- Think about ethical situations you have experienced in practice.
- Write a summary of your experiences, and explain how the situation was resolved or ended.
Recently I have been acting as a resource to a family who’s patriarch was nearing his end of life. I was providing information in the ambulatory care setting for their ailing 84-year-old father who was suffering from multiple chronic conditions, including congestive heart failure, diabetes, acute respiratory distress, and was now recovering from a stroke with permanent weakness and dysphasia. The patient has been displaying increased delirium and agitation on a daily basis and is no longer able to have coherent conversations with others. The patient’s wife has insisted on a full code because just six months ago the patient was living independently with his wife in their own home. Since his stroke he is not able to stand on his own, feed himself or comprehend what is going on around him, let alone communicate his basic needs or wishes. The patient’s son has been trying to explain the ramifications of maintaining this status to his mother and feels his father would not want to be on a ventilator or living brain dead. After numerous conversations with the doctor and nurses, the patient’s son wishes to place the patient in hospice care, as he feels this is what his father would want. However, the patient’s wife is insisting that some physical therapy is all the patient will need. Last week, the patient returned to the emergency room due to shortness of breath as a complication of his worsening congestive heart failure and acute respiratory distress syndrome.
After understanding more of the family dynamics and the patient’s wife’s role as the health care proxy, the interdisciplinary team had to work together to better inform the patient’s wife of the risk and benefits in keeping the patient as a full code. Eventually the patient’s code status was changed to do not resuscitate and a few days later he passed away in the hospital.
As a nurse, it was clear to me that the patient’s condition was not likely to improve, and that the patient’s odds of returning to an independent living condition were small. It is times like this where nurses and doctors are required to have the frank and difficult conversations with families to ensure that the patient’s wishes are being carried out. According to the American Nurses Association Position statement, “[n]urses are obliged to provide comprehensive and compassionate end-of-life care. This includes recognizing when death is near and conveying that information to families. Nurses should collaborate with other members of the health care team to ensure optimal symptom management and to provide support for the patient and family” (American Nurses Association, 2016). During my interactions with the family, I would give insight, comforting words, and outside perspective to help them understand what was going on with their loved one so that they felt less overwhelmed by the totality of the situation.
Reference:
American Nurses Association. (2016). Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life. https://www.nursingworld.org/~4af078/globalassets/…
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