Week two Discussion Theory
Think of a surprising or challenging practice situation in which you felt underprepared,
unprepared, or uncomfortable. Select an important nursing issue/topic that was inherent to
the identified situation.
Last year I took care of a 20-year-old male with metastatic testicular cancer for almost three
months. The nursing issue inherent to this situation is an ethical dilemma relating to a lack of
understanding of prognosis and false hopeYour text here 1
of recovery.
Briefly explain the situation
The patient was transferred to our facility for extracorpeal membrane oxygenation (ECMO) due
to refractory cardiopulmonary failure. Patient was receiving a chemotherapy that severely
damaged the function of his heart and lungs. Patient was given hope that ECMO would allow his
heart and lungs to rest and heal, which is true. Venous arterial ECMO has a higher rate of
survival than not using the treatment. The dilemma is the side effects and complications that can
occur from ECMO and the fact that the patient had a terminal diagnosis. He was on ECMO for
82 days. While in the hospital he developed a stage IV pressure injury and had a fasciotomy of
the left lower leg due to compartment syndrome from being on vasopressors. After he went to
surgery for the fasciotomies and debridement of the pressure injury, he was started on continuous
renal replacement therapy (CRRT). The patient and his family (from Mexico) were being told his
wounds were looking better and the doctors wanted to continue with the ECMO to give patient
more time to recover. They were not discussing the CRRT in rounds. There were some heated
discussions between nurses and residents about the medical interventions and nursing was
ignored. After 75 days of ECMO and no signs of improvement of patient’s heart and lung
functions an ethics and palliative care consult was made after patient and family visited with a
chaplain. The patient died after 82 days of ECMO when the line was lost, and he hemorrhaged.
The parent’s and patient’s biggest fear was him dying alone and he did.
Identify the nursing issue inherent in the identified situation
The issue inherent to this situation is that the voices of multiple nurses were not heard or respected.
It felt like the patient was an experiment since the ECMO team had not ever had a patient on
ECMO this long and none of them were discussing the fact that patient failed every trial of weaning
off ECMO, even after coding twice. They refused to give up; maybe it was a combination of ego
and the patient’s youth.
As a method of refection, use Carper's Patterns of Knowing to analyze the situation. In your
discussion, address ONE of the following Patterns of Knowing: What was one personal belief
that impacted your actions? (Ethics)
I had a hard time separating the ways of knowing and choosing one to discuss. Emotion influences
actions (Carvalho, Hamilton, Burke, McDonald & Griggs, 2020). Ethical knowing is a moral
element which aligns with Nightingale’s question of what a nurse ought to do in each situation
(Jacobs, 2013). Everyone was emotional in this situation and with good reason. This was a young
This study source was downloaded by 100000832361371 from CourseHero.com on 01-22-2022 23:44:48 GMT -06:00
https://www.coursehero.com/file/59802548/Week-2-Discussion-Theory-NR501NPdocx/
Think of a surprising or challenging practice situation in which you felt underprepared,
unprepared, or uncomfortable. Select an important nursing issue/topic that was inherent to
the identified situation.
Last year I took care of a 20-year-old male with metastatic testicular cancer for almost three
months. The nursing issue inherent to this situation is an ethical dilemma relating to a lack of
understanding of prognosis and false hopeYour text here 1
of recovery.
Briefly explain the situation
The patient was transferred to our facility for extracorpeal membrane oxygenation (ECMO) due
to refractory cardiopulmonary failure. Patient was receiving a chemotherapy that severely
damaged the function of his heart and lungs. Patient was given hope that ECMO would allow his
heart and lungs to rest and heal, which is true. Venous arterial ECMO has a higher rate of
survival than not using the treatment. The dilemma is the side effects and complications that can
occur from ECMO and the fact that the patient had a terminal diagnosis. He was on ECMO for
82 days. While in the hospital he developed a stage IV pressure injury and had a fasciotomy of
the left lower leg due to compartment syndrome from being on vasopressors. After he went to
surgery for the fasciotomies and debridement of the pressure injury, he was started on continuous
renal replacement therapy (CRRT). The patient and his family (from Mexico) were being told his
wounds were looking better and the doctors wanted to continue with the ECMO to give patient
more time to recover. They were not discussing the CRRT in rounds. There were some heated
discussions between nurses and residents about the medical interventions and nursing was
ignored. After 75 days of ECMO and no signs of improvement of patient’s heart and lung
functions an ethics and palliative care consult was made after patient and family visited with a
chaplain. The patient died after 82 days of ECMO when the line was lost, and he hemorrhaged.
The parent’s and patient’s biggest fear was him dying alone and he did.
Identify the nursing issue inherent in the identified situation
The issue inherent to this situation is that the voices of multiple nurses were not heard or respected.
It felt like the patient was an experiment since the ECMO team had not ever had a patient on
ECMO this long and none of them were discussing the fact that patient failed every trial of weaning
off ECMO, even after coding twice. They refused to give up; maybe it was a combination of ego
and the patient’s youth.
As a method of refection, use Carper's Patterns of Knowing to analyze the situation. In your
discussion, address ONE of the following Patterns of Knowing: What was one personal belief
that impacted your actions? (Ethics)
I had a hard time separating the ways of knowing and choosing one to discuss. Emotion influences
actions (Carvalho, Hamilton, Burke, McDonald & Griggs, 2020). Ethical knowing is a moral
element which aligns with Nightingale’s question of what a nurse ought to do in each situation
(Jacobs, 2013). Everyone was emotional in this situation and with good reason. This was a young
This study source was downloaded by 100000832361371 from CourseHero.com on 01-22-2022 23:44:48 GMT -06:00
https://www.coursehero.com/file/59802548/Week-2-Discussion-Theory-NR501NPdocx/
