Case Study One
Being a nurse for a little more than five years my understanding of advance directives is that it helps an individual decide the type of health care they would like in the event they are not able to speak for themselves. It is also very common knowledge that these decisions are made when a person is mentally competent to make their own healthcare decisions.
In the case scenario, one of Maryland RN Standards of Practice that applies is Standard V. Ethics. According to this regulation the Registered Nurse’s practice is guided by the code of Ethics where ‘The RN is expected to maintain client confidentiality within legal and regulatory standards. The RN is expected to deliver care in a manner that preserves client autonomy, dignity and rights. Maryland RN Standard of Practice (2010). Retrieved from http://www.mbon.org/practice/rn_standards.pdf According to this practice the RN should have mentioned the advance directives to Mr. E’s brother prior to explaining him the entire situation. The RN should have clarified that Mr.E did not want to have any life saving measures and wanted his younger brother to speak for him in the event he could not speak for himself. The American Nursing Association code of Ethics of Privacy and Confidentiality (2010) states: Registered Nurse is to provide physical and auditory privacy about discussion of personal nature and protect confidentiality of information. The RN can only disclose information that is pertinent to patient treatment and welfare and to only those that are involved with patient care. (p, 6). T o begin with initially, I would have explained Mr. E’s brother about his wishes over the phone to help the brother make the right decision. However in this case Mr.E’s brother was not notified about Mr.E’s wishes over the phone. The situation could be handled diffrently, when Mr.Y came to the hospital to see Mr.E, I would have taken him to a private room to discuss patient’s situation along with the physician. This will help protect patient’s privacy also keep the patients wishes confidential. The other major problem in this situation was that a verbal consent was received from Ms.H who according to the case study is not listed as the power of attorney. I would have reminded the physician about getting consent from the designated power of attorney prior to the patient being vented. I will also try to remind Mr.Y about the patient’s wish of not being vented or have a CPR done as stated in the advance directive According to Honberg (2010), “Most states presume people are competent at the time they make advance directives and directives require the draft to be signed by two adult witnesses who confirm to the person’s capacity at the time the advance directive is drafted” (p.1). Based on the above statement, Mr.Y’s advance directive is complicated because first of all he is mentally challenged and secondly it is not clear if family members were aware at the time the advance directives were made. In addition the advance directive did not have any family members signatures to attest his competence. According to Powers (2005), “Treatment of frail or elderly patients should receive careful consideration when making decision about aggressive treatment based on the outcome and quality of life” (p,1). Therefore Mr.Y should clarify the prognosis of Mr. E with the physician before giving consent for placing Mr.E on a ventilator. Based on the ANA code of Ethics (2010): The nurse has a right to preserve, protect and support patient’s rights to self-determination. In the event patient lacks capacity to make decision, the surrogate should be contacted to make decisions for the patient (p.7). Since in the above scenario, Mr.E’s advance directive is complicated with his brother listed as a spokesperson who is not clear about Mr. E’s wishes, I would have contacted the ethics committee of the hospital to help Mr. Y make a correct