...Ethical Dilemma from Current Events Family Presence During Resuscitation Tracy Sitek Grand Canyon University Ethical Decision Making in Healthcare NRS 437V Barbara Trabelsi April 17, 2011 Ethical Dilemma from Current Events Over the last decade, controversy over family presence during resuscitation (FPDR) and invasive procedures has markedly increased. Historically, it has always been thought that having a family member that was hysterical or asking questions for clearer understanding of the situation was a deterrent or distraction for the staff while they were trying to provide care to their critically ill relative. No one wanted the family in the room as they might potentially become another patient or they were in the way of the care providers. The family was escorted to a more private setting such as a quiet room, to await the occasional visits from staff to update them on the status of their loved one. A recent article written by Tamekia L. Thomas called “Family Presence: To Stay or Not to Stay?” discusses the idea that if family members were given the choice of being present during invasive procedures or resuscitation of a loved one, they would be at the bedside (Thomas, 2008). This presence has proven to assist in the bereavement process, provides the family with reassurance that all efforts were made during the resuscitation and decreases anxiety for the family. However, a change in culture is a slow process and controversy continues due to lack...
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...DR. CRESS THEORY 2 DR. Cress theory of color confrontation explores the practice of White Supremacy. She sees white supremacy as an organized system to ensure white genetic survival. According, to Dr. Cress white supremacy is practiced by white in order to ensure the genetic survival of the so called white race. Dr. Cress believes that whites practice this form of Supremacy whether they are conscious of it or not to ensure their survival. She goes on to state, that it is important for people of color to understand the system and dismantle. This theory theorizes that during slavery, White men realized feelings of confirmed genetic inferiority as a result of the inherent genetic dominance and biological inheritance of darker skin over a genetic recessive state such as albinism. Dr. Cress Color-Confrontation theory postulates that whites desired and still do desire sexual alliances with non-whites, both male and female, because it is only through this route that whites can achieve the illusion of being able to produce color. The extreme rage vented against even the idea of a sexual alliance between Black male and the white female, which has long been a dominant theme in the white supremacy culture, is viewed by the Color-Confrontation theory as a result of the white male’s intense fear of the Black male’s capacity to...
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...Why Is It Important for Nurses to Allow Family Presence During Resuscitation Efforts? Cloressa Dizney University of Texas at Arlington College of Nursing Why Is It Important for Nurses to Allow Family Presence During Resuscitation Efforts? The idea of Family Presence During Resuscitation is a controversial topic for sure but has been around for quite some time. Most major health organizations such as the American Heart Association (AHA), the Emergency Nurses Association (ENA), the American Association of Critical Care Nurses (AACN), the American Academy of Pediatrics (AAP), and the American College of Emergency Physicians endorse the practice of FPDR and still it is not a widely accepted practice. Why is this? The following three articles will discuss the positive and negative beliefs from the perspectives of both health professionals and the patient’s families. This paper will also support why it is important to offer FPDR and establishing policies to do so. The first article by Jensen and Kosowan (2011) addresses cardiac health care professional’s perspectives on FP during CPR. Some opponents in healthcare argue that FPDR would be too traumatic of an experience for families to watch. Family interference, increased staff stress, and legal action on the resuscitation team were also concerns of healthcare professionals. The article reports research done in several Canadian hospitals regarding the beliefs of health care providers on the topic of FPDR. The research found that...
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...Attitudes and Beliefs Regarding Family Visitation After Implementation of a Formal Visitation Policy in the PACU Maria Walls, BSN, RN A quality improvement project was created to examine staff attitudes and beliefs regarding visitation after implementation of a formal visitation policy in the PACU. A 10-item questionnaire was distributed and collected from each staff member in the PACU after implementation of the formal policy. Results showed that although 83.7% of staff would want the option to visit their family member in the PACU, only 47% of staff believe that families should have the option to visit in their own PACU. The perceived barriers reported by staff were staffing issues, the possibility of exposure to infection, privacy issues, staff anxiety, the possibility of visitors witnessing resuscitation, and lack of education of families. The survey results show that more existing education is needed. Consequently, the current policy is posted in all waiting areas for families, and a mandatory in-service was created and presented to staff on how to communicate effectively with family members. Keywords: family visitation, staff attitudes, perceived barriers, PACU. Ó 2009 by American Society of PeriAnesthesia Nurses ALTHOUGH MANY EMERGENCY DEPARTMENTS around the country are allowing family members at the bedside during resuscitations, there is resistance to family visitation in the postanesthesia care unit (PACU). Family visitation benefits both families and patients,1 and at a...
