Vulnerable Body Critical Discourse Of Code Blue Nursing Essay

Vulnerable Body Critical Discourse Of computer regulation Blue Nursing EssayWhen row of Code Blue ar announced through all overhead speakers, my heart always skips a beat, and I get out start my someoneal struggle again among skipper, legal and ethic tariff did I nurse the rightfield make upion on a right patient and did I do a right thing?Code blue means a patient, who is in Full Code perspective, is suffering a eccentric of cardio-respiratory find out, and immediately carrys a starting of full advanced cardiac life hold protocol, including cardiopulmonary resuscitation (CPR), medication, and mechanical ventilation (Lewis, Heitkemper Dirksen, 2006, p.166). I cast been working in an adult inpatient medical specialty unit for six years. I backside not exactly remember how m either(prenominal) times I initiated a scratch blue call and view participated with the resuscitation team. Most of the patients that I fuck off entangled in edict blue have died during the resuscitation process with a huge mess of blood, airway secretion, urine, bowel sweat and medication on his or her body or survived little than 24 hours. After each resuscitation action, I felt emotionally drained, depressed, guilty, helpless and frustrated with the code status conclusion Full Code. In this paper, by presenting a resuscitation scenario, I lead conduct a communication analysis approximately this clinical dilemma from both liberal-humanist and scientific-medical perspectives. Through analysis, I belowstood that clinical dilemma glide bys all the times, and it also will happen in the future. Nurses need to seek how to explore the contradiction in termss or tensions from different discourses and commiserate them to grieve over. At the sack of the paper, I discuss the implication of the future nursing practice establish on the cognition acquired from this discourse analysis.Personal StoryIt was my first year in an adult inpatient medicine unit after my g raduation from a nursing school. Mr. D was a 97 years old widower. He was admitted to the infirmary for congested heart failure, shortness of breath and also found to have pneumonia. He was intubated for respiratory barrier in the intensive boot unit then aftermathually developed multisystem organ failure, sepsis, and meningitis. Also, he was at the quit correspond of liver disease, and illustrated by brain damage signs from circulating toxins, hepatic encephalopathy. Arriving at my unit, he complained of shortness of breath and dizziness. His jaundiced skin glowed bright yellow. He showed delirium, repeated the same questions in slurred voice incoherently. He presented a marginal blood pressure, lungs were full of fluid, and oozed blood from his gums and injection sites was hardly to clot. unanimous his limbs were extremely swollen. Nasogastric feeding resistance was in situ. Oxygen was supplied at 4-liter by nasal prongs with saturation of 88 92%. mend checking orders t o create a Kardex, I realized his code status was Full Code, and mendeleviums upgrade notes indicated that decisiveness of code status was discussed between health care team and family three times.Two days later, I found Mr. D was not responding to my greeting and touch during my hourly round checking at 1000 in the morning no breathing sound heard, and no palpable pulse. I hit the code blue button on the wall at beside and started CPR. A code blue announcement mechanically was delivered through overhead speaking system. Code team arrived in one minute. Night gown was stripped off an aged body was totally naked. Deep suction via yankauer was made in rush, a provide was inserted down his throat, and then into his lungs in a harsh manner, and a ventilator took over his breathing, blood storied in his mouth a cardiac monitor was hooked up to his chest chest coalescency was made in a powerful manner to reach the depth of 5cm, rib and sternum bone broken noise was heard a big ne edle-like catheter for getting artery blood gas by a respiratory therapist was poked into to several locations, blood contaminated his right upper arm and intimate t towering venopuncturing for intravenous cannula insertion by a nurse was re-poked four times on both extremely swollen arms and blood messed on forearms isosource of nasogastric feeding came from his nose and mouth, foul odour smelled epinephrine was injected 2 times defibrillator was applied three times with strong electric shock. Twenty minutes later, the doc ordered to stop the resuscitation effort and give up. Mr. D was left naked in the fork up, lying without moving, lethal pale on his face. Everybody was exhausted, leaving the room with disappoint on face, and huge mess on the bed and floor. Tears were running down in familys cheek, too sad to say a word.Analyzing Personal differenceFull code is permission for a code team to insert a ventilation tube into failing lungs, apply electric shock to a fibrillating heart, and unleash a extra blood of punctures, dissections, and exsanguinations on the human body. A resuscitation based on Full Code is supposed to be performed aiming in offering the patient a put on. However, these interventions are marginally effective (Hiberman, Kutner, Parsons Murphy, 1997 Perers, Abrahamsson, Bang, Engdahl, Lindqvist Karlson, et al, 1999), lives saved and operation restored only for a abject number (15% worldwide average) of people (McGrath, 1987 Saklayen, Liss Markert, 1995 Schneider, Nelson Brown,, 1993). Subjecting a dying person to CPR who is believed there is virtually no hope of survival is a terrible way to practise