Provide one example, with supporting evidence, of nurses using available resources to address ethical issues related to clinical practice
OR
Provide one example, with supporting evidence, of nurses using available resources to address an organizational ethical issue
Example One: Nurses use available resources to address ethical issues related to clinical practice
Ethical issues nurses face in their clinical practice can be extremely difficult to manage. One of these issues is related to how nurses view and relate to organ donation while providing end-of-life care to patients that have suffered a traumatic accident. In an article written by Ellen Bridget Linde BSN, RN, titled, "Speaking Up for Organ Donors", she states, "as nurses, we face tough ethical dilemmas as we provide end-of-life care, especially when our patients are candidates for organ donation….nurses must consider respect for life and bodily integrity in light of the procedure for recovering organs. Nursing is primarily grounded in beneficence (doing good) and nonmaleficence (not doing harm). But nurses interpret these guiding principles in various ways. Some, believing that removing vital organs is what kills the patient, view organ donation performed under current criteria for pronouncing death as an act of killing. Others suggest that organ donation is a “moral duty, an obligation,” considering society’s lack of alternative healthcare resources. But not all nurses are comfortable with a value system driven primarily by the needs of transplant recipients rather than by the needs of the potential donor" (2009). Due to the extremely sensitive nature of organ donation and end of life care, FF Thompson Hospital nurses are empowered to utilize available resources to properly manage these ethical situations. The events below depict a recent event involving a traumatic event and the process the nursing staff used to guide them through their clinical situation. A middle aged male was brought into our Emergency Department (ED) after experiencing a traumatic accident. Cardiopulmonary resuscitation (CPR) was being done by Emergency Medical Staff (EMS) when he arrived. The nursing code team had anticipated his arrival and all team members were present. EMS had been providing CPR for approximately one hour before arrival to the ED. The patient was pulseless and his pupils were fixed and dilated. The resuscitation effort continued. The patient's family had medical training background and understood the gravity of the situation. This did not however remove the feelings of grief for the family. The wife asked about the probability of brain damage and/or death. The primary nurse learned quickly from the family that the patient was an organ donor and it was clearly specified on his driver’s license. Once the patient was identified as an organ donor, the nurse utilized available resources, and promptly called the Nursing Supervisor to ensure the proper process was followed. The nurses referred to the policies and procedures surrounding organ donation to prepare for the possibility of donation. (Exhibit EP17.1).
Exhibit EP17.1: Policies and Procedures
EP17 Exhibit CC.02.004 Pronouncement_of_Death, Post Mortem Care (4870_7).pdf
CC.02.004.01.01 Brain Death, Guidelines for Tests to be Considered Employed (4872_1).pdf
LR.05.011.01.05 Organ and Tissue Donation, Required Referral Process (1836_0).pdf
LR.05.011.01.07 Eye and Tissue Bank, Required Referral to (1837_0).pdf
LR.05.014.01 Withdrawal of Ventilatory Support (4889_4).pdf
The Nursing Supervisor worked to collaborate with the healthcare team and utilize all possible resources to manage the clinical situation. The primary nurse called social workers and the chaplain service team to provide emotional and spiritual support to the family. The patient continued to decline and the family was adamant that the patient’s desire for organ donation be considered. Following the procedure, the Nursing Supervisor called the Organ Procurement Organization the Finger Lakes Donor Recovery Network (FLDRN), who then provided guidance to the healthcare team. They changed their focus from resuscitative efforts to preservation of viable organs for donation. Within an hour, the FLDRN coordinator was within our Emergency Department to assist the family and team to prepare for the donation process. The primary nurse identified a fellow colleague to come in to assist. One of our Emergency Department nurses, who is also employed at a larger hospital Intensive Care Unit and has extensive experience in the donation process, was called and she came in to help with the situation. Her extra support and guidance allowed the bedside nurses to tend to the patient and family, while she aided in the donation process. The on-call neurologist was called and came in to determine the extent of injury to