Ethical Issues In Nursing

I know that in my 25+ years of nursing there have been many issues that have involved one issue or another involving ethics of some sort, but probably the freshest in my mind has to be the one presented a few weeks ago. We had a patient on my unit (step-down) that came in nearly unresponsive from home that was a 78 year old male. Family states "they found him like this. He did have multiple health issues such as chronic renal failure on hemodialysis three times a week that he had missed for a week, congestive heart failure, atrial fib (controlled), diabetes, history of CVA x2, c-diff on admission that the family states that he had off and on a few months, so mostly a very sick patient to say the least. He was worked up from head to toe and showed no signs of another CVA, his A1C was good, BNP for his CHF was really not too bad.

Obviously, he had been without dialysis and this was to be expected. The adult grandchild that lived with him stated that he had been getting around fine and he wasn't aware that he had not been going to dialysis until he came in the hospital and the nephrologist was questioning why he had went without dialysis for a week. The admitting doctor(hospitalist), pulmonologist, nephrologist, cardiology, neurologist all kept passing the buck around the table about one thing or another playing the "wait and see game". He had been days without any nutrition (unable to have PO and no TF) and all MDs kept saying "let's wait another couple of days and then we'll decide on a DNR or put in a TF." The pulmonologist states he talked to part of the family about a DNR the day after the patient was admitted, and no one wanted to discuss a DNR status with him, but the problem was he wasn't talking to the POAHC. They plan was to do dialysis daily with the hopes of increasing his level of consciousness which did