Do Not Resuscitate Requests/Issues
Running Head: DNR 1
Do not Resuscitate Requests/Issues
Tamiki Jackson HCA322: Health Care Ethics & Medical Law
Instructor: Linda Hoppe
September 16, 2013
Running Head: DNR 2
Do not Resuscitate Requests/Issues Do not resuscitate is a hot topic among families, health care professionals, and government agencies. It comes with complex issues ranging from a patients right to die to controversial law suits.
One might ask what does DNR mean, and what is its purpose? DNR stands for do not resuscitate and it is a …show more content…
legal document that is found in a patient’s medical record or chart. It is defined as “orders given by a physician indicating that in the event of a cardiac or respiratory arrest “no” resuscitative measures should be used to revive the patient” (Pozgar, George 2012). Many have found themselves in an emergency situation and in need of a hospital. Some so severe that life support is needed. The patient may or may not want life sustaining devices and that is where the DNR comes into play. What is so unique about this order is when a patient has an established advance directive in their medical records DNR’s are honored, and the patient dies on his or her own terms with no artificial devices to sustain life and no attempts to revive them. However, in the event that an advance directive does not exist complications can arise and often do because the final decision at a tragic time is left to the family or physician/facility. Doctors are sworn by their Hippocratic Oath to save lives to the best of their ability. DNR’s could possibly create legal/ethical dilemma when it is analyzed. The ethical issue can be found within the Hippocratic Oath, doctors have pledge to save lives but DNR’s demand that they do the opposite. By law it is required that DNR’s are in the patient’s medical record to be honored when needed otherwise one could be facing a law suit.
Running Head: DNR 3 “Hippocrates (460-375 B.C.), an ancient Greek physician considered the “Father of Medicine,” constructed the groundwork for the principles of ethics in medicine over 2,500 years ago in his establishment of the Hippocratic Oath” (Jhala CI; Jhala KN 2012).
Once a resident has completed medical school and is on his or her way to become a physician they must pledge the Hippocratic Oath at graduation. This tradition started before Christ and it continues today. They have pledge to protect life by all means which includes artificial devices. How can a piece of paper change something that has been sworn since the beginning of time? Over time the oath has been revised to incorporate the new centuries and modern medicine. In spite of the oath DNR orders were introduced into medical facilities. The orders came into play for many reasons but the one that sticks out is terminally ill …show more content…
patients. Tragic diseases such as cancer, HIV, and leukemia cause patients to become incapacitated, incompetent, and in severe pain. Stages of these diseases are irreversible and ultimately leads to death. Patients that do not wished to endure any more suffering have an advance directive and a DNR in their medical records. In the event that their breathing stops they do not want to be sustain by artificial means. Legally the hospital/physician are required to do the right thing and if a patient has done their legal part (advance directive and DNR) it will be carried out. Most people do not have either of the two and have not had a conversation with family members about being resuscitated. Issues arise when family members or physician have to make a very hard decision.
Running Head: DNR 4 The law requires that DNR’s be written, signed, and dated by a physician. One’s state has to “acknowledge the validity of DNR orders in cases involving terminally ill patients in which the patients’ families make no objections to such orders. Orders must comply with statutory requirements, be of short duration, and be reviewed periodically to determine whether the patient’s condition or other circumstances (e.g., change of mind by the patient or family) surrounding the “no code” orders have changed” (Pozgar, George 2012). If the document is not current physician might face law suit. Current resources that address DNR orders are palliative care and hospice. “Palliative care (PC) focus on management of patients with progressive advanced disease. The primary focus is to maintain or to improve patients ' quality of life and to support the care givers” (Palliative Medicine, 2008). Centers like these specialize in making sure that DNR orders are signed, dated, and written by the physician. The centers are dedicated to making the patient comfortable and respecting their Patient Rights. They address the issues that hospitals cannot. Making sure that the family understands the patient dying wish, discussing the details of a DNR orders, attaching an advance directive, and providing advice on power of attorney. They are equipped with medication to keep the patient comfortable and they help them make their journey through death by providing education and understanding. In 2010 “Medicare and Medicaid Services (CMS) estimated that 5% of beneficiaries who died in 2008 accounted for 30% of its $446 billion annual budget. Approximately 80% of the budget was spent during the patients ' final month and covered costly resuscitation efforts, aggressive treatments, and ventilator support” (McGrath, Lori S. ; Gargis Foote, Dorothy ; Frith, Karen H. ; Hall, W. Michael 2013).