health care it is inhumane and it is an assault. disdain significant improvements made in training, equipment, and drugs, the overall CPR survival rate has remained al most(prenominal) the same over the past 30 years (Beall, 2001). Findings from 33 studies showed that about 16% of patients under age 70 and 12% of patients aged 70 and older survived CPR only (Kaye Mancini, 1996).After participating in the resuscitation for Mr. D, I have been struggling over this real scenario at (1) what is the quality of goal (2) who can decide the code status and (3) what can I do for advocating my patient?As a nurse, I have to deal with crucial purposes with each of my patients. With the participating in the resuscitation for Mr. D and witnessed his goal, I am wondering what is a quality death? What a kind of process is a quality death? Who defines it? What is the resuscitation doing? How much do patients in storage life stage have to visualize about what dying is like? How well patients dignity could be sustaind and integrated into the resuscitation process? How well patients wish could be respected in the decision of code status? How does a patient want everything to be done to extend his life Full Code in hospital parlance, or a patient wants to let his/her death happen naturally without hobble a Do non bri ng to order? Does the Full Code status unfeignedly arrive at the patients gratify or just benefit a substitute decision makers/familys interest? As for Mr. Ds scenario, is the Full Code status his real wish? Is the dying process his real belief about dying? Is the dying process his real value about the death? Did he image his death with broken sternum and ribs, massive blood mess and contamination? Did he image that, at the end of life, he was surrounded by the code team rather than by his family members? Unfortunately, I have no solution to seek the true answers yet I felt the contradiction and tension between the resuscitation on behalf of a Full Code status and quality death professionally, I have duty of care to participate in the resuscitation action and do whatever required for such a purpose, but ethically and morally, I do not want to do any harm on my patients during the resuscitation. It has become my clinical dilemma of struggle for many years.The decision of code stat us is a complex and controversial topic. Theoretically, it seems impartial and easy to declare either patient or patients substitute decision maker will be the subject to make decision about code status. However, in the real working environment, I famed that many patients indications on code status are blank, not checked yet and sometimes they are left as blank for a long period also, some patients code status has been changed reversely from Do Not Resuscitate to Full Code by their family Mr. D was one of such examples. It tells me that the decision process in not a straight-forward linear procedure it is organic or dynamic. The bewilderment for me is who is the real decision maker during this organic process, the patient own, patients family/substitute decision maker or a health care provider? As a regulated professional, a health care provider is rarely taking action as such decision maker usually, either patients or their family will be. While the patient is capable, it is cl ear that the patient decides it for himself or herself. However, my wondering is that there are so many factors that will impact patients capacity when decision needed to be made on the code status, such as age, medical condition, the quality of life, religious views and overall wishes. Further more(prenominal), like the perception on pain, capacity is really subjective a sound judgement on patients capacity also is problem. Who can decide a patients capacity is either intact or impaired without any interest conflict? Like Mr. Ds scenario, due to his senior age and confused medical condition, his daughter was his decision maker from the admission the humans of his condition was recorded as deteriorated daily, and he had been incapable to provide any comment about his code status the progress notes show us that his code status has been changed from Full Code to Do Not Resuscitate, and then back to Full Code again during a five-week period of hospitalization. Is there any interest conflict in the process period his daughter made decision of turning over on his code status for him, and does such change will really benefit him in relieving suffering, restoring functioning and amend his quality of life?As a member of heath care team, what I can do to advocate my patients decision is really confine so that I am feeling helpless. Being a sick people in a hospital might be very stressful in additional to physical symptoms, people may feel anxious, depressed and helpless. Also, family members might be place under a difficult time and fructify during a medical crisis family members may disagree, emotions might be high and medical information can become confusing agent. In such a stressful circumstance, any executable irrational decision could be made without considering the reality and possibility. Perhaps, we can say nurses are wise(p) to provide information, as well as nurses know more about the patients daily condition than a physician so that a nurse reall y can make some good input for health care team and family in decision-making to advocate patients benefit however, the final decision is totally depending on patients or their substitute decision-makers understanding about the context of code status they are lawfully disposed(p) the power. Like Mr. Ds case, his decision-maker alternatively requested