Moral Distress
What is the opposite of Moral Distress?
Moral Comfort
Name 3 members of the interprofessional team that can participate in a code?
Physician
Respiratory Therapist
What does ECG/EKG stand for?
Electrocardiogram
What is an SDM?
A Substitute Decision-Maker is a person who makes decisions on your behalf if you are not able to make them yourself.
Caridogenic shock arises from the failure of which organ?
Moral Resilience
As a student, which part of a code blue can we participate in?
Chest compressions
(Can also run supplies)
An arterial line is used to continuously monitor:
Blood pressure
What are the two main types of decisions an SDM needs to make?
Personal care and Healthcare decisions
Personal care includes health care, nutrition, shelter, clothing, hygiene and safety.
Healthcare decisions examples:
to have cardiac resuscitation if he or she stops breathing or has a heart attack?
to continue or stop dialysis?
to have surgery no matter what?
to be started on tube feeding?
to have a blood transfusion or blood product?
to go to the Intensive Care Unit and be on a breathing machine?
to have a breathing machine turned off and have a peaceful death?
Norepinephrine, dopamine, and epinephrine are all...
List 3 out of the 8 concepts of Moral Distress
Commitment:
The concept of commitment was defined as the willingness to take action for a patient based upon the nurses’ moral conviction.
Sensitivity:
moral sensitivity refers to the ability to recognize and weigh pros and cons of a moral issue on behalf of patients.
Autonomy:
Autonomy is the ability of nurses to make choices on behalf of the patient for a moral action.
Sense Making:
The concept of moral sense-making within the model refers to the ability of the nurse to give meaning during moral encounters.
Judgment:
Moral judgment involves the nurses’ ability to consider both sides of a moral situation and determine the best course of action.
Conflict:
Conflict involves the discordance between morally appropriate actions and is a key concept in the MDT.
The essential features of moral conflict are choice, advocacy, autonomy, pain, suffering, values, and relationship
Competency:
Moral competency was defined as the nurses’ ability to make moral sense of a situation and act with the best moral behaviors.
Certainty:
The last concept in the MDT is moral certainty. This is when a nurse knows with absolute conviction what is the best course of action to take for a patient.
Cardiopulmonary arrest occurs in almost 1 per ____ hospitalization days
1000
What does a P wave represent on an ECG?
Atrial depolarization
True or False: A patient can only have 1 SDM
False: The law states that you can have multiple SDMs
When a person has multiple family members at the same level on the hierarchy (e.g., several children) healthcare providers cannot choose or require that only one act as the SDM.
What are 2 common causes of cardiogenic shock? (There are more than 2 answers)
Acute MI
Mechanical defect
Contractility defect
Pulmonary embolus
Right or Left ventricular failure
Aortic dissection
What are some strategies for building moral resilience?
Developing self-awareness (for example, examine positive and negative assumptions that may be guiding your behavior) and essentially be less biased
Learning to self-regulate to disrupt negative patterns of thinking and behaving (Methods to help with this include mindfulness-based stress reduction, meditation, and movement practices such as yoga and tai chi)
Nurturing the willingness to take courageous action in a CALM, COOL and COLLECTED manner
Seeking support from others. Friends, family, colleagues or leaders
What patient factor, according to Becker et al. (2019), is found to be a predictor of patient choice of DNR status?
Health literacy (the ability to comprehend medical consequences)
How long does Holter ECG monitoring take?
1-2 days
True or False: The SDM has FULL control over the patient.
False:
autonomy is a negative right: although patients can refuse treatment or insist that it be withdrawn, there is no right to demand it.
Ex:
The Ontario Superior Court of Justice recently determined that, under both Ontario’s health care consent legislation and common law, physicians do not require consent to withhold cardiopulmonary resuscitation (CPR) that they believe to be medically inappropriate.
What do iontropic drugs do to the body?
They increase (positive) or decrease (negative) contractility of the heart.
Repeated episodes of moral distress that aren’t resolved can accumulate as “moral residue,” with nurses ultimately experiencing burnout and leaving their jobs—or even their careers.
Job attrition causes organizations to incur turnover costs.
unresolved moral distress can negatively impact the quality of patient care, potentially leading to adverse patient events.
Thereby hindering the organization's reputation in the community as well
What is typically the first drug given in cases or cardiac arrest?
Epinephrine (1 mg IV)
Which monitor type is the gold standard used for initial screening, identifying, and evaluating patients with chest pain?
12-lead ECG
According to the hierarchy, who would be the SDM in a care scenario where the patient does not have a spouse or partner?
1. Brother of patient
2. Step-sister of patient
3. Mother of patient
4. 17 year old son of patient
3. or 4.
Both the mother and son of the patient are equal on the hierarchy of the SDM. Either can be the SDM or both
Cardiogenic shock is characterized by peripheral vasoconstriction and critical end-organ damage caused by inadequate ____ ____ and ____ ____.
Cardiac Output/Stroke Volume & Oxygen Delivery