Post 2 replies to classmates or your faculty member. Be constructive and professional. Minimum of 175 words per reply.
Response #1
Caregiving
Transporting a patient: EMS is quicker, but the helicopter staff is better trained. Working in a rural ER with no specialties, and we have a STEMI at 3am. The ground truck is 2 minutes away with a 25-minute drive to the receiving facility. The helicopter is 40 minutes out with a 12-minute flight to the receiving facility. The patient needs a cath lab now, but which is more important? EMS staff is trained, but not well enough if the patient goes south in route (crew that night isn’t the most reliable in critical situations). Life flight staff is top notch in critical situations.
Beneficence
We used the helicopter as it was the safest option for the patient in the end. Even though the EMS would have been quicker, we could not ethically put our patient on a truck with a crew that we knew was not the best in critical situations. We put the patient on the helicopter with the crew that would be able to best care for the patient, even if he had to wait in our ER a bit longer.
As a side note I would like to point out that this is a decision that we did not come to lightly. It was a rough two minutes of which option to take for the best benefit for our patient.
Westrick, S. J., MLS, JD, PhD (2014) Essentials of Nursing Law and Ethics
Response #2
End-of-life issues are something that I have dealt with and seen many times in my unit. Most recently I cared for a man with no close family in town. He received a new diagnosis of stage 4 cancer with metastasis from the liver to the bones. This patient had a poor prognosis and his emergency contact (mother) was notified. His mother then flew down from Pheonix to California to see her son and to discuss treatment options. The Palliative care team held a meeting with the patient’s mother and informed her of the options as the patient’s code status was still a full code. This patient’s GCS status would often waver between a 14 and 15. The mother wanted to maintain the patient’s full code status while the patient had no solid input. The patient would state things like, “whatever my mom thinks is best I am going to do.” This was an issue because this patient was suffering in pain, very distended and edematous. He did not have the strength to move in bed and was refusing to eat.
An article I came across regarding end-of-life ethics, discusses autonomy and the difficulty many families have in balancing areas of cultural, social, and economic considerations (Findings, 2019). While the palliative team did not believe the patient’s mother’s initial decision was indefinite, and all parties agreed to hold another meeting involving the patient’s aunt (a potential caregiver in another city), it was my job as the primary nurse to advocate for this patient. I would provide active listening to the patient and his mother while centering the patient’s plan of care around family and patient wishes.
Reference
Findings from Singapore General Hospital Reveals New Findings on Nursing Ethics (Navigating complex end-of-life decisions in a family-centric society). (2019, November 22). Health & Medicine Week, 1337. https://link.gale.com/apps/doc/A606007754/HRCA?u=u…