PHE 435 Prescott College Do Not Attempt Resuscitation Policy Discussion

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PHE 435 Prescott College Do Not Attempt Resuscitation Policy Discussion

Nursing homework help

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In the assigned readings, a major focus was the need for institutions/agencies to establish policies that adequately addressed a pressing problem/dilemma/concern. In some cases, these organizations were compelled to develop policies due to perceived violations to the rights and welfare of patients, proxies, and society.

What components would a policy need to contain to support an Ethics of the Good? Please note, I am not asking you to develop an entirely new policy, just identify the necessary components. You can use a sample topic to provide background (ex. DNR, needle exchange, etc.).

https://www.youtube.com/watch?v=CQmYIdctnR8&feature=youtu.be

https://www.youtube.com/watch?v=FAfxR4HE-Qk&feature=youtu.be

Hello class!

 

Reading the Code of ethics for nurses with interpretive statements (2015), one would be forgiven for assuming that nurses are on par with Saints. This document provides the criteria and expectations of the moral and ethical standards of the profession (Goudreau, & Smolenski, 2022). Nurses are to practice their craft with compassion and respect, taking care to include the individual patient, their family, group, and community. The nurse must advocate for their patient as if they were advocating for their own family but respect the autonomy of the patient at the same time. He or she must strive to continually improve the ethical environment and conditions that they work in as well as advance the nursing practice through research and scholarly inquiry, while also helping to eliminate health disparities and integrate principles of social justice into nursing practice (ANA, 2015),

One real-life example of a much-needed policy can be examined in Provision 5. This provision outlines the expectations that nurses owe to themselves the same care and concern that is shown to their patients (ANA, 2015). Last week, the nation (at least those that watch sports or own a television) watched a 24-year-old athlete in peak physical health receive CPR due to Commotio Cordis. Damar Hamlin received CPR in front of the world, leading to the suspension of the football game just minutes into the first quarter due to the emotional distress of his teammates and the opposing team. Many news outlets discussed how emotionally disturbing this scene was and how affected onlookers were watching paramedics save his life. Both teams were taken to their respective locker rooms to debrief and collect themselves, waiting for news about their teammate and the game was rescheduled due to the unprecedented events of that night.

Since this incident, many jokes and satire-laced videos have been made about nurses and how there is little support following participation in a code. It is known that debriefing following a code improves both the technical skills as well as the mental health of healthcare providers (Conrad & Morrison, 2018). However, debriefings following these high-stress events are at the discretion of the facility or department and there is no general policy, requirement, or even encouragement to have or participate in this type of reflection. If nurses are to truly follow Provision 5 and take care of themselves as well as they care for patients, why would something that is known to help providers not be utilized? A policy to help guide these reflections or debriefings may help leaders to know exactly how to care for their staff and reduce a barrier to implementing this intervention, helping to improve the mental health of nursing staff, reduce burnout and moral distress, and improving retention for the facility in which a policy such as this is implemented.

 

Lily Shugart

 

Reference

ANA. (2015). Code of ethics for nurses with interpretive statements. ANA, American Nurses Association.

Conrad, & Morrison, R. D. (2018). MP31: Debriefing critical incidents in health care: a review of the evidence. Canadian Journal of Emergency Medicine20(S1), S51–S52. https://doi.org/10.1017/cem.2018.185

Goudreau, K. A., & Smolenski, M. C. (2022). Health policy and advanced nursing practice (3rd ed.) Springer.

