BSN IV-B Group 2 NCM 122a INP

Abidog, Bernales, Cando, Dayandante, Roles of a Beginning Nurse

Espeleta, Ignacio, Nilo, Sanchez, Visaya

TASK 1. GROUP ACTIVITY: Brainstorming

1. What ethical issues have you identified above the case?
Þ The ethical issues that have been identified are physicians have to judge the situation and
provide appropriate treatment prognosis so that patients can make an autonomous choice
of treatment preferences or patients’ family can make these choices for them and work
towards act of beneficence for the patient. While carrying out this act of beneficence, the
physician has to provide information about the treatment, especially in case of futile
treatment so as to avoid any undue harm to the patient. In case of futile treatments,
healthcare providers also have to consider the allocation of limited resources available to
manage the case scenario so as to avoid inequity.
Þ Healthcare providers should take an initiative and discuss patient’s goal for end-of-life
care or palliative care, as their preferences can change from person to person. Some
patients might target for cure or some for-comfort care, hence this trustful
communication can avoid the ethical crisis surrounding that topic. The stability of these
health preference goals is another issue as it has a potentiality to change with illness.
Hence, the health scenario in each specific case has to be renewably evaluated so as to
opt for scenario-based preferences.

2. What values and beliefs about the case have you identified?
Þ Two of the most important values and beliefs that has been identified within the case is
Respect for life and compassion to save lives. As nurses we were given the task to
become healthcare providers, thus holding a life in our hands everyday ang making sure
that those patients will return to their families healthy. Respect is an essential component
of a high-performance organization. It helps to create a healthy environment in which
patients feel cared for as individuals, and members of health care teams are engaged,
collaborative and committed to service. Within a culture of respect, people perform
better, are more innovative and display greater resilience. On the contrary, a lack of
respect stifles teamwork and undermines individual performance. It can also lead to poor
interactions with patients. Cultivating a culture of respect can truly transform an
organization and leaders set the stage for how respect is manifested.
Þ Compassionate nursing care is the main element in providing quality health services to
patients, and it maybe is the best and most valuable gift that a nurse can give the patient
in health systems. That is why nurses have always tried and been interested in meeting
the patient’s need through demonstrating altruism and despite all limitations and hurdles.
Recent reports and studies have demonstrated, however, that the patients do not have a
pleasant experience with nurses’ behaviors at clinical settings. McCabe showed that the
hospitalized patients complained about the lack of a proper connection and experiencing
an inconsiderate, uncompassionate, and unfriendly relationship with nurses; so that
according to the patients, these have led to a degradation of the quality of nursing cares.
All these are reported while compassion and mercy are the foundations of nursing and
 along with professional knowledge and clinical skills, nurses must be committed to
providing humane care with compassion to the care receivers.

