DB week 3.2 nur 391
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William Rainey Harper College *
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180
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Philosophy
Date
Feb 20, 2024
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In order to post to this forum, complete the assigned readings up to this point in the course. Re-read pages 46-47 in the Butts & Rich textbook on Ethical Dilemmas. Briefly scan upcoming readings. This discussion will help you to get started
on the Case Analysis paper, due in Week 5.
Instructions:
You will select and describe an ethical dilemma that you experienced as an RN or a student nurse.
What happened? Be sure to avoid actual names and other
identifying information.
What makes it an ethical dilemma?
Who are the key participants and/or stakeholders? Explain what makes them "key."
In your response to classmates' posts, do you believe they have, in fact, selected a true ethical dilemma? Explain. What are the most relevant facts in the case? What additional information would you request to inform decision-making? If that information is not available, how would you proceed?
When I just started working in my unit, I experienced an ethical dilemma with a dying patient
whose family wanted to keep the patient alive as much as possible with all medical treatments. A patient was 60 years old female who admitted to progressive care unit with complicated pneumonia. This patient was well known in our unit. She usually was admitted with multiple diagnoses such as heart failure and COPD exacerbations, acute kidney injuries, or altered mental status. The patient had breast cancer which metastasized to vital organs. In addition, the patient was a dialysis patient who had her hemodialysis three times per week. Because the patient had delirium or altered mental status, she decided to make her surrogate and power of attorney (POA) her sister. The patient did not have any husbands or children. Being a primary RN of this patient, I noted that something went wrong and contacted the attending doctor and pulmonologist to check the patient. The patient’s vital signs were stable; however, her mental status changed and stopped eating and drinking for more than 24 hours. The patient was asking to let her go and cannot suffer anymore. The patient was Full code and received all medical treatment. I also spoke with my supervisor and case manager, they suggested to consult palliative care and hospice. The attending doctor contacted POA who was disappointed with the suggestion of hospice and palliative care. When the patient’ sister arrived at the hospital she denied any meeting with hospice nurse and changing the patient “do not resuscitate” (DNR) status. The doctor explained to
POA that patient was actively dying, and the main goal was alleviation of suffering and provision of comfort in death. Finally, POA agreed to a meeting and, eventually, the patient became a hospice patient. Akdeniz et al. (2021) stated “
the decision to withhold or withdraw interventions or treatment is one of the difficult decisions in end-of-life care that causes ethical dilemmas. If a patient and physician agree that there is no benefit in continuing an intervention,
the right action is withholding or withdrawing the interventions” (p.4). After withdrawing all medical treatments, the patient died within couple hours.
The main ethical dilemma is end of life decision. The patient’s family members wanted to prolong the patient’s life with all medical treatment despite actively dying patient. The key participants were the patient, patient’s POA, attending doctor, palliative doctor, and hospice nurse. Because the patient lost her capacity to make her decision, POA was only making decision in this case. The other participants explained the situation and prevention of suffering to the patient and dying in comfort. Reference
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care.
SAGE Open Medicine
,
9
, 1-9. https://doi.org/10.1177/20503121211000918
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