Running Head: DNR 5 Running centers for terminally ill patients can be costly although uninsured patients are treated as well. A great solution to DNR order is the portable DNR order. “A portable DNR order is a do-not-resuscitate directive that travels with the patient. One way to improve continuity among providers and organizations is to develop statewide portable DNR and end-of-life orders that ensure patients’ wishes are followed regardless of setting” (Payne JK ; Thornlow DK 2008). This alterative allows information to be current, it is right at the physician’s fingertips, and the patient and their family are informed. When one has the information in their hands it gives the family time to adjust to the decision and to confirm that affairs are in order. Feuding amongst family members about the final decision slows the process down and it keeps the patient on artificial means until a decision is reached. Life support as reported previously drove up the cost of health care for Medicare and Medicaid. Keeping a patient on life support that has a DNR order is against the patient’s rights and it drives up the cost of health care. That is why portable DNR order should be the new alterative. Gerontology Nursing reported an eighty-four year old women was admitted for pneumonia. She came from a nursing home and once she was admitted she went into acute-onset respiratory distress and the physician on duty intubated her and sent her to intensive care. Her daughter stated that her mom would not want to be intubated. The physician was aware that the patient had a nursing home DNR order but her medical records did not reflect an updated DRN. If the patient had a portable DNR order she would have only received the antibiotics that she came for and she would have never been intubated.
Running Head: DNR 6 “To meet these challenges, several states have enacted legislation requiring the portability of do-not-resuscitate (DNR) orders, or orders that continue from one setting to another” (Payne, Judith K, PhD, RN, AOCN, CS; Thornlow, Deirdre K, PhD, RN, CPHQ 2008). The use of portable DNR’s will not change the principal’s autonomy, fidelity and confidentiality. Autonomy means allowing the patient to make their own decision about their health care. It is their right to be resuscitated or not and as long as the patient has made a competent decision the health care professionals has to respect that even if it goes against their moral beliefs. Fidelity is being true to an obligation. Once DNR orders are written the physician must carry out those orders. The doctor should check periodically to see if the patient still wants the order and advise them about having a portable DNR. Confidentiality is protecting a patient’s identity. Family members may ask the provider questions such as; who is on the advance directive as a guardian?
Has the DNR been updated? Can they make changes? Confidentiality protects the patient and keeps the health care professional from divulging any patient information. Violating this principal can be grounds for termination and it guarantees any health care professional/facility a trip to court. Nurses have taken a confidentiality pledge called the Nightingale Pledge. “I promised to do all in my power to maintain and elevate the standard of my profession, and hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling” (McGowan, Claire, 2012). All three principals must be applied when caring for patients in order to maintain confidence, trust, and an open relationship with the provider. Patients give very sensitive information to facilities and they need to be assured that it will not get into the wrong
hands.