3. What could have been different if the requirement of DNR was consummated?
Þ The purpose of this order is to prevent unnecessary and unwanted invasive treatment at
the end of life. If the DNR was consummated for patient tj, cardiopulmonary
resuscitation should not have been attempted, and along with CPR, other resuscitative
measures such as electrical shocks and intubations would be avoided.
4. What are the current hospital practices for DNR?
Þ A DNR order is applicable only in the event of a cardiopulmonary arrest and does not
refer to withholding or discontinuing other supportive therapies that may be in place
(such as the ongoing administration of cardiotonic drugs, an endotracheal tube, etc.).
Þ The attending physician/provider must provide the DNR order, either in writing or
verbally. A verbal DNR/DNAR order may be taken by a licensed nurse and co-signed by
the physician/provider within 24 hours.
Þ The physician/provider may write a DNR/DNAR order only when:
o Agreed to by a fully informed patient with decision-making capacity, or
o In accordance with an advance directive or the expressed wishes of the patient, or
o Agreed to by the designated healthcare agent(s), for a patient without decision-
making capacity. Washington State law defines the order of priority for
designated healthcare agent(s) as:
§ A legal guardian with healthcare decision-making authority.
§ The person with healthcare decision-making authority named in the
Durable Power of Attorney.
§ The spouse
§ Adult children (when more than one person, all must agree)
§ Parents (when more than one person, all must agree)
§ Adult brothers and sisters (when more than one person, all must agree)
o He/she deems CPR to be futile and life-sustaining treatments would be of no
benefit to the patient. There is no obligation to render futile care. Futile care is
any treatment that is not likely to benefit the patient, is one that the patient does
not have the capacity to appreciate and/or is very likely to require permanent
dependence on medical care with the burden outweighing any benefits.
Þ The physician/provider will ensure documentation in the medical record reflects the
evaluation, discussion, and decision-making process.
Þ The DNR/DNAR order may only be rescinded by the attending physician/provider, in
consultation with the patient or designated health care agent(s).
Þ The DNR/DNAR order itself should be clearly documented and communicated.
Þ Unless otherwise clarified and documented, a DNR order is temporarily suspended while
a patient is undergoing a surgical procedure and receiving care within the surgical
operatory. If DNR/DNAR is present, there will be clarification of wishes with
patient/designated health care agent(s) prior to surgery. The DNR order is again in full
force when the patient leaves the surgical operatory.
Þ Modifications to Full Resuscitation (Full Code) or DNR/DNAR orders will not be
accepted.
TASK 2. CLINICAL VIGNETTE
 Þ Who would be the most affected by the reorganization?
o The Charge Nurse/RN is the most affected in the reorganization because he/she is
the head of the health care team and responsible for the maintaining the clinical
and patient care standards for the 28-bed capacity of the oncology unit. Also
responsible for the day-shift staffing. His/her role also deals with the senior health
management professionals. Also offers advice regarding the best ways to improve
the facility care. Lastly his/her role as the charge nurse is responsible for the
implementation of new nursing care strategies for the patients.
o A healthcare institution requires enough and safe levels of staffing in order to
function properly and offer services in a safe and efficient manner. Adequate
staffing levels enable improved patient care by reducing nurse fatigue, preventing
burnout, and increasing patient satisfaction. Hospitals are restructuring to
maintain their economic viability, but they need to do so without adversely
affecting the outcomes of the care they provide. The redesign of nursing services
also is leading to changes in the roles and responsibilities of RNs and to increased
emphasis on interdisciplinary teams. These developments have prompted
uncertainty in employment and great concern among RNs about the potential for
erosion of quality of hospital care, and about their own well-being.

Þ Evaluate your rationale for both the selection of your choice and the rejection of
others.
o As a group we have come up with this reorganization, based from what we have
observed during our duty in the Ward, delegating is one of the most important thing
that a charge nurse can do. It can save a lot of time and it can improve efficiency,
and it reduces errors. If one man has given a specific job for the day, he can follow
through and still have the time to help others with their task and still be competent
nurses. There was no sign of rejection from others because we all observed the same
thing. Delegation can save considerable time. In the short term, it can give you the
ability to better perform your duties and free you up to focus on other challenges.
In the long term, it builds valuable skills in those you delegate to, making it easier
to delegate to them in the future.

Þ Explain how you would go about implementing this planned change?

o To implement a successful change, the organization and employees must be open
to change and make short-term and long-term planning. The clearer the objectives,
the better the plan will be for change. Create a long‐term policy for ongoing change,
this approach applies behavioral science knowledge to the planned development of
organizational strategies. Its goal is to change people and the quality of their
interpersonal relationships. The aims of organizational development are Encourage
cooperation, Eliminate, conflict, increase motivation, improve problem solving,
Open lines of communication and develop mutual trust. For short term create
development tools consist of consultants, surveys, group discussion, and training
sessions.

Reference:
Institute of Medicine (US) Committee on the Adequacy of Nursing Staff in Hospitals and Nursing
Homes; Wunderlich GS, Sloan F, Davis CK, editors. Nursing Staff in Hospitals and Nursing
Homes: Is It Adequate? Washington (DC): National Academies Press (US); 1996. 5, Staffing and
Quality of Care in Hospitals. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK232662/

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Do Not Resuscitate (DNR)/Do Not Attempt Resuscitation (DNAR) Policy. (n.d.). WhidbeyHealth.

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