Case Study

In your responses to the posts provide individual postings be constructive and insightful comments that go beyond that of agree or disagree. Please number each responses to the postings with individual responses. 1)Eric posted this response: In this proposed scenario the patient's wishes are unknown at the time CPR is initiated. There is also an obvious disagreement between the four adult children. According to the ANA's Position Statement on Nursing Care and Do Not Resuscitate and Allow Natural Death (AND) decisions, “If the patients wishes are unknown, the patients best interest is the prime consideration.” Therefore, I feel that the best interest of the patient would be to continue CPR. The family would have to step aside until the patient's final wishes were clarified/verified. It is also unclear whether there is a spouse available to make such decisions this also would have to established. If the family is unable to produce the Health Care Proxy documentation this issue would have to be dealt with by the attending physicians and facilities ethics committee. If the documentation was present and valid the health care team would have to follow the Health Care Proxy's wishes. I would hope that the chosen daughter would take time to discuss the matter further with her siblings to facilitate their grief process. It would be part of the nurses' role to educate the family about advanced directives and to further facilitate the discussion about the patients' personal wishes concerning end of life care. By doing so the nurse would be meeting the needs of the entire family. 2)Marita posted this response: The legal implication for the registered nurse (RN) in this circumstance is that he/she will not be subject to criminal or civil liability for actions performed in good faith. The Advance Directive was not made known at the time cardiopulmonary resuscitation (CPR) was initiated. Emergency care should never be withheld pending the inquiry of an Advance Directive. Ethical implication for the RN is that he/she is an advocate for the patient and autonomy of the patient should be respected. The Advance Directive is a legally binding document written by a competent adult and the hospital facility is legally bound to carry out the wishes of such a directive. This is a stressful situation for the family of the patient. One daughter has the Advance Directive appointing her as the proxy. A proxy is another person who will exercise the right on the patient's behalf to help carry out patients' wishes and clarify the interpretation in the Advance Directive. The patient did not want to be resuscitated if his heart were to stop. Two of the children argue that CPR has already been started and should not be stopped. The nurse must remember that the family is appropriately distraught. Steps to resolve the conflict between family members must initiated. The nurse is an advocate for the patient and family. Most hospitals have policies and procedures in place to follow for conflict resolution. Discontinuing CPR will respect the autonomy of the patient and the hospital is legally bound to this with the Advance Directive now in hand. There are four children of the patient at the emergency department. Two of the children are in agreement to honor the Advance Directive. The other two siblings disagree and want the staff to continue CPR. It may not be possible to meet the needs of each family member because of conflicting views between the siblings. The nurse will keep an open line of communication with the family and mediate sources of conflict. The family can be referred to an ethics consult team or ethics committee if the conflict is not resolved. It is not reasonable to think that CPR will continue while the family resolves their conflict. The hospital is legally bound to carry out the wishes in the Advance Directive. 3)Crystal posted this response: The legal implication for the registered nurse (RN) in this circumstance is that he/she will not be subject to criminal or civil liability for actions performed in good faith. The Advance Directive was not made known at the time cardiopulmonary resuscitation (CPR) was initiated. Emergency care should never be withheld pending the inquiry of an Advance Directive. Ethical implication for the RN is that he/she is an advocate for the patient and autonomy of the patient should be respected. The Advance Directive is a legally binding document written by a competent adult and the hospital facility is legally bound to carry out the wishes of such a directive. This is a stressful situation for the family of the patient. One daughter has the Advance Directive appointing her as the proxy. A proxy is another person who will exercise the right on the patient's behalf to help carry out patients' wishes and clarify the interpretation in the Advance Directive. The patient did not want to be resuscitated if his heart were to stop. Two of the children argue that CPR has already been started and should not be stopped. The nurse must remember that the family is appropriately distraught. Steps to resolve the conflict between family members must initiated. The nurse is an advocate for the patient and family. Most hospitals have policies and procedures in place to follow for conflict resolution. Discontinuing CPR will respect the autonomy of the patient and the hospital is legally bound to this with the Advance Directive now in hand. There are four children of the patient at the emergency department. Two of the children are in agreement to honor the Advance Directive. The other two siblings disagree and want the staff to continue CPR. It may not be possible to meet the needs of each family member because of conflicting views between the siblings. The nurse will keep an open line of communication with the family and mediate sources of conflict. The family can be referred to an ethics consult team or ethics committee if the conflict is not resolved. It is not reasonable to think that CPR will continue while the family resolves their conflict. The hospital is legally bound to carry out the wishes in the Advance Directive. Legal and Ethical Aspects of End of Life Care discussion postings