An elderly comatose patient was brought into the ER after being involved in a minor accident. Although the patient did not require surgery, his condition required specialized attention as he seemed to have difficulty breathing. The patient was put on life support, during which the primary physician made a preliminary assessment of his condition. It was late in the evening, and the physician’s shift was coming to an end. Later that night, the patient became convulsive as he slipped in and out of coma. His symptoms exacerbated, as the episodes of shortness of breath increased. From the attending nurse’s perspective, the patient needed advanced care fast, as the management interventions were getting ineffective. In one occasion, the patient’s heart failed, necessitating resuscitation.But there was a problem. The attending nurse realized that the physician had made a do not resuscitate (DNR) order in the patient’s notes. The dilemma was whether to abide by the DNR order or resuscitate in an attempt to save the patient’s life. The nurse revoked the DNR order and called for resuscitation of the patient. The patient’s vitals stabilized and was prepared for surgery the following morning.
The patient was a 71 year old male who had been fell from the elevator at a shopping mall.Due to the impact of the fall, the patient had slipped into unconsciousness and had been rushed into the ER by paramedic services. He had been alone at the mall, and thus, there was no family member to accompany him to the hospital. From the preliminary physician’s assessment and lab reports, the patient was hypertensive and diabetic. However, it was impossible to gather his further medical history then. The primary physician ascertained that due to the patient’s lab diagnosis, age, and possible head trauma sustained in the fall, it would be almost impossible for him to make it out of the comma. Putting the [patient on life support was intended to monitor his progress and vitals while his heart was functional. However, if the heart failed, the physician deemed it unnecessary to resuscitate as it would be almost impossible for the patient to make it. The decision to not resuscitate was made solemnly by the physician, based on his assessment of the patient, without the involvement of the patient’s consent or family.
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From the nurse’s perspective, the primary physician might have been wrong in making the DNR order. Failing to involve the patient or their family in an decision pertaining to their health and treatment procedures may be a violation of the ethical and legal practice codes ( Pettersson, Hedström, & Höglund, 2018). However, the physician may still be justified in his decision, given that a decision had to be made and there was no one to obtain consent from. The patient was in a coma and there were no immediate family members to consult. In resolving this dilemma, the nurse used this gray area and decided to rescind the DNR order. It was a vital call, as the resuscitation was successful. On the other hand, contravening the physician’s order is a professional misconduct. The nurse used non- maleficence and beneficence as the ethical principles to guide her decision. In resuscitating the patient, she ensured that the patient obtained the benefits of care without harm ( McDermott-Levy , Leffers, & Mayaka, 2018) . These are two of the fundamental ethical principles in healthcare.
The nursing interventions that may have been helpful in solving the dilemma are:
Providing care in line with the ethical principle of non-maleficence
Providing optimum care for the best patient benefits.
Ensuring patient autonomy in making decisions on the health of the patient
References
Pettersson, M., Hedström, M., & Höglund, A. T. (2018). Ethical competence in DNR decisions–a qualitative study of Swedish physicians and nurses working in hematology and oncology care. BMC medical ethics , 19 (1), 63.
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing outlook , 66 (5), 473-481.