change of his code status from Do Not Resuscitate to Full Code on his behalf that resulted in futile and miserable resuscitation, even if his most responsible physician could not apply any influence on it. Health care providers are not legally granted such a power, and ethically, we also can not apply our opinions, judgement or extract on patients or their decision-makers decision. So, I have been struggling over the relationship between power and knowledge under such circumstance, knowledge is not and does not have the power at all. What we can do is through information providing to authorise our patients or their decision-maker to use their power to make a right prize on code status to avoid such futile and miserable resuscitation happened on Mr. D without any benefit, but harm.Exploring Discourse AnalysisThe clinical dilemma as identified in the above scenario, the contradiction and tension are mainly triaged from respecting the patients own or their decision-makers quality on code status while providing our resuscitating intervention. In order to understand the issue, I did literature review on decision making on code status choice. I chose the patients or their decision-makers decision of choice on their code status and how to empower them in making a right decision by information providing to advocate for patients benefit in quality of life at the end of life as my focus. In the following sections, I will use Mr. Ds case to analyze this clinical dilemma from both liberal-humanist discourse and scientific-medical discourse perspectives.Scientific-medical discourse empower patients to make right choice on code statusAccording to Grant, Giddings Beale (2005), the scientific-medical discourse is based on the biomedical mode of medical science. Its core concept is that a human body is a collection of different split that are organically organized and form different systems that manifest as a set of symptoms (Brown Seddon, 1996, a, b). It constitutes the scientific fundamentals and becomes the root of nursing science (Grant, Giddings Beale, 2005, p.499). That is the reason I chose it as one of my discourse.Medical knowledge explicitly tells me that life maintenance must be under the subordination of homeostatic balance, which is followed by normal functions of all organs and homeostatic control mechanism can maintain only in a relative narrow constancy (Thibodeau Patton, 2005, p.16). CPR is a fearful technique that is used on the people who are might be suffering cardiac arrest in order to deliver oxygen to blood stream and maintain a cardiac circulation to bound vital organs, such as such as the brain, be oxygenized to be alive, to delay brain death, and maintain the heart to remain responsive to defibrillation in many type of patients, it virtually never works for a patient with an advanced age and life-threatening illness who is dying of the underlying disease, there is very limited benefit because survival is rare (As articulated by Grant, Giddings and Beale (2005), nurses had sound technical knowledge of corporate diseases, the associated symptoms, predisposing causes, and appropriate treatment (p.499) from medical science. Under the influence of biomedical model ideology, the interventions of nursing care have been constructed as a set of tangible, specifically operate-able and measurable procedures that are implemented in a methodical manner step by step, for example, nursing process. Reflecting on Mr. Ds case, by informing them the updated condition and possible prognosis through my careful and objective assessment, I can support my patient or t heir decision-maker to claim a right code status to avoid a violent death that occurs during an advanced cardiac life support and artificially prolonged life maintenance. It is not to apply my opinion or choice on them. It is to empower them to make right choice in a supportive manner to preserve patients dignity and quality of life, as well as death. In such a way, my professional virtue also will be benefited in maintaining, professional contradiction and personal tension will be avoided.Liberal-humanist Discourse Advocating PatientAccording Grant, Giddings Beale (2005), the liberal-humanist discourse of nursing care is a holistic coming the patient is viewed as a whole person and a unique individual, not the collection of different parts only. Empathic nursing care does not only deal with patients biomedical issues, but also underline patients shore leave, rationality, emotions, understandings and dignity it is characterized by respecting patients self-determination, free c hoice, and self-representation (Praeger, 2002). The ethic ideology of liberal-humanist discourse of nursing care is underpinned by two assumptions nurses commitment to a pull therapeutic interpersonal relationship of care and having moral obligation to act (Dyson, 1997, p. 200) on behalf of patients (Grant, Giddings Beale, 2005). Such a sound holistic approach becomes the grand rationale I cull it as one of my discourses. Also, it casts and shapes my best nursing practice by providing my patients and their family holistic caring.However, it must be understand that such an universal or global ideology itself has an underlying contradiction and tension that I undergo in my patient Mr. Ds scenario, that is, under some circumstance or specific context, it is difficulty that empathetic nursing care must have commitment to trust interpersonal relationship by respecting the patients autonomy and at the same time, nurses also have moral obligation to act on behalf of the patient.As for Mr. Ds case, health care team