Care During Short Staffing

The Medicine program in your hospital has been struggling with high volumes of acutely ill patients, and short staffing due to sick calls and burnout. Normal “surge” protocols are no longer working and even the float pool is depleted. The headlines are describing a dire situation indeed, with patients and families reporting long waits for call bells to be answered, and patients left in pain and without help to get to the bathroom. After a straight week of being unable to fill all vacant nursing assistant shifts, and months of overtime, the staff on one unit ask for an ethics consultation, to help them identify priorities for care. This is a situation that might benefit from a meeting to identify the major ethical concerns and collaborate on interventions that could relieve some of the pressure on staff. You attend the unit just before morning shift report. Gathering as many people as possible, you convene a short unit meeting to identify the biggest...
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Should we enact a slow code for this neonate?

Malik was born at 32 weeks gestation after an otherwise unremarkable pregnancy to parents of Iranian descent who identify as Shia Muslim. Malik had Respiratory Distress Syndrome and required mechanical ventilation until day five, with nasal continuous positive airway pressure for an additional four days. After three weeks the team noticed he had a distended abdomen and his clinical status deteriorated to the point of reintubation. After an evaluation, the team discovered a malignancy involving his small bowel, liver, diaphragm, and abdominal wall. The pediatric oncologist was consulted by the NICU. She determined that the prognosis was very poor, and that infants diagnosed with this kind of aggressive malignancy usually lived only two months. She explained to the parents that there are no long-term survivors known in the literature, but that she’d reach out to an authority on this malignancy at another medical center who may know more. This authority confirmed the dismal prognosis and recommends against chemotherapy or other aggressive...
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