Martha Jurchak

Clinical ethics residency for nurses: an education model to decrease moral distress and strengthen nurse retention in acute care.

The experience of unaddressed moral distress can lead to nurse attrition and/or distancing from patients, compromising patient care. Nurses who are confident in their ethical decision making abilities and moral agency have the antidote to moral distress for themselves and their colleagues and can act as local or institutional ethics resources. We describe a grant-funded model education program designed to increase ethics competence throughout the institution.

AJOB Case Presentation: Family Request for Organ Donation in a Case of Donation After Cardiac Death (“DCD”)

Mr. John Roberts (a pseudonym) is a 69-year-old man who lived at home independently with a past medical history of diabetes, depression, palpitations, dysphagia, gastric reflux, and hypertension, who called emergency medical services (EMS), and then was found down when they arrived. He presented to the Emergency Department with severe headache and was found to have large right subdural hematoma (SDH) and temporal intracranial hemorrhage (ICH) with evidence of cerebral herniation. He had an emergent craniotomy and SDH evacuation and was admitted to the intensive care unit (ICU). He was treated aggressively for a week, but there was no significant change in his clinical presentation. He was nonverbal and unresponsive to stimulation. Ten days after admission, in the course of providing nursing care, he was found to have pauses in his heart rate when laid flat. In a cardiology consult the following day, it was noted that he had pauses in his heart rate of up to 12 seconds when laid flat, and before that his heart slowed to a rate of 40. This would resolve when his position was changed with the head of the bed being elevated. The cardiology consult note concluded that the etiology of his frequent pauses in the setting of lying flat was likely related to increased pressure on his medulla. He had known herniation. He had a very poor neurologic prognosis per his primary team with “very little chance of meaningful recovery.” Later that day, the family members, who had been discussing the goals of care for him, decided that he would not want his life continued in such a neurologically devastated state and requested that life-sustaining treatment be withdrawn and that comfort be the primary goal. They also requested that if possible he be an organ donor. In this situation the only option was for donation after cardiac death (“DCD”). This required, according to the hospital policy,

Patient With a Devastating Embolic Stroke: Using Weekly Multidisciplinary Ethics Rounds in the Neuroscience Intensive Care Unit to Facilitate Care and Communication

Abstract The challenges families face in making decisions for loved ones after a severe stroke are best supported when the treatment team has the opportunity to share information and perspectives. Weekly multidisciplinary ethics rounds provides a very good forum for just such discussions. Using a case example, this article describes the framework for ethics rounds and its utility in a neuroscience intensive care unit.