the brain and the possibility of brain death. After a comprehensive review, the neurologist determined that the patient had no brain stem reflexes and his head Computerized Tomography (CAT) scan showed diffuse ischemic/hypoxic injury. After the results and prognosis were shared with the family, they decided to withdraw care and proceed with the donation of his organs. To ensure the proper procedures were followed, the nursing supervisor consulted the Chief Nursing Officer (CNO). The hospital CNO serves on the Ethics Committee and provided guidance and support for the team. There are ethical issues that are involved with organ donation. One ethical issue is related to the resuscitating and treating a patient in attempts to save a life versus resuscitating a patient to harvest organs for donation. Another ethical issue is related to ensuring that the patient does not have brain function and does not have hope for survival, but remaining viable for organ donation. The team worked closely together to ensure the criteria were met for donation, while being sensitive to the psychological and emotional concerns of the patient’s family. The policies and procedures were closely reviewed with the FLDRN coordinator, the CNO, nursing supervisor, and staff. The process of organ donation involves the activation of the on-call operating room team. The team was called in and briefed on the situation. The CNO identified the need to ensure the FLDRN physician had the proper credentials for performing the procedure within our organization. She promptly called the Chief Executive Officer (CEO). He ensured the physician had emergency privileges for the harvest to progress (Exhibit 2). The patient was brought to the operating room. His immediate family was able to be with the patient for the withdrawal of life support and moment of death. The Intensive Care Unit, social workers, and the Organ Procurement Professionals were present to provide emotional support.
Exhibit EP17.2
EP17 Exhibit 2.1 Emergency Credentialing.pdf
Due to the low volume of patients who have organ donation within our organization, an annual read and review of FF Thompson's Organ, Tissue, and Full Body Donation Policy and Procedure (Exhibit EP17.1 ) is a required Monthly Educational Component (MEC) for all nurses, along with an ethics-related article with posttest from Nursing Spectrum, our electronic Continuing Educational Unit (CEU) platform. The focus for August-September of 2014 is on The Organ and Tissue Donation Choice and Advocating for Patients During End of Life (Exhibit EP17.3a) along with the roster of nurses that have completed the education (EP17.3b).
Exhibit EP17.3a Screenshot of Required Education
Exhibit EP17.3b
Exhibit EP17.3b Roster End of Life Advocation.pdf
After the above case was completed, many staff expressed interest and the need for a case study was explored. All of the team members who were involved in the case were cordially invited to a case review, with an open session for all staff to learn about organ donation and review ethical considerations during the process. An after-action review was created by the donor recovery team (Exhibit EP17.4). Members who attended the review consisted of the operating room team, emergency room staff, intensive care unit staff, nurse managers, clinical nurse specialist, and CNO. The case review was set for 15 minutes, however the team was extremely engaged and the review lasted approximately 30 minutes. The donor recovery reiterated how impressed they were with the entire organization and the great use of resources to facilitate the donation process. The donor team compiled power point presentations to our hospital for educational use and to provide education to staff that were unable to attend. The education is available for system wide viewing (Exhibit EP17.5).
Exhibit EP17.4: Evidence of support to hospital staff regarding Donor Recovery Network after above case
Exhibit EP17.5
EP 17 Exhibit 5.1 RETB Presentation-EYETISSUE- 2014.pdf
EP17 Exhibit 5.2 Organ Donation (FLDRN) - Nursing Orientation Inservice 2014.pdf
EP17 Exhibit 5.3 Donor Management 2014.pdf
The staff involved in the above organ donation process felt a sense of support and understanding from the Nursing Supervisor, CNO, all physicians, and social workers involved in the process. In acknowledgement of the amazing team work that went into the donor recovery process, the CNO sent recognition to all team members involved (Exhibit EP17.6). While ethical situations within the healthcare field can arise at any moment, the nurses at FF Thompson Hospital feel supported and have complete access to policies, procedures, experts, and fellow support staff to help guide them through difficult situations.
Exhibit EP17.6: Two examples of Cheers for Peers for nurses involved in organ donation process