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...decade, the family presence during resuscitation has been an increased controversial issue. Although, there are many professional organizations support the notion of family presence, the controversy still continues. Many family members were asked to leave the bedside of their loved one during resuscitation. Parents are often separated from their kids during medical emergencies. The reason behind this can be the existing fear that the family members may interfere with resuscitation efforts or it will traumatize them psychologically. A moral conflict exists because of the existence of two opposing obligations. The obligation to the family members who wants to be present with their loved ones during medical emergencies and the obligation to healthcare providers who do not want the presence of family members to witness the resuscitation efforts. It is very important to examine the perceptions of patients, families, and health care providers when determining a solution for the family stay during medical emergencies. Often health care providers assume that the family members may interfere with the resuscitation efforts (Thomas, 2008). Another fear is that the family member may not be able to control their emotions, there by hindering the resuscitation efforts. Many organizations such as Emergency nurses Association and Associations of Critical Care nurses support the presence of family members during resuscitation. Findings from one study suggest that the family members...
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...Family Values Paper Family Values Paper The concept of family as the client has become an integral part of nursing practice. The American Nurses Association states that nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. It is this thinking that nursing continues to strive to assist patients not only achieve their optimal physical health, but also their family culture is equally important when it comes to healing. As nurses continue to understand the dynamics of a patient’s family system, it is clear that the word “family” draws upon much more than just blood relatives. In the health care setting a family can be viewed as the people who come together to support a patient during a health crisis. That support may be seen directly at the bedside, through conversations via phone, or helping to assist in the discharge process. As a nursing workforce it is our responsibility to understand how the roles of a family affect our individual patients, and work to incorporated those roles into their therapeutic environment. An issue in today’s emergency departments that continues to draw attention from aspects of the medical profession is the use of family presence during cardiopulmonary resuscitation. “While it appears that the evidence clearly indicates positive...
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...Burns: Understanding Nursing Research, 4th Edition Critiquing Exercise Knott, A. & Kee, C. C. (2005). Nurses’ beliefs about family presence during resuscitation. Applied Nursing Research, 18(4), 192-198. |STANDARDS/EVALUATION CRITERIA 50|KEY CONCEPTS IN CRITIQUE | |points | | |Descriptive Vividness 5 pts | | |Was the significance of the study adequately described? |1. The significance of the study was adequately described. | | |Family presence (FP) during resuscitation is a matter that | |Was the purpose of the study clearly described? |warrants more investigation as to whether or not it should, or | | |should not be allowed. Furthermore, the study proposes the | |Were the interpretations presented in a descriptive way that |necessity of protocols in place in institutions to guide | |illuminated more than the quotes did? |decisions on this matter. | | | ...
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...due to severe abdominal pain which revealed necrosis of a large portion of her large intestine. Following this, she spent many weeks in the intensive care unit with a diagnosis of septic shock. During her time in the ICU, she was mechanically ventilated for several weeks. In addition, she had evidence of kidney injury and subsequent hyperkalemia that resulted in cardiac irregularities. Her experience as a patient and my experience as the family point person in communicating with the healthcare team and observing the nursing staff played an important role that led to my decision to focus my future nursing career on critical care nursing. I was inspired by the overall knowledge, commitment, and diligence of the night shift nurse who cared for my mother consistently. He was very compassionate with us, extremely knowledgeable in responding to all of our questions about the pathophysiology of her condition, and explaining the rationale of the treatment approach made a positive difference in her outcome. “Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. A critical care nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care.” (aacn.org) Requirements for a critical care nurse involve both certification and skills. Certification: The minimal requirement to be a critical care nurse is an RN...
