Question

You are a practical nurse who is caring for Ms. Cranford. She is 87 years old, mentally competent, and has lived alone since her husband died 10 years ago. Her medical history includes type 2 diabetes, chronic renal failure, and arterial insufficiency. She was admitted to the hospital with chest pain, feeling faint, a pulse of 48, and a blood pressure of 98/56. The physicians and nurses stabilized Ms. Cranford with medications and intravenous fluids but later informed Ms. Cranford and her only son that she would need a pacemaker to regulate her heartbeat. After the physician explains the procedure and risks involved, Ms. Cranford pondered the situation for a long while before discussing it with her son and the physician. Ms. Cranford informed her son that she has decided not to get the pacemaker. He becomes upset with her and requests a meeting with the physician. Ms. Cranford’s son meets with the physician to discuss possible options for his mother. Following the meeting both the physician and Ms. Cranford’s son revisit the issue with her in an attempt to persuade her to reconsider her decision but she continues to refuse the recommended treatment. She and her son argue. The physician tries to explain to Ms. Cranford that the pacemaker is for her benefit, in her “best interest” and involves minimal risk to her. Ms. Cranford feels pressure to change her decision. Once you become aware of the problem, you visit with Ms. Cranford and her son to assess and evaluate the ethical issues involved with her case.

Case Study Questions: You are a practical nurse on the ethics committee consulted about Ms. Cranford’s case. Please answer the following questions:

1.What are the central ethical issues and questions in this case?

2.What ethical principles are in conflict in this case?

3.What additional data may be needed to analyze this situation ?

4. What is the role of the practical nurse caring for Ms. Cranford?

5.What is the role of the practical nurse on the ethics committee?

Answer 1

ANSWER 1: THE CENTRAL ETHICAL ISSUES IN THIS CASE IS:

• Forcing Ms. Cranford for making a decision regarding choosing a pacemaker and she feels pressured to change decisions.
• Every patient has right to choose his treatment and make the decision for himself, even the patient has right to refuse the treatment, no one can force him to change his decision.
• Autonomy is the central ethical issue in this case.

ANSWER 2; ETHICAL PRINCIPLES THAT ARE CONFLICT IN THIS CASE IS:

• AUTONOMY: It means nurses are required to administer drugs and other treatment, but at the same time patient has right to refuse them, this is called autonomy.
• It is right of client to make decisions for himself and nurse and physician has to follow and respect the values, beliefs and decision of the patient.
• There should be no judgment and coersion by nurse or physician and the patient has all rights to accept and refuse treatment.

ANSWER 3; THE ADDITIONAL DATA NEEDED TO ANALYZE SITUATION IS:

• mental health status of Ms. Cranford.
• Spend time with Ms. Cranford to know her feelings regarding treatment and whether she really wants a pacemaker, or is it her own decision?
• Analyze the feelings of his son also.
• Analyze the situation of coersion,
• is there lacking in the intelligence of adult, or any issues.

ANSWER 4: ROLE OF NURSE IN CARING MS. CRANFORD ARE:

1. PROTECT RIGHT OF PATIENT: the most important role of nurse while caring Ms. Cranford is to preserve her rights like right to refusal, right to make contact and decisions, justice, and other ethical issues like accountability, fidelity and beneficence.
2. UNDERSTAND FEELINGS OF PATIENT: nurse has a duty and role to understand the feelings, thoughts of patient and accept his decisions, values and belief and accpt the individual as a unique person.
3. FAMILY INTERVENTIONS: Nurse is not having roles and duties only for the patient but she also has duty towards family, nurse has to maintain the integration of family, reduce conflicts, arrange a meeting for them where they can solve their concerns and issues. Nurse should identify needs and set goals for family dysfunction.
4. ADVOCATE : Nurse also act as advocate who does advocacy for the right of patient, she can teach a client where her roles and rights are interrupted and she can provide a right pathway to the patient and this way she can advocate the client.
5. RESOURCE AVAILABLE: Nurse also act as resource provider, she can provide alternative suggestions regarding her treatment and it will depend on patient's choice whether she accepts those alternative ways or not.
6. COLLABORATION: Nurse while caring any patient has a role to collaborate with other health care team members to provide holistic and comprehensive care to patient.

ANSWER 5: ROLE OF NURSE ON ETHICAL COMMITTEE:

• REPORTING: Every detail and issue has to be consulted and discuss with ethical committee to resolve the issues.
• RECORDING: Documentation is the integral role of nurse, she has duty to record and report every issues timely without delay, should be clear and accurate.
• STRENGTHEN THE COMMITTE: Nurse also has a duty to identify the lacking area, needs of committee and strengthen the environment, discuss and communicate issues with committee and try to solve the problems.
• MAKE POLICY AND PROCEDURE: Nurse also helps the committee to make the policy, rules and regulations in organizations she helps in setting the standard of nursing care and ethical issues.
• SUPERVISION; Nurse has role of supervising and monitoring the other employees and make sure there are no breaching or breaking of any ethical issues.
• TEACHING AND TRAINING: Nurse also has role of teaching  and provide training to other nursing staff regarding maintaining ethical principles and how to Improve standard of care.