Nursing Ethics

Topics: Ethics, Nursing, Health care Pages: 15 (4846 words) Published: September 6, 2011
Teaching Clinical Ethics Using a Case Study: Family Presence During Cardiopulmonary Resuscitation Ainslie T. Nibert
Crit Care Nurse 2005;25:38-44
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Critical Care Nurse is the official peer-reviewed clinical journal of the American Association of Critical-Care Nurses, published bi-monthly by The InnoVision Group 101 Columbia, Aliso Viejo, CA 92656. Telephone: (800) 899-1712, (949) 362-2050, ext. 532. Fax: (949) 362-2049. Copyright © 2005 by AACN. All rights reserved.

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Teaching Clinical Ethics Using a Case Study

Family Presence During Cardiopulmonary Resuscitation
Ainslie T. Nibert, RN, PhD

issue debated among healthcare professionals who routinely face lifethreatening situations. Presentation of a case study involving a family’s presence during CPR provides students in a critical care nursing course valuable experience in making ethical decisions that will prepare the students for the inevitable dilemmas faced by professional nurses.

Case Study
A 40-year-old man lost control of his vehicle and struck a guardrail in a single-car collision. He was not wearing a seat belt and was thrown through the windshield, sustaining a traumatic, closed-head injury. He was brought to the trauma center via helicopter and was admitted to the surgical intensive care unit. The night staff provided support to the patient’s wife during her first visit to see her husband, who was receiving mechanical ventilation and was unresponsive and surrounded by multiple invasive catheters and equipment. The trauma team briefly met with her soon after admission to explain her husband’s grave prognosis. The next day, a senior student in an undergraduate critical care nursing course assisted the nurse preceptor in managing the patient’s complex care. The patient’s wife came into the unit for her second visit just as the nurse preceptor and the student were preparing the patient for the morning visit. As the patient’s wife approached the bedside, the alarms of the monitors for the cardiac and arterial catheters sounded, indicating a cardiac arrest, and CPR was initiated. The healthcare personnel

ritical care nurses often find themselves in the midst of challenging ethical situations that involve conflict between the needs of critically ill patients and the patients’ family members and the preferences of physicians and other healthcare providers who initiate and manage resuscitation measures. Yet, many critical care nurses have reported



To receive CE credit for this article, visit the American Association of Critical-Care Nurses’ (AACN) Web site at http://www, click on “Education” and select “Continuing Education,” or call AACN’s Fax on Demand at (800) 222-6329 and request item No. 1109.

that they received little preparation in their basic education programs to deal with these sensitive issues. Because new graduate nurses often choose to specialize in critical care, nurse educators who design and teach undergraduate critical care nursing courses are obligated to address ethical decision making as part of the curriculum. In this article, I present a case study of an ethical issue in critical care and describe a method of clinical ethical analysis that nurse educators can use when teaching students about making ethical decisions in clinical practice. The presence of patients’ family members during cardiopulmonary resuscitation (CPR) is an ethical


References: 1. Molter N. Needs of relatives of critically ill patients: a descriptive study. Heart Lung. 1979;8:332-339. 2. Hanson C, Stawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department’s nine-year perspective. J Emerg Nurs. 1992;18:104-106. 3. Emergency Nurses Association. Resolution 93:02: Family presence at the bedside during invasive procedures and/or resuscitation. Presented at: General Assembly of the Emergency Nurses Association; Des Plaines, Ill; 1993. 4. Emergency Nurses Association. Presenting the Option of Family Presence. Park Ridge, Ill: Emergency Nurses Association Department of Nursing Resources; 1995. 5. Belanger M, Reed S. A rural community hospital’s experience with family-witnessed resuscitation. J Emerg Nurs. 1997;23:238-239. 6. Chalk A. Should families be present in the
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