This document discusses several key ethical and legal issues faced by critical care nurses, including informed consent, use of restraints, end-of-life decisions around life-sustaining treatment, organ donation, and resolving ethical problems. It outlines important ethical principles like autonomy, beneficence, and justice. It also addresses issues like medico-legal cases, documentation, and the most concerning ethical issues reported by nurses.
The term "care transitions" refers to the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.
Definition of Triagea
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the . Right patient to the
Right place at the
Right time with the
Right care provider
The term "care transitions" refers to the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.
Definition of Triagea
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the . Right patient to the
Right place at the
Right time with the
Right care provider
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
medical surgical nursing , nursing management of burn patients, it includes definition, classification of burn injury, clinical manifestaion, assessment of burn injury , management of patient with burn, care given to the patient.
Polices for intensive care units / critical care units ANILKUMAR BR
What is a Policy?
A Policy is a statement, verbal, written or implied, of those principles and rules that are set by Board of Directors as guidelines on organizations actions.
There should be written polices for the intensive care units or critical care units which will guide the personnel working there.
The polices making body, there should be representation from administrative team, medical team and the nursing team.
ADMISSION POLICES: This should specify whether the patients can be admitted directly to CCU /ICU or through the casualty department.
There should be polices regarding the admission of medico-legal cases.
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
medical surgical nursing , nursing management of burn patients, it includes definition, classification of burn injury, clinical manifestaion, assessment of burn injury , management of patient with burn, care given to the patient.
Polices for intensive care units / critical care units ANILKUMAR BR
What is a Policy?
A Policy is a statement, verbal, written or implied, of those principles and rules that are set by Board of Directors as guidelines on organizations actions.
There should be written polices for the intensive care units or critical care units which will guide the personnel working there.
The polices making body, there should be representation from administrative team, medical team and the nursing team.
ADMISSION POLICES: This should specify whether the patients can be admitted directly to CCU /ICU or through the casualty department.
There should be polices regarding the admission of medico-legal cases.
In this PPT you will learn what is autonomy whether is important or not and so on.
Every one of us should mentally capably for thinking and decision making and that's why we are humans, but there are people who are not mentally complete and their which or needs depend on others and it's really sad.
consent and confidentiality are important and are the reason why you are a good doctors.
The confidentiality brings you a new customers who trust you because you keep their information secrets and this type of confidentiality is part of Hippocrates Oaths.
Now-a-days public are expecting Skills, Knowledge as well as Ethical behaviour from Doctors. This PPT gives the 2 basic principles of Bio-ethics in brief & apt form
Psychosocial care of coronavirus disease 2019Nursing Path
The novel Coronavirus (nCoV) epidemic in 2019 -2020 has recently emerged. The route of transmission is not totally known, although it is known that it can spread from person to person, and local health care systems may be ill-equipped to handle a large-scale outbreak.
The blood electrolytes—sodium, potassium, chloride, and bicarbonate—help regulate nerve and muscle function and maintain acid-base balance and water balance. ... Thus, having electrolytes in the right concentrations (called electrolyte balance) is important in maintaining fluid balance among the compartments
Hospital infection control programs can help healthcare organizations monitor and improve practices, identify risks and proactively establish policies to prevent the spread of infections
Outcome-based education (OBE) is an educational theory that bases each part of an educational system around goals (outcomes). By the end of the educational experience, each student should have achieved the goal.
Assessment is part of the everyday activities of nursing professionals. Assessment is the only way by which a teacher can know how successful his teaching was and what areas in teaching need improvement.
A mental health disorder characterised by feelings of worry, anxiety or fear that are strong enough to interfere with one's daily activities.
The term "anxiety disorder" refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD), panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias.
Selection and organization of learning experienceNursing Path
Curriculum is the educational design of learning experiences for the students. Curricular experiences include course content as well as learning activities. The selection and organization of curricular experiences must also reflect the philosophy of the school. The identifying and organizing of curricular experiences begins with the analysis of curriculum objectives. The most commonly used approach in selecting learning experiences is the logical approach in which the process is treated as content in curriculum development.
