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Ethical Issues in Critical Care Nursing

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  • 0:00 Ethical Issues in…
  • 1:14 Palliative Care &…
  • 2:19 Advance Directives
  • 3:23 Living Wills
  • 3:48 Medical Power of Attorney
  • 4:15 Lesson Summary
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Instructor: Lacey Russell

Lacey has a Master's of Science in Nursing with a specialization in Acute Care Nurse Practitioner

In this lesson, we will discuss a few of the common ethical issues that critical care nurses deal with on a daily basis. We will also learn about legal documents that will help make decisions should ethical issues arise.

Ethical Issues in Critical Care Nursing

Critical care nurses face ethical issues on a daily basis, whether involving professional ethics or helping a patient or family sort out their own ethical issues. This lesson touches on a few of the most commonly ethical issues in critical care nursing: palliative care, withdrawal of care, advance directives, and medical power of attorney.

Let's say Patient J has suffered damage to his lungs and can no longer breathe on his own. He will be attached to a ventilator for the rest of his life, and he needs to be revived several times a month. However, Patient J is awake and oriented the majority of the time. During one oriented period, he asks to be made a DNR, or do-not-resuscitate patient, meaning that if his heart stops again, he doesn't want to be brought back.

Patient J's sister doesn't agree with this and tells the hospital her brother isn't competent. She threatens to sue if the hospital allows her brother to become a DNR patient. She wants everything done to keep him alive. The cycle of Patient J's heart stopping and being revived continues for several months. Finally, the hospital is able to assemble an ethics committee to determine that Patient J is competent and able to make his own decisions. He chooses to become a DNR patient and dies peacefully within a few days.

Palliative Care & Withdrawing Care

In Patient J's situation, once he became a DNR, he didn't remove his ventilator; he chose palliative care. Palliative care is caring for a patient to relieve pain and make the dying process as peaceful as possible. Depending on patients' wishes, they're given food and hydration, but nothing considered a life-saving measure, such as CPR, dialysis, or surgery, unless a surgery is to relieve pain and not aimed at curing the patient.

Had Patient J decided that he wanted to remove the ventilator that was keeping him alive, he would have been withdrawing care. This is seen a lot in patients who are brain dead, but their heart is still beating. In this case, all life-saving components, such as the ventilator and any medications, would be stopped, and the patient would be allowed to pass away.

Patient J's scenario is all too common in the intensive care unit. When a patient is dying, one family member might want everything done to keep the patient alive, while other family members (or the patient him or herself) might want a peaceful death. This is when an advance directive or medical power of attorney is very useful. If the patient has neither, the hospital ethics committee must determine what the appropriate action is.

Advance Directives

An advance directive is a statement that is written by the patient and signed by two witnesses (not family members) that details how the patient would like to be cared for should he or she become terminally ill or unable to make decisions, in which case this document appoints someone to make medical decisions for the patient. Doctors and nurses use this statement to determine what the patient's wishes are and make sure they are followed. There are two types of advance directives: living wills and medical power of attorney.

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