terminal patient asks nurse not to report problem to physician

What do terminally ill and very sick patients want from their physicians?

I imagine terminally ill and very sick patients vary greatly in how “real” they want their physicians to be – some likely want to talk about the difficult issues while others might want to stay hopeful and perhaps not talk directly about the end. As a provider, how do you navigate that? A few strategies. Ask permission.

What happens if a nurse fails to report a safety concern?

Nurses have a responsibility to keep patients safe at all times. Failing to report safety concerns in their work areas not only places patients at risk, but nurses and other staff as well. Nurses may feel like they are too busy to take time out to report or may be concerned about retaliation.

How can nurses avoid divulging patient information to family members?

To avoid inadvertently divulging health information inappropriately, nurses should be familiar with their organization's policies and procedures; some facilities must have written release of information forms or use passwords/other identifying information with family members.

Why is my patient not taking in all the information?

Some patients may not take in all of the information you provide up front, particularly if they have received a new diagnosis. Providing your contact details, such as your e-mail address and telephone number, may allow them to ask you questions in their own time, after the consultation has finished.

Would you ever hide information from a patient about a terminal or pre terminal diagnosis in an effort to bolster their spirit or attitude?

Would you ever hide information from a patient about a terminal or preterminal diagnosis in an effort to bolster their spirit or attitude? Answers: Yes, I soften it and give hope even if there's little chance, 14.6%

Is it ethical to withhold the truth from dying patient?

When is it justified for me to withhold the truth from a patient? There are two main situations in which it is justified to withhold the truth from a patient. As noted above, if the physicians has compelling evidence that disclosure will cause real and predictable harm, truthful disclosure may be withheld.

Should terminally ill patients be told?

Patients do not need to be told that they are terminally ill. However, this does not mean we should pre- tend we can cure them of incurable illnesses or that we should withhold prognostic information from those who want it.

What is an example of Nonmaleficence in nursing?

For example, if a diabetic patient asked a healthcare professional for a coke and the healthcare professional denied the request in order to prevent the patient from drinking something that could harm them, that would be an act of nonmaleficence.

Is it ever justified for a nurse to withhold information from the physician?

Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient's knowledge or consent is ethically unacceptable.

What are ethical issues in palliative care?

The ethical dilemmas included inadequate communication, provision of nonbeneficial care, patient autonomy usurped/threatened, issues with symptom management and the use of opioids, issues related to decision making, and issues related to discontinuing life-prolonging therapies.

What to say to a patient who asks if they are dying?

“Have you had anyone close to you go through something like this before? What do you remember about that experience?” “Is it all right with you if we talk more specifically about your prognosis?” “I'm afraid I have some bad news – is it ok if I share it with you now?”

How do you announce a terminal illness?

Tell one very trusted family member or friend and ask that person to spread the word among your loved ones. Meet with family members and friends individually to talk about your condition. Hold a "family meeting" to explain the news. Ask a doctor, nurse, or social worker to talk to your family or to be with you when you ...

How do you communicate with a terminally ill patient?

Using your body languageMaintain an open posture with your arms uncrossed.Keep eye contact.Avoid barriers between you and the person you're talking with.Sit at an appropriate distance so that the person you're speaking with doesn't feel overwhelmed.Leaning forward may help to indicate that you are listening intently.

What are the 4 main ethical principles in nursing?

There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each patient has the right to make their own decisions based on their own beliefs and values. [4].

What is an ethical dilemma in nursing?

An ethical dilemma in nursing is a situation where a nurse must decide between competing values and know that no matter what choice they make, there are consequences. Ethical dilemmas may conflict with the nurse's personal values or with the Code of Ethics for Nurses.

What are the 7 ethical principles in nursing?

The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity. Justice is fairness. Nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of.

Why did the nurse not notify the ICU practitioner?

The nurse noted the results in the health record, but did not notify the ICU practitioner because he assumed the practitioner was returning to the unit to reassess the patient. The patient’s blood pressure two hours after the second unit of plasma was reported as 63/21 mmHG. The nurse notified the on-call resident of the blood pressure and ...

When to invoke the nursing chain of command?

Invoke the nursing chain of command if there is a delay in the response from practitioner or significant concern with practitioner action taken.

How long after stat order was blood available?

The blood bank records indicated that the blood was available 20 minutes after the stat order was received. One hour later, the ICU nurse had not received the blood and noticed the oncoming shift had arrived. He gave the oncoming nurse report regarding the patient and even though both nurses were concerned that the blood had not arrived ...

