The determination of the potential for cardiac arrest is readily apparent in some patients. Patients with the greatest potential for cardiac arrest require close scrutiny for the signs and symptoms of respiratory and hemodynamic instability. This investigation will attempt to determine the best methods of administering high quality chest compressions in CPR. The PICO(T) acronym represents a format that can be used to create an answerable research question. The PICO(T) formulated question for this investigation is: In adult cardiac arrest, will the utilization of automated chest compressions compared to physical chest compressions during cardiopulmonary resuscitation improve survival outcomes? PICO(T) components consist of patient population (P), intervention (I), comparison (C), outcome (O) and time (T). The PICO(T) components used to formulate the answerable research question are: Patient population: adults in cardiac
John was a 76 year old gentleman returning to an orthopaedic ward following a total hip replacement under general anaesthetic. The agreed care plan was to regularly monitor John’s vital signs over the next several hours in accordance with local hospital resuscitation trust policy (2012) and the National Institute
The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.
DNACPR orders are of considerable concern to ambulance staff, the patient and their families in tackling requests at the end of life (NHS End Of Life Care Programme 2007). A study by Stone et al. (2009) showed nearly all participants had questioned whether interventions performed were correct for the patient when using cardiac life support on patients they thought were terminal. When a patient requires resuscitation and a DNACPR is in place immediate sharing of information is critical. At certain points in the patient care pathway incompatible systems may mean DNACPR requests are not being followed and inappropriate resuscitation being attempted.
The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's
Advance directive structures vary from state to state, but all include two distinctive parts: health care treatment directive and the durable power of attorney (Later & King, 2007). The health care treatment directive is defined as a listing of procedures that the patient may choose to be completed in the preservation of their life or to not be done (Halpern et. all, 2013) Areas that are covered within this section include cardiopulmonary recessitation (CPR), and intubation CPR is used within the health care system as an intervention that is used when the patient’s heart stops. Labeled as do not
The Supreme Court of Canada’s ruling concerning physician-assisted dying in the case of Carter vs. Canada answers the following two questions: 1) Does the current law against physician-assisted dying infringe an individual’s right to life, liberty and security and 2) If the law is a violation of this right, is this violation justified under the Charter of Right’s general limitation clause. The Supreme Court of Canada’s decision on the first question was in the affirmative. The Supreme Court rules that the prohibition of physician assisted dying is void because it deprives a competent adult of assistance when “(1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition
Hospitals and other health care facilities also contribute to the failure of advance care directives, by failing to include copy of the patients advance directives in his or her chart. Physicians may be unaware of a patients advance directives, even when the document is placed in the patients chart. Healthcare directives have failed because, we as healthcare providers don't enforce it. For example, upon admissions we may ask the question do you have one, but we do not express the importance of an advance care directive to our patients. Failure of an advanced care directive can simply be because; the form was started but never completed. Due to human factor mistakes sometimes happen, a person that has chosen “Do not resuscitate” may be resuscitated, and prolong his or her life vice versa. In an emergency situation especially those that
With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient
Tennessee law on advanced directives is a document that tells your family, friends, and doctors on how you want to be treated in an emergency. Advance directive can be a document or a living will in which you state the plan of care when you are no longer able to communicate treatment choices or decision. Advance directives is not only for the elderly but it can be at any age even if you are not sick at the time of the document. This document list the details of treatment that you want implemented if a serious incident was to happen. It would tell what interventions should be used in your care. Some of the choices would include a full status code where the patient wants CPR or a do not resistant code can be used for treatment. The client can also have the option of limited interventions with each code status. It would include artificial ventilation or artificial feeding and any type of tubes associated with your treatment. The client can also be specific if he or she wants just medical treatment only including the use of drug therapy. In this paper, we will look at Tennessee law and various
I identified priorities in my patient assignments when one of my patients became unstable. I had a patient whose pulse oximetry was reading in the 80% with 6 L of oxygen. At that time, that patient was my main priority. I quickly got my preceptor, and informed her of the situation. She informed the physician and I implemented the order to give the patient IV Lasix to diuresis the fluid out of the patient’s lungs so he could breathe better. We ended up calling a code and we moved him to the ICU where he could be constantly observed.
“Physician Aid in Dying Gains Acceptance in the U.S.”, written by Paula Span, was published on January 16, 2017 for The New York Times. This article focuses on the views of patients and doctors who have experienced aid in dying and expresses the many obstacles that stand in the way of the entire process. It was written to inform many people about physician aid in dying and shed light on the strings attached to the validation of the fatal substance. The author intended the audience to be the general public so that everyone will be able to learn more about assisted suicide so that it could potentially lessen the difficulty of going through aid in dying. Span claims that physician aid in dying comes with numerous hurdles throughout the overall
Physician aid-in-dying (PAD) also known as Physician Assisted Suicide (PAS) is a widely debated ethical issue that surrounds the American court system (Starks, Dudzinski & White, 2013, p.1). PAD “refers to [the] practice in which a physician provides a competent, terminally ill patient with a prescription for a lethal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life” (Starks et al., 2013, p.1). Physician aid-in-dying is legal only in three of fifty states: Oregon, Washington and Vermont. It is permissible under “strict patient eligibility criteria” and mental and emotional competence (Starks, et al., 2013, p.1).
A Do not resuscitate (DNR) order is a legal document written by a licensed physician, which is developed in consultation with the patient, surrogate decision maker, and attending physician. This document indicates whether the patient will receive resuscitative care, cardiopulmonary resuscitation (CPR), or advanced medical directives, in the setting of cardiac and/or respiratory arrest. A DNR can also be referred as a no code when identifying a patient’s resuscitation status. If a patient has an existing DNR it allows the resuscitation team, taking care of the patient, to either withhold or stop any resuscitation measures, and therefore respect the patient’s wishes. Historically, DNR orders did not become active in the care of patients until 1974, when it was identified that patients who received CPR, and survived, had significant morbidities (Braddock & Derbenwick-Clark, 2014). Braddock and Derbenwick-Clark further noted, the American Heart Association (AHA) recommended that physicians, in consultation with the patient, family, and or surrogate, place on the patients chart when CPR was not indicated. This documentation is now what we refer to as the DNR order and has become the standard to allow autonomous respect for patients, and their families, to make informed medical decisions. Therefore, the purpose of this paper is to discuss the legal aspects, ethical issues, and the application surrounding the DNR order.