Running Head: DNR 7 All patients have legal rights when using any hospital or facility. The Patient Self-Determination Act of 1990 reads a patients right will consists of he or she “directing their medical and nursing care as it corresponds to existing state law” (Pozgar, George 2012). Also included in the rights of patients are self-determination and a right to be informed. The laws intertwine with ethical values. First most individuals are competent enough to make a decision about their life. Weather it is a good choice or bad one the decision has been made. A health care worker must be professional at all times and not judge, because there will be a day when the patients choice is not the same as the provider. When one faces a challenge like this the best course of action is explain the pros and cons of the patient’s choice, and the pros and cons of the doctor choice. Send the patient home with literature to read and be more informed. Advise him or her to speak with their family. DNR orders are easy to carry out when all are informed. As long as it is within the law patients should be able to determine their destiny. To look at it from a moral view point DNR’s are a simple way of the patient saying they relinquish their lives. Having an order like this makes it easier for the family, the decision has been made and now we have to honor it. “Medicare is the single largest payer for hospice care. Although a significant increase in hospice use has occurred in the last 10 years, one-half of the patients enroll in the last 3 weeks of life (National Hospice and Palliative Care Organization [NHPCO], 2009). Additionally, research reveals that about one- third enroll in the last week of life, and 10% enroll on the last day. The mean length of stay is 49 days, with less than 17% of patients receiving 6 months of care (Medicare Payment Advisory Commission, 2009). Also 60% of Medicare decedents were not enrolled in hospice at the time of their death.
Running Head: DNR 8 These dismal statistics reinforce the importance of the role of nurses in helping patients weigh the benefits and burdens of continued treatment, understand their prognosis, and deliberate on the option of palliative treatment, including the hospice care option” (Lachman, Vicki D 2011). Introducing theses stats proves that health care professionals do recognize a patient right to be informed. The nurses are getting the information out and the patient are responding by seeking alternative means to comfort them in their last days. Cultural diversity is important to a facility because there are so many different cultures seeking medical attention. It makes the patients feel comfortable to know that someone from the ethnicity works among the professionals. Language barriers are broken which reflects in a better quality of care for the patient. Ethically speaking diversity is what one seeks when facing issues like DNR’s. When there is no one to speak on the behalf of the patient physicians consult the Ethics Committee. It is a diverse committee consisting of clergy-men, community business leaders, politicians, nurses, doctors, lawyers, and a quality control manager. They are supposed to be diverse in order to be ethically balanced. However, todays ethic committees consist “of those involved in clinical ethics are practicing health professionals, the question of qualification is especially challenging as the role of ethics committees and, increasingly, ethics consultation services are becoming increasingly important to the functioning of health care institutions” (BMC Medical Education; 2013). In relation to the DRN decision making they should be the objective ear. Called upon when needed but the concern lies when a panel is mostly doctors and nurses. Can they make the right decision? They are bound by their duty to save lives and they are employed by the hospital. Are they concern with what is best for the patient or the hospital? When it comes to making serious decisions society can only pray that the right thing be done.
Running Head: DNR 9 They have lawyers to advise them of their legal rights and the rest is left to their moral belief of what is right and what is wrong. Hospitals also have standards and policies the demand that any employee must do the best when caring for a patient. Through the years laws, policies, and standards have changed. The Hippocratic Oath has been revised to fit the current century, modern medicine has come into play, and patients are in charge of their health care. Under these categories ethical decisions and laws will change because new technology and medicine mandates it. Hospitals will have to evolve and that will mean more changes are to come. Do ethical standards need to be reviewed? Yes, and if it is needed some viewpoints should be changed to fit the new world. To ensure that this happens hospitals should send employees into the communities and research the new ethical way of thought. Submit findings and incorporate what was learned into new policies and standards. A refresher course on ethical decision making verses health care laws is always good for employees. Meeting set goals will keep the hospital/facility out of the courtroom and servicing more patients. An ethical goal to set is do what is best for the greater good. When one is trying to understand DNR orders remember DNR stands for do not resuscitate is a hot topic among families, health care professionals, and government agencies. It comes with complex issues ranging from a patients right to die to controversial law suits so do not be afraid to ask questions.
