Etico y legal

A 9-year-old child has terminal cancer, but the parents do not want the child to know the prognosis.  Over the past few days, the child has started asking questions such as what dying is like and whether the child will die.  What action by the nurse is most appropriate?

•   1. Encourage the parents to openly discuss the child's questions

•   2. Notify the health care provider about the child's questions

•   3. Remind the child that everyone is trying to help the child get better

• 4. Tell the child to ask the parents these questions about death

Answer explanation

School-age children (ie, age 6-12) understand the concept of death and may sense impending death before their health deteriorates; these children may demonstrate their fear of death through uncooperative behavior.  Terminally ill children need accurate information about their treatment and prognosis.  Parents should be involved in open communication with the child from the beginning of treatment, before they have to answer difficult questions once the child's health declines.

When caring for a terminally ill child who has questions about death, the nurse should encourage parents to openly discuss the child's questions.  Members of the health care team (eg, nurse, grief counselor, social worker) can work with parents to have these difficult conversations with their child.  Discussing the child's questions about death supports the parents' autonomy, advocates for the child's needs, and lessens anxiety about death (Option 1).

(Option 2)  The health care provider should be informed; however, the parents should initiate the conversation about death with the child.

(Option 3)  Reminders that everyone is trying to help the child get better dismiss the child's concerns and do not facilitate open and honest communication.

(Option 4)  The nurse should attempt to bridge the communication gap between the child and parents by encouraging parents to discuss the topic with the child.

A nurse is working on discharging a client when the client expresses interest in becoming an organ donor. Which action by the nurse best facilitates the organ donation process? 

• A.Providing the client with information about how to register as an organ donor.

• B.Advising the client to sign an organ donor card and carry it with them at all times.

• C.Scheduling the client for immediate organ donation surgery upon expressing interest.

• D.Assisting the client in completing advance directives specifying their wish for organ donation.

Answer explanation

Choice A is correct. This option aligns with the nurse's role in providing education and support to the client. By giving the client information about how to register as an organ donor.

Choice B is incorrect. While signing an organ donor card can indicate the individual's intention to donate their organs, it is not the most effective action for facilitating the organ donation process. Open communication with family members and healthcare providers is necessary to ensure understanding and consent. Merely carrying an organ donor card may not be sufficient to ensure that the client's wishes are understood and honored, especially if family members are unaware or not supportive of the decision.

Choice C is incorrect. Organ donation typically occurs after a thorough evaluation process to determine donor suitability and match recipients based on medical criteria and organ availability. Rushing the process without proper evaluation and consent could jeopardize the safety and success of the donation process and may not align with the client's wishes or medical suitability.

Choice D is incorrect. Advance directives specify an individual's preferences for medical treatment in the event they are unable to communicate their wishes. While specifying the wish for organ donation in advance directives can be helpful, it is not the primary action for facilitating the organ donation process.

A patient has completed a living will stating that he does not want intubation, mechanical ventilation, or artificial nutrition/hydration should he become unable to communicate his preferences related to medical care. However, the patient’s adult children have expressed their opposition to the patient’s wishes. Which are appropriate nursing actions?

Select all that apply.

• A.Notify the patient’s physician, the nursing supervisor, and the risk manager.

• B.Explain to the patient’s family that the living will cannot be changed at this point.

• C.Encourage the family to discuss their feelings to try to resolve this issue.

• D.Request a consult with the facility ethics committee if needed.

• 
  E.Advise the patient to just go along with the wishes of his adult children.

Answer explanation

Choices A, C, and D are correct. Should such a conflict be observed, the nurse should notify the patient’s physician, the nursing supervisor, and the risk manager. It is also important to encourage the family to discuss the issue among themselves and with the above individuals, to resolve the conflict. A consult with the ethics committee may also be indicated.

Choice B is incorrect. The patient may revoke or change an advance directive at any time, either orally or in writing.

Choice E is incorrect. By law, the patient has a right to autonomy and self-determination, including the right to choose and refuse treatment.

A client has just been diagnosed with a terminal illness. She decides to execute a living will in the unit and asks the nurse to be the witness of the will. What is the most appropriate response by the nurse?

• A.“I’m sorry, but under the law, we’re not allowed to witness living wills.”

• B.“Let me call the doctor. Maybe he can witness it for you.”

• C.“Your family are the only people that can serve as witnesses.”

• D.“Let me call the hospital attorney; he needs to be present when you sign your will.”

Answer explanation

Choice A is correct. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses.

Choice B is incorrect. This statement is inaccurate. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses.

Choice C is incorrect. This statement is false. Witnesses for the signing of the will can be specific individuals; it does not necessarily mean only family.

Choice D is incorrect. The hospital lawyer is not needed to be present in signing the living will.