How old was the patient when she had twins?

The patient was a 38-year-old female admitted for a Cesarean delivery of twins. The babies were delivered without incident, but the patient experienced excessive post-operative vaginal bleeding attributed to placental accreta.

What is the core nursing function?

Maintain thorough, accurate and timely patient assessment and monitoring, which are core nursing functions.

What is risk management in healthcare?

Risk management is an integral part of a healthcare professional’s standard business practice. Risk management activities include identifying and evaluating risks, followed by implementing the most advantageous methods of reducing or eliminating these risks.

Is CNA a trademark?

All products and services may not be available in all states and may be subject to change without notice. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2017 CNA.

What to do if patients don't want information?

If patients don't want information, find out who they want us to communicate with. Establish a surrogate decision-maker.

What is the patient thinking about when they are given a life threatening diagnosis?

Patients are thinking about their own mortality the moment they're given a life-threatening diagnosis. Often the doctor is trying to protect the patient, and ironically the patient is trying to protect the doctor. Usually both parties know that the disease is serious.

What to do when a patient asks a direct question?

So one of the things I try to do is make sure the patient actually wants the information he or she is asking for, and whether the timing and setting are correct. Often when probed, patients are not ready to hear difficult information, or they might need some time or a loved one present.

Why do doctors broach the topic of end of life?

I think many patients are actually glad when physicians broach the topic of end of life. It removes some of the anxiety and creates a partnership where the patients knows they have a physician who will take care of them both in good times and hard times. It also opens up the ability for both parties to talk about hard topics, rather than avoid them.

Do doctors get training?

Most physicians don't get formal training except in small bits and pieces during medical school or residency. Unfortunately we all pick up habits during our practice over time, and we don't get regular feedback on our communication from our colleagues or our trainees.

Can you talk when you are in pain?

Establish a comfortable setting. No one can talk when they are in pain or uncomfortable.

Do oncologists appreciate directness?

Yes, several. I appreciate directness. As an oncologist and a palliative medicine physician one of the things that we spend a great deal of time on is communication. The tenets of that are pretty basic - if someone wants the honest truth you provide it, but with empathy, kindness and a plan forward.

Why do physicians discuss cases with a knowledgeable colleague?

Physicians reported that discussing the case with a knowledgeable colleague helped them decide whether or not to report suspicious injuries. The clinician's past experiences with CPS. Clinicians who believed that CPS involvement would result in a negative outcome for the child or family were less likely to report.

What is the failure to meet a child's basic needs?

Neglect is the chronic failure to meet a child's basic needs-clothing, nutritious food, cleanliness, educational opportunity, medical and dental care, protection, shelter, and supervision. Though the four forms of maltreatment are defined separately, they often co-occur against one child.

How to report child abuse?

The level of suspicion required to report suspected abuse is not clearly defined. But, with the knowledge that physicians tend to underreport suspected abuse, the following recommendations are made to increase physicians' confidence in making appropriate reports: 1 Obtain continuing education regarding child maltreatment. Routinely seeking out local and national opportunities for continuing education related to child abuse and neglect can help you maintain a current understanding of child maltreatment. 2 Know reporting laws. Familiarizing yourself with the reporting laws and to whom reports should be made in your state (i.e., CPS or law enforcement) can lessen the ambiguity in the reporting process. 3 Consult with colleagues. Establishing collaborative relationships with colleagues to consult with regarding difficult cases can assist in the decision-making process. Physicians in private practice who do not have colleagues readily available may want to create a referral process with local agencies that have teams who make these decisions. 4 Know your local CPS staff. Forming relationships with your local CPS staff members can facilitate an open line of communication and establish a better sense of the guidelines used by the agency.

How to maintain a current understanding of child abuse and neglect?

Obtain continuing education regarding child maltreatment. Routinely seeking out local and national opportunities for continuing education related to child abuse and neglect can help you maintain a current understanding of child maltreatment.

Why is it so hard to document the number of children who are maltreated annually in the United States?

The number of children who are maltreated annually in the United States is difficult to document because: (1) definitions vary across tribal, state, and federal jurisdictions; (2) the standards and methods of collecting data vary considerably; and (3) many cases go unrecognized and unreported [5].

Do pediatricians report suspicious injuries?

A 2008 study found that pediatricians in an office-based setting do not always report suspicious injuries [4, 5]. Physicians from two national pediatric practice-based research networks were recruited and 434 reported information from more than 15,000 injuries seen in their offices.

Is it the responsibility of a physician to determine if a child is being neglected?

