Question

You are working as a nurse on a cancer floor in a large urban hospital. You come into work and learn that you will be working with several new patients during your shift change briefing meeting. One of those patients, Jane, has been admitted to the hospital due to issues related to a cancer diagnosis. She was given medication to address a cancerous tumor along with Propofol to sedate her for the procedure.  

During the shift change meeting, you learn that Jane had lost touch with reality after her procedure and the prior shift nurses made sure everyone knew that Jane was a real pain to deal with because she was non-cooperative and was acting irrationally. She was pulling out her IVs and trying to leave the hospital. Unfortunately, she was a bit like Houdini and could even slip out of the restraints. She also shouted at people that were not in her room and “folded her laundry” in mid-air. Jane also insisted that she was in tremendous pain.

One of the confounding issues is that Jane has a family member who recently showed up to direct Jane’s care, but she does not want any medical treatment for Jane because the family member is convinced that it is the medication that is creating the situation of Jane losing touch with reality. As you interact with Jane and her loved one, you begin to suspect that there was more to this situation than was being reported by the previous nursing shift. You then go to Jane’s complete medical history and find that there is a diagnosis of schizophrenia when Jane was admitted to the hospital for mental health issues almost 20 years prior.

You ask Jane and her loved one about the ways that Jane is handling her schizophrenia, and they explain that she doesn’t take any medication for it, but manages it using LSD and holistic treatments. Jane insists that she has not had any mental health episodes for almost 20 years because of the holistic treatments. Jane and her loved one are insisting that she not be given more medication because it just makes her mental state more confused and her behavior worse. She is obviously in pain, and you want to be able to help alleviate some of her suffering, while you work to stabilize her mental state.  

You realize that the prior nursing shift had just ignored Jane because she was just too difficult to deal with on a very busy floor. Given that Jane has not received any medication for the last 12 hours, you find that there are some problems with her quality of care due to her challenging behavior.  

Describe and explain the ethical issues that you identified in Jane’s situation. Provide evidence from the scenario and from your course materials this week as support of your claims.

• List and explain at least three ethical issues related to the care that Jane has received.
• What steps would you take to correct the issue of Jane’s medications?
• What steps would you take to address the quality of care provided?

Answer 1

I

1. first issue, jane had not received any medcation for last 12 hours and quality of care was also affected because previous staff was busy in that floor. so previous staff ignored jane because of her aggressive behaviour.

2. jane was cooperative and behaved differently ,pulling of the IV stand, she tried to escape from hospital.She could slip out of bed thats why she was restrained to bed because of challenging behaviour

3. any more medication that could alter her mind. jane and her loved one claimed that any more medication that make her confuded and her behaviour therefore janes and relatives refuses treatment

II

calm patient and relatives and support them and educate about the necessary of treamentt provided.

obtain psychiatric history of jane and consult with physician about her previous medication (LSD) and treatment

consult with physician about continuing her LSD medication

provide jane the treatment which is ordered by physician.

iii.

provide them calm and quiet environment

speak in low and slow voice and assure her that  provided treatment is beneficial. it is not going to affect her

after calming her and her relative, her pain to be relieved

inform them about pain treatmnent available to her

educate them need of treatment at present.

administer her pain reliever

position her in a such way that is comfortable to her

provide alternative therapy like listening to music, reading to reduce her pain

provide her single pain reliever

get informed consent if they are not willing for treatment