Running Head: DNR 10
References
BMC Medical Education (2013) Education and the improvement of clinical ethics services. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=39&sid=cd967102-b6ed-40d3-b9ad-fedefe934476%40sessionmgr10&hid=17&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=edb&AN=86883436
Jhala CI ; Jhala KN (2012) The Hippocratic oath: a comparative analysis of the ancient text 's relevance to American and Indian modern medicine. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=2&sid=ed50523b-dad9-4559-b56c-63f8ebe0dbdc%40sessionmgr4&hid =116&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=cmedm&AN=23032817
Lachman, Vicki D (2011) Ethics, Law, and Policy. Nurse 's Role in Increasing Patient Access to Hospice Care. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=35&sid=cd967102-b6ed-40d3-b9ad-fedefe934476%40sessionmgr10&hid=116&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=aph&AN=64468885
Running Head: DNR 11
References
McGowan, Claire (2012) Patients ' Confidentiality. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=17&sid=cd967102-b6ed-40d3-b9ad-fedefe934476%40sessionmgr10&hid=6&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=c8h&AN=2011696788
McGrath, Lori S. ; Gargis Foote, Dorothy ; Frith, Karen H. ; Hall, W. Michael (2013) Cost Effectiveness of a Palliative Care Program in a Rural Community Hospital. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=15&sid=329a6171-fa00-4b5b-b5d9-c810b0bfe711%40sessionmgr104&hid=4&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=c8h&AN=2012214596
Palliative Medicine (2008) Abstracts of the 5th Research Forum of the European Association for Palliative Care (EAPC). Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=17&sid=329a6171-fa00-4b5b-b5d9-c810b0bfe711%40sessionmgr104&hid=116&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=c8h&AN=2010058456 Running Head: DNR 12
References
Payne JK ; Thornlow DK (2008) Clinical perspectives on portable do-not-resuscitate orders. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=9&sid=329a6171-fa00-4b5b-b5d9-c810b0bfe711%40sessionmgr104&hid=105&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=aph&AN=33938159
Pozgar, George (2012) Legal and Ethical Issues for Health Professionals Third Edition. Retrieved from http://online.vitalsource.com/books/9781449685065
Do not Resuscitate Requests/Issues
Tamiki Jackson HCA322: Health Care Ethics & Medical Law
Instructor: Linda Hoppe
September 16, 2013
Running Head: DNR 2
Do not Resuscitate Requests/Issues Do not resuscitate is a hot topic among families, health care professionals, and government agencies. It comes with complex issues ranging from a patients right to die to controversial law suits.
One might ask what does DNR mean, and what is its purpose? DNR stands for do not resuscitate and it is a …show more content…
legal document that is found in a patient’s medical record or chart. It is defined as “orders given by a physician indicating that in the event of a cardiac or respiratory arrest “no” resuscitative measures should be used to revive the patient” (Pozgar, George 2012). Many have found themselves in an emergency situation and in need of a hospital. Some so severe that life support is needed. The patient may or may not want life sustaining devices and that is where the DNR comes into play. What is so unique about this order is when a patient has an established advance directive in their medical records DNR’s are honored, and the patient dies on his or her own terms with no artificial devices to sustain life and no attempts to revive them. However, in the event that an advance directive does not exist complications can arise and often do because the final decision at a tragic time is left to the family or physician/facility. Doctors are sworn by their Hippocratic Oath to save lives to the best of their ability. DNR’s could possibly create legal/ethical dilemma when it is analyzed. The ethical issue can be found within the Hippocratic Oath, doctors have pledge to save lives but DNR’s demand that they do the opposite. By law it is required that DNR’s are in the patient’s medical record to be honored when needed otherwise one could be facing a law suit.
Running Head: DNR 3 “Hippocrates (460-375 B.C.), an ancient Greek physician considered the “Father of Medicine,” constructed the groundwork for the principles of ethics in medicine over 2,500 years ago in his establishment of the Hippocratic Oath” (Jhala CI; Jhala KN 2012).