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...Concept Analysis Carrie G. Alexander Chamberlain Concept Analysis The concept of comfort is one that nurses provide every shift; however, it is not always easy to define. Katherine Kolcaba’s Comfort Theory will be used. Walker and Avant’s method for concept analysis will be used. The first step is to select a concept, which is comfort. The next step is determining the purpose of the analysis. The purpose is to define what comfort means and what comfort measures are and how they are used in nursing. The third step is to identify the uses of the concept of comfort. This includes definitions of term comfort and a literature search. The fourth step is to determine the defining attributes of comfort. This allows for insight into the concept and includes the characteristics of comfort. Comfort can mean many things to many people. Comfort can be caring words, caring touch, warm blankets, pain relief or encouragement. The fifth step is a model case or a real life example of the concept that includes the attributes of the concept and a borderline and related case. The sixth step is to identify consequences and antecedents and consequences. The final step is to define empirical referents or measurable ways to show the occurrence of comfort. Purpose The concept of comfort is used frequently in nursing practice; however, it is not always clearly defined. It is a basic value of nursing care and interventions and is frequently described as comfort measures. A basic understanding...
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...Original article | Published 3 February 2011, doi:10.4414/smw.2011.13157 Cite this as: Swiss Med Wkly. 2011;141:w13157 Do not attempt resuscitation: the importance of consensual decisions A qualitative study Lorenz Imhofa, Romy Mahrer-Imhofa, Christine Janischb, Annemarie Kesselringc, Regula Zuercher Zenklusend a b c d Zurich University of Applied Sciences ZHAW, Institute of Nursing, Winterthur, Switzerland Department of Education, Training and Professional Development, Stadtspital Waid Zurich, Switzerland Institute of Nursing Science, University of Basel, Switzerland Department of Medicine, Pourtalès Hospital, Neuchâtel, Switzerland Correspondence: Lorenz Imhof PhD RN Zurich University of Applied Sciences Institute of Nursing School of Health Professions Technikumstr. 71 CH-8401 Winterthur Switzerland lorenz.imhof@zhaw.ch pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education. Key words: decision-making; multidisciplinary collaboration; end-of-life issue; resuscitation orders Introduction Since the 1980s, “do-not-attempt-resuscitation (DNAR)” orders have become common in medical practice. DNAR orders are given for 50–60% of patients who die a non-sudden death, with wide variations among countries. DNAR orders apply to only 19% of hospitalised patients in Italy, but to as many as 83% in Sweden and 86% in Switzerland [1, 2]. The frequency of DNAR decisions in...
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...Nurses Impact Lives Beyond: Case Studyd Nurses Impact Lives Beyond: Case Study Nurses Impact Lives Beyond Pre-hospital Phase: It was cold and dark, when the helicopter was dispatched to a scene flight for motor vehicle crash with double entrapment one May morning at 0230. Two of the three patients, are unresponsive and in critical and unstable condition. This is the first encounter our patient would have with a registered nurse providing and directing his care. The nurse possesses both acute care and pre-hospital expertise and would work collaboratively with police, fireman, good Samaritans, EMT’s and paramedics to access the patient, provide timely triage, life -saving interventions and rapid transport to the closest trauma center. Each team member has a pre-defined and respected role; the nurse is the senior health care provider and assumes the leadership role with a calm, confident demeanor that is reassuring to the team. This patient was a 25 year old man, unrestrained driver of a vehicle that hit a brick wall head-on at a high rate of speed. Of his two passengers, one of them is a brother, all require 20 minutes of extrication time from the severely damaged vehicle. After freeing our patient, the team works together to assess and stabilize him. His initial vital signs are worrisome, with a BP of 140/80, pulse of 160 and spontaneous respiratory rate of 8. The nurse assumes his care and quickly supports his respiratory rate by bagging and suctioning...
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...cardiogenic shock, anaphylactic shock, neurogenic shock, and septic shock (Urden, Stacy, & Lough, 2006). This essay will analyze septic shock based on the analysis of a presented case study. To further understand this concept, a review of treatment and management of septic shock as used in the writer’s practice setting will be discussed. The writer chooses the “case study one” as an issue of septic shock because Karen’s vital signs, physiological and behavioral symptoms are clear indicators of septic shock. Septic shock is described as the body’s inflammatory response to overwhelming infection (Urden, Stacy & Lough 2006). It is also classified as existence of an infection with hypotension despite fluid replacement along with the presence of tissue perfusion abnormalities (Urden, Stacy & Lough 2006). According to Bench (2004), the diagnostic criteria for septic shock include a heart rate greater than 90 beats per minute, a respiratory rate greater than 20 beats per minutes, an increased white cell count, hypotension, and temperature greater than 38 degrees or less than 36 degrees. Karen met these criteria with an increased temperature of 41 degrees which is usually an indicator of infection, increased heart rate and respiratory rate. (Urden, Stacy & Lough 2006). According to Bench (2004), the diagnostic criteria for septic shock include a heart rate greater than 90 beats per minute, a respiratory rate greater than 20 beats per minutes, an increased white cell count, hypotension...
