Principles of Patient Autonomy
Hello, so I know the instructions might seem a little much, but it’s because I need this paper done exactly as specified. Below you’ll find the instruction and content that I’ll provide for the essay, I just need you to really elaborate however you can on it. I am also going to attach a journal you can reference to. Thanks.
Instruction for writing:
• Introduction: brief description of situation (Provide a clear and concise introduction to the patient related ethical situation; provide rationale for why the situation is an ethical dilemma)
•Describe a situation from the clinical setting: What happened? Who was involved? (Describe what happened, who was involved, & What actions were taken by you and other members of the healthcare team; discussion is well-developed; 2-3 paragraphs)
•Include how the situation demonstrated nursing ethics or demonstrated a lack of nursing ethics regarding the basic principles such as Respect for autonomy, Nonmaleficence, Beneficence, Justice, Veracity, Confidentiality, and Fidelity. (which in my instance is Autonomy)
•Discuss what you felt like in the situation. Describe your actions and theactions of others in that situation (Discusses what emotions were felt regarding the situation. Explains how the experience contributes to professional development. Discuss other actions or options)
•Evaluate the experience. Explain how the experience makes sense to you, why it is important, how it contributes to your professional development. Mention any other actions that could have been taken (Demonstrate an insightful and thorough understanding of the ethical nature of a patient care experience)
•Summarize how you will act if the situation ever happens again
Reference citation: Cite one text book and one journal article in support of the ethical discussion of the patient care situation (I have attached a journal article below, so if you can find any ethical book that basically defines autonomy and site it, which should be just fine.)
CONTEN:
So during my ICU rotation, I decided to pick and write about this 84year old male who was found unresponsive by a family member and admitted with cerebrovascular accident like symptoms. He had a history of hypertension, asthma, and type 2 diabetes mellitus. Upon admission an MRI was done and the results showed a massive area of acute infract involving the right middle cerebral artery, distribution occlusion in the right petrous internal carotid artert as well as the right middle segment cerebral artery, and bilateral mastoid air cell disease.
Upon assessment, he was obtunded, responded only to vigorous and painful stimuli with Decerebrate posturing, unable to speak or follow commands, and had left hemiparesis. His pupils were 3mm, irregular, brisk. He has a nasogastric tube inserted due to suspected ileus and coarse crackles on all lobes of lung.
Ok now for the ethical dilemma. This patient was originally a DNR, but upon admission, his family changed his status to full code because they feared that proper treatment would not be administered if he was left a DNR. When the day nurse in charge of him saw his lab and MRI results, he called the doctor in charge of the patient to find out If he’d seen the result and was aware of his code status. The doctor then said he has had that patient for years and that he was supposed to be a DNR and not a full code, so the family was called immediately to resolve the issue. Upon family arrival, they said yes that they changed his code status due to fear of him not being properly treated and also that they were not yet ready to let him go.
The doctor showed them and explained the meaning of his MRI results and even went on to say that it was a miracle infact that he was still breathing on his own, and that it won’t be long before he’ll need to be intubated due to the percentage of brain damage. He explained that them putting him on full code was not going to improve his quality of life that it was only going to prolong his suffering. He also assured them that just because a person is a DNR don’t mean they stop getting medical treatment, and that the difference between a full code and DNR is just that they won’t interfere with normal death process when it comes.
After the teaching, the patients wife and sons agreed that he be put back on DNR, but his daughter absolutely refused. She cried and trew herself on her dad while saying she could never agree to it. She started getting mad at her mother and brothers for agreeing to such and told them to leave. Her brothers had to finally take her home. He was switched back to DNR before my shift ended. I felt so sad for what they had to go through and I really don’t know what I’ll do if I were to be in their shoes.
Principles of Patient Autonomy
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A patient, 84 year old, was brought in to the hospital’s ICU unit by the family members. He was suffering from a number of complications that are life-threatening. According to the doctor, who had treated the patient severally in the past, the patient was supposed to be hospitalized under the Do No Resuscitate (DNR) code and not the full code. This meant that the patient would receive health care support, but would not be resuscitated in case the process of death took place (Jacelon, 2004). The patient’s family members were aware of the code, but they changed to the full code in fear that their father may not get the health care the required at this time. The dilemma resented in this case is that that patient had requested that, in case the time death came, he would like to be left to die naturally and that the hospital should not interfere in the process. The family on the other hand did not want to lose the patient and so they changed the codes. As for the doctor in charge, he wanted to honor the last wishes of the patient and the natural process of death take place if that time came (Joffe, Manocchia, Weeks & Cleary, 2003).
From the clinical setting the patient had earlier been to the hospital suffering from his ailing health status, with minimal signs of improvement relative to his advanced age and development of the health complications. In light of the situation, the patient had requested to be left to die in case his health failed again (Jacelon, 2004). However, when the patient was brought in, the family had changed the code to full and this led to full health care and our nursing team tried to resuscitate his status. One of the registered nurses looked into the health record after the patient had been to the MRI and discovered that the patient was not supposed to be under the full code but DNR. The doctor on shift advised us to inform the patient and then change the code.Although the family objected to idea at first, they finally agreed and the patient code was changed back to DNR.
The situation is one of the best examples I have had in my career that demonstrates the true elements of nursing ethics. In this case, the patient requested the hospital in advance that in case he ever came back with ailing health, the hospital should not intervene in the process of death. To a nurse, health care should always be patient centered. At the same time the princ...