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing.
Swine influenza is an infection caused by any one of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) is any strain of the influenza family of viruses that is endemic in pigs
Abortion is the ending of pregnancy by removing an embryo or fetus before it can survive outside the uterus. An abortion that occurs spontaneously is also known as a miscarriage.
The enterobacteriaceae basic properties.ppsx xNursing Path
The Enterobacteriaceae are a large family of Gram-negative bacteria that includes, along with many harmless symbionts, many of the more familiar pathogens, such as Salmonella, Escherichia coli, Yersinia pestis, Klebsiella, and Shigella.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Dr. Jayesh Patidar
PhD., M.Sc. Nursing, MBA
Asst. Professor
Joitiba College of Nursing, Bhandu.
2. • Ethics have always been an integral part of nursing.
• Nurses at all levels/areas of practices experience a
range of ethical issues during the course of their day-
to-day work.
• Critical care has come to be associated with high-
tech, aggressive & often risk-filled medical care.
• The critical care nurse are often confronted with
ethical & legal dilemmas related to various ethical
principles & it has increased dramatically since the
early 1990s.
• Many dilemmas are byproducts of advanced medical
technologies & therapies developed over the past
several decades.
4. Legal and Ethical Issues Informed
Consent
• Consent problems arises because patients
experiencing acute, life threatening illness
that interfere with their ability to make
decisions on treatment/ participation in
clinical research.
• The informed consent is based on the
principle of autonomy.
• Consent denotes voluntary agreement,
permission or compliance.
5. Legal and Ethical Issues Informed
Legal and Ethical Issues Informed
Consent
Consent
• It implies to permission by the patient to perform
an act on his body either for diagnosis or
therapeutic procedure.
• The four elements of consent are;
voluntariness
capacity
knowledge
Decision making
6. Type of consent
1. Implied Consent
2. Expressed consent: (verbal written)
7. Points to be considered in consent
• Consent must be given voluntarily
• If patient is not mentally capable (critical patients)
informed consent should be obtained from surrogate or
legal next of kin.
• It should be given by a person of sound mind & above
the age of 18 years.
• Requires the disclosure of basic information considered
necessary for decision making
• Patients providing consent should be free from pain &
depression.
8. • Consent obtained from a minor
• Consent given under fear, fraud or
misrepresentation
• Consent obtained from the person who is not fit
• Consent obtained in language not understood by
the person
• Consent obtained from person under
sedation, intoxication or semiconscious
• Consent obtained without providing adequate
information on the possible risks are invalid under
law.
9. MEDICO LEGAL CASE
• A medico legal case is any case
where the discipline of medicine
comes to help the legal fraternity in
its discharge of duties.
• Interface of medicine & law is multi
dimensional & can be quite complex
& perplexing.
• Health care professionals have to be
very cautious in dealing with the
medico legal cases.
10. MEDICO LEGAL CASE
• Request of the patient or relatives or
friend for not registering the case as
medico legal should not be accepted.
• The MLC should be registered as soon
as physician suspect’s foul play or case
brought several days after the
incident.
• The MLC is received in hospital by; any
case brought by police for the purpose
of examination & reporting & any case
referred for expert management &
advice.
11. Following Cases Should be Considered As
MLC& to be Intimate To The Police
Regarding Such Cases,
• All cases of injuries
• All cases of burn
• Alleged cases of assault
• All cases of suspected or
evident of poisoning or
intoxication
• Case referred from court
12. • Cases of suspected or evident Count…
criminal abortion
• Cases of unconscious/comatose
where its cause is not natural or not
clear
• Cases brought dead/dead on
arrival/sudden unexpected death etc
• Cases of suspected self inflicted
injuries or at tempted suicide
The important considerations in MLC
are notification to police, collection &
preservation of samples, recording of
dying declaration etc.
