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Nicole S

Discussion # 1

  Patient preferences are important to follow, especially when it comes to end of life choices and decisions. When I was a new nurse, I had an elderly lady who was admitted to my unit, she was in her mid-nineties, had a feeding tube, was not alert or oriented and had several large pressure ulcers on her sacrum. She had been a DNR and on hospice care when the family decided over the holiday season that they wanted to remove her DNR. During this time the feeding tube was accidentally pulled out, and she was experiencing some end-of-life symptoms such as severe bradycardia and was admitted to the hospital. There were different opinions of the family of this patient. Some of her children wanted to reinstate her DNR order and allow her to pass peacefully, while others wanted the hospital staff to do everything medically possible to keep her alive. This became a large issue that ended up involving nurse managers, physicians, social workers, and hospital administrators. “Often, DNR orders are the most controversial in family dynamics (Tajari, 2018). Families often try to convince the healthcare team to overturn the DNR directive. As a nurse, the patient is the priority of care and nurses are the patient’s advocate” (Haley, B, 2021). If a patient makes themselves a DNR when they are in their right mind, should someone at a later time be able to revoke this decision? As a healthcare professional, it is imperative that we provide patient-centered care, and not based on our feelings. “Failure to employ appropriate decision-making techniques can lead to significant problems” (Kon, A.A., et al., 2016). There are decision-making aides available for patients and family members to look over when making these end-of-life decisions (Healthwise Staff, 2021).

            After several meetings with the family and support staff, the family came to the agreement of reinstatement of the DNR order. “Patients rely on clinicians to be clinically wise and make sound judgment as experts in their profession. When clinicians do not meet this expectation, they fail patients and communities” (Melnyk, B. M., & Fineout-Overholt, E., 2018, p 224). Changing the code status takes away from the patients’ autonomy, and as healthcare providers we are to deliver patient-centered care.

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Aigielinn M

Discussion # 2

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One situation that I have experienced was with a patient who was diagnosed with diabetes but was noncompliant with insulin and was not living a healthy lifestyle. The patient was admitted because they had an infection on their foot which caused the foot to turn black in color and had