Ms. Anna vanDahm, one of the wealthiest and most influential people in town, was
ID: 96659 • Letter: M
Question
Ms. Anna vanDahm, one of the wealthiest and most influential people in town, was placed in the hospital's intensive care unit (ICU) after undergoing kidney replacement surgery. Because of the inability to deliver high-quality care as a result of financial constraints and a high turnover rate related to nurse discontentment with the dictatorial leadership styles of ICU nurse managers, the ICU was regularly short of qualified staff nurses. As a solution to this problem of short staffing, nurses from other units with lower levels of client acuity were routinely floated to the ICU, often without regard to whether they were cross-trained to take on ICU responsibilities. Abigail Friendly, an RN without prior training or experience in caring for ICU clients, was floated to the ICU, where she was assigned to provide care for Ms. vanDahm, who had responded very poorly to her surgery and was put on a life-support system by a physician just before Nurse Friendly's arrival. While Nurse Friendly was caring for her, Ms. vanDahm communicated, in the presence of her oldest son, that she did not want to be resuscitated in the event of cardiopulmonary arrest. When her shift ended a few minutes later, Nurse Friendly, exhausted and overwhelmed by what she had just experienced, left for home. Shortly thereafter, Ms. vanDahm sustained a cardiopulmonary arrest: however, in the absence of proper documentation and notification, she was resuscitated. Subsequently, the son, angry that his mother's request had not been followed, consulted an attorney, who promptly contacted the hospital's CEO. The next day, Nurse Friendly, who had always received highly positive performance evaluations over the 5 years she was employed by the facility and also was subject to protection under the provisions of an antidiscrimination statute, was told by the manager of her unit that she was being fired effective immediately. Nurse Friendly a. On what grounds could Nurse Friendly be found legally liable for malpractice? b. What actions should have been taken by Nurse Friendly to prevent malpractice in this type of situation? c. What ethical dilemma(s) did Nurse Friendly face in this situation? d. What factors should have been considered by Nurse Friendly in dealing with the ethical dilemma(s) encountered in this situation?Explanation / Answer
A do-not-resuscitate order or DNR order is a medical order written by a doctor. IT instincts health care providers not to do cardiopulmonary resuscitation(CPR) if a patients' breathing stops or heart stops beating.The doctor writes the order only after talking it with the patient if poss.., proxy or patients family.
a) In order for a DNR order to have legal effect meaning that it would be entered into patients hospital chart and emergency medicos would have to honor it in outside a hospital setting it must be signed by patients physician. This concept is reinforced in Patients Self Determination Act of 1991 legally. Pts may wear a bracelet or carry paperwork that allows responding paramedic to honor physicians dnr order. Nurse Friendly did not convey patients wishes to the doctor nor did she inform attending personnel after her shift of patients dnr order.
She can be pressed for constitutional violation, breach of contract, infliction of emotional distress and negligence.
b) Nurse Friendly should have immediately informed the patients physician or the emergency personnel which would be adequately trained to handle this kind of situations. Also a talk with patients family would have been helpful.
c)The UKCC code of professional conduct (1992) states that every registered nurse and health visitor should act to promote and safeguard wellbeing of patients. Therefore how does withholding life saving treatment comply with code of conduct. Conflict arises because decision to not resuscitate may be seen as not promoting patients wellbeing and an omission on nurses part.
On other hand clauae 7 of code of conduct states that a nurse should recognise and respect uniqueness and dignity of patient and respond to need of care...The nurse who do not comply with patients dnr order may be seen as violating this cause.
d)nurse friendly should have considered the 4 basic principles involved in dnr order
1.autonomy- allow individual the right to make his or her decision.
2.Beneficience- duty to do good
3.Non maleficience- duty to do no harm
4.Justice- to treat all patients fairly in terms that risks and benefits are equally balanced.
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