Resolution

Last we were discussing a case scenario in which an elderly couple (husband was being admitted to the hospital) told the physician they wanted everything done in case patient deteriorated and the physician despite this wrote orders for DNR (Do Not Resuscitate). You have had time to consider your actions. You could do nothing, or you could advocate for your patient as delegated in most nurse practice act. This is not only a scenario but an experience I had several years ago. After the physician handed me the admitting orders and I saw the DNR order I asked if he (the physician) had gone back and discussed advance directives with the couple again and he replied that he had not. At this point I had told him that it was my understanding that they had declined the DNR and that I would be more than happy to go back with the physician to see the couple to clarify this. The physician replied that it was not necessary and that they did not understand. Informed the physician that if they do not understand how did they consent to a DNR. The response I received was that they were elderly and he should be a DNR. It is not our place as health care professionals to pass judgment on the decisions patients and families make; our responsibility is to ensure that their rights are upheld and their decisions honored; regardless of our personal opinion. I went back and spoke with the couple and indeed they understood what CPR entailed and what a DNR was, and they wanted full resuscitation at this point in time. At this point I notified the charge nurse and nursing supervisor of the situation and the medical director was than contacted and he spoke with this physician and made him go back and speak to the couple and than he had to rescind his DNR order and write in the chart that the patient was a full code. Sometimes advocating for patients can be intimidating as you may have to speak up to someone you view as powerful; however, remembering that you are protecting your patient can help alleviate some of this fear (it does for me). So can you see in this scenario where the patient's rights were not being upheld by the physician? Where there any ethical problems that you saw when the case scenario was first presented? When we began this course we looked at the basic principles of medical ethics as well as the Patient's Bill of Rights, if you understand and know these you will be able to recognize situations in which you may need to act as an advocate. Always follow your chain of command as able. As you progress through your nursing career being an advocate may not get any easier, as some situations can be quite complex, but your experience will help you become more effective. Advocating for patients and families is the most important aspect of being a nurse; whether you work at the bedside or conducting research to improve outcomes you are advocating.