DNR Reflection

Complete the DNR interactive case study. Associate what you have studied in your weekly materials with what is presented in this case study.
After you view the case study, reflect upon what you have learned and how it is related to the learning materials. Compare the case study to your nursing practice and give a similar example from your experience in which you might have run into an ethical situation
Your reflection content should be a minimum of 500 words, equal to six paragraphs.
Scenario: It’s been a long day, you have a patient who is actively dying after a sudden CVA the
family has been camped out all day at your work station.
CNA: code blue code blue room 142 bed one code blue room 142 bed one.
Scenario: The patient is unresponsive and the CNA is performing CPR
NURSE: do not resuscitate he has a DNR (Do not resuscitate)
SON: I have the power of attorney he is a living wills that states all heroic measures must be
taken
Scenario: The family seems to have conflicting information what should you do first to calm the
situation down.
Option:
A. Tell the family they are out of line and need to leave the room immediately.
B. Engage in conversation immediately with the family right there in the room.
C. Escort the family out while calming them down so you can focus on the patient.
You need to concentrate on the patient you have something in your pocket Click to see what
it is in your pocket. Keeping these cards in your pocket can be critical as in this instance it
helped to confirm that the patient was indeed a DNR upon admission to the floor.
NURSE: stop CPR immediately
Scenario: the CNA has stopped CPR
Scenario: You need to check the patients vital signs. The patient ends up having no palpable pulses and there are no signs of life the nurse tells the code blue team that the patient is a DNR status and they should leave.
SON: get back in there you need to resuscitate him
Scenario: The son is upset but the patient had a DNR upon admittance as we continue think about the following questions
Did the nurse have a crucial role to play in this situation? if So what was it? what responsibility if any does the family have in a situation like this? what responsibility if any did the patient have in this situation?
DOCTOR: please tell me the sequence of events
NURSE: the patient remained on bed rest after his IBC filter placement surgery that concluded at 1630 he had been stable he requested to get up and go to the bathroom at 1815 and I provided the OK for him to walk to the restroom with the assistance of the CNA after one last incision
assessment the CNA reports that while getting him out of bed it was discovered that the oxygen
tubing was too short she left to get longer tubing for the patients oxygen leaving the patient
under the supervision of his daughter when the CNA got back he found the patient had taken the
oxygen off and left it on the bed as he tried to get up on his own despite the pleading of his
daughter not to she witnessed the collapse and yelled for help as the CNA was returning to the
room the CNA unaware of the DNR status began CPR and called the code blue.
Scenario: The doctor is satisfied with the report he asked his speak to the family
DOCTOR: can you all please come with me so we can talk
SON: I am going to sue this hospital!
Scenario: You overhear the outburst your intuition tells you, you are going to court.
Advanced directives is a term used to encompass documents such as a living will durable power of attorney and durable power of attorney and healthcare DPAHC. A living will is simply a statement that the patient makes in writing describing his or her wishes pertaining to how or where he or she wishes to die and it becomes active when a person has been deemed
incapacitated vegetative state or terminally ill. A durable power of attorney is a legal document that allows a trusted individual friend or family member to be the legal representative in all non healthcare legal matters involving a patient like an elderly person. A durable power of attorney for health care DPAHC is a document through which a patient makes known his or her wishes about the treatments he or she wishes to have or not to have throughout the course of an acute illness or in the dying process. Had the son in this particular case kept an on-going and open discussion with his father about any changes he wanted to make to the DPAHC prior to the emergent hospitilization the sun may or may not have had more decision-making capacity.
Unfortunately that wasn’t the case and thus there was an unfortunate disconnect between the two key parties involved in the DPAHC the appointed decision maker and the patient. This is not an
unusual occurrence a recent study expands on this by stating when discussions about end of life
preferences do take place they frequently lack the clarity and detail needed by significant others
and health care providers to honor their preferences clinical scenarios like this are tenuous at best
and more so if a family is in disagreement with each other or their loved one at the time of an
arrest or when actively dying. One has to wonder if the horror the family experienced as they
witnessed their father’s life come to an abrupt end while health care providers withheld care was
an influence in their decision to file a lawsuit. There are a lot of nuances to what we do that are
not well understood by laypersons. Three pieces of information concerns me in this case the lack
of communication between the father and son with regard to updating the patient’s preferences
the misunderstanding the son had that a power of attorney can override the wishes of a patient
and the lack of communication between both patient and family. Perhaps the son could have
double checked the code status with the physicians and verified that the advance directives were
in the chart or updated with the patient prior to surgery. Maybe a conversation between father
and son prior to surgery could have closed the circle of communication. The fact is this that there
are no better advocates for health care consumers than themselves, the patients family members
or trusted friends who hold the durable power of attorney for health care DPAHC. That said we
should always ask ourselves does a family member or one who holds the power of attorney know
what effective advocacy means. Part of advocacy is knowing what questions to ask what
information to provide and verify in the hospital and always knowing at any given moment the
exact wishes of a loved one so there are no surprises or unnecessary and unhealthy turmoil
surrounding a patient and family during a health crisis. Advanced care planning would have
played a critical role here in this case illustrates why with every hospitalization or change in
health status there should be a family talk taking place so that everyone is in line with what the
patient wants treatment wise under various circumstances or stages of illness (IE CHF). While
nurses seem to approve of and support discussion related to end of life preferences and advanced
care planning they lack sufficient knowledge to feel comfortable initiating or engaging in crucial
conversations. Studies have found that nurses identify the benefits of advanced directives and
have positive attitudes but lack knowledge and confidence to affectively discuss end of life
issues with patients and families. The literature related to nurses attitudes about advanced
directives to an unmet need for increased knowledge and confidence to address barriers and
ethical dilemmas in end of life care (Putman-Casdorph, 2009). It is our responsibility as nurses to
teach patients and their family members one very important thing, with every hospitalization or
change in health status advanced disease the talk has to happen. Questions must be asked
advanced care planning doesn’t stop once an advance directive is signed the concept is a living
thing the patient’s voice must remain front and center during each discussion and healthy death it
would serve our families well and prevent costly lawsuits if we started the conversation and
engaged in thorough teaching about advanced care planning.

SAMPLE SOLUTION

Good interprofessional communication is a critical component to achieve improved patient outcomes and enhance safety. The lack of it creates conditions necessary for the occurrence of medical errors which are recipes for severe patient injury or even death (Müller et al., 2015). For healthcare professionals working as a team to care for a patient, communication is very vital as any mistake due to miscommunication can be fatal.
The DNR case scenario presented is a perfect example of how miscommunication among care team members can be detrimental. The case reveals numerous instances of miscommunication. First, the patient has a DNR order, which is an order written by a physician restraining healthcare providers not to undertake cardiopulmonary resuscitation on the patient if their breathing stops or if the heart stops beating. Unfortunately, the CNA is unaware of the DNR order and activates the code…