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...Lynda Sowemimo Pathogenic Neisseriae Microbiology Special Project Northwestern College Introduction Neisseria is a large genus of bacteria that colonize the mucosal surfaces of many animals. This genus (family Neisseriaceae) of parasitic bacteria grow in pairs and occasionally tetrads, and thrive best at 98.6°F (37°C) in the animal body or serum media. Of the 11 species that colonize humans, only two are pathogens, Neisseria meningitidis and N. gonorrhoeae. In N. meningitides and N. gonorrhoeae, DNA transformation requires the presence of short DNA sequences (9-10 monomers residing in coding regions) of the donor DNA. These sequences are called DNA uptake sequences. Biochemical identification/ Genetic transformation Neisseria meningitidis (also called the meningococcus), one of the most common causes of bacterial meningitis and the causative agent of meningococcal septicaemia. Neisseria gonorrhoeae (also called the gonococcus), which causes gonorrhea. Neisseria meningitidis has a polysaccharide capsule that surrounds the outer membrane of the bacterium and protects against soluble immune effector mechanisms within the serum. It is considered to be an essential virulence factor for the bacteria. N. gonorrhea possesses no such capsule. Neisseria meningitidis Often referred to as meningococcus, Neisseria meningitidis is a gram negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a life-threatening sepsis. Neisseria...
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...The nursing management of pediatric seizures, for which patient safety is the priority, should be driven by the clinical presentation of the child’s event. This article will present an algorithm to assist bedside nurses in safely caring for children with a variety of seizure types. The algorithm can be used as a road map to assist staff nurses in safely and appropriately stocking patients’ bedsides with emergency equipment as needed for children with seizures. However, to understand the clinical symptoms of a seizure, it is important to first review basic pathophysiology and seizure classification. What Is a Seizure? Seizures are a common neurologic disorder of childhood, and many pediatric nurses will care for children with epilepsy during their careers. The term “seizure precautions” is used frequently in nursing practice; however, its definition varies among institutions. Childhood epilepsy has many phenotypes, and while some children require airway clearance and ventilatory support in the event of a seizure, many will not. The bedside equipment for a child with seizures should reflect the patient’s symptoms. To that end, an algorithm based on seizure classification and current practice in seizure precautions is presented to aid bedside nurses in safely caring for children with seizures. The algorithm may also be used to assist in educating parents about the safest way to care for their child at home, without sending contradictory messages about different needs for equipment...
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...value of these advance directives to the patients, their families; and the authorities that these advance directives give the above mentioned interested parties. | Contents Application Paper on Advance Directives 3 Abstract of Application Paper 3 Advance Health Care Directives 3 The Natural Death Acts 3 Legal Precedents for Advance Directives 3 Advance Health Care Directives: 4 California’s Advance Directive Law 4 The Natural Death Acts 5 Inception and Legal Basis 5 Current situation of N.D.A.s 5 Value of Advance Directives to Patient, Family, and Caregiver 6 Value to Author or Patient 6 Health Care Facility 6 Are Advance Directives Really Effective? 7 Living Will Example 8 References 13 Application Paper on Advance Directives Abstract of Application Paper This paper will examine the short history of Advance Directives in California, the other states that have added A.D.s, and what the legal basis and historical basis for these acts are. Previous to the Advance Directives, very similar laws are Natural Death Acts. In this report I will review some of the similarities, and differences between the A.D.s and the N.D.A.s. In the 1970s, with the modernization of health care facilities, some patients, especially sick or elderly, would disagree with standards of care of hospitals they receive when they are afflicted by Alzheimer’s, or Trauma, or Comas. In those cases and others, families and caregivers, hospitals, or doctors will often disagree...
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