Every day, hospital case managers must make decisions — large and small — that affect the lives of their patients. Some of these are ethical decisions — what the case manager “ought” to do in a given situation. Since many decisions must be made quickly, hospital case managers should consider their ethics and plan ahead rather than reacting solely in the moment.

Audiovisual modules may improve knowledge and comprehension of ICU procedures, according to the results of a study of critically ill surgical patients and their legally authorized representatives.

Clinicians must be careful about imposing medical staff priorities over patients’ priorities. Making presumptions is dangerous. Ethicists can help by explaining the provider’s responsibility to offer accurate information.

Parties clash regarding comfort levels and how aggressive treatment should be. The lack of advance directives for so many patients exacerbates the problem. Nurses and other colleagues can join the conversations to assist or outright substitute for physicians who are unwilling or unable to engage deeply.

Consider psychological, biological, spiritual, and social factors, and the role they play in understanding illness and healthcare delivery. Using this model, clinical ethicists can encourage dialogue between healthcare professionals caring for seriously ill patients.

Hospitals could put a policy in writing to make clear the obligation of staff to follow a patient’s previously expressed decisions and the obligation of the surrogate to make the decision the patient would want, not the decision the surrogate would want.

Follow the four “Rs”: Recognize what is behind problematic decision-making, Release preconceived attitudes, Reconsider new approaches, and Restart with a fresh focus.