Please give well written and well thought answers, Thanks! CASE STUDY- Using cri
ID: 121751 • Letter: P
Question
Please give well written and well thought answers, Thanks!
CASE STUDY- Using critical thought, research and respond to the question below with a minimum of 3-5 sentences.
Tina loves her mother Beverly dearly, however, Beverly’s case of Alzheimers is getting worse day by day and she is no longer able to provide Beverly with the treatment she needs. After considering all options available she has made the difficult decision to move her mother to a highly recommended nursing home that specializes in providing patients suffering from Alzheimer with the best care possible. This facility provides both short and long term care.
When the day arrives for Beverly to be moved to the nursing home, she is not in great condition. They proceed forward with the move and upon arrival they ensure that Beverly is made comfortable while Alice completes the necessary paperwork. The preparation leading to Beverly’s move has fatigued Tina and she does not complete all the forms but promised to complete them within the next 2 days. Understanding the importance, Tina does ensure to give them Beverly’s advance directive. She explain’s that if Beverly’s heart stops beating, she did not want to have CPR, surgery, antibiotics, etc. Alice made sure to sign the color-coded DNR order and left the rest of the paperwork for another day when her mind was fresh.
Early the next morning Tina is awaken in a fog by the telephone. It is the nursing home. They explain to Tina that Beverly suffered a “cardiac episode” and that 911 was called. Beverly was transported to the local hospital. Tina rushes out of the house to the hospital. When she arrives, she find that Beverly is in ICU connected to a ventilator, a heart monitor, and has an intravenous line. Tina is furious and searches for the hospitals’ patient representative. Tina doesn’t understand how her mother’s wishes were disregarded and ended up exactly in the opposite position she wanted. “Why wasn’t the advance directive and DNR not followed? Doesn’t my mother’s wishes mean anything,” she fumed?
1) What are your thoughts on why the advanced directive and DNR were not respected? Who is at fault for this? Is disciplinary action necessary?
2) How important is it to discuss and clarify with administration and staff what DNR is to reduce conflict between policy and practice?
3) The only true way to know what DNR means to a patient and/or patient rep is through discussion on a case by case basis with each patient and/or patient rep. How often do you think this occurs and should this become common policy? What role should the ethics committee play in such a discussion with the patient and/or patient rep?
Explanation / Answer
1. DNR is a do-not-resuscitate order signed by patient or family to state that if heart stops working or breathing stops, CPR or ventilation should not be provided. In this case, they are asking for natural death.
Tina signed DNR but it was not respected, this can happen only when the staff is not aware of the importance of DNR and lack of consideration.
This is the fault of nursing home. It was the responsibility of staff of nursing home to understand the guidelines if a DNR is signed and to follow it strictly.A disciplinary action should be taken in this case.
2. There is a conflict between policy and practice in such case because of lack of proper discussion about the policy. The staff and administration should have a knowledge about the order and there should be a proper discussion on practice to follow DNR. If a DNR is signed in nursing home, it means the staff cannot perform resuscitation or cannot transfer the patient to hospital for CPR or ventilation. This guideline should be followed with nursing home policy with proper training and discussion with staff and administration.
3. There is a lack of proper discussion while signing or following DNR. It should be strictly followed. Ethics committee plays an important role in discussion with the patient or patient rep about DNR. There should be a thorough discussion with staff and patient when DNR is signed about the importance of DNR and why it is signed. The discussion should involve all those medical conditions that can occur and why DNR is signed. If any problem to patient occurs in nursing home, the DNR is shown to hospital before transferring patient to hospital. The hospital also follows DNR. This should be included in organization policy that discussion to be done with patient or patient rep about each and every condition while signing DNR and proper staff training to understand the importance about following DNR.