Nursing Roles and Values

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NVT2 Nursing Roles and Values 724.7.1-01,03,05, 7.2-01-05,07

In healthcare circumstances present themselves where organizational, governmental, and patient centered goals diverge. One divergence healthcare workers face occurs when a patient refuses healthcare by completing a Advanced Directive such as in the case study when Mr. E refused the ventilator, feeding tube or CPR. Florida Statute 765.302 states: “(1)  Any competent adult may, at any time, make a living will or written declaration and direct the providing, withholding, or withdrawal of life-prolonging procedures in the event that such person has a terminal condition, has an end-stage condition, or is in a persistent vegetative state” (1995-2012). Dr. G and the nurse believe that Mr. E will die without the feeding tube and ventilator. In the case study the nurse is struggling with this very dilemma, the patient wishes do not follow the physician’s plan of care. With rapid treatment to support the respiratory system (ventilator), antibiotics and nourishment (feeding tube) it is likely that Mr. E will recover however, he does not want the ventilator or feeding tube. The nurse and physician are faced with an ethical dilemma, insert the tubes and save his life or follow the patient’s wishes which may end his life.

The Pennsylvania, Professional Nursing Law states:
“(9) The licensee has been guilty of immoral or unprofessional conduct. Unprofessional conduct shall include departure from or failing to conform to an ethical or quality standard of the profession. The ethical and quality standard of the profession are those embraced by the professional community in this Commonwealth. In proceedings based on this clause, actual injury to a patient or individual or group need not be established” (2007). The nurse has a quality of care dilemma, follow the patient’s wishes or follow the standard of care for pneumonia. The nurse’s role is to provide quality, ethical, patient centered care and follow physician orders (assuming they are appropriate). Mr. E needs the ventilator to survive a critical illness and it is the nurse’s role to educate the patient, especially since the patient is mildly retarded. The nurse must assure the patient understands the critical nature of his illness and that pneumonia is, in most cases, recoverable. Also, the nurse’s role is to be the patient’s advocate by finding treatment options. The option of a tube feeding could be a compromise. The nurse should suggest total parenteral nutrition (TPN- nutrition through an intravenous line) instead of a feeding tube which would meet the patient’s needs and avoid feeding tube placement. The International Council of Nurses (ICN) state in their Code of Ethics for Nurses, “The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment” (2006). This statement supports the nurse’s action of educating the patient and brother. It is important that the patient and brother understand Mr.E’s degree of illness, the pneumonia and aspiration condition process, how the medical profession can treat him, and how he will most likely regain his health. Also, the nurse will share the law on living wills and right to choose. Once all information has been shared and understood, the patient and brother can make an informed decision. It is the nurse’s ethical responsibility, as stated in ICN’s Code of Ethics, to provide the patient and family with enough information and options to make an informed decision. Without all the information listed above the patient and family does not have enough information to make an informed decision. Dr. G and the nurse are questioning if Mr. E is capable of making decisions due to the hypoxia. Mr. B, the brother of Mr. E, has been made the durable power of attorney. Since the physician has questioned Mr. E’s capability, the power of attorney should be involved in the medical care decisions. Also, since Mr. E has a diagnosis...
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