care, and that family members would not be mentally prepared causing coping issues post-resuscitation (Duran, Oman, Abel, Moziel, & Szymanski, 2007). It is important for healthcare professionals to know their beliefs and learn the benefits of family presence during the resuscitation process to be able to practice client/family centred care. According to Holzhauser, Finucane, and De Vries (2006) presences during resuscitation made coping easier after an unsuccessful event, provided a sense of control as families are included in the decision making process, and fostered the development of meaning full relationships. Holzhauser et

role of the family? These are some questions that require policy formulation to state clearly end-of-life decisions in the ICU.

Usually either patients or families have the legal rights to determine what medical course to take with the patient when it comes to the diagnosis of death, in this case the family's conflict needs be considered. The healthcare staff involved in the patient’s care must communicate with the family members during this difficult time. If the patient is determined to be dead, the family will need support from the health care staff that has been involved in the patients care, all available hospital resources, including medical, nursing, social work, ethics, and pastoral care will be a good resource for the family members. Lawyers will usually advise health care staff to work with the family in the most compassionate way possible, the lawyers should be there to help with any conflict between the family members, and this will also help the organization against any future malpractice suits against the health care staff and organization.

Palliative care is a type of health care for patients and families facing life-threatening illness, and helps patients maintain their dignity and quality of life so close to the end. During my clinical at Rosthern Hospital, I had a few experiences with patients and their end of life care. In these situations the patients, their families, and the healthcare team have been confronted with many ethical dilemmas. At Rosthern, there were three different patients who had a difficult time during their end of life care. T. C. was in his early 80’s and he did not have do not resuscitate (DNR) order, so when he coded, he received CPR and was revived. Aftern his resuscitation he had crippling deficits in his memory and much of his motor function. M. T. was in her 70’s, and she was diagnosed with stage 4 lung cancer and deteriorated quite quickly. Finally, H. M. was in his 80’s and was expected to pass quickly, so he was moved to palliative care room before Christmas, but since then has lived longer than expected, and has received palliative care for quite some time. It is important to remember than in palliative care the patient is the priority, and according to Dr. Aveyard (2004), when a patient denies care, “care cannot be given. To do so would be infringing on patient autonomy and to contravene the principles of consent” (2004, p. 1). I analyzed my experience with these patients at Rosthern Hospital using the Carper’s Five Ways of Knowing (1978) and I will reflect upon palliative