PHHE 435/535 Ethical Decision Making for Health Professionals Module 8A Cardiopulmonary Resuscitation Master of Public Health Program – Copyright © 2017. Board of Trustees of Northern Illinois University. All Rights Reserved. Objectives • Will be able to identify important terms used in CPR • Describe the history/effectiveness of resuscitation efforts • Discuss the efforts to restrict its unconditional use • Describe the development of institutional policies for not attempting CPR • Identify major ethical concerns 1 CPR Procedures 1. Establish unresponsiveness and call for help 2. Check for breathing 3. Open the airway Photo Credit: U.S. Naval Forces Central 4. Begin basic rescue breathing CPR Procedures 5. Check for pulse 6. If pulse is present – rescue breathe only Photo Credit: Army Medicine 7. If pulse is absent – perform chest compressions CPR Procedures • Efforts often fail to revive patient • May leave patient with extensive brain damage resulting from lack of blood to brain 2 Under what circumstances should CPR not be administered? • Terminal patient – hospice • Might cause more harm than benefit – frail and old Not reasonable http://www.fractal.org/Fractal‐Research‐and‐Products/Dissecting‐Fractals_bestanden/dissecting_lungs.jpeg Rationale for CPR • “Attempting” CPR • Often fails to prevent death • Survivor may sustain harm 3 Rationale for CPR Photo Credit: U.S. Army Africa • The provision of relevant medical information may affect how family responds to requests about CPR History of CPR • Its application in surgery Operating & Recovery Rooms Emergency & Intensive Care Rooms Throughout the Institution History of CPR • Team must respond very quickly 4 History of CPR • Coding (attempting CPR) • No Code (no attempt) History of CPR • CPR became widespread emergency treatment http://salempress.com/store/images/editorial/cpr.jpg History of CPR • Number of successful efforts is not very encouraging 5 History of CPR • Outcomes of Cardiopulmonary Resuscitation in the Elderly – Ann Intern Med 1989 Aug 1;111(3):199-205 – Murphy DJ; Murray AM; Robinson BE; Campion EW History of CPR • CONCLUSION: – Cardiopulmonary resuscitation is rarely effective for elderly patients with cardiopulmonary arrests that are either out-ofhospital, un-witnessed, or associated with a systole or electromechanical dissociation. History of CPR • 1983 – 14% of those who coded were discharged • 1988 – 6% of those who coded were discharged 6 History of CPR • Questioned whether it was good clinical practice for emergency department personnel to attempt CPR when arrest occurred outside hospital History of CPR • 1/3 successful CPR that occur in hospitals • Not all of these who are successful will be able to be discharged Questions • Is it reasonable to initiate CPR when it: – Often fails – Brings additional burdens to patient • Does it make sense? 7 Questions • Should patients/family members be informed of these statistics? http://www.marinalibrary.com/Images/manthinking.gif Questions • What happens when you ask patients over 60 if they would want CPR attempted? • What happens when you inform them of the survival rates? http://www.news.com.au/common/imagedata/0,,5694282,00.jpg Questions 41% 22% 8 Questions • Would you want CPR if had a life expectancy of < 1 year? 11% Questions • Tell them the probability of survival until discharge 5% Conclusion • Does is make sense to revive a dying cancer patient every time arrest? • Reasonableness to attempt reversal of all arrest • Ethical response many times is to do nothing 9 Withholding CPR • Can be emotionally difficult for health care providers http://img.dailymail.co.uk/i/pix/2007/10_01/kateDM0410_468x690.jpg Withholding CPR Photo Credit: zeevveez Withholding CPR • Might be providing inappropriate care 10 Withholding CPR • Might be providing inappropriate care • Might be letting someone die that could have benefited Withholding CPR • National Conference on Standards for Cardiopulmonary Resuscitation and Emergency Cardiac Care (1974) Recommendation • Withhold in cases of terminal, irreversible illness where death is not unexpected • DNR order should be written in the patient’s progress report 11 Fallout • Many providers felt distress over this situation Photo Credit: The U.S. Army Still not enough • Guidelines needed http://www.semdsa.org.za/images/guidelines.jpg DNR Policy (1976) Mass. General Hospital Beth Israel Hospital • Centered on physician • Centered on patient • MD decide when attempting CPR inappropriate • Allowed patient to refuse CPR efforts • Write DNR order in chart • Regardless of medical condition • Required MDs to get consent before writing DNR order 12 Need for Policy • Need for sound moral thinking/dialogue about attempting CPR (1984) La Guardia Hospital • Administration had decided to not involve patient/proxy • Not write DNR in medical chart • DNR designated by purple dot to file card • Not trace to any one physician Dealing with Controversy • Recommendations of Grand Jury – – – – Failure to face ethical dilemma openly Decision jointly made Documented in medical chart Patient/physician/proxy can cancel DNR at any time 13 Dealing with Controversy • New York Hospital (1984) • No one attempted CPR when the patient arrested • Rose Dryer • 87 years old • Admitted with pneumonia Dealing with Controversy • Health Department brought administrative charges • Hospital admitted to violating patient’s rights not getting consent • Promised to develop written policies Policies http://www.broward.edu/images/Central/policies.jpg 