Question

Module 14 Ethics Case Study

The home health nursing department in your hospital is facing budget cuts and staff limitations. To accommodate the patients who are being discharged earlier with more acute nursing needs in the home, your manager has proposed limiting visits to some chronic patients. She has proposed closing cases of “noncompliant” patients and patients who show no improvement despite visits from the home health nurse for several months.

One such patient is Mrs. Lombardi. She is a 76-year-old woman with a stasis ulcer on her right ankle. You have been visiting her twice a week for the last 7 months, doing dressing changes on the wound and monitoring her diabetes. She has very brittle diabetes, is overweight, and lives alone. The wound is clean but has shown no sign of healing. Mrs. Lombardi is a heavy smoker, with a 55-year history of smoking two packs per day. You have counseled her regularly about the risks of smoking, but she says she has no interest in stopping at this late stage of her life and besides, she has tried many times to quit using many different methods and has never been successful. She is aware that her ability to health the ulcer may be compromised by continuing to smoke.

Your manager now says that because Mrs. Lombardi continues to smoke, she is “noncompliant” with her treatment. She recommends, additionally, that you close her case and stop the home visits since the wound shows no evidence of healing.

1. Is Mrs. Lombardi acting irresponsibly regarding her health by continuing to smoke?

2. Does she have a right to expect continued treatment given the fact that the ulcer is

unhealed?

3. What is your responsibility as her visiting nurse in this situation?

Answer 1

1. Is Mrs. Lombardi acting irresponsibly regarding her health by continuing to smoke?

-yes ( because she knows that the ulcer is not healing and one of the cause is smoking

2. Does she have a right to expect continued treatment given the fact that the ulcer is unhealed?

- yes,

because ulcer is nonhealing she should be having other complaints like pain, itching etc

her diabetes should also be treated.

it is our duty to treat any disease to the best of our knowledge respecting the right of the patient

3.What is your responsibility as her visiting nurse in this situation?

- keep the wound clean, prevent from further infection

- control diabetes

- monitoring BP, Blood sugar values

-she is her in old age so giving her frequent visit prevents from developing anxiety, fear.