Once a resident has completed medical school and is on his or her way to become a physician they must pledge the Hippocratic Oath at graduation. This tradition started before Christ and it continues today. They have pledge to protect life by all means which includes artificial devices. How can a piece of paper change something that has been sworn since the beginning of time? Over time the oath has been revised to incorporate the new centuries and modern medicine. In spite of the oath DNR orders were introduced into medical facilities. The orders came into play for many reasons but the one that sticks out is terminally ill …show more content…
patients. Tragic diseases such as cancer, HIV, and leukemia cause patients to become incapacitated, incompetent, and in severe pain. Stages of these diseases are irreversible and ultimately leads to death. Patients that do not wished to endure any more suffering have an advance directive and a DNR in their medical records. In the event that their breathing stops they do not want to be sustain by artificial means. Legally the hospital/physician are required to do the right thing and if a patient has done their legal part (advance directive and DNR) it will be carried out. Most people do not have either of the two and have not had a conversation with family members about being resuscitated. Issues arise when family members or physician have to make a very hard decision.
Running Head: DNR 4 The law requires that DNR’s be written, signed, and dated by a physician. One’s state has to “acknowledge the validity of DNR orders in cases involving terminally ill patients in which the patients’ families make no objections to such orders. Orders must comply with statutory requirements, be of short duration, and be reviewed periodically to determine whether the patient’s condition or other circumstances (e.g., change of mind by the patient or family) surrounding the “no code” orders have changed” (Pozgar, George 2012). If the document is not current physician might face law suit. Current resources that address DNR orders are palliative care and hospice. “Palliative care (PC) focus on management of patients with progressive advanced disease. The primary focus is to maintain or to improve patients ' quality of life and to support the care givers” (Palliative Medicine, 2008). Centers like these specialize in making sure that DNR orders are signed, dated, and written by the physician. The centers are dedicated to making the patient comfortable and respecting their Patient Rights. They address the issues that hospitals cannot. Making sure that the family understands the patient dying wish, discussing the details of a DNR orders, attaching an advance directive, and providing advice on power of attorney. They are equipped with medication to keep the patient comfortable and they help them make their journey through death by providing education and understanding. In 2010 “Medicare and Medicaid Services (CMS) estimated that 5% of beneficiaries who died in 2008 accounted for 30% of its $446 billion annual budget. Approximately 80% of the budget was spent during the patients ' final month and covered costly resuscitation efforts, aggressive treatments, and ventilator support” (McGrath, Lori S. ; Gargis Foote, Dorothy ; Frith, Karen H. ; Hall, W. Michael 2013).
Running Head: DNR 5 Running centers for terminally ill patients can be costly although uninsured patients are treated as well. A great solution to DNR order is the portable DNR order. “A portable DNR order is a do-not-resuscitate directive that travels with the patient. One way to improve continuity among providers and organizations is to develop statewide portable DNR and end-of-life orders that ensure patients’ wishes are followed regardless of setting” (Payne JK ; Thornlow DK 2008). This alterative allows information to be current, it is right at the physician’s fingertips, and the patient and their family are informed. When one has the information in their hands it gives the family time to adjust to the decision and to confirm that affairs are in order. Feuding amongst family members about the final decision slows the process down and it keeps the patient on artificial means until a decision is reached. Life support as reported previously drove up the cost of health care for Medicare and Medicaid. Keeping a patient on life support that has a DNR order is against the patient’s rights and it drives up the cost of health care. That is why portable DNR order should be the new alterative. Gerontology Nursing reported an eighty-four year old women was admitted for pneumonia. She came from a nursing home and once she was admitted she went into acute-onset respiratory distress and the physician on duty intubated her and sent her to intensive care. Her daughter stated that her mom would not want to be intubated. The physician was aware that the patient had a nursing home DNR order but her medical records did not reflect an updated DRN. If the patient had a portable DNR order she would have only received the antibiotics that she came for and she would have never been intubated.
