Response to my peer Gladys John-TOPIC 3 DQ 1

Gladys John
Posted Date

Jul 18, 2022, 11:38 AM

There is a legal mandate for hospitals and healthcare facilities to comply with the Patient Self-determination Act (PSDA) (Walerius, et al., 2009). First, a “Living Will” is a legal document that reflects a person’s wishes and preference for treatment and cares at the time that the person creates and signs it. Response to my peer Gladys John-TOPIC 3 DQ 1

Second, Advance Care Planning is a deliberative, continuous, and modifiable process that goes beyond one document, or even one conversation (Poveda-Moral, et al., 2021).

Problems arise when a patient’s condition suddenly changes. Firstly, we have to look at the patient’s armband. At our facility, we have a purple band on the patient’s hand. This band indicates the patient is a “Full DNR”. Other institutions may have a different color. We are legally not allowed to perform CPR to bring that patient back to life in case there is no sign of life or no pulse. Response to my peer Gladys John-TOPIC 3 DQ 1

If the patient does not have the purple band, then we should not automatically think that they are “Full code” and vice versa. Sometimes a purple band is not the only thing we must be looking at. There are more places to confirm the status of a patient’s advance directives. It will be written on our nurse’s station board if you have a board that is not visible to outsiders.  Response to my peer Gladys John-TOPIC 3 DQ 1

It will be written on the chart binder. It will be written on the face sheet. Finally, there must be a physician order in place. There also must be a patient signed pink MOLST form in the chart. These things are the responsibilities of the admission nurse. What if the admission nurse and doctor failed to do this? It becomes the responsibility of the next shift to go through everything that was missed. Response to my peer Gladys John-TOPIC 3 DQ 1

From then onwards all professionals become equally responsible to know about their patient’s advance directives. If there is difficulty to access the computer services, in which there may or may not be evidence of those advance directives; then there is an ethical dilemma. We should try not to create or put ourselves and others in this position. Response to my peer Gladys John-TOPIC 3 DQ 1

That is why as soon as we meet our patient we must try to find out if the patient was given education regarding Advance Directives. Sometimes patients do not know the meaning of Advance Directives. It is in simple words the patient’s preferences of what all treatments they wish to have in case they are unable to provide us with answers at a stage in their life when it is a medical emergency and they become unconscious or totally incapacitated to make sound decisions for themselves. Response to my peer Gladys John-TOPIC 3 DQ 1

Normally all are considered to be Full Code and doctors will do everything they can to save the patient’s life unless they are sure if the patient was a DNR. If there is time they will contact the next of kin. Spouses or children or parents or guardians can be contacted but there can be conflicts when different family members would have differences in decisions to be made for their loved ones. Response to my peer Gladys John-TOPIC 3 DQ 1

We must remember we are only allowed to speak with the one or two whom the patient has authorized us to speak. Ethical dilemmas can occur if a patient got divorced and now a new wife wishes to make decisions for her husband but unfortunately, the ex-wife’s name is mentioned as the health care proxy or next of kin. But not all patients have a family. Response to my peer Gladys John-TOPIC 3 DQ 1
At times close friends act as decision makers or surrogates. The terms health care surrogate, health care proxy and medical power of attorney are all used interchangeably.

The ethics committee is always a place to go to ask for decision-making in case we are faced with dilemmas. They are allowed to make the right decisions because their team consists of nurses, doctors, social workers, lawyers, clergy members, and other healthcare decision-making professionals.

References:

Poveda-Moral, S., Rodríguez-Martín, D., Codern-Bové, N., José-María, P., Sánchez-Valero, P., Pomares-Quintana, N., Vicente-García, M., & Falcó-Pegueroles, A. (2021). Managing ethical aspects of advance directives in emergency care services. Nursing Ethics, 28(1), 91–105. https://doi org.lopes.idm.oclc.org/10.1177/0969733020952112

Walerius, T., Hill, P. D., & Anderson, M. A. (2009). Nurses’ knowledge of Advance Directives, Patient Self-determination Act, and Illinois Advance Directive Law. Clinical Nurse Specialist CNS, 23(6), 316–320. https://doi-org.lopes.idm.oclc.org/10.1097/NUR.0b013e3181be3273

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Also check: Response to my peer Nancy Foulk-TOPIC 3 DQ 2