Such instances present physicians with difficult decisions. It is not the physician's responsibility to determine the intent of the parent or caregiver, or whether abuse or neglect occurred.

Something (s) to Talk About

But even when these conversations do take place, are doctors and patients really talking about the important issues?

Tips for Talking About Death

End-of-life care discussions can be emotionally draining, regardless of whether the conversation occurs among family members, or between patients and their doctors. But the prevailing words of wisdom on the matter, from long-time family caregivers and health care providers alike, are to have these talks sooner rather than later.

What does it mean when a patient's condition is a dead end?

Patients can have very high expectations and trust in the system, and when it appears that their condition is a medical “dead end” or that their prognosis cannot be determined with precision due to the nature of the disease, it can be very upsetting.

Why do patients seek professional help?

Patients seek professional help because they are in pain or are concerned.

Why do doctors need reassurance?

In a complex clinical case, doctors may seem so preoccupied with finding the solution to the clinical problem that it is sometimes easy to forget that the patient might be overwhelmed by anxiety, frustration and negative emotions, and require re-assurance to feel safe, at ease and trust in the doctor.

How does not being in control affect communication?

Not being in control can trigger negative emotions and can make communication difficult . Empathy and effective listening can help with this. Also, keeping the patient informed and involving them in the decision-making process is the basis for giving them a sense of control.

What are the emotions of patients?

Patients can be overwhelmed by a variety of beliefs and emotions: frustration, feeling they have little to no control over their diagnosis and health condition, uncertainty over the course of their treatment and prognosis, fear, worries, and overall dissatisfaction with the healthcare system.

What are the factors that affect healthcare interactions?

Two important factors are the local healthcare setting in which the interactions take place, and the variation in clinical practice between regions and countries. In particular, the majority of healthcare settings are overworked and overstretched to meet demand, and this continuously affects interactions.

Is being defined by diagnosis the only thing in their lives?

Being defined by their diagnosis and labelled as “a patient” is not , and should not be, the only thing in their lives. The healthcare practitioner. There is a wide variability in the development of appropriate communication skills among European healthcare practitioners and this has been a challenge.

How to consider patient complaints about another otolaryngologist?

Considering serious patient complaints about another otolaryngologist requires thinking maturely and examining the facts. “First, establish the veracity of a patient’s complaint, then evaluate any documents that might indicate incompetence or unethical behavior, as well as the otolaryngologist’s own history, examination, and evaluation, to uncover the case’s facts,” Dr. Holt said.

What is incompetence in medical?

Incompetence, however, is a subset of unethical behavior in the sense that a physician fails to properly adhere to standards of care and lifelong learning, doesn’t stay up to date, and/or fails to follow professional and specialty guidelines, state medical board regulations, and laws of the land.

What is the most problematic aspect of being a nurse?

Nurses are constantly faced with issues that require critical thinking and decision making. One of the most problematic concerns involves ethical dilemmas.

Why should nurses verbally communicate concerns to their supervisor?

Nurses should verbalize concerns to their supervisor so that assignments can be switched or replacements found. However, when possible, nurses should practice in care areas where they will be less likely to be faced with these dilemmas. Personal beliefs can also affect how nurses approach patient education.

Why are privacy screens important for nurses?

Privacy screens help reduce the visibility of patient charts, and passwords are required to access integrated systems. Nurses must keep patient privacy as one of their top priorities. However, breaches can occur even with the best intentions. One common occurrence involves divulging health information to a family member.

Why should nurses include the family in their prognosis?

Being open and honest about the prognosis using factual data is also essential, but at the same time, nurses should include the family to educate on pros and cons of treatment and work to inspire hope, encouragement, and positivity.

What is ethical dilemma in nursing?

A common ethical dilemma nurses face is when the values and beliefs of the patient differ from the family. For example, a family may ask members of the healthcare team to downplay (or even avoid disclosing) the severity of a diagnosis to avoid burdening the patient.

How to avoid inadvertently divulging health information inappropriately?

To avoid inadvertently divulging health information inappropriately, nurses should be familiar with their organization's policies and procedures; some facilities must have written release of information forms or use passwords/other identifying information with family members.

How does HIPAA protect health information?

HIPAA laws protect healthcare consumers from having their personal health information shared inappropriately. Nurses are trained to protect private health information in nursing school and throughout their career by their employer. Healthcare technology is set up to protect privacy as well. Access to electronic health records is granted and monitored. Privacy screens help reduce the visibility of patient charts, and passwords are required to access integrated systems.

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