Running Head: DNR 6 “To meet these challenges, several states have enacted legislation requiring the portability of do-not-resuscitate (DNR) orders, or orders that continue from one setting to another” (Payne, Judith K, PhD, RN, AOCN, CS; Thornlow, Deirdre K, PhD, RN, CPHQ 2008). The use of portable DNR’s will not change the principal’s autonomy, fidelity and confidentiality. Autonomy means allowing the patient to make their own decision about their health care. It is their right to be resuscitated or not and as long as the patient has made a competent decision the health care professionals has to respect that even if it goes against their moral beliefs. Fidelity is being true to an obligation. Once DNR orders are written the physician must carry out those orders. The doctor should check periodically to see if the patient still wants the order and advise them about having a portable DNR. Confidentiality is protecting a patient’s identity. Family members may ask the provider questions such as; who is on the advance directive as a guardian?
Has the DNR been updated? Can they make changes? Confidentiality protects the patient and keeps the health care professional from divulging any patient information. Violating this principal can be grounds for termination and it guarantees any health care professional/facility a trip to court. Nurses have taken a confidentiality pledge called the Nightingale Pledge. “I promised to do all in my power to maintain and elevate the standard of my profession, and hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling” (McGowan, Claire, 2012). All three principals must be applied when caring for patients in order to maintain confidence, trust, and an open relationship with the provider. Patients give very sensitive information to facilities and they need to be assured that it will not get into the wrong
hands.
Running Head: DNR 7 All patients have legal rights when using any hospital or facility. The Patient Self-Determination Act of 1990 reads a patients right will consists of he or she “directing their medical and nursing care as it corresponds to existing state law” (Pozgar, George 2012). Also included in the rights of patients are self-determination and a right to be informed. The laws intertwine with ethical values. First most individuals are competent enough to make a decision about their life. Weather it is a good choice or bad one the decision has been made. A health care worker must be professional at all times and not judge, because there will be a day when the patients choice is not the same as the provider. When one faces a challenge like this the best course of action is explain the pros and cons of the patient’s choice, and the pros and cons of the doctor choice. Send the patient home with literature to read and be more informed. Advise him or her to speak with their family. DNR orders are easy to carry out when all are informed. As long as it is within the law patients should be able to determine their destiny. To look at it from a moral view point DNR’s are a simple way of the patient saying they relinquish their lives. Having an order like this makes it easier for the family, the decision has been made and now we have to honor it. “Medicare is the single largest payer for hospice care. Although a significant increase in hospice use has occurred in the last 10 years, one-half of the patients enroll in the last 3 weeks of life (National Hospice and Palliative Care Organization [NHPCO], 2009). Additionally, research reveals that about one- third enroll in the last week of life, and 10% enroll on the last day. The mean length of stay is 49 days, with less than 17% of patients receiving 6 months of care (Medicare Payment Advisory Commission, 2009). Also 60% of Medicare decedents were not enrolled in hospice at the time of their death.
Running Head: DNR 8 These dismal statistics reinforce the importance of the role of nurses in helping patients weigh the benefits and burdens of continued treatment, understand their prognosis, and deliberate on the option of palliative treatment, including the hospice care option” (Lachman, Vicki D 2011). Introducing theses stats proves that health care professionals do recognize a patient right to be informed. The nurses are getting the information out and the patient are responding by seeking alternative means to comfort them in their last days. Cultural diversity is important to a facility because there are so many different cultures seeking medical attention. It makes the patients feel comfortable to know that someone from the ethnicity works among the professionals. Language barriers are broken which reflects in a better quality of care for the patient. Ethically speaking diversity is what one seeks when facing issues like DNR’s. When there is no one to speak on the behalf of the patient physicians consult the Ethics Committee. It is a diverse committee consisting of clergy-men, community business leaders, politicians, nurses, doctors, lawyers, and a quality control manager. They are supposed to be diverse in order to be ethically balanced. However, todays ethic committees consist “of those involved in clinical ethics are practicing health professionals, the question of qualification is especially challenging as the role of ethics committees and, increasingly, ethics consultation services are becoming increasingly important to the functioning of health care institutions” (BMC Medical Education; 2013). In relation to the DRN decision making they should be the objective ear. Called upon when needed but the concern lies when a panel is mostly doctors and nurses. Can they make the right decision? They are bound by their duty to save lives and they are employed by the hospital. Are they concern with what is best for the patient or the hospital? When it comes to making serious decisions society can only pray that the right thing be done.
