Ethics Exemplar
Submitted by Kaleigh Bassett
Tags: death emergency department ethical principles ethical principles in nursing ethical values ethics nursing ethics patient concern
During my career as a nurse in the Emergency Department, I have come across several ethical issues. One ethical issue stands out above the rest. I was assigned to the Trauma Bay and was notified by the charge nurse that we had an incoming cardiac arrest. The team of nurses, physicians, physician residents, pharmacy and respiratory responded to the Trauma Bay to prepare for the patients arrival. The doctor who responded was a new physician who worked only a few days a month at our facility.
I was assigned by the primary nurse to obtain IV access and give ordered medications to the patient during the resuscitation efforts. I verbalized understanding and the patient soon after arrived with CPR in progress. The patient was "found down" and looked to be around 60 years old. The EMS crew states they were able to get the patient intubated and gave several doses of epinephrine.
I was able to obtain secondary IV access and an order for epinephrine was ordered by the attending physician. I verbalized understanding in close loop communication and gave the medication. After several minutes of compressions, the doctor called out to stop compressions for a pulse check. The patient had a pulse, although faint, and an order for IV infusion epinephrine was ordered. I once again verbalized understanding and started the infusion.
The patient lost pulses and compressions were resumed. After another two rounds of compressions, the attending physician asked if anyone had any other ideas regarding the resuscitation effort. No one had any other suggestions so the compressions were stopped and the respiratory therapist checked for a carotid pulse while the physician simultaneously did a cardiac ultrasound to check for cardiac movement. The respiratory therapist noted a faint carotid pulse with minimal cardiac activity on the US.
The attending physician called out a time of death and started to take off his PPE and ordered the respiratory therapist to stop giving respirations to the patient. I felt ethically at this time that a tme of death could not be called on a patient with a pulse. I did know the physician well and was nervous to speak up regarding my feelings that the patient was not deceased and it is unethical to stop giving breaths to a patient that was clinically alive.
I decided to do what was right for the patient and spoke with physician about not withdrawing respiratory efforts and time of death could not be called on a patient with a pulse. The physician communicated with me that the medications were keeping the patient alive and if it were not for the epinephrine infusion, the patient would be deceased. We both determined that ethically the patient was not clinically deceased and placed the patient on the ventilator so he would have adequate ventilations and turned off the IV infusion of epinephrine. It was satisfactory to all staff in the room and we stood by to check if the patient would loose pulses without the medication.
Several minutes passed and the physician agreed that the patient had not lost pulses so we would continue care and treatment of the patient. The patient did live for several more hours which allowed for family to be by the bedside of the patient and say their goodbyes. He passed away and the physician was able to call time of death ethically.
After the situation, the staff was voicing their agreement that they as well did not fell comfortable with the physician calling a time of death on a patient with a pulse. They were happy that I had verbally endorsed my concerns regarding the situation. I encouraged them to do the same in the future to ensure the proper treatment of patients. I was proud that I was able to stand up for the patient who did not have a voice at that moment.