1) Exercise 4-3 … (Guido, p. 48)
Mrs. R., an 87- year- old patient, has a past history that includes coronary artery disease, a previous stroke, and advanced Alzheimer’s disease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family members visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days, but can be contacted should any change in Mrs. R.’ s condition occur. Her primary physician has practiced in this community for multiple years; he is well known for his reluctance to discontinue any type of life support for any patient. When questioned, Dr. G.’ s consistent response is, if this were his frail 92- year- old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major medical center, where she can receive more advanced care, including vigorous rehabilitation and physical therapy, so that she may eventually return to a long- term nursing care facility. How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
2) Case study end of Ch 3 … (Guido, p. 40)
Until recently, Tyrell Dueck was a normal eighth-grader in Canada, hoping that his favorite team would win the Stanley Cup for the third time. Then, early in the school year, he slipped climbing out of the shower and discovered a lump on his leg. He was then diagnosed with bone cancer.
After receiving two rounds of chemotherapy and being told that further therapy would mean the amputation of his leg, he announced that he wanted therapy stopped. He and his parents, devout fundamentalist Christians, decided to leave his health in God’s hands and seek alternative therapy. The decision sparked a court battle between his parents, who supported Tyrell’s decision, and the health care team, who sought to compel continued medical treatment and the planned amputation. The battle ultimately ended when doctors said that his cancer had spread to his lungs and that there was little more that could be done for Tyrell.
What are the compelling rights that this case addresses?
Whose rights should take precedence?
Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right?
How would you have decided the outcome if his disease state had not intervened?
3) Exercise 4.1 (Guido, p. 44) – Jody Smith – apply the MORAL model to resolve the dilemma.
4) Exercise 4.4 (Guido, p. 50).You are one of the staff registered nurses in a busy emergency department in a large metropolitan area. Several of the patients have existing chronic health care problems and frequently return to the emergency center for reevaluation and follow-up treatment. As a means of working with these patients, you and some of your co-workers have increased the amount of time discussing discharge orders and the need for compliancy with discharge orders, prescriptions, and treatment plans. This has resulted in longer “wait times” for incoming patients, and the nurse manager has dictated that nurses are to limit their discharge instructions to essential facts, informing patients that they need to read the written materials and call their family health care providers if further problems arise.
Examine the above scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy? Do the 10 questions outlined by Malone (as listed in Guido, p. 50) assist in this process? Draft a proposed policy to address the issue you have identified.
What is the problem?
Where is the process?
How many are affected?
What possible solutions could be proposed?
What are the ethical arguments involved?
At what level is the problem most effectively addressed?
Who is in a position to make policy decisions?
What are the obstacles to policy interventions?
What resources are available?
How can I get involved? (Malone, 2005, p. 138)
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