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, the nurse and the healthcare team did not effectively place Mr. Johnson and his family at the center of care. While the nurse followed the wife’s wishes by initiating cardiopulmonary resuscitation (CPR) when Mr. Johnson experienced cardiac arrest, it is unclear whether Mr. Johnson’s own wishes regarding end-of-life care were ever discussed or documented. The focus seemed to be on adhering to the wife’s wishes, which may not necessarily align with Mr. Johnson’s own preferences and values.
Additionally, the nurse’s comment about feeling terrible for putting Mr. Johnson through CPR when there is no hope for him to regain consciousness suggests that the healthcare team might not have adequately communicated with the family about the prognosis and potential futility of aggressive interventions. The family should have been included in a discussion about Mr. Johnson’s condition, prognosis, and his own wishes for end-of-life care to ensure that the care provided is in alignment with his best interests.
- Were Mr. Johnson’s dignity, privacy, and confidentiality respected in this scenario? Explain your answer.
Mr. Johnson’s dignity, privacy, and confidentiality were not adequately respected in this scenario. When Mrs. Johnson asked, “What’s wrong?” in the presence of her husband, the nurse responded with “He’s having a cardiac arrest,” without considering the privacy and emotional needs of both Mr. Johnson and his wife. This could have been handled in a more sensitive manner, such as asking Mrs. Johnson to step outside the room before providing such information.
Furthermore, Mrs. Johnson overheard the nurse and the certified nurse assistant (CNA) discussing Mr. Johnson’s prognosis and their feelings about the resuscitation efforts. This breach of confidentiality and privacy is not in line with ethical standards of patient care. Patients and their families have the right to confidentiality, and discussions about a patient’s condition and prognosis should be conducted in a private and respectful manner.
- How did the nurse demonstrate high standards of ethical conduct in this situation?
The nurse in this scenario did not demonstrate high standards of ethical conduct. While it’s important to respect the wife’s wishes, the nurse should have also prioritized a discussion with both the wife and the patient regarding the patient’s own preferences for end-of-life care, especially if there were no advance directives or documentation outlining Mr. Johnson’s wishes.
Additionally, the nurse’s comments to the CNA about feeling terrible for putting Mr. Johnson through cardiac resuscitation without hope for recovery showed a lack of professionalism and empathy. Instead, the nurse should have engaged in open and honest communication with the family and focused on providing emotional support during this challenging time. Ethical conduct in this situation would involve maintaining the patient’s dignity, respecting privacy and confidentiality, and ensuring that the family is informed and involved in decision-making to the extent possible.