14 Review of Criteria of DNR Policies • Important to understanding ethics of attempting/withholding effort to revive patients in arrest Essential Elements of DNR Policy • Physicians have responsibility of initiating discussion patient/proxy of CPR if reason to believe arrest might occur Essential Elements of DNR Policy • CPR is a medical treatment, so patient should be consulted • Must be told in advance, may not be time later • Avoid situation where CPR attempted when not desired 15 Essential Elements of DNR Policy • Final word belongs to patient/proxy Essential Elements of DNR Policy • Final word belongs to patient/proxy – MD must inform of all risks, benefits Essential Elements of DNR Policy • Final word belongs to patient/proxy – MD must inform of all risks, benefits – Ensure getting informed consent 16 Essential Elements of DNR Policy • Strong moral tradition behind shared decision-making / not forcing Proxy Doctor Nurse Essential Elements of DNR Policy • Documenting DNR order Essential Elements of DNR Policy • Documenting DNR order – Permanent record 17 Essential Elements of DNR Policy • Documenting DNR order – Permanent record – Process leading to Essential Elements of DNR Policy • Documenting DNR order – Permanent record – Process leading to – Reasons for it Essential Elements of DNR Policy • Documenting DNR order – – – – Permanent record Process leading to Reasons for it Person responsible for it 18 Essential Elements of DNR Policy • Patient/proxy may cancel at any time, effective immediately!!! DNR Order Essential Elements of DNR Policy • Morally necessary to immediately cancel • Why? • Does not compromise a code team who are concerned with forcing treatment on patient Essential Elements of DNR Policy • Review DNR order frequently (every 24 hours) • Situation could change, improving likelihood of successful CPR intervention 19 Essential Elements of DNR Policy • 100% genuine effort unless patient stated wanted limitations/restriction places on efforts • Exclude intubation/defibrillation Need to respect wishes Essential Elements of DNR Policy • Show/Slow Codes not ethical practice Essential Elements of DNR Policy • Show/Slow Codes not ethical practice • What does good ethics require? 20 Essential Elements of DNR Policy • Show/Slow Codes not ethical practice • What does good ethics require? – Establish the DNR status of patient likely to suffer an arrest ASAP Essential Elements of DNR Policy • DNR not affect other life-sustaining treatments Essential Elements of DNR Policy • DNR not affect other life-sustaining treatments – None withheld, diminished, withdrawn 21 Essential Elements of DNR Policy • DNR not affect other life-sustaining treatments – None withheld, diminished, withdrawn – DNR no direct bearing on other treatments Essential Elements of DNR Policy • Special consideration of DNR during surgery Essential Elements of DNR Policy • Special consideration of DNR during surgery – MD needs to discuss possibility of attempting CPR during surgery/post op, in good position to reverse arrest Before surgery!!! http://www.columbia.edu/cu/iraas/wpa/images/slideshows/murals_surgery1.jpg 22 Essential Elements of DNR Policy • In some cases, may not be appropriate • Hospice patient may maintain DNR during surgery • Morally reasonable Essential Elements of DNR Policy • Occasionally, DNR requires legal intervention • Disagreement between family members, proxy, and MD Essential Elements of DNR Policy • Good Policy should contain these components 23 Who Develops Policy? • Hospital ethics committees • Medical staff • Administration http://images.google.com/imgres?imgurl=http://lh3.google.com/_8jUoJPaCI3o/RmCM3jQh08I/AAAAAAAAAF0/Uyvoov9YqXw/s800/John%2BDoe% 2BUngagged.jpg&imgrefurl=http://picasaweb.google.com/lh/photo/ej5zr6OJZzAw9RJPS1PkpA&h=540&w=800&sz=117&hl=en&start=14&tbnid=Ca mgiLbEl1uJrM:&tbnh=97&tbnw=143&prev=/images%3Fq%3Dethics%2Bcommittee%26gbv%3D2%26hl%3Den%26sa%3DG Continue 24 PHHE 435/535 Ethical Decision Making for Health Professionals Module 8B Cardiopulmonary Resuscitation Master of Public Health Program – Copyright © 2017. Board of Trustees of Northern Illinois University. All Rights Reserved. Policy Example Introduction – Provides Direction • Goal – 1 Introduction – Provides Direction • Goal – protect the moral and legal integrity of both patients and staff by preventing CPR attempts that are unwanted/unreasonable Policy Example • Informed Consent – Informed of benefits, burdens, risk, odds of survival Policy Example • Informed Consent – MD will discuss CPR/DNR order 2 Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness 3 Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness • Irreversible loss of consciousness Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness • Irreversible loss of consciousness • Likely to have arrest Policy Example • Informed Consent – MD will discuss CPR/DNR order • Patient asks for it • Not live for > years • Serious/irreversible illness • Irreversible loss of consciousness • Likely to have arrest • MD believes patient not want CPR 4 Policy Example • Informed Consent Photo Credit: Seattle Municipal Archives – Assist patients in reaching an informed decision about CPR Policy Example • Informed Consent Photo Credit: 807th Medical Command – MD writes DNR order in medical chart after getting informed consent – May issue DNR order w/o IC under what condition? – Must write down reason for Policy Example • Informed Consent Photo Credit: Save the Dream – Minors (