This is the final post. I have tried to use quiblo to make a quiz but after trying to register three times I am going ahead on my own.
The following are two scenarios and I would like your thoughts on each. I will put my thoughts at the end. I had intended a open question where several could post.
Scene one
You are assisting a patient with her AM care, her daughter, also her Power of Attorney (POA), is in the room and they are talking. The patient is telling her daughter she wants to be a Do Not Resuscitate (DNR). The daughter is arguing in favor of resuscitation. You move on and finish your shift. You are off for a few days and return to work to find the patinet has had a massive decline. Conversation s are occuring with the daughter and doctors about making the mother a DNR. The daughter does not know what to do. What should you do?
Scene two
The patient has demonstrated DNR wishes in the past but has not been consistant and has changed his mind repeatedly. The patient has five children and has never chosen a POA. The patient has now declined to the point of no longer eating, he is failing for lack of nutrition. The doctor has come to the room and spoken with three of the five children as he believes the patient needs a PEG (feeding) tube. The children are not decided and do not agree what would honor the wishes of the father. The family members have begun speaking to members of the staff that they have spent time with over the last several hospitalizations. They are seeking opinions on PEG tubes and what to do or how to change their siblings mind. What should the staff do? Who should be involved?
There are so many ethical issues that arise and I only see the options I am familiar with. I would be interested in others views.
Scene one: There would not have been knowledge if the staff had excused self during private family converation. If the staff had spoken with doctor or social staff when conversation occured perhaps avert issue. Speaking to the doctor after returning to work, he then could speak to family. Speaking directly to the family member. Ignore everything. These are not listed in a particlar order but if nothing was done on the day of the conversation in the room letting the doctor know would be better then nothing.
Scene two: Staff should not be involved in family matters and personal opinions need not confuse family issues. The doctor and social staff may need to meet with the family to discuss concerns and previously stated patient desires. All staff from all departments should be reporting family approaches to the nurse to report to social services.
Sunday, February 19, 2012
Friday, February 17, 2012
Autonomy and respect: Do we really care?
Ehtics are determined by codes arranged by many agencies to include the American Nurses Association. We discuss respect for human life and dignity, beneficence, autonomy, and justice. We are to be compassionate and respectful of the dignity of others lifes.
This is where things get more difficult. Each person we are to respect and provide dignity for will vary from us. We have societal ethics, laws, we must adhere to and professional codes we are to uphold. We work in areas with short staffing, diversity of both clients and peers, longevity, and in an ethical mine field. We must make decisions and need decision making framework to proceed through this mine field.
Situations such as :
The placing of a catheter in a client to obtain a specimen when she is terrified. She can and does refuse but is considered incompetent and the family is deciding. It must be done, correct? What of the staff can they be forced to participate?
A patient with an old issue with addiction has a serious injury. Pain medicine is ordered. The patient has questions regarding the addictiveness of the medicine but is in servere pain. Do you medicate now and discuss stopping the medication later.
A more difficult patient, female and in and out of the hospital. No determined issue but severe abdominal pain, the doctor orders a variety of medications. She is demanding and rude and constantly complains of pain. You can not be one minute late with the medicine. The floor is short on the night shift and she starts. The morning nurse comes into find her almost in a coma and after much effort the patient is transfered to the ICU. The night nurse reported letting the patinet have "everything" the doctor had ordered for her. Who is responsible for what happened? The report showed the patinet awake and pushing the buttons up to about an hour before she slipped into the coma. Could more people then the night nurse be responsible? No calls were made indicating the pain was not controlled with one medication at a time. There were limits on which medicatins could be given together and others had been given. She was alert and demanding medication for comfort.
Something I have not heard addressed, except by a peer with a relegious preference, is things like having a Muslim feed a patient pork, a vegan feed a person meat, and the like. We are to provide for our patients and some situations are seperate. I object to one procedure but have not ever taken a job where I would be exposed.
Thinks to think about.
Reference
This is where things get more difficult. Each person we are to respect and provide dignity for will vary from us. We have societal ethics, laws, we must adhere to and professional codes we are to uphold. We work in areas with short staffing, diversity of both clients and peers, longevity, and in an ethical mine field. We must make decisions and need decision making framework to proceed through this mine field.
Situations such as :
The placing of a catheter in a client to obtain a specimen when she is terrified. She can and does refuse but is considered incompetent and the family is deciding. It must be done, correct? What of the staff can they be forced to participate?
A patient with an old issue with addiction has a serious injury. Pain medicine is ordered. The patient has questions regarding the addictiveness of the medicine but is in servere pain. Do you medicate now and discuss stopping the medication later.