discussed the code status choice in multiple family meetings based on informed decision principle. The whole caring process demonstrated the empathetic caring by respecting familys decision on the code status choice, taking appropriate and timely resuscitation action morally on behalf of the decision maker. However, the misery result was the violation of patients dignity and quality of death in the dying process, which is actually avoidable and it morally generates the ethic guilty and tension in health carers emotion, because health carer eventually does not have the legal authority to take action to morally prevent such an avoidable misery event to be happened. Such contradiction and tension in professional, legal and ethic principles basically contribute to my trouble and confusion.Implications for Nursing PracticeThe discourse from either scientific-medical approach or the liberal-humanist approach, while peoples life reaches the end stage life-sp an, not only does the physical body, but also the person as a whole, become a vulnerable object. Being a ill person in a hospital can be terribly overwhelming with physical symptoms, anxiety, depressed and helpless, as well as invasive treatment, diagnostic interventions and a variety of information that is related to each procedure. A treatment is supposed to be of benefit if it relieves suffering, restores functioning and improves quality of life it will become a burden if it causes pain, prolongs dying without offering a benefit or increases distress. When we emphasize that patients do have some control over what kind of treatments they do and do not want, but in how many cases patients really implement their control over the treatments? Taking Mr. Ds scenario as an example, being in his senior age and impaired cognitive status, it is impossible for him to be a host to get his treatment and care plan under the control of his wishes his decision maker on his behalf, driven and mas ked by a general graceful desire that is often seen in the most of people, just wants everything has to be done to remain alive to save and prolong his physical life, even if a few more minutes, legally places not only his physical body, but also a person as a whole at the risk of vulnerable position unconsciously while choosing a Full Code status. As a nursing member of the code team, I have professional obligation to do some inhumane resuscitation actions on his vulnerable body and impair his dignity of death. So, put myself into Mr. Ds shoes, if either my parents or I were in his age and health condition, I really need the preservation of self-determination, free choices and self-representation in decision making on code status choice aim DNR, let me go naturally without pain, suffering and inhumane resuscitating effort.Our patient-center nursing care philosophy always makes us be aware of that patients need to be supported, not blamed (Kammerer, Garry, Hartigan, Carter Erlic h, 2007). From the liberal-humanist discourse of nursing care views, move to trust interpersonal relationship with patients, empathy and communication are two core concepts. When a persons life is at the brink of death, a clear mind is a rarely existed. Often, it will be more difficulty to accept and respect a frail mind than a frail body. Terminally ill people may look differently, feel even worse and terrible, and think in another way. They need advocacy, trade protection and caring in humane, patient, and professional ways. Supporting their ability to get their lives under control is no less important than keeping their blood pressure under control. Communication in an empathetic passion is more conducive to doing the right thing than rigid legal documents. Nursing has moral, as well as professional, obligation to communicate our scientific-medical knowledge to support patients in determining what kind of code status they want to be and make their wishes known to their love one s. Family is an integrated part of our clients, which are facing a difficult position during a medical crisis. Identically, we have above obligation to support patients family members in knowing what a loved one wanted that will help them get peace of mind that they are honouring the wishes of their loved one. In such a way, our professional development will be in growth, and our personal distress that is involved in the discourse tension will be released.SummaryAccording to the learning goals of this course, discourse from scientific-medical approach and liberal-humanist approach on a real clinical situation is presented in this paper. Personal distress, frustration and confusion arisen from the clinical dilemma have been analyzed. Nursing care can be explored from different kinds of contradictory discourses. whole these contradictory discourses might contribute to nurses feeling of distress, frustration or confusion when encountering different clinical situations. The liberal-hum anist example of ethic of care focus on viewing a person as a whole and respecting patients self-determination, free choice, and self-representation, bur patients need advocates and support from scientific-medical approach in decision-making. Furthermore, for professional and personal development, nurses should learn to understand these different discourses in one situation and take effective strategies to solve the clinical dilemma. Committing to a trust therapeutic interpersonal relationship with patients will help nurses understand patients better, and it also helps nurses to find the meaning of the event so that effective solutions could be figured out to solve clinical dilemma.