I choose this topic because nursing personnel are primary care givers and their attitude towards caring patients and their family member’s matters enormously. Medical and nursing professional consider code status as an essential part of individual treatment. As I have observed that in clinical setting, most of the time when the patients code reported as do not resuscitate (DNR), health care professionals don’t give appropriate attention and care to them as compare to full code patients. Often do not resuscitate misinterpreted as do not care. I am so privileged that I get an opportunity to share my feeling and discuss this ethical issue at this platform. I want to convey this message to all health care professionals that patients whether with full code or DNR should get equal right, respect, justice and dignity in treatment without any discrimination between them.
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Background:
Human beings are the creation of God and he treats all us of with equally.
One of the most eminent verdicts by Publilius Syrus “as men, we are all equal in the presence of death.”
Code status of the patients is noteworthy and one of the essential components of treatment.
Patient diagnosis, age and prognosis of disease play a significant role in deciding either to keep patient full code or DNR.
There are many controversial views on it. As Norra Macready had said in his paper that “More than 70% of respondents recalled situations when confusion around a DNR order led to problems in patient care,”
Thesis statement:
However, in my contention equal attention and care should be given to both full code and DNR patients by health care professionals.
BODY:
Opposing argument:
It is an acceptable fact that full code patients required extra care from health care professionals; on the other hand if DNR patients deteriorate they do not require any prompt action.
Full code patients are vulnerable requires additional and extra vigilant care as compared to DNR patients.
End of life care issues are not seen experimentally as caregivers do not have time and not much to do for them.
Supporting argument:
I partially agree with opposing argument However, I would like to challenge this view by sharing my experience in clinical setting that those patients who are DNR usually completely neglected by health care professionals.
The word is DNR is misinterpreted by caregivers as “do not CARE”.
Sometimes concerns related to end of life care are over looked. As caregivers should provide caring attitude towards terminally ill patients.
Opposing argument:
It is a fact that patients with full life support enjoys all rights and receives all care and respect with dignity.
Rights of patients in terms of safety, care and treatment vary from individuals response and their diagnosis
Human dignity and respect to full code is given more as these are patients whose life can be preserve.
Supporting argument
However, I assert that under the umbrella of principle of justice every patient who comes to the hospital for treatment should get equal rights.
It is the rights of patient to receive equal care and comfort from health care professionals regardless of their code status.
Respecting patient’s dignity and treat them as human beings. Thus, care for them as much as possible.
Opposing argument:
Attitude of the health care team members plays a decisive role in taking care of patients and family members.
Health care members pay more attention to full code patients and their family members and develop a trust building relationship with them easily.
DNR patients and their family member are left on their own as health care team members.
Supporting argument
Although above opposing argument is a fact to an extent. However, I oppose this point as every patient and their family members expect a therapeutic relationship with the health care team members.
DNR patients also demand psychology and emotional attention and must be given comfort care.
Care for all patients must be provided without setting boundaries as this breathes negative impact about the healthcare staff.
Conclusion:
In conclusion, equivalent and comfort care should be offered to every patient regardless of their code status.
By following this practices, we should not violate principle of justice, rights of individuals and by maintaining therapeutic communication we can also built a trust worthy and satisfying relationship with the patients and their family members.
Moreover, it will give us internal satisfaction as we all health care personnel had taken a pledge that we will do all work in favor for our patient and will protect them from any harm.
Should Full Code and DNR Patients be Treated Equally?
Human beings are the creation of God, who treats his humanity with equality and fairness. One of the most eminent verdicts by Publilius Syrus is “as men, we are all equal in the presence of death.” Death is inevitable and individuals must face the dreadful fear of death at one point or another. In clinical settings, dealing with the code of the patients becomes a foremost and challenging task for the healthcare providers. It is a noteworthy and essential component of a successful treatment. Patients’ diagnosis, age and prognosis of disease play a significant role in deciding either to keep patients full code or DNR. There are many controversial views on it. As Norra Macready (2007) had said in her paper that “More than 70% of respondents recalled situations when confusion around a DNR orders led to problems in patient care.” Such statistics pose various controversial dilemmas. Are DNR patients truly neglected by healthcare professionals in terms of care and comfort? Is the healthcare staff more receptive towards full code patients? According to Tayeb et al (2010) “The basic duty of health care providers is to preserve human health and life. In cases in which recovery is hopeless, the role of health care providers does not end but rather is modified.” However, in my contention equal attention and care should be given to both full code and DNR patients by healthcare professionals.
