Do-not-Resuscitate orders are given to patients, who are present for surgery or other anesthetic procedures in the clinical setups (Bartlett, 2015). Both the doctors and patients share common misconceptions about the benefits and dangers of being subjected to the resuscitation (Santonocito et al., 2013). The case below illustrates how the dilemmas emerge in DNR.
The case description I was taking care of a competent patient, who signed DNR without his family’s knowledge. Doctors were aware of the situation. He specifically requested the staff not to inform his family regarding the DNR; otherwise, they would make him withdraw from consent. He suffered from lung cancer and as time passed on, the medical staff followed his wish. The family members next to the bedside requested me to start the CPR. I informed them about legal documentation thus ought to ask the supervisor to come to assist. However, the family members did not understand thus wanted the staff to do CPR to avoid taking a legal action. Even after showing them the legal documentation, they still insisted that the nurse was required to perform the CPR. Making the matters worse, the family members started doing the CPR on the patient. They even made arrangements to relocate the patient to a different facility. As things got worse, we had to call the security department to assist the family members to walk out of the facility. After they calmed down, we allowed them to say their final goodbye to their dear one. The situation was sad, but I need to respect my patient’s needs as a nurse since I had legal documents that I have to follow regardless of how critical and sad the situation was.
Ethical dilemmas in the case The last stage of the illness resulted in the patient signing the DNR document and requesting his decisions on DNR not to be told to the family. The situation was difficult for me but as a nurse, I had two primary choices to make about the case. One of the choices was to keep the DNR document by the patient privately as a way of respecting his decisions on his life and health. As such, only the DNR guidelines were to be used for the treatment of the patient as he requested thereby no CPR was to be done as requested by the surrogates (Bartlett, 2015). The other choice was to inform the family members about the DNR agreement and document thereby turning down their request for the CPR. If so, the family was supposed to withhold the CPR process that they wanted to start on the patient as a way of respecting the patient's decision. Telling the family about the DNR document would mean that the patient’s confidentiality and autonomy would have been violated (Dobrowolska et al., 2007).
Ethical organization thoughts on the case The case has conflicts with three primary principles of ethics, which are beneficence, respect for autonomy in addition to non-maleficence. The American Association of Nurse Anesthetists provides guidelines on DNR to make the right decisions for the patients. The association’s thoughts on the case were that the decision made to share the information with the patients family on DNR was important. It was essential since it prevented the family from taking the patient for CPR, which was not suitable for him at that level. The organization’s guidelines states that patients should be actively involved in their care as well as their decision should be respected and kept as confidential. Thus, it was right for me to follow the decisions that had been made by the patient, which were in line with the guidelines provided for CRNA. The American Association of Nurse Anesthetists, in addition to the Department of Aging Disability and Home Care requires the principle of beneficence to be applied always to maintain the patient’s safety and promote health. As such, based on the case, I should have informed the family on the DNR document signed by the patient. After sharing out the information with the family, it was important to educate them on the dangers of subjecting the patient to CPR to maintain safety.
Application of the code of ethics The ICN Code of Ethics for Nurses argues that all people should build excellent nursing and practice on the respect for human rights and life (Dobrowolska et al., 2007). Therefore, the decision to maintain confidentiality on the DNR as requested by the patient was important. However, due to the attempts of the family members to carry out the CPR outside the hospital, there was the need to break the privacy for the safety of the patient. The code also requires the nurses to create a safe environment as well as offer quality care to ensure the improvement of the patient’s health (Dobrowolska et al., 2007). Therefore, it was good to respect the decision and privacy of the patient as a nurse, but not telling the family about the document. Therefore, critical decision-making was required for the case at hand.
Congruence of the decision made with the ICN Code of Ethics The decisions made in respect to the patient’s wish outlined in the DNR document were congruent with the ICN Code of Ethics for Nurses. It is because they followed the request made by the patient on his health despite the family members compromising the situation. The sharing of the information with the family was to ensure that the patient’s safety and decision was maintained. Therefore, it is valid to argue that the decisions made were in line with the provisions of the code of ethics in nursing.
Economic, social, cultural, or spiritual nursing considerations nurses should be cognizant of when challenged with this issue. In most cases, patients with terminal illnesses are desperate and wish to die. Therefore, they may emphasize on the DNR procedures. During such cases, nurses should provide help that would result in effective communication to resolve any conflict of interest between the patient and family decision makers. The nurse should educate the family members and the patient on the importance and disadvantages of DNR and CPR to equip them with the right knowledge that would assist in the decision-making process. DNR orders should be accepted due to the urge to respect autonomy and the rights of the competent adult patients to make decisions about their lives (Bartlett, 2015). When a nurse is confronted with DNR cases, they should take three primary measures such as obtaining the counsel from the ethics committee in the hospitals, identifying all the factors that result in good decision-making and establishing a plan of action through a written document to act as evidence of the agreement. The patient’s decisions should be followed to the later unless in emergency occurrences where the nurses need to make a vivid decision to save the life and respect autonomy. It is essential for nurses to participate in teaching and training so that they have the skills to make decisions, establish effective communication as well as practice autonomy. A nurse should also offer moral support to both the patients and their families during the treatment periods (Santonocito et al., 2013).
References
Bartlett, L. S. (2015). Do-not-resuscitate. Nursing2016 Critical Care, 10(3), 44-47.
Dobrowolska, B., Wrońska, I., Fidecki, W., & Wysokiński, M. (2007). Moral obligations of nurses based on the ICN, UK, Irish and Polish codes of ethics for nurses. Nursing Ethics, 14(2), 171-180.
Santonocito, C., Ristagno, G., Gullo, A., & Weil, M. H. (2013). Do-not-resuscitate order: a view throughout the world. Journal of critical care, 28(1), 14-21.
