case study week 1

 

After you view the case study, respond to the following:

  1. What is the role of the nurse? List two actions (interventions) you would have done differently in this scenario with rationales.
  2. What is the role of the family?
  3. Clearly relate the Nursing Code of Ethics to the case study scenario.
  4. Relate at least one Provision from the ANA’s Code of Ethics to the case study scenario.

A minimum of 500 substantial words is required. Do not exceed 600 words. No cover page is required. References must be within the last five years. Your submission should be double-spaced. Use the following headings in your paper:

  • Role of the Nurse
  • Actions/Interventions
  • Role of the Family
  • Nursing Code of Ethics

Read the following case:

Narrator: it’s been a long day. You have a patient who is actively dying after a sudden CVA. The family has been camped out all day at your workstation.

Code Blue is suddenly called for room 142 bed 1

Narrator: the patient is unresponsive, and the CNA is performing CPR.

Daughter: do not resuscitate! He has a DNR!

Son: I have power of attorney! He has a living will that states all heroic measures must be take!

Narrator: the family seems to have conflicting information. What should you do first, to calm the situation down?

Narrator: escort the family out while calming them down. You need to concentrate on the patient.

Narrator: you check in your pocket and you see a DNR card for the patient.

Nurse: stop CPR immediately!

Narrator: the CNA has stopped CPR. You need to check the patient’s vital signs. The patient ends up having no pop, Abel pulses, and there are no signs of life.

Narrator: the nurse tells the code blue team that the patient is a DNR status, and they should leave.

Son (to code team): get back in there! You need to resuscitate him!

Narrator: the son is upset, but the patient has a DNR upon admission.

Dr.( to nurse): please tell me the sequence of events.

Nurse: the patient remained on bedrest after his IVC filter placement surgery that concluded at 16:30. He has been stable. He requested to get up and go to the bathroom at 18:15 and I provided the OK for him to walk to the restroom with the assistance of the CNA after one last incision assessment. The CNA reports that while getting him out of bed, it was discovered that the oxygen tubing was too short. she left to get longer tubing for the patient’s oxygen, leaving the patient under the supervision of his daughter. When the CNA got back, he found the patient had taken the oxygen off and left it on the bed as he tried to get up on his own, despite the pleading of his daughter, not to. she when is the collapse and yelled for help as the CNA was returning to the room. The CNA, unaware of the DNR status, begins CPR and called a code blue.

narrator: the doctor satisfied with the report. He asked to speak to the family.

Dr.: can you all please come with me so we can talk?

Son: I am going to sue this hospital

Narrator: you overhear the outburst. Your intuition tells you, you are going to court.

Narrator: advanced directives is a term used to encompass documents, such as a living will, durable power of attorney, and durable power of attorney in healthcare. A living will is simply a statement that the patient makes in writing, describing his or her wishes pertaining to how, or where here she wishes to die, any becomes active when a person has been deemed incapacitated or terminally ill. A durable power of attorney is a legal document that allows a trusted individual to be the legal representative and all non-healthcare illegal matters involving a patient. Durable power of attorney for healthcare is a document through which a patient makes known his or her wishes about the treatments. Here she wishes to have or not to have throughout the course of an acute illness or in the dying process. had the sun in this particular case, kept an ongoing and open discussion with his father about any changes he wanted to make to the DPAHC prior to the emergent hospitalization, the sun may have had more decision-making capacity. Unfortunately, that wasn’t the case and thus there was an unfortunate disconnect between the two key parties involved in the DPAHC, the appointed decision maker, and the patient. this is not an unusual occurrence. A recent study expands on this by stating, (when discussions about end of life preferences do take place, the frequently lack the clarity and detail needed by significant others and healthcare providers to honor the preferences.) Clinical scenarios like this or genius at best and more so if a family is in disagreement which each other or their loved one at the time of an arrest, or when actively dying. one has to wonder if the who the family experienced as THE witnessed their father‘s life come to an abrupt end while healthcare providers with healthcare was an influence in their decision to file a lawsuit. There are a lot of nuances to what we do that are not well understood by Lab persons. Three pieces of information concerns me in this case: the lack of communication between their father and son, with regard to updating the patient’s preferences, the misunderstanding, the son had that a power of attorney can override the wishes of a patient, and the lack of communication between both patient and family. Perhaps the sun could have double check the code status with the physicians and verified that the advanced directives were in the chart or updated with the patient prior to surgery. May be a conversation between family, father and son prior to surgery could have closed the circle of communication. The fact is this that there are no better advocates for healthcare consumers than themselves, family members, or trusted friends, who hold the durable power of attorney for healthcare. That said, we should always ask ourselves: does a family member, or one who holds the “power of attorney “know what effective advocacy means? Part of advocacy is knowing what questions to ask, what information to provide, and verify in the hospital, and always knowing at any given moment the exact wishes of a loved one, so there are no surprises or unnecessary turmoil surrounding a patient and family during a health crisis. Advanced care planning could have played a critical role, and this case illustrates why. With every hospitalization or change in health status, there should be a family talk, taking place, so that everyone is in line with what the patient wants treatment-wise under various circumstances or stages of illness. Well nurses seem to approve of and support discussion related to end-of-life preferences in advanced care planning, they lack, sufficient knowledge to feel comfortable initiating or engaging in crucial conversations. “Have found that nurses identified the benefits of advanced directives and have positive attitudes, but lack knowledge and confidence to effectively discuss end of life issues with patients and families. The literature related to the nurses attitudes about advanced directives points to an un need for increased knowledge and confidence to address, barriers, and ethical dilemmas in end of life care.” (Putman-Casdorph, 2009) it is our responsibility as nurses to teach patients and their family members, and one very important thing: with every hospitalization or changing health status, the talk has to happen. Questions must be asked. Advanced care planning doesn’t stop once an advanced directive assigned. The concept is a living thing. The patient’s voice must remain front and center during each discussion and healthy death. I would serve our families as well if we started the conversation and engaged in teaching about advanced care planning.

case study week 1

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