It is an acceptable fact that full code patients require superfluous care and attention from healthcare professionals in order to avoid a life-threatening scenario. It is a truth that vigorous and remarkable efforts are required from the healthcare teams in order to save the lives of individuals that are critical and on full code. Furthermore, end-of-life care issues are not seen in practice since nurses tend to be overly involved in providing attention to full code patients. Consequently, this stimulates a lower level of prioritization for DNR patients with respect to full code patients amongst the healthcare staff. I accept that in practicality, such mode of behavior is based on sound argument, that full code patients actually require additional care over DNR patients. In this respect, I partially agree with opposing argument, However, I would like to challenge this notion by sharing my experience that DNR patients are usually completely neglected by healthcare professionals. I contend that this is due to a pre occupied thought of the health team members that full code patients require extra care whereas DNR patients need none. Likewise, the term DNR should not be misinterpreted as “do not care”. An article regarding legal and ethical issues published in the Merck manual stated that, “a DNR order does not mean “do not treat” rather, it means only that CPR will not be performed.” Moreover, end-of-life care must be adequately provided by the healthcare staff rather than being overlooked and neglected upon for terminally ill patients.
It is a fact that patients with complete life support are entitled to have all rights and receives comprehensive care and respect with dignity. In terms of safety, care and treatment, full code patients also enjoy detailed attention which varies from patients’ response and their diagnosis. Full code patients acquire ample benefits including being treated with absolute dignity and self-respect. However, I assert that patients with a DNR code status find their rights usually violated. They are mostly left alone and considered ineligible for any medical treatment. It should be taken into consideration that under the umbrella of the principle of justice, every patient who comes to the hospital for treatment should get equal rights. As Jeanne (2006) stated, “The nurse respects the worth, dignity, and rights of all human beings, irrespective of the nature of their health problems.” It is the right of every patient to receive equivalent care from healthcare professionals regardless of their code status. Respecting patient’s dignity is a significant portion of compassionate care.
Care provided by healthcare professionals should be family-centered care, as Duran el al., (2007) stated:
Family-centered care is an approach in which care is provided not only for patients but also for the patient’s families. The goal of family-centered care is to meet the needs of patient’s families, including their needs for information and support. (p.271)
The approach of healthcare members plays a decisive role in taking care of the patients. It has been observed that full code patients and their family members receive additional support from the healthcare team as compared to DNR patients and their family members. Healthcare members tend to develop a trustworthy relationship with them easily and provide holistic care which includes physical as well as psychological aspects. DNR patients and their family members are usually left on their own as healthcare members exhibit discernment based on the notion that nothing can be done for this patient by the staff and the hospital, and that the patient is about to depart from this life. I strongly oppose this point, as all patients and their family members expect a therapeutic relationship with their healthcare members. DNR patients demand psychological as well as emotional attention in order to receive holistic care. Jeanne (2006) asserted that “Patients or families may need extensive explanations and psychosocial support during an extremely stressful time”. DNR patients must be well cared all the time, as sometimes, we may see drastic changes sand breakthroughs in medical technology that may allow speedy recovery of such DNR patients in which case the patient’s family would want the DNR void. Care must be provided without setting boundaries as this breathes negative emotions about the healthcare staff as well the hospital amongst patient’s families that they are not being cared for adequately.
In conclusion, equivalent and comfort care should be offered to every patient regardless of their code status. By following this practice, we will not violate the principles of ethics, such as principle of justice. Furthermore the rights of all individuals would be preserved by maintaining therapeutic communication and build a trustworthy and satisfying relationship with the patients and their family members. This will impose a positive impression of our workers and the organization. Moreover, it will give us an internal satisfaction as we all healthcare personnel have taken a pledge to do the best in our patients’ regards and always work in favor for our patient and provide them with benefits and protect them from harm. One benefit that the community will have is that end-of-life care issues will be highlighted and will be taken care in a good manner. By doing this, we can promote and preserve health and alleviate the sufferings of the terminally ill patients which will help them to face their upcoming challenges with courage.
