Term Paper on "DNR Palliative Care and Ethics"

Term Paper 5 pages (1340 words) Sources: 5

[EXCERPT] . . . .

Nursing Ethics

The end of life phase is the most important and testing time for all the people involved right from the patient to the relatives and the care providers. Statistics indicate that less than 10% of humans embrace sudden death while the rest die after a prolonged period of illness. [EPEC Team]. In this stressful environment nurses are confronted by ethical dilemmas, the efficient management of which necessitates a balanced understanding of patient needs and respect of their autonomy. The DNR is one important and delicate ethical issue faced by nurses providing care to terminally ill patients. Let us have a brief overview of the ethical concerns and the nursing practice standards in the palliative care settings and in particular the implication of the DNR from the nursing perspective.

THE DNR (Nursing implications)

The DNR (do not resuscitate) order is a request which advices against the use of Cardiopulmonary resuscitation for revival of the heart function of the patient who has a cardiac or pulmonary arrest. Typically, the request for DNR is given as an advance directive by the patient, but in cases where the patient is in comatose state the physician discusses it with the family before recording the DNR order. [Hanna Mari Hilden et.al, 2004] the DNR order in effect takes away the obligation on the part of the attending nurse or the physician to revive the failed heart using CPR. Nurses in palliative care have to face cases where the DNR is applied consistent with the patient's autonomy. Invariably nurses are subjected to moral conflicts with the DNR order as it tends to contradict with their professional motive of cure. Studies have proved

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that for nurses providing palliative care, moral distress can be debilitating and affecting their job satisfaction considerably. It is also widely recognised that conflicts between the physician and the nurses arising out of the disagreement with the interventions in palliative care setting creates a stressful work environment for nurses. Differences in expectation of Prognosis between the nurses and physicians and the lack of understanding of life support devices on the part of the families make palliative nursing a stressful and demanding profession. [Ariana G. Gross]

End of life fatigue is a fairly common symptom observed in palliative care and in most cases it is associated with other symptoms like pain, dyspnoe and anorexia. Research results indicate that fatigue tends to steadily increase during the course of the disease and is most pronounced during the end of life period. Patients who are nearing death frequently experience fatigue and most of their joint movements are crippled resulting in the formation of pressure ulcers and acute pain in the joint regions. Continuous lying on the bed without any kind of motion will lead to the formation of sores, which would further aggravate pain. [EPEC Team]

It is important for the care providers to notice these symptoms and manage them as effectively as possible. From a nursing perspective it is necessary to understand the physiological changes that occur so that better care can be administered during the final stage of life. "The care of dying people is of such central importance to all members of our society that the manifold inadequacies are something which must be redressed, rediscussed and improved." [Field & James 1993, 27] as the patient gradually shifts from sickness to death the nurse becomes the central role attending to the psychological social and physical consequences of the illness. Though end stage fatigue is observed as a common condition in most of the cases of terminal illness there are a variety of symptoms that contribute to as well as occur in conjunction with it.

In palliative care the role of the nurse is most significant as we are more concerned with treatment of symptoms rather than perception or diagnosis. Fatigue and depression in end stage is not homogenous in nature making it difficult to understand the underlying psychopathology. Furthermore most people fall into "dysphoria" (demoralizing syndrome) in which case clinical evaluation is inappropriate, as the… READ MORE

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Quoted Instructions for "DNR Palliative Care and Ethics" Assignment:

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Nursing Research Paper that needs to address the Ethics portion of the Nursing Practice Standards. It will need to compare ethics in DNR and pallative situations. I will send you some articles/journals/periodicals that I kept to write paper. The information might need some supplementation. Thanks. *****

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