Workplace Dilemma

Running head: WORKPLACE DILEMMA

Workplace Dilemma

When working in the ICU there are many ethical issues and healthcare decisions made daily. The physicians work hard to bring a positive patient outcome as much as possible; however there are times when the outcomes are not as desirable. At this point, when a patient continues to deteriorate, the path of death can be short or long. There are times when a physician feels that further measures to attempt to save a life will only result in a negative outcome, such as death, vegetative state, and/or suffering.

In this particular incident, an elderly female patient, Ms. B. had severe respiratory and cardiac distress resulting in CPR and ventilator support. She had a nutritional deficit prior to admission that dated as far back as six months according to the family. She had lost her appetite and had lost about 20 pounds in the months leading up to her illness. The nutritional deficit was an important role in her end days.

Her course of treatment lasted over three weeks within the ICU, she would progress slightly only to deteriorate a couple of days later. This was a vicious cycle Ms. B. went through for these weeks. The physicians were honest with the family, telling them that a recovery was not possible, the family urged on. The family being of Catholic upbringing was not ready to make any decisions that would result in her demise. Their faith was solid throughout her illness, the priest visited and prayed with the patient and family daily.

The dilemma in the workplace was the difference in opinion of the nurses in comparison to the family's feelings and cultural feelings towards death. This patient had many bedsores on her bottom, heels, and even her arms. Her skin would tear even during the most gentle of turns in the bed. Her skin would weep constantly, causing her bed pads to be changed about every two hours, which was excruciating to the patient. Due to her low blood pressure, she was not able to be sedated very often. The family did not want her sedated because they associated the low blood pressure with her dying; this was an issue that they had some control over. When she was sedated, she would sleep from the exhaustion of the illness. The family viewed this as "knocking her out", which they did not believe in.

She had received fluids and medicines to keep her blood pressure up. Her kidneys were showing signs of failure along with some liver abnormalities. Each day, the nurses would change because the nurses could not handle working in the sad environment that was also wet and messy from the weeping skin wounds. When taking care of the patient, the misery in her eyes as she followed the person around the room almost begging to have relief. Every touch and move was painful, the family only saw that she was awake and with them. The fear of losing their mother was evident and the desire for her to live was enormous. The most important thing to them was to make decisions that they could live with and that was not to do anything that contributed to her death.

The differences in ethical opinion from the family's point of view had to do with their close-knot family with a strong Catholic background. Their religious view did not allow for withdrawal of care, this was not something that they could live with. As a nurse, ethical care involved providing care that was kind and gentle. Providing comfort was important in times of suffering for each of the caregivers in the hospital.