ethical dilemma group c

4080 Mrs. Stone

GROUP C

ETHICAL DILEMMAS: INTENSIVE CARE SETTING

END OF life care

When pateints are in the ICU, they can unexpectadly become unable to make health care decisions for themselves...

“U.S. studies showed 57 percent of families reported conflict as a loved one was dying and 35 percent fought as death drew near,” (Betkowski, 2020).

cOMMON cONFLICTS

DNR/DNI

DO NOT RESCUSIATE

Often times family do not wish for them to be DNR, even when its in their best interest.

Interventions

PROCEDURES

Examples include: NG tubes, feeding tubes, and other invasive procedures.

Medications

PAIN & SIDE EFFECTS

Level of conciousness vs. need for pain meds.

SIGNIFIGANCE

"It's easy for family conflict to flare up...I saw family members fighting over their mom's deathbed or even fighting with the dying person, and that's harmful because family ties are so important during that time."

DONNA WILSON, rn, phDUniversity of Alabama

According to the article, “This study reveals a 4.9-fold increase in online AD completion as well as more comprehensive completion since the onset of the COVID-19 pandemic…” (Auriemma et al., 2020)

Understanding Patient Ethical Principles

It is our responsibility as a healthcare team to understand and practice these ethical pruinciples when providing patient care. ALL of these principles apply in providing end of life care.

Autonomy

Patient right to self determiniation (decision making).

Beneficience

Responsibility to provie useful and beneficial interventions for the patient.

Nonmalfience

Refraining from causing uneccessary harm to the patient.

Fidelity

Honesty and transparency regarding a patients status and prognosis.

LAWFUL DOCUMENTS

AVANCED DIRECTIVE

HEALTH PROXY

LIVING WILL

WE BELIEVE

Responsibility of providing the most optimum care for the patients and their wishes

Require all patients to have a legal document in the form of an advanced directive or health care proxy. This allows all patients to have true self directed care without the risk of immoral family influence and conflict.

REBUTTLE:

- Lack of function, access, and resources. -Conflict amongst familiies is inevitable. .

Refute:

- If the health care system can approach this as a primary action, it prevents conflict from arising in the latent stages of patient care causing more conflict during trying times.- It is evident that there is no way to completely avoid conflict regardless of when these documents are created. However including them in all primary care decreases the amount of stress and conflict among the patient, family, and health care team during the ending stages of life.

Methodology

OUR GOAL:

Togther we can!

Our goal as a nursing community is to foster meaningful, dignified, and peaceful end of life care that respects the wishes, autonomy, and moral rights of the patient. Preventing conflict during this time is just one way we can help achieve this goal.

Interdisciplinary Approach

Solutions and Interventions:

Providers-advocate for families and patients
Social workers- resources
Chaplin & Mental Health Concelors-emotional support
Ethics Committee-no family
Hospital Legal Team-if problems

INTERDISCIPLINARY

End of life care survey

Akdeniz, M. Yardmici, B. Kavukcu, E. 2021. Ethical considerations at the end-of-life-care. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958189/ Ashwini Bapat, M. (2019, November 12). What is palliative care, and who can benefit from it?. Harvard Health. https://www.health.harvard.edu/blog/what-is-palliative-care-and-who-can-benefit-from-it-2019111118186 Auriemma, C. Halpern, S. Asch, J. et al. 2020. Completion of advanced directives and documented care preferences during the CoronaVirus 2019 COVID19 pandemic. Journal of the American Medical Association. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768372 Betkowski, Bev. 2020. Family conflict during bereavement, studies show families are under more stress as end-of-life care has moved out of hospitals and into homes, says U of A grief researcher who recommends ways to ease tension. University of Alabama Folio. https://www.ualberta.ca/folio/2020/07/family-conflict-common-during-bereavement-study shows.html#:~:text=Some%20of%20the%20U.S.%20studies,end%2Dof%2Dlife%20phase.