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
References: Code of Ethics for Nurses With Interpretive Statements, Nursing World| Code of Ethics American Nurses Association. (2001). Retrieved January 23, 2012, from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Tools-You-Need/Code-of-Ethics.pdf Florida Statute 765.204 Health Care Advanced Directives Capacity of principal; procedure. (1995-2012). Retrieved January 21, 2012, from http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=765.204&URL=0700-0799/0765/Sections/0765.204.html Florida Statute Chapter 464, Nurse Practice Act. (2007). Retrieved January 26, 2012, from http://www.doh.state.fl.us/mqa/nursing/info_practiceAct.pdf Florida Statute 765.304 Health Care Advanced Directives Procedure for living will. (1995-2012). Retrieved January 21, 2012, from http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=765.304&URL=0700-0799/0765/Sections/0765.304.html Florida Statute 765.302 Health Care Advanced Directives Procedure for making a living will; notice to physician. (1995-2012). Retrieved January 21, 2012, from http://www.leg.state.fl.us/statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=765.302&URL=0700-0799/0765/Sections/0765.302.html Pennsylvania Professional Nursing Law, RN Law. (2007). Retrieved January 26, 2012, from http://www.portal.state.pa.us/portal/server.pt/community/state_board_of_nursing/12515 Position Statement: Role of the Registered Professional Nurse in Ethical Decision-Making. (2005). Retrieved January 20, 2012, from http://www.nysna.org/practice/positions/position6.htm The ICN Code of Ethics for Nurses. (2006). Retrieved January 23, 2012, from http://www.icn.ch/images/stories/documents/about/icncode_english.pdf Jones, E. (2009). HIPAA ‘Protected Health Information:’ What Does PHI Include? Retrieved January 26, 2012, from http://www.hipaa.com/2009/09/hipaa-protected-health-information-what-does-phi-include/ Stein, G.L. (October 2007). U.S. Department of Health and Human Services Advance Directives and Advance Care Planning for People with Intellectual and Physical Disabilities. Retrieved January 21, 2007, from http://aspe.hhs.gov/daltcp/reports/2007/adacp.htm