Running Head: DNR 9 They have lawyers to advise them of their legal rights and the rest is left to their moral belief of what is right and what is wrong. Hospitals also have standards and policies the demand that any employee must do the best when caring for a patient. Through the years laws, policies, and standards have changed. The Hippocratic Oath has been revised to fit the current century, modern medicine has come into play, and patients are in charge of their health care. Under these categories ethical decisions and laws will change because new technology and medicine mandates it. Hospitals will have to evolve and that will mean more changes are to come. Do ethical standards need to be reviewed? Yes, and if it is needed some viewpoints should be changed to fit the new world. To ensure that this happens hospitals should send employees into the communities and research the new ethical way of thought. Submit findings and incorporate what was learned into new policies and standards. A refresher course on ethical decision making verses health care laws is always good for employees. Meeting set goals will keep the hospital/facility out of the courtroom and servicing more patients. An ethical goal to set is do what is best for the greater good. When one is trying to understand DNR orders remember DNR stands for do not resuscitate is a hot topic among families, health care professionals, and government agencies. It comes with complex issues ranging from a patients right to die to controversial law suits so do not be afraid to ask questions.
Running Head: DNR 10
References
BMC Medical Education (2013) Education and the improvement of clinical ethics services. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=39&sid=cd967102-b6ed-40d3-b9ad-fedefe934476%40sessionmgr10&hid=17&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=edb&AN=86883436
Jhala CI ; Jhala KN (2012) The Hippocratic oath: a comparative analysis of the ancient text 's relevance to American and Indian modern medicine. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=2&sid=ed50523b-dad9-4559-b56c-63f8ebe0dbdc%40sessionmgr4&hid =116&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=cmedm&AN=23032817
Lachman, Vicki D (2011) Ethics, Law, and Policy. Nurse 's Role in Increasing Patient Access to Hospice Care. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=35&sid=cd967102-b6ed-40d3-b9ad-fedefe934476%40sessionmgr10&hid=116&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=aph&AN=64468885
Running Head: DNR 11
References
McGowan, Claire (2012) Patients ' Confidentiality. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=17&sid=cd967102-b6ed-40d3-b9ad-fedefe934476%40sessionmgr10&hid=6&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=c8h&AN=2011696788
McGrath, Lori S. ; Gargis Foote, Dorothy ; Frith, Karen H. ; Hall, W. Michael (2013) Cost Effectiveness of a Palliative Care Program in a Rural Community Hospital. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=15&sid=329a6171-fa00-4b5b-b5d9-c810b0bfe711%40sessionmgr104&hid=4&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=c8h&AN=2012214596
Palliative Medicine (2008) Abstracts of the 5th Research Forum of the European Association for Palliative Care (EAPC). Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=17&sid=329a6171-fa00-4b5b-b5d9-c810b0bfe711%40sessionmgr104&hid=116&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=c8h&AN=2010058456 Running Head: DNR 12
References
Payne JK ; Thornlow DK (2008) Clinical perspectives on portable do-not-resuscitate orders. Retrieved from http://ehis.ebscohost.com.proxy-library.ashford.edu/eds/detail?vid=9&sid=329a6171-fa00-4b5b-b5d9-c810b0bfe711%40sessionmgr104&hid=105&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=aph&AN=33938159
Pozgar, George (2012) Legal and Ethical Issues for Health Professionals Third Edition. Retrieved from http://online.vitalsource.com/books/9781449685065