Do Resuscitate Status: a Legal and Ethical Challenge for Nursing
Do Resuscitate Status: A Legal and Ethical Challenge for Nursing
Shawn Wolkart
Senior Integrative Seminar
Spring A semester, 2010
University of Saint Mary
Abstract
A status of do resuscitate in those critically ill patients may result in a slow code. A slow code is a situation where the nursing staff decides to do less than the standard set forth by advanced life support algorithms and the nurse practice act and allow the patient to die instead of possibly sustaining life. The legal implications include falsification of documents and breaching the standard of care set forth by the nurse practice act. The ethical issues include malfeasance, dishonesty, and taking on the role of deciding who has a chance to live during a life threatening situation, demonstrating medical paternalism.
When I was in nursing school, I did my rotations in a couple of intensive care units (ICU). Often I cared for patients who were very ill and possibly dying. I took very seriously the task of discussing do not resuscitate (DNR) status with the patient and family, even as a student. Many times, death was anticipated and those involved were ready to make a decision toward do not resuscitate status. The legal and ethical dilemma arose when the patient or family was against DNR status and wanted everything done. Some of the intensive care units that I have worked in had an unwritten status of "slow code" that the nursing staff would assign to patients that, according to consensus, would not survive. This slow code meant that the staff would call the code after the patient was too far-gone for successful resuscitation or that advanced cardiac life support (ACLS) protocol drugs would not be given. It may have been less than adequate CPR or decreasing the concentration of oxygen used. I had the understanding that life saving resources was not to be wasted on these patients. I heard nurses talk about squirting the drugs into a garbage can or into the mattress of the bed.
Shawn Wolkart
Senior Integrative Seminar
Spring A semester, 2010
University of Saint Mary
Abstract
A status of do resuscitate in those critically ill patients may result in a slow code. A slow code is a situation where the nursing staff decides to do less than the standard set forth by advanced life support algorithms and the nurse practice act and allow the patient to die instead of possibly sustaining life. The legal implications include falsification of documents and breaching the standard of care set forth by the nurse practice act. The ethical issues include malfeasance, dishonesty, and taking on the role of deciding who has a chance to live during a life threatening situation, demonstrating medical paternalism.
When I was in nursing school, I did my rotations in a couple of intensive care units (ICU). Often I cared for patients who were very ill and possibly dying. I took very seriously the task of discussing do not resuscitate (DNR) status with the patient and family, even as a student. Many times, death was anticipated and those involved were ready to make a decision toward do not resuscitate status. The legal and ethical dilemma arose when the patient or family was against DNR status and wanted everything done. Some of the intensive care units that I have worked in had an unwritten status of "slow code" that the nursing staff would assign to patients that, according to consensus, would not survive. This slow code meant that the staff would call the code after the patient was too far-gone for successful resuscitation or that advanced cardiac life support (ACLS) protocol drugs would not be given. It may have been less than adequate CPR or decreasing the concentration of oxygen used. I had the understanding that life saving resources was not to be wasted on these patients. I heard nurses talk about squirting the drugs into a garbage can or into the mattress of the bed.
References: Pozgar, G. D., (2007). Legal aspects of health care administration (10th ed.). Sudbury, MA. Jones and Bartlett Publishers, Inc. Boyle, P.J., Dubois, E. R., Ellingson, S. J., Guinn, D. E., & McCurdy, D.B. (2001). Organizational ethics in health care: Principles, cases, and practical solutions. San Francisco: Jossey-Bass.