13. MEDICAL DOCUMENTATION
• The proper medical documentation is legal
necessity.
• A good record should be
correct, clear, comprehensive, chronologica
l & contemporaneous.
• It is the fact that good records are
indispensible for proper care & treatment
of patients.
• Consent from patients before carrying out
any procedure is mandatory legal, ethical &
moral requirement. Similarly the document
once prepared has also to be preserved for
specified period of time (3 years from the
date of commencement of treatment).
14. MEDICAL DOCUMENTATION
• If any request is made for medical records either by
patient/authorized attendant/legal authorities, the
documents shall be issued within period of 72 hours
& refusal to do so would be misconduct.
• The following medical documents are almost
important as for as legalities are concerned: specialist
consultations & referral slips, nurses
record, treatment record, TPR chart, BP monitoring
chart, IO chart, operative notes, anesthetists
notes, progress report, final diagnosis, discharge
summary & follow up notes etc. as for as medical legal
issues are concerned e.g. death certificate, medico
legal reports, medico legal investigation reports, all
are of immense important & have to be very specific.
15. USE OF RESTRAINTS
• Restraints are intervention that limits a
person’s freedom to move. It can be
physical or chemical.
• Researcher reported that the use of
physical restraint can lead to: skin
trauma, muscular atrophy, nosocomial
infection, constipation, incontinence,
limb injury, contractures, depression,
anger, decline in functional & cognitive
state & increasing agitation.
16. USE OF RESTRAINTS
• Because restraints limit movement
they also limit autonomy.
• Considering the
physical, psychological & ethical
aspects of physical restraint (risks &
benefits), it is advocated that such is
only used when all other methods of
managing the problem have
failed, employed with caution & as a
last resort & use least restrictive
method possible.
17. DECISIONS REGARDING LIFE SUSTAINING
TREATMENT
• Usually there are two levels of treatment to
consider is: ordinary care (non invasive &
treatments like providing nutrition, hydration
& antibiotic therapy) & extraordinary care
(complex, invasive & experimental
treatments like CPR, advanced life support,
dialysis & other therapies).
• However the ethicists believe that any
treatment can become extraordinary
whenever the patient decides that the
burdens outweigh the benefits.
18. 1. Cardio pulmonary resuscitation
decisions
• Resuscitation efforts are used to
reverse the clinical sign of death (loss
of spontaneous respiration, loss of
cardiac function & unconsciousness).
• Ethical questions arise on use of CPR
& emergency cardiac care.
• In what situations should
resuscitation efforts be used? How
long should efforts continue?
19. Count…
• A generally accepted position is that
resuscitation should cease if the physician
determines the efforts to be futile or hopeless.
According to AHA 2000 health care providers
may stop CPR when 30 minutes (adult/child) or
15 minutes (newborn) of advanced life support
have been attempted without restoration of
heart rate & breathing.
• The Do Not Resuscitate (DNR) order is still not
documented legal practice in India. It is a verbal
communication between the clinician & the
patient’s relative or caregiver.
20. Count…
• The autonomy of the patient also remains a weak
concept. The law is silent or ambiguous on most
issues related to end-of-life care.
• The financial status of the patient appears to be
the deciding factor. In most cases health-care
expenses are entirely borne either by the patient
or by the patient’s relative
• Withholding or stopping resuscitation efforts is
ethically & legally appropriate if the
patient/surrogate has previously made his
preferences known through advanced directives.
21. 2. Withholding or withdrawal of
life support
• “Withholding” refers to never
initiating a treatment, whereas
“withdrawing” refers to stopping a
treatment once started.
• The distinction between not
starting a treatment & stopping it
is not itself of ethical significance;
what is whether the decision is
consistent with the patient’s
interests & preferences.
22. Count…
• Ending treatment for sound moral reasons
does not violate professional obligations.
Health care professionals may find it
emotionally more difficult to withdraw a
treatment than to withhold it.