A more difficult patient, female and in and out of the hospital. No determined issue but severe abdominal pain, the doctor orders a variety of medications. She is demanding and rude and constantly complains of pain. You can not be one minute late with the medicine. The floor is short on the night shift and she starts. The morning nurse comes into find her almost in a coma and after much effort the patient is transfered to the ICU. The night nurse reported letting the patinet have "everything" the doctor had ordered for her. Who is responsible for what happened? The report showed the patinet awake and pushing the buttons up to about an hour before she slipped into the coma. Could more people then the night nurse be responsible? No calls were made indicating the pain was not controlled with one medication at a time. There were limits on which medicatins could be given together and others had been given. She was alert and demanding medication for comfort.
Something I have not heard addressed, except by a peer with a relegious preference, is things like having a Muslim feed a patient pork, a vegan feed a person meat, and the like. We are to provide for our patients and some situations are seperate. I object to one procedure but have not ever taken a job where I would be exposed.
Thinks to think about.
Reference
Thursday, February 16, 2012
Video on ethics
How we are affected at work
Often when we talk about ethics we are talking about the activity surrounding a patient. The following thoughts eventaully impact a patinet but start with the staff. Floating a nurse, it is a means to a staffing need for the institution but it is not often favored by the staff member. I have been present when staff have refused a float assignment and they feel justified. The agency feels justified in requesting the nurse to fill a need elsewhere in the organization.
In one case the nurse claims she was told to go to the float, find someone else or go home. She went home and later was disciplined as her supervisor said the last was never an option. The nurse had complained that she was not quailifed to go the the area in question and would endanger the patients and her license. The organization did have a policy in place requiring nurses to float. For not following policy she was terminated.
She sued and the board upheld the hospital rule even in the face of her concern for patinet safety. She again sued through public policy protecting patients and a jury found in her favor as she was not offered additional education in the area she was to be sent to.
In this case the state board of nursing did not support the nurse but public law did.
This case is mentioned because as nurses we may be asked to step into an area we are not experts in, the decision to persue an ethical course can be involved, costly and may not turn out the way we believe to be correct. Etichal issues are determined by people applying principles of right and wrong through their own perceptions and morals.
Reference
Westrick, S.J. & Dempski, K.,(2009). Essentials of Nursing Law and Ethics, Sudbury, MA. Jones and Bartlett Publishers.
In one case the nurse claims she was told to go to the float, find someone else or go home. She went home and later was disciplined as her supervisor said the last was never an option. The nurse had complained that she was not quailifed to go the the area in question and would endanger the patients and her license. The organization did have a policy in place requiring nurses to float. For not following policy she was terminated.
She sued and the board upheld the hospital rule even in the face of her concern for patinet safety. She again sued through public policy protecting patients and a jury found in her favor as she was not offered additional education in the area she was to be sent to.
In this case the state board of nursing did not support the nurse but public law did.
This case is mentioned because as nurses we may be asked to step into an area we are not experts in, the decision to persue an ethical course can be involved, costly and may not turn out the way we believe to be correct. Etichal issues are determined by people applying principles of right and wrong through their own perceptions and morals.
Reference
Westrick, S.J. & Dempski, K.,(2009). Essentials of Nursing Law and Ethics, Sudbury, MA. Jones and Bartlett Publishers.
Wednesday, February 15, 2012
Ethics and Media
When I was a girl the television had three channels and went off at midnight. When major events occurred the only show was the news. Couples had seperate beds and children listened to their parents. I am not sure how much I learned from televsion but this generation gets so many imputs. The internet, tweets, facebook, television, music and then life all have impact. I see movies offering ethical issues and some solutions involve breaking rules.
It is noted that ethics are ethics and should not harm another, should not embarass you if published in a prominent newspaper, should be transparent (something you would admit to), and should be what you believe in (Chen, 2009).
It is noted that ethics are ethics and should not harm another, should not embarass you if published in a prominent newspaper, should be transparent (something you would admit to), and should be what you believe in (Chen, 2009).
Chen, G. M. (2009). A journalist’s guide to the ethics of social media. Retrieved from http://savethemedia.com/2009/10/19/a-journalists-guide-to-the-ethics-of-social-media/
Avatar
I attempted to post an avatar but I have a title and nothing to look at.
I cannot seem to get it to load here but I do have the link. I would love to know what others have done.
I selected publish and blogger and filled in the form but it stated failed.
http://www.voki.com/mywebsite.php
As I consider avatars it is a method of communicating audio and some form or representation of self to others. I wonder if the representation affects preception of validity of conversation?
I cannot seem to get it to load here but I do have the link. I would love to know what others have done.
I selected publish and blogger and filled in the form but it stated failed.
http://www.voki.com/mywebsite.php
As I consider avatars it is a method of communicating audio and some form or representation of self to others. I wonder if the representation affects preception of validity of conversation?
Wednesday, February 8, 2012
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