Drowning: Ethical Considerations (Nursing)

00:00 Ethical considerations and conversations regarding drowning can be extremely difficult. My favorite role in nursing is one where the family members will never remember my name.

00:12 My role was a clinical liaison and that meant, when a code was called, my only job was to go down, be with the family from the time they arrived until the time I walked them back out to their car. So that role gave me an incredible experience of watching families walk through this.

00:30 Now, because they're under such stress, they would never remember who I was, but it was my job to do everything I could to support them.

00:36 A client who has experienced drowning is going to facility is going to necessitate some ethical considerations and some really difficult conversations. The biggest decision that has to be made is how long do we continue resuscitation efforts, if the patient is not responding? Now, we may also consider special circumstances like they were in cold water drowning. But if the patient is not responding, have to make a call on how long we continue resuscitation.

01:06 When the healthcare-team is considering stopping resuscitation, these are some things that are thought about and talked about with the patient's family.

01:15 To talk about whether the patient has a poor neurological prognosis, they might have to make a decision about withdrawing life-sustaining therapy.

01:24 They may also want to know, obviously, about how do we know if the patient is brain dead? And what does that mean? How do you determine that? And are they a possible candidate for organ donation? These are heavy, heavy questions.

01:40 As I shared, my role was family support, so I had the privilege that this was my only focus.

01:47 So I had to find a way to balance hope, but not to give them false hope, because a prognosis might not be good.

01:55 So I would go back and forth between the code room and the family and say "they're doing everything that they can, the patient has not responded yet," and I would just give him small updates so that they had some idea of what was going on. I didn't dash their hopes, but I didn't tell them everything was going to be okay. That was the best way we found to support families through these really difficult decisions. Now it got very challenging when the family didn't get along before this crisis. So, then this type of crisis can cause some, ugh, serious disagreements and even physical altercations.

02:31 You have to navigate those as best you can, maybe move family members to different rooms.

02:35 You just have to respond in the moment as the nurse.

02:39 Now you have to think about resource allocation.

02:42 Is this appropriate to have them in ICU? Should they have access to specialized therapies, like ECMO? Again, these are all very heavy decisions.

02:52 Also let's look at prevention.

02:54 We know that as health care team members, we are mandated we have a legal responsibility to report anything that seems like suspected neglect or abuse, because our role is to advocate for patient's health and for the appropriate prevention measures.

03:10 Each hospital has an ethics team and that will be involving nurses, physicians, therapists, pharmacists, clergy, people from all different professional teams that will come together and have a conversation in support of the family.

03:26 So, either the patient, if they're able, or the family can also come to these meetings. The toughest conversations I've ever experienced have been quality of life considerations.

03:36 Now, if we have something that's a legal document that would be called, like an advanced directive, that's where the client, when they're in their right mind, wrote out exactly what they wanted done. If anything happened like this in their life where they could not make the decision.

03:53 Unfortunately, we don't always have that.

03:55 So we have to do our best with the family members and what we do know about the patient and have discussions about what are the long-term outcomes and what is going to be their quality of life.

04:07 We want to do everything we can to identify what the patient's values and preferences were in decision-making.

04:14 Now, I can say for my own parents, my dad did not want to fill out an advance directive and he said, that's you, kid, you be my advance directive.

04:23 Which mean I had to make the decision to not code my dad again and to turn off all the attachments.

04:31 That was okay because I was prepared for it and I knew it.

04:34 But I'm a health care member.

04:37 Families are not often equipped with that knowledge to know when they can feel comfortable looking at the issues of quality of life and what you should do with withdrawing care.

04:49 So just be patient. Keep it in mind that this is new for everyone, and do your best to facilitate therapeutic communication.