• On the other hand, it is often important to
start a treatment to evaluate whether it
works, until a diagnosis is confirmed. It is
better to start the treatment & later stop if it
is ineffective.
23. Count…
• Decisions about treatment at the end of life are often
difficult & best made after careful discussions between
the health care professional & the patient (or surrogate).
• The nurse ensures that the patient/surrogate
understands the information by clarifying technical
terms & helping the patient weigh treatment options.
The patient then considers his or her own values &
wishes in the context of prognoses & realistic options.
The final decision reflection the patient’s wishes should
be supported by the nurse & other members of the
health care team.
• The nurse is morally permitted to refuse to participate in
withholding or withdrawing treatment from the patient
as stated in section 5.4 of the Code of Ethics.
24. Points to be considered
• Withdrawal of life support is indicated
if the patient has Glasgow coma score
is less than 5, absence of pupil &
motor response 3 days after arrest.
• Communicate frequently throughout
the critical care stay, not just when
death is imminent.
• Provide consistent, honest
information.
• Keep the discussion on
withholding/withdrawing life support
based on patient wishes & the burden
versus benefits of the various options
25. Points to be considered
• Recognize that the patient & family
are anticipatory grieving & provide
support.
• Most decisions regarding
withdrawal/ withholding of life
support are not made in courts. It
made based on open communication
with patient, family & surrogate as
appropriate.
26. • Despite the success there is severe shortage
of organs to meet the demand. Potential
donor may agree to donate organs/tissues at
any time by signing a donor card, but final
consent for donation by the patient, family or
surrogate is needed before transplantation
team harvest the organ.
• The removal of organs can be accomplished
without causing significant harm to living
donor or organ removal are performed only
in donor who meet the legal definition of
brain death. Everyone has the right to donate
their organ/tissues.
27. • The important ethical principles useful in decision making
on transplantation include respect for persons, autonomy,
beneficence, Nonmaleficence, justice & fidelity.
• Critical care nurses are in a position to act as the link
between potential organ donor & organ transplant
recipients & point out the need for critical care nurses to
learn the process of identifying potential donors.
• Cost versus outcome – an ethical issue?
• The cost of intensive care treatment is very expensive &
time consuming. There is much debate today in both the
nursing literature & popular press about whether the
outcomes from intensive care treatment off set the high
cost of prolonging life using technology & scientific know-
how
28. ETHICAL ISSUES OF MOST CONCERN
The five most frequently cited ethical issues
reported by the nurse surveyed were:
• Protecting patients’ rights & human
dignity
• Providing care with possible risk to your
health (eg. TB, HIV, violence)
• Respecting/not respecting informed
consent to treatment
• Staffing patterns that limit patient access
to nursing care
• Use/non use of physical/chemical
restraints
29. ETHICAL ISSUES OF MOST CONCERN
A combined analysis of reports revealed the
following as being the most personally disturbing
issues faced by the nurses surveyed:
• Staffing patterns that limited patient access to
nursing care
• Prolonging the dying process with inappropriate
measures
• Working with an unethical/incompetent/impaired
colleague
• Providing care with possible health risk
• Not considering a patient’s quality of life
30. WAYS TO RESOLVE ETHICAL PROBLEMS IN
CRITICAL CARE SETTING
1. Gather the relevant facts & identify the decision
maker(s) & the stakeholders.
2. Identify the ethical problem(s). Involve others in
the process & use consultation resources as
appropriate.
3. Analyze the problem using ethical guidance &
resources.
4. Deliberate about the action alternatives in light
of guidance; choose one & justify the choice.
5. Evaluate & reflect.
31. • The ethical & legal responsibility of nurse working in
critical care areas has increased since 1990s. Nurses
must maintain & continually update their
knowledge base & clinical competence.
• Failure to do so could not only cause harm to
patients but could also put nurses & their employer
at risk for allegations & professional negligence.
• As a registered nurse working within the health care
industry it is important to consider all sides of the
ethical debate & to always act within the law & with
the best interests of the client in mind.