Leadership and Ethics

The ethical situation that comes to mind this week is religious ethics.  This theory focuses on religion, which is depicted by the parent’s upbringing and the older family members typically.  One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is very important when you have a baby in the NICU (Neonatal Intensive Care Unit) that is in need of the transfusion and the parent will not consent.  The treating neonatologist will need to get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, the religious code of ethics is based on the upbringing of the parent (Denisco & Barker, 2012).

The parent refusing to allow treatment of transfusions to their baby would be a hindrance to the baby’s care, while at the same time as nurses we are trying to promote a  family-centered type of care involving the caregivers in the decision making and treatment  (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).  When my baby was in the level 3 critical NICU, they had open rooms, because the babies were too critical to be in closed rooms.  I watched a baby in front of us get sicker by the day and hearing the nurses and the doctors speak about the need for a blood transfusion and other treatments.  By the time they gave the baby the blood transfusion, it was too late, and the baby was terminal.  You as the parent are watching and hearing this because, in this type of critical setup, there is nothing between you and the next bed except a curtain and in front of you there is not a curtain.  As a nurse I thought to myself, how can they be having this discussion right in the open this way? As a parent I thought, how can these parents watch their baby die? I thought about how those nurses felt and if I were the nurse in that situation, what would I have done?

With the use of religious ethics, we may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs as long as the baby is being taken care of and there is not a medical threat to the baby’s life. When I stop and think about the nurse manager that was supposed to be the example, all we heard from her was complaints about the parents and how ignorant they were.  A part of me agreed, however, the nurse part of me, the part that is compassionate with the parents dealing with a decision they probably hate to make came out.  I said to the manager, we are all very much entitled to our opinions and they may not be the views of our patients, but in this crisis, we just need to support the parents because the baby will receive a transfusion whether they agree or not by court order.

References

Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 569-581). Retrieved from https://campus.capella.edu/web/library/home

Meadow, W., Feduter, C., & Matheny-Antomennaria, A. H. (2012, April 13, 2010). A premature infant with necrotizing enetrosoliteis. Special Articles-Ethics rounds. http://dx.doi.org/10.1542/peds.2010-0079

 

 

Nurses In Telehealth and Why It is Important

Our technology through the years has been advancing to provide patients with nurses that can manage their care through the telephone and through field visits in their homes.  With the recent pandemic that has spread throughout the globe, more than ever the field of nursing doing telehealth has become important.

Through my job as an independent nurse consultant, I am able to provide much needed and sought after medical information to my patients and their family caregivers via telephone and telehealth.  In order for me to do this, I must be able to have good communication skills and if I am providing telemedicine a good eye for what may be concerning my patient.  In the past few years, telehealth has grown.  According to the American Academy of Ambulatory Care Nusring (AACN).  “Telehealth practice originally began when registered nurses (RNs) were available to patients by telephone to ensure they had access to health care. The RNs triaged patients to appropriate levels of care. ”

Many people lately since the pandemic occurred ask me what do you do for work?  My answer is, as a nurse consultant, I educate and assess my patients about their medications, symptoms, and chronic disease processes.  I ensure that they are making follow up appointments with their primary care doctors or their specialist.  Together we develop a plan of care that will best suit their current situation.  Now I also have injured workers that are seeing their doctors and anxious to get back to work.  They sometimes have chronic conditions that through my assessment they may or may not know about.  These are the moments when as a nurse consultant, I can educate them, provide best practices, and refer them to their primary care doctor to get the help that they need.  As for their injuries, I help them to get the right treatment ordered and coordinate their visits to another specialist that can help them when a referral is needed.  My job does not end there though, coordinating light duty work for the,m with their employing agency is another aspect of what I do.

Having a telehealth nurse allows doctors the ability to follow up with patients that are not able to come to the office as frequently by carefully monitoring the medications that they are on after they are reconciled with their pharmacist.  It also allows for a team approach in managing their healthcare with their caregiver and the patient to provide autonomy, a willingness to participate, and be involved in their own healthcare.

One important time that my patients benefit from is pre and post-surgery.  These are scary times for patients and knowing that they have a nurse to contact them and review their instructions before surgery, plan for their needs after surgery, and contact them afterward, assures them that they can manage their needs while waiting for the follow up with their doctor.

This year with Hurricane Dorian almost hitting Florida, there was preparation to plan ahead for patients especially those that were in need of a special needs shelter due to compromised health.  It takes preparation at the beginning of the hurricane season to assess all your patient’s needs and plans for disaster.  I usually start this around June 1st right when hurricane season starts so that if one should happen, we are prepared with the patient’s plan of care.  Once the warning is issued that we need to prepare, then I contact each one of my patients and put their emergency plan into place.  I visit each patient and make certain that they are prepared.  Once the danger is over, I follow up with each patient by phone and when it is safe to go out, I will visit them in their homes to ensure that they are safe.

Most all my patients receive an in-person visit from me at their home or doctor’s office but they also receive phone calls to maintain the communication lines open about their care.  Usually, I have flexibility in my schedule to take time off to spend it with my husband and my son or catch up on housework to free up my weekends.  However, during this pandemic of COVID-19, my short days have turned into 16 plus hour days almost 6 days a week and somedays 7 ( although I try to not let that 7th day happen).  Many ask what happened to your comfortable hours?  Well COVID-19 changed that !!  My patients are scared, they have more questions, I have more telehealth visits at doctor’s offices with patients because I am not able to go per my contracted client accounts; it is for their protection and mine.  So although tiring, I am grateful that I can still provide the care that they need through telehealth.

So today someone dropped off a sign at my door that says they are praying for healthcare heroes and first responders.  I am honored to be among the professions that help support our patients at home to keep them safe during this pandemic.  Every telehealth visit that I make with each patient has a COVID-19 question and answer session and they know that if they have a question, they can contact me.

So today, find a healthcare worker and honor them with a kind word of encouragement.  We are here working for the health of our country.

This is the sign that was left on our front yard today( Pardon the garden we were going to start planting flowers in it until COVID-19…times are too busy for gardening)

Rosie Moore, DNP, RN

Follow Rosie’s Nurse Corner

Website:  Windermere Baby and Family