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Old 11-14-2015, 06:11 PM
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Default Making Ethical Decisions

Nurses need to be familiar with the principles of medical ethics, identified as autonomy, beneficence, justice and nonmaleficence. All healthcare facilities accredited by The Joint Commission are required to have ethical resources on hand to help guide staff through potentially difficult ethical situations.

Nurses may run into situations in which they question a patientís consent or ability to consent. It could be that a nurse believes the patient has not been fully informed of the risks and benefits of a treatment. Or a nurse may not believe a patient is capable of understanding the situation and making decisions about his care, or is being coerced by a relative to make certain decisions.

It is the duty of the nurse to advocate for their patient and help the patient obtain the proper information, evaluations or support they need from physicians and others to correct the imbalance.Nurses must also maintain their patientsí privacy.

Most ethical issues to most often arise around end-of-life issues, which includes machines which allow us to keep people alive Ö sometimes indefinitely. On the flip side, what should a nurse do if a patient decides to terminate or reject certain life-saving treatments because they violate a religious belief?

We cannot override the patientís decision to decline the treatment, provided the patient or decision-maker has been adequately informed of the risks and benefits.

Ethically speaking, we can only offer options, information and support for their decisions.

https://news.nurse.com/2015/10/19/ti...s/#prettyPhoto

There are other instances, other than end-of-life issues, when patient advocacy comes into play. I have observed that over the years, as we become more and more politically correct, the less patient advocacy I see. I used to be a huge patient advocate but in the past 10 years all it has accomplished has been to get me in trouble and not change anything for the patient. It's become increasingly difficult to speak to physicians about patients rights without getting caught between the physician and the employer. I still feel that I am a patient advocate but I have backed down to the point that I will not put my job on the line for a patient. It used to be that it was appreciated by the employer when the nurse advocated for their patient. No anymore. At least that has been my observation which has kept me more quiet than not. Thoughts?
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Old 11-14-2015, 06:31 PM
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My very first run in with an ethical question was shortly after I moved to second shift in the OR. We had a patient come down, already had one BKA and was scheduled for the other leg. Family had had the patient declared incompetent in order to proceed with surgery. However, now I had this patient sitting in front of me telling me exactly what would happen if that gangrenous leg wasn't amputated. He was ready for the consequences; the family was not. Sounded pretty darn competent to make that decision himself. Fortunately, the charge nurse, anesthesiologist, and eventually the surgeon agreed. We ended up sending the issue to the ethics committee. Not surprisingly, he never returned to have the surgery. So, sometimes it's not the nurse questioning the patient's ability to understand the situation and give consent; it's that the nurse has to advocate when others have made that determination without a basis.

I am willing to risk my job when it comes to a situation where the patient's wishes are evident, he/she states an understanding of the consequences, and it appears others have meddled with his/her ability to make an informed decision.
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Old 11-15-2015, 01:51 AM
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Awesome video from ZDogg, MD about end of life issues.

https://youtu.be/NAlnRHicgWs

Working in hospice, ethical issues abound. I wish doctors would get better at being honest with their patients about end of life sooner. The ones we get who die an hour or two later in our inpatient unit could have benefited from weeks or months of care that would have improved the quality of the time they had left. Sometimes it's the family or the patient who won't accept reality, but too often it's a doctor who can't let go of the battle module, and the victory/failure paradigm that goes with it. :(
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