Question

What are the patient's needs or desires?

• What are the needs or desires of others involved?

• What relationships are affected in this situation?

• What institutional factors affect this situation?

• What principles or rules of the code are in conflict?

• What values are in conflict?

• What elements of the Code pertain?

• How might the Code inform your analysis or decision?

• If you were that nurse, how would you reason, ethically, about this?

• What arguments would you make for your position?

• In your ethical analysis, what would be acceptable options for action?

• What would not be acceptable options?

Case 1

Jean Thatcher is a 47-year-old single white attorney with multiple sclerosis. She is frequently admitted to the transitional care facility for complications related to her multiple sclerosis. Since she quickly exhausts the patience and best efforts of the staff, she is rotated among several units, all of whom know her well and her inpatient stays on their unit are anticipated with fear and trepidation. The staff's best efforts to educate her about appropriate self-care and preventive practices have fallen on deaf ears. She refuses to cooperate when her support is elicited for bathing, position changes, and the like. Her one visitor