In: Nursing
Baby Sherman is a neonate admitted to the NICU at the county
hospital where you work as the NICU nurse manager. Mrs. Sherman had
an amniotic fluid embolus during her delivery, and Baby Sherman
experienced anoxia. Consequently, Baby Sherman had an Apgar score
of 0 at birth. The baby was resuscitated but remains unconscious.
All of the baby’s organs experienced hypoxic insult. Baby Sherman
was placed on a ventilator, and parenteral nutrition was later
initiated. Mrs. Sherman is physically very weak and experiencing
grief, along with her husband, over the condition of their infant.
They have two other young children, ages 2 and 5 years. Baby
Sherman has been weaned from the ventilator but has remained
unresponsive. Mr. and Mrs. Sherman have requested that the hospital
staff discontinue their infant’s nutrition and hydration. The NICU
medical, nursing, and social work staff have not previously
experienced a situation quite like this one.
Questions
You are meeting with the neonatologists, the NICU charge nurse, the infant’s primary nurse, the hospital chaplain, and the social worker in the NICU. What do you contribute to the group’s discussion with regard to how you believe the staff should proceed in providing the best care for Baby Sherman and her family?
How do the Baby Doe rules affect this case?
One of the staff RNs comments, “I think the mother and father are being selfish about their request to withdraw nutrition from Baby Sherman. I think it is because they don’t want to be bothered with taking care of her at home.” How do you address these comments?
Which surrogate decision-making standard should be used in this case? What, if any, influence should the interests of Baby Sherman’s siblings have in decision making?
Caring for Baby Sherman and interacting with her family has caused a great deal of moral suffering for the NICU nursing staff. What behaviors might you expect to observe among the nursing staff? What do you do, as the nurse manager, to address this situation?
As would be expected, Mr. and Mrs. Sherman also are experiencing a great deal of moral suffering and grief. How would you handle your personal interactions with Mr. and Mrs. Sherman, and what would you do to help educate your staff in working with families in a situation such as this one? What do you know, or what information can you locate, about the grief parents experience when their infant is extremely impaired and a decision about withholding or withdrawing life support is being made? How would you try to help Mr. and Mrs. Sherman?
As the nurse manager, you contact the chairperson of the hospital ethics committee to make a referral for the Sherman’s case. Imagine the nurse manager and ethics committee chairperson during the referral phone call. What information is important to discuss? What questions are important to ask? Remember, the committee chairperson has no information about the case.
Withdrawing Artificial nutrition and hydration must be
considered as a health care professional when the patient suffering
with illness considering baby comfort during the dying
process.Provide support to parents and implement the care in such
away from the baby at least receive nutrition and hydration for her
initial illness and never of starvation..The nurse must control the
timing of death and avoid the intention of hastening the baby
death.
Baby Doe rules affect this case if the physician or parents choose to
withhold complete treatment when the exceptions are met, it will be
considered as liable and medical negligence..
Advice nurses to avoid such comments when they are in the grief of baby
and his suffering..
Stopping artificial respiratory support and nutrition, the baby
suffer from dehydration...in some conditions like congenital
abnormalities and severe hypoxic syndrome. The medical team and
family can agree to stop artificial feeding serves the palliative
the goal of ending prolonged sufferings..
No, not with baby Sherman's siblings' support; the parents made
decisions due to Sherman's prolonged suffering due to artificial
nutrition and ventilator..
Artificial hydration and nutrition become morally optional in
clinical situations where the burden of treatment continues
biological existence..it is the other constituent part of the care
provided to newborns expected to improve, and no losses need it; it
makes sense. Point of family and professional judge make benefit
newborn when interventions lose their ethical justification..
Grief is a painful and exhausting feeling; when to deal with this sorrow,
we have to allow ourselves to express our feeling can help a
bereaved person recover. Grief counseling can help emotionally
normal. As a nurse, have good communication with family..concentrate
your concern on listening carefully with compassion..never judge
their feelings, and don't criticize their expressions. Human
touch make support with Mrs.Sherman..
Teach the staff about grief crisis intervention and how to
communicate with their emotional needs..never hurt with negative
opinion and how it harms the profession and rules as a nurse..family
and patient always expert care and support from health care
providers..
Grief parents experience when their infant is extremely impaired
and a decision about holding or withdrawing life support due
to the suffering of their newborn due to prolonged artificial
ventilator and artificial nutrition, which hurt their loved one
more.As a parents, they see their baby suffering in such a way like
this..