A nurse is working on discharging a client when the client expresses interest in becoming an organ donor. Which action by the nurse best facilitates the organ donation process?

• A.Providing the client with information about how to register as an organ donor.

• B.Advising the client to sign an organ donor card and carry it with them at all times.

• C.Scheduling the client for immediate organ donation surgery upon expressing interest.

• D.Assisting the client in completing advance directives specifying their wish for organ donation.

Answer explanation

Choice A is correct. This option aligns with the nurse's role in providing education and support to the client. By giving the client information about how to register as an organ donor.

Choice B is incorrect. While signing an organ donor card can indicate the individual's intention to donate their organs, it is not the most effective action for facilitating the organ donation process. Open communication with family members and healthcare providers is necessary to ensure understanding and consent. Merely carrying an organ donor card may not be sufficient to ensure that the client's wishes are understood and honored, especially if family members are unaware or not supportive of the decision.

Choice C is incorrect. Organ donation typically occurs after a thorough evaluation process to determine donor suitability and match recipients based on medical criteria and organ availability. Rushing the process without proper evaluation and consent could jeopardize the safety and success of the donation process and may not align with the client's wishes or medical suitability.

Choice D is incorrect. Advance directives specify an individual's preferences for medical treatment in the event they are unable to communicate their wishes. While specifying the wish for organ donation in advance directives can be helpful, it is not the primary action for facilitating the organ donation process.

A client has just been diagnosed with a terminal illness. She decides to execute a living will in the unit and asks the nurse to be the witness of the will. What is the most appropriate response by the nurse?

• A.“I’m sorry, but under the law, we’re not allowed to witness living wills.”

• B.“Let me call the doctor. Maybe he can witness it for you.”

• C.“Your family are the only people that can serve as witnesses.”

• D.“Let me call the hospital attorney; he needs to be present when you sign your will.”

Answer explanation

Choice A is correct. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses.

Choice B is incorrect. This statement is inaccurate. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses.

Choice C is incorrect. This statement is false. Witnesses for the signing of the will can be specific individuals; it does not necessarily mean only family.

Choice D is incorrect. The hospital lawyer is not needed to be present in signing the living will.

You are caring for a 33-year-old male client at the end of life. This married client has two children; the son is 14-years-old and the daughter is 8-years-old. Both of these children are being prepared for their father’s imminent death. Which consideration should be incorporated into your explanations of death with these children?

• A.Children before the age of 12 view death as terrifying so the nurse should not discuss death with these young children.

• B.Children before the age of 12 do not have any perspectives about death, its meaning, and its finality or lack thereof.

• C.The cognitive development of young children impacts their understanding of death.

• D.The cognitive development of young children before 12 has no impact on their understanding of death.

Answer explanation

Choice C is correct. The cognitive development of young children impacts their understanding of death. Since the meaning of death and the finality of death vary according to the age of the child, the nurse should listen to and support these children according to their level of understanding.

Choice A is incorrect. Nurses should openly discuss death with children as the need arises. Young children do not view death as terrifying, they do not even see death as final.

Choice B is incorrect. Children before the age of 12 do have perspectives about death, its meaning, and its finality or lack thereof. Although, these perspectives are not the same as older children and adults.

Choice D is incorrect. The cognitive development of young children before 12 most definitely impacts their understanding of death and its finality.

A client scheduled for surgery indicates on their preoperative questionnaire a religious preference with spiritual needs.  Which action is most appropriate for the nurse to make at this time?

•   1. Ask the client when a spiritual leader or clergy member is coming to visit

•   2. Document the response and notify the health care provider and perioperative team

•   3. Follow up with the client regarding the nature of their spiritual needs or religious practices

•   4. Notify the hospital chaplain and tell the client that the chaplain will come by to assist

Answer explanation

Spirituality and religious beliefs are often integral parts of a client's life and can be therapeutic in the management of illness.  Some studies have found that clients who engage in regular spiritual or religious practices have shorter recovery times, better coping mechanisms, and improved health outcomes.  Spiritual, cultural, or religious needs should be accommodated within the plan of care.

During the nursing process, the nurse should first assess the client's needs to best address them.  By following up with the client regarding the questionnaire and asking about the specific nature of spiritual needs or religious practices, the nurse can effectively assist the client and create an appropriate plan of care (Option 3).

(Option 1)  Asking a client if a spiritual leader or clergy member is coming to visit may alarm the client or raise suspicion about the surgery.  It also assumes that the client's religious or spiritual practices involve a spiritual leader or clergy person.

(Option 2)  The nurse should attempt to gather more information before notifying the perioperative team.  Simply documenting the questionnaire response does not address the client's spiritual needs.

(Option 4)  The chaplain should not be called until the nurse has assessed the client's specific needs.  The client may not wish to see a chaplain.