Nursing care and evidenced based practice

Roles and Values

A. Discuss the evidenced-based practice regarding advance directive DNR

Nursing care is purposed to meet the comprehensive needs of both the patients and their families throughout their healthcare process. This is especially fundamental in the care of patients and their corresponding loved ones at the end of life. Nurses are advocates for the rendering of honourable and compassionate care. Nurses actively take part in examining and ascertaining the responsible and suitable use of interventions so as to decrease any instances of unwarranted treatment and patient anguish and suffering (American Nursing Association, 2012).

B. Discuss the nurse’s moral responsibility by doing the following:

1. Describe the nurse’s responsibility to the patient in the scenario

In the case of Mr. Miles, the nurse has a moral responsibility to provide advocacy and protection of both the patient and his desires, which encompasses his request to be a do not resuscitate patient. Despite the fact that there may be apprehension amongst other professionals within the healthcare institution and also amongst Mr. Mile’s family concerning his decision to be a DNR, a patient that is well knowledgeable and capable has the freedom and right to decline treatment and lifesaving procedures. The main responsibility of the nurse in this regard would be to make certain that Mr. Miles is fully aware and comprehensively understands his diagnosis, the course of his medical condition, and the options available for treatment. Subsequent to ascertaining that the patient is fully competent, the nurse ought to conduct an exhaustive discussion of the prospective risks together with the benefits that are associated to the form of treatment to confirm of his understanding. Thereafter, the nurse is responsible for conveying such information to other healthcare professionals and work mates, including the patient’s attending physician.

a. Discuss a potential moral dilemma that the nurse in the scenario may encounter. Include resolution strategies in your response.

In the scenario encountered for Mr. Miles, the nurse faces a moral dilemma. To begin with, in the event that the nurse decides to support the decision for Mr. Miles to be a DNR, then he or she may end up being dismissed from the patient’s care team by his family. To make matters even worse, the nurse may experience shunning from his or her colleagues in the healthcare facility. In this sort of scenario, Mr. Miles would continue to be a full code patient with the medical team providing emergent procedures in an endeavour to resuscitate him against his wishes, continue to worsen from a health point of view, experience a cardiopulmonary arrest, code for a period of time and pass on. On the other hand, if the nurse manages to get the attending physician to set the DNR order delineating patient treatment objective and comforting measures, then it implies that Mr. Miles would be a DNR as he desires, continue to worsen from a health point of view, experience a cardiopulmonary arrest, code for a period of time and pass on. It is imperative to note that despite that the final outcome is the patient’s death, there are two completely different routes with moral consequences.

However, there are resolution strategies to this scenario.

One of the key solutions is to grant Mr. Miles the chance to see out his own advanced instruction before his medical condition worsens. Another strategy would encompass setting up an emergent family meeting at the time when Mr. Mile is septic prior to being medically unresponsive. The key significance of this approach is that it will provide an opportunity for the patient to express and communicate his DNR wishes to the family members and also the healthcare team assigned to him. Moreover, this grants the nurse an ideal chance and time for advocating for the patients desires as communicated. Moreover, this provides the family members with ample time to take in the information regarding Mr. Miles’ course of medical condition devoid of any resuscitative procedures.

2. Describe the impact of the advance directive DNR on the stakeholders in the scenario

i. Patient

The main impact of a DNR on a patient is the fact that he or she is able to fulfil the right to made end of life desires well known. Imperatively, if the desire to become a DNR is not adhered to, then the patient is forced to continue living a life that is compromised. This is a significant impact for the reason that the decision to resuscitate him or her implies that the patient is the one who gets to live a life that is contradictory of his or her wishes.

ii. Nurse

As a stakeholder, the nurse is also impacted by the DNR. On one hand, if the DNR is adhered to as the patient desires, then the nurse will be proud that he or she supported and advocated for the wishes of the patient and rendered care as is expected of the nursing role. On the other hand, if the DNR wishes are not adhered to, this will still significantly impact the nurse for the reason that the nurse will have to live knowing the desires of the patient are not being followed and is living a life not wanted.

iii. Family

The DNR also has a major impact on the family of the patient. This becomes all the more impactful in the event that the family is not aware or is not in agreement with the patient’s desire to be a DNR. This is more often than not because the family and loved ones are not yet ready to give up and lose the patient. In such instances, it is imperative for the nurse to share and provide first-hand knowledge of the patient’s desires and also provide comfort and the procedure of the DNR. This grants them an opportunity in allowing the patient to have his or her wishes fulfilled.

C. Discuss how a provision from the American Nurses Association (ANA) code of ethics should relate to the nurse’s professional practice.

1. Analyze how this provision applies to the scenario

The provision of the ANA Code of Ethics is that nurses are obligated to advocate for and play a significantly active role in instigating dialogues about DNR with the patients, families and also colleagues within the assigned health care team. Imperatively, nursing care is focused toward satisfying the comprehensive wishes of the patient subsequent to signing the DNR.

2. Describe the importance of patient autonomy

Nurses have the key responsibility of respecting the autonomy of patients while improving their health. In particular, there might be numerous instances that the nurse may attack this basic need during nursing care. As a result, it is imperative for nurses to respect patients’ autonomy by means of providing essential information and encouraging them to take part in the process of decision making. In this case, it is imperative for the nurse to ensure that Mr. Miles signs the DNR independently, subsequent to being provided comprehensive information and also while in a sound frame of mind (Griffith and Tengnah, 2017).

D. Discuss the legal implications associated with this case by doing the following:

1. Identify potential legal conflicts among patient, family, nurse, and organization

Potential legal conflicts among patient, family, nurse, and organization encompass the fact that health care providers who try to resuscitate patients against their individual wishes are in violation of the patients’ legal right to self-determination. In addition, the provision of a treatment that is bound to be futile is being in violation of the bioethical principle of non-mal-efficiency and might in a legal perspective be deemed to be battery if the predicted harm in fact takes place. Moreover, the CPR procedures ought to not just be grounded on procedural and legal issues but also need to include the ethical ideologies. So that, due contemplations are combined to respect the patients’ independence, devoid of harm and extra miseries and defensible equal opportunities in a certain setting of the society (Sa’id and Mrayyan, 2016).

2. Discuss how the potential legal conflicts identified in part D1 will affect the nursing role

These potential legal conflicts have an impact on the nursing role. According to Adams et al. (2011), nurses are usually at the patients’ bedside and spend shifts with patients. As a result, they cultivate trusting relationships and are competent to not only assess but also to fulfil the needs of the patient. The conflicts might influence the nursing role as the wishes of the patient might be contradictory to the wishes of the patients. In the same manner, regardless of being presented wishes by the patient, the legal rules demand actual signing of the form and therefore the nurse cannot implement such wishes.