The Ethical Dilemmas of CNAs


Article Categories: Legal and Ethics & Other

Ethical dilemmas - As the term suggests, is a form of conflict between what the head thinks, what the heart feels, and what a person is bound to do or follow. Healthcare is a treasure trove of stories of nursing assistants and other staff being obliged to do something that may not be right. Patient care in this situation is extra-challenging and can be upsetting to CNAs who, as a result, experience moral distress.



Let’s consider these three cases (which may look all too familiar to you):

Case #1

CNA Anne works in a hospice. She knows an 87-year-old patient with advanced liver cancer has signed a Do Not Resuscitate (DNR) form. Because he is terminal, his heart began to fail and he was revived through CPR. Three days later, he is too weak to move and is experiencing confusion because the cancer has spread to his brain.

His death became imminent and he was in and out of consciousness. The family insisted that resuscitation should continue and the doctor, however hard he tried to explain the patient's terminal condition, met with the ethics committee who decided it was best to follow the family's wishes.

Anne’s patient seems to be rotting from the inside. After three more resuscitations, and some moaning which indicated he might be in pain, he finally passed away. Anne is heartbroken, as he was her patient for many years. She sincerely felt that he suffered unnecessarily and against his wishes. Anne felt the family should have let him go in peace. Before his death, she cared attentively for him still, giving him bed baths and mouth care, but with a heavy heart.

Case #2

CNA Pete is very fond of his nursing home patient. His patient is a competent 75-year-old veteran with endless stories of his pursuits, the war itself, and his wife, who passed ten years ago.

For the past few weeks, though, Pete’s patient has become increasingly aloof. The staff think his demeanor might have something to do with his only daughter moving out of the state and not visiting as often. Lately, he is refusing to eat and drink or even take his medications despite encouragement from his physicians and nurses. Pete thinks his patient is getting worse, but he can’t help him while he still refuses help.

Pete made an extra effort, finding a book his patient loved and giving it to him. He tried engaging him in conversation about his favorite topics, especially at meal times, just to get him to eat but Pete failed miserably. Pete knows his patient needs proper nutrition and adequate hydration, or he will get sick and die. Even though the patient has the right to say no, Pete feels pressure in his heart to convince his patient to eat.

Case #3

CNA Suzie is working in a nursing home, and one of the residents is a 79-year old retired female teacher with advancing Alzheimer's disease. Suzie's patient is getting worse. Her confusion becomes more and more frequent.

Lately, the patient is demanding to go home. She needs to “make dinner” for her teenage son, who will want something to eat when he gets back from school. Suzie tells her patient that her son will not be home for another three hours, plenty of time to watch her favorite movie and still have time to cook dinner after.

In reality, her son had recently died of a heart problem, at 59 years old. Suzie's patient agreed to watch the movie, and soon after, forgot that she had to cook dinner.

Suzie feels bad that she lies to her patient to avoid upsetting her. Suzie feels she should tell the truth about her son's passing, but she doesn’t for fear that her patient would become unnecessarily distressed. So, Suzy kept telling white lies and it has been effective in calming her patient. But, she felt guilty about it day after day. Soon, Suzie felt burned out.

Ethical dilemmas are sometimes without solutions, as they fall within the boundaries of legal considerations and agency policies. If a situation is not breaking a rule or policy, then technically there isn’t a problem requiring a solution. But what about the internal conflicts and emotional distress felt by nursing assistants?

It is up to the CNA to find the tools to cope. They may also be proactive by participating in efforts to improve patient care, so that ethical dilemmas become less common. Before these conflicts cause burnout to set in, CNAs should seek out support and try to remember the positive impacts that nurse assisting has on patients’ lives.

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