End-of-Life Care Part 2

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

1. Did the nurse and the healthcare team place Mr. Johnson and his family at the center of care? Explain your answer.
2. Were Mr. Johnson’s dignity privacy and confidentiality respected in this scenario? Explain your answer.
3. How did the nurse demonstrate high standards of ethical conduct in this situation?

1. The nurse and the healthcare team did not effectively place Mr. Johnson and his family at the center of care in this scenario. While they did respond to Mrs. Johnson’s initial distress and initiated CPR in accordance with her wishes, the subsequent conversation overheard by Mrs. Johnson suggests a lack of patient-centered care. The nurse’s comment about feeling terrible putting Mr. Johnson through cardiac resuscitation when there is no hope for him to regain consciousness and have any quality of life indicates a potential lack of consideration for Mr. Johnson’s best interests and dignity. Instead of focusing solely on the wife’s wishes, the healthcare team should have engaged in a more thorough and compassionate conversation with the family to ensure that the care provided aligns with Mr. Johnson’s values and preferences, especially if it becomes apparent that further aggressive interventions may not be in his best interest.
2. Mr. Johnson’s dignity, privacy, and confidentiality may not have been fully respected in this scenario. While the decision to initiate CPR was made in response to Mrs. Johnson’s wishes, the overheard conversation between the nurse and the CNA suggests a breach of privacy. The nurse discussed Mr. Johnson’s prognosis and the ethical dilemma surrounding his resuscitation within earshot of Mrs. Johnson, potentially violating his right to confidentiality and privacy. It’s essential for healthcare professionals to have sensitive conversations about a patient’s condition and prognosis in private settings to maintain their dignity and privacy.
3. The nurse demonstrated some aspects of high standards of ethical conduct in this situation by following the initial directive to call a code in response to Mrs. Johnson’s request for resuscitation. However, ethical conduct also involves ensuring that care aligns with the patient’s best interests, values, and preferences. In this case, the nurse may not have fully explored these aspects with the family or considered the potential futility of further interventions for Mr. Johnson’s condition. Ethical conduct would require a more comprehensive and patient-centered approach, which involves open and compassionate communication with the family to make decisions that prioritize the patient’s well-being, dignity, and quality of life.