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Ethical And Legal Issues in Critical Care Nursing PowerPoint Presentation

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This medical PowerPoint presentation talks about critical care nursing, a demanding and complex specialty that deals with patients who require intensive and often life-saving interventions. As such, there are several ethical and legal issues that critical care nurses may encounter in their practice which are discussed in this presentation.

Tags : Critical Care Nursing, Critical care nurses, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 3320 | Downloads : 2

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Slide 1-

Chapter 3 Ethical and Legal Issues in Critical Care Nursing Copyright © 2017 Elsevier Inc. All rights reserved.
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Critical care nurses face ethical issues every day Informed consent Withholding or withdrawal of treatment Organ and tissue transplantation Confidentiality Distribution of health care resources Advanced technology for life-sustaining treatments Greater frequency in critical care Ethical Issues Copyright © 2017 Elsevier Inc. All rights reserved. 2
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Obligation to protect patients Serve as patient advocates Professional organizations promote ethics and advocacy American Nurses Association Code of Ethics for Nurses with Interpretive Statements American Association of Critical-Care Nurses An Ethic of Care Nurse Advocacy Copyright © 2017 Elsevier Inc. All rights reserved. 3
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Emotionally charged Significant change in patient’s condition Confusion about facts Hesitancy about the correct set of actions Deviation from customary practice Need for secrecy regarding proposed actions Ethical Dilemma Warning Signs Copyright © 2017 Elsevier Inc. All rights reserved. 4
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Quick Quiz! The nurse recognizes which statement as a potential ethical issue? “The physician explained my mother’s poor prognosis.” “If the breathing machine is helping my mother, why is the doctor asking me about removing the breathing tube?” “My mother has designated my brother to make decisions.” “Can I assist with some of my mother’s care?” Copyright © 2017 Elsevier Inc. All rights reserved. 5
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Ethical Decision-Making Process(See Figure 3-1) Assess Contextual factors Physiological factors Personal factors Consider options Patient wishes Burden versus benefit Ethical principles Potential outcomes Develop plan with patient, surrogate, family, and team Act on plan Evaluate plan Short-term outcomes Long-term outcomes Apply to other cases Copyright © 2017 Elsevier Inc. All rights reserved. 6
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Copyright © 2017 Elsevier Inc. All rights reserved. 7 Figure 3-1. The process of ethical decision making.
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Autonomy Right of self-determination concerning medical care Beneficence Duty to prevent harm, remove harm, and promote the good of another person Nonmaleficence Not to intentionally inflict harm Ethical Principles Copyright © 2017 Elsevier Inc. All rights reserved. 8
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Justice Fair distribution of health care resources Veracity Truthfulness Fidelity Faithfulness to commitment Confidentiality Respect for right to control information Ethical Principles(Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 9
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Quick Quiz! The nurse recognizes that this principle guides health care decisions: Autonomy Beneficence Nonmaleficence Justice Copyright © 2017 Elsevier Inc. All rights reserved. 10
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Advocacy Open communication of patient’s wishes and ethical concerns True collaboration with health care team members Dilemmas can result in moral distress Formal mechanisms (The Joint Commission) Bioethics committees Ethics consultation Opportunities for critical care nurses Institutional Ethics Committee membership Ethics forums and rounds Peer review Quality improvement committee membership Institutional review boards (research) Nurse Involvement in Ethical Decision Making Copyright © 2017 Elsevier Inc. All rights reserved. 11
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Quick Quiz! The nurse recognizes which situation may warrant an ethics consultation? “We’ve met as a family and agree that we should withdraw life support.” “My mother has designated her minister as her health care surrogate.” “We’ve met as a family and want mother to be resuscitated if her heart stops.” “Mother never got around to completing her living will, so I think she would want everything done. My brother disagrees.” Copyright © 2017 Elsevier Inc. All rights reserved. 12
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Nurses are required to care for assigned patients Contractual relationship Abandonment Severing professional relationship when patient is in need of care Must ensure that patient care is arranged with another nurse, including breaks and lunch Moral conflict A nurse is not required to practice if a situation violates his or her moral or religious beliefs Patient care must be transferred to another to avoid abandonment How should nurses approach situations that result in moral conflict? Duty to Treat Copyright © 2017 Elsevier Inc. All rights reserved. 13
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Selected Issues Copyright © 2017 Elsevier Inc. All rights reserved. 14
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Competence: ability to understand Voluntariness: consent without coercion Disclosure of information Diagnosis Proposed treatment Probable outcome Benefits and risks Alternative treatments Prognoses if treatment is not provided Elements of Informed Consent Copyright © 2017 Elsevier Inc. All rights reserved. 15
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Factors to consider: Constitutional rights Quality of life Impact of advanced technology Medical Futility Ordinary versus extraordinary care Life-Sustaining Treatment Copyright © 2017 Elsevier Inc. All rights reserved. 16
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Ordinary Versus Extraordinary Care Ordinary care Common, noninvasive, and tested treatment Nutrition, hydration, antibiotics Extraordinary care Complex, invasive, experimental treatment ACLS, dialysis, unproved therapies Copyright © 2017 Elsevier Inc. All rights reserved. 17
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Quick Quiz! Which therapy or treatment often falls between ordinary and extraordinary care? Intravenous fluids at 100 mL/hr Puréed diet for nutrition Feeding tube for hydration Renal dialysis Copyright © 2017 Elsevier Inc. All rights reserved. 18
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Should a patient be “coded”? A do not resuscitate (DNR) order is needed to not initiate a code Advance directives are useful in guiding decision making PRIOR to code Family presence during codes is promoted CPR Issues Copyright © 2017 Elsevier Inc. All rights reserved. 19
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Definitions Withholding: not initiating Withdrawal: weaning or removing Comfort measures maintained Debate views on withholding and withdrawal of life support Life Support Copyright © 2017 Elsevier Inc. All rights reserved. 20
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Communicate frequently Engage in consistent, honest communication Base decisions on patient’s wishes Provide psychological support to the family Helping Families Make Decisions About Life Support Copyright © 2017 Elsevier Inc. All rights reserved. 21
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Patient’s right to initiate advance directive Patient’s right to consent to or refuse treatment Patient Self-Determination Act Copyright © 2017 Elsevier Inc. All rights reserved. 22
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Communication about preferences for treatments if patient is incapacitated Do not resuscitate (DNR) Natural death Living will Treatments desired and what should be withheld Durable power of attorney for health care Determines who makes decisions Health care surrogate or proxy Advance Directive Copyright © 2017 Elsevier Inc. All rights reserved. 23
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Patients who are brain dead are often candidates for organ donation Brain death criteria Everyone has the right to donate organs Conflict of patient’s designation versus family members’ views on donation Designated requesters seek consent Organ and Tissue Transplantation Copyright © 2017 Elsevier Inc. All rights reserved. 24
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What are some examples of situations in which a nurse might have moral or religious convictions that would interfere with the duty to treat? What actions are required of the nurse when conflict exists? Critical Thinking Challenge Copyright © 2017 Elsevier Inc. All rights reserved. 25
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Discuss Who has: Living will? Durable power of attorney for health care? Do your family members know your wishes? Identify strategies that can be implemented to get more people to complete advance directives. Critical Thinking Challenge(Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 26
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What are issues related to organ donation? What are strategies to increase donation, especially among ethnic minority populations? If you have a signed organ donor card, can your family members overrule your wishes? Critical Thinking Challenge(Cont.) Copyright © 2017 Elsevier Inc. All rights reserved. 27