State Regulations and Nursing Standards
In this case study the patient, Mr. E, has made it abundantly clear through his words and his actions that he does not wish to be placed on a ventilator. In spite of these declarations, the doctor obtains consent from a family member who does not have the authority to grant permission. The nurse involved in Mr. E’s care has a legal obligation to intervene, something that he/she has failed to do. This obligation stems from the Standards of Competent Performance, California Code of Regulations Title 16 Section 1443.5 which clearly states: “the registered nurse acts as a client’s advocate, as circumstances require, by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided”. (http://www.rn.ca.gov/regulations/title16.shtml)
By ignoring the wishes of the patient, the nurse has clearly violated an important tenant of the California Code of Regulations. Situations like this can be very challenging are used to giving orders and not having them questioned. An intimidated nurse is, especially for new, inexperienced nurses. Advocacy is not for the faint of heart and many physicians an unsafe nurse and it is vitally important that nurses speak up when faced with dilemmas like this. If the nurse in this instance was afraid to speak up, he/she should have gotten the charge nurse or clinical manager involved to ensure that Mr. E’s rights were not violated. Laws like this were instigated for precisely this reason, to prevent providers from running roughshod over patient’s rights.
Code of Ethics
Not only does the nurse have a legal obligation to advocate for the patient, but an ethical one as well. Statement three in the ANA code of ethics mandates that: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient”. ("ANA Code of Ethics”) Clearly the nurse has failed to honor this guiding principle of the nursing profession. Patients are often scared and intimidated in settings like this and are afraid to speak up for themselves. If we as nurses don’t advocate for them, it may not happen, as in this case study.
Impact of the Code
While the nurse has an obligation to advocate for all of his/her patients, the reality is that some patients will require more help than others. By nature of his cognitive deficiencies and medical condition, Mr. E would require more assistance in this area than a higher functioning patient. This patient has declared both verbally and in writing his desire to not be placed on a ventilator. This pt was not hypoxic, not with an SpO2 of 88% and the fact that he was mildly developmentally delayed did not justify the extreme measures that the physician wanted to take. By not standing up for the patient, the nurse was just as culpable as the physician. The whole point of a code of ethics is to provide guideposts for nurses to follow when navigating uncharted ethical waters.
Ethics of Putting Patient on Ventilator
The reality is that with an oxygen saturation level of 88%, the pt would have been fine with supplemental oxygen via a nasal cannula, certainly until his medical power of attorney had arrived. Not only were his rights violated, but there wasn’t even a valid argument to do so. Being intubated against your will would be an extremely traumatic experience, virtually impossible to accomplish without sedation. The first stanza of the ANA Code of Ethics states that the nurse “practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems”. ("ANA Code of Ethics,") If the nurse had done the right thing and...