Ethical Descions Using Models

We as nurses witness cases similar to Jody Smith's situation nearly every day. Although the patient is not always a nurse, that really does not influence how and when we utilize ethics in our practice. Jody is a retired nurse that has sustained a hip fracture with replacement and a cerebrovascular accident (CVA) with left sided paralysis. Jody has been placed in an acute care facility to receive therapy for her CVA. She is very weak and depressed and thinks that everything the doctors are doing is a waste of time. Jody is refusing to participate in therapy and refusing her medications. She states "Why can I not just die in peace?" The physicians are certain she will make a full recovery and will be able to go home. They are encouraging the family to believe in her full recovery. The physicians refuse to communicate with Jody and only find time to have conversations with the family. The physicians are also ignoring Jody's request to stop all treatments and just leave her to die. We are not sure at this point how the family feels about the information they are be told. Choosing this case study was easy because I have dealt with a lot of people in this situation before and when I read this I felt like I was back in the acute care setting reading one of my patient's charts and scheduling a care plan meeting with her and her family. Also, I chose this case study because the patient is a nurse and I like to think we pay special attention to our own when they are in trouble.

Using the Moral Model

Using the moral model is a straightforward way to solve patients and families problems in an uncomplicated manner. When we are care planning our patients care and discharge we basically using this model more than we think.

Massage the Dilemma

There are several issues to define and identify in this particular case. (Burkhardt & Nathaniel 2002) Jody is a patient and a nurse and has every right to be included in her care plans. Her physicians are sure she could make a complete recovery and be "good as new". (Burkhardt & Nathaniel 2002) Her family is siding with the physicians and believes she will make a full recovery. Jody is very depressed and is reluctant to believe anyone and wishes to die. She is not being heard and this is causing her to become more angry and refusing treatment. The therapy department is not making any progress with Jody and will be forced to drop her from their schedule if they can not show any progress.

Outline the Options

This case needs immediate attention and action. The entire health care team needs to call together a meeting to determine how they are going to help Jody through this awful dilemma. Some options to discuss would be getting Jody help with her depression. She has failure to thrive and needs to speak with a therapist. Getting her to talk with a therapist will help her to open up her express her feelings. The nursing staff and therapy staff need to approach her in a more demanding manor and insist she goes to therapy and not let her refuse so easily. The nurses need to be firm with her and tell her that she is a nurse and knows how important it is to take her medications. They also need to spend time talking with her and letting her know that they have seen patients in a lot worse condition make a complete recovery. Jody knows how the process works and she is just too depressed and overwhelmed to see the far ahead. The staff needs to set her goals to be very short and reachable. Someone who is suffering from a CVA and can only use one side of their body has a very difficult time being positive. The family needs to spend more time taking with mom and grandma and encouraging her to get better for her grandchildren's sake. The staff needs to give her something to live for. The family should bring in the grandchildren to visit and tell her how much she is missed at home. The physicians should talk with the patient and not completely ignore her request. They could offer her alternatives to her current treatments. Instead of therapy being both physical and occupational, just let occupational work with her for a little while. An entire team of health care providers attempting to rehabilitate you can be overwhelming. She could be refusing therapy because she is in a lot of pain. Jody needs to be assessed and reassessed. She also needs to be evaluated every couple of days and if one implementation is not working it needs to be changed. This should be done every couple of days until they see something that actually works. Offer her therapy at home once she is done being treated for the CVA. (Burkhardt & Nathaniel 2002)

Resolve the Dilemma

The staff needs to verbalize to the physicians about how unethical they are being by excluding Jody from the treatment plan. During the care plan meeting with the staff, patient and family each member needs to be open and direct with Jody. Sometimes when a patient is faced with all her family and staff they don't seem so uncooperative. The staff will offer the new options to Jody and see how she takes to them. The family will offer their support and help during each implementation. The physicians will sit down with Jody and apologize for excluding her and let her know that her best interest is always their concern. Jody will be given small precise goals to achieve and will be rewarded with each completed goal. Her rewards will include things such as going on a visit to her children's house. Having something she desires but maybe can't have all the time while she is recovering. The staff should incorporate a living will and her DNR status. This is important incase something else would go wrong during her healing.

Act by Applying the Chosen Options

The new orders for Jody include referral to the facilities psychologist. The psychologist starts to have visits with Jody to determine what is causing her failure to thrive. The psychologist places her on antidepressants and an appetite stimulate. Both of these medications will improve her mood and help her gain her strength back by eating. The occupational therapist will meet with Jody in her room and attempt small goals for her, such as using her brush and silverware. Nursing will encourage her to do more for herself and ask the family to stop doing so much for her. The physicians are going to come in and see her on their routine rounds and inform her of her treatment and order changes. (Burkhardt & Nathaniel 2002)

Look Back and Evaluate the Entire Process, Including the Implementation

After a few days have passed with the new care plan in place, the staff, family and Jody will meet again to review the effectiveness of the plan. Each member of the healthcare team's department head and key staff will attend the meeting. The staff will ensure that all parties are incorporating the care plan per their agreement. The health care team will address any issues that have prevented them from carrying out their plan. As long as there is progress the care plan can continue. At that time any changes that need to be made to improve the plan should be made and all parties must agree. The staff documents meticulously all communication with all members of the team, patient and family. The nurses are the bases of the advocacy support for the patients. At all times the nurse needs to keep the ethical concerns of her patients and her peers. (Burkhardt & Nathaniel 2002)

References

Burkhardt, M. & Nathaniel, A. (2002). Ethics & issues in contemporary nursing (2nd ed.) New York: Delmar.

Ethics and Humanities Links (1996).The Program in Society and Medicine. Retrieved January 9, 2007, from Ethics and Humanities Links Web site: http://www.med.umich.edu/psm/resources.html

Contini, Lisa Marie (11/2000). Values Clarification Destroys Conscience. Retrieved January 12, 2007, from Catholic Culture Web site: http://www.catholicculture.org/docs/doc_view.cfm?recnum=3512

Huitt, H (2004). Values Retrieved January 12, 2007, from Values. Educational Psychology Interactive Web site: http://chiron.valdosta.edu/whuitt/col/affsys/values.html