Case Study: End-of-Life Care Part 2
While Mrs. Johnson is visiting her husband, the monitor alarm goes off and the nurse rushes in. Mrs. Johnson asks, “What’s wrong?” The nurse says, “He’s having a cardiac arrest.” Mrs. Johnson yells, “Save him, please save him!” The nurse calls a code, initiates cardiopulmonary resuscitation (CPR), and asks Mrs. Johnson to step outside while the team works on her husband. Mrs. Johnson calls her children and tells them to come to the hospital as soon as they can. The code team restores Mr. Johnson’s cardiac rhythm. While waiting outside the room when the nurse and the certified nurse assistant (CNA) care for Mr. Johnson and straighten up the room, Mrs. Johnson overhears the nurse tell the CNA how terrible she feels putting Mr. Johnson through cardiac resuscitation when there is no hope for him to ever regain consciousness and have any quality of life. The CNA asks why they have to call a code, and the nurse explains that they must adhere to the wife’s wishes.
Discussion Questions
- Did the nurse and the healthcare team place Mr. Johnson and his family at the center of care? Explain your answer.
- Were Mr. Johnson’s dignity privacy and confidentiality respected in this scenario? Explain your answer.
- How did the nurse demonstrate high standards of ethical conduct in this situation?
- Did the nurse and the healthcare team place Mr. Johnson and his family at the center of care? Explain your answer.
In this scenario, it appears that the nurse and the healthcare team did not fully place Mr. Johnson and his family at the center of care. While the nurse did call a code and initiate CPR in response to Mrs. Johnson’s request, the nurse’s comments overheard by Mrs. Johnson and the CNA suggest that the nurse may not have fully considered Mr. Johnson’s best interests and quality of life. It seems that the decision to proceed with cardiac resuscitation was driven more by the wife’s wishes rather than a thorough assessment of Mr. Johnson’s prognosis and the potential benefits and burdens of such aggressive intervention. To truly place the patient and their family at the center of care, healthcare professionals should engage in open and honest communication with the family, involve them in shared decision-making, and ensure that interventions align with the patient’s best interests and values.
- Were Mr. Johnson’s dignity, privacy, and confidentiality respected in this scenario? Explain your answer.
In this scenario, there are some concerns about the respect for Mr. Johnson’s dignity, privacy, and confidentiality. When the nurse discussed her feelings about the situation with the CNA, it compromised Mr. Johnson’s privacy and confidentiality. Furthermore, the nurse’s comment about feeling terrible putting Mr. Johnson through cardiac resuscitation when there is no hope for him may have been insensitive and could be seen as a lack of respect for his dignity and autonomy. Mr. Johnson’s preferences and values regarding end-of-life care should be taken into consideration, and discussions about his care should be held in a more private and respectful manner. It’s essential for healthcare professionals to maintain the privacy and confidentiality of patients and to ensure their dignity is upheld, even in difficult situations.
- How did the nurse demonstrate high standards of ethical conduct in this situation?
The nurse in this scenario demonstrated some ethical concerns rather than consistently adhering to high standards of ethical conduct. While the nurse did respond to Mrs. Johnson’s request for CPR and initiated a code, the subsequent comments overheard by Mrs. Johnson and the CNA raise ethical issues. The nurse’s expression of feeling terrible about resuscitating Mr. Johnson without hope for improvement suggests a possible conflict between personal emotions and professional obligations.
To demonstrate high standards of ethical conduct, the nurse should have engaged in clear and compassionate communication with the family, including discussing the prognosis and potential outcomes of CPR. Additionally, the nurse should have respected Mr. Johnson’s autonomy and values, ensuring that any decisions made regarding his care were aligned with his wishes and best interests. Maintaining professionalism, privacy, and sensitivity in difficult situations is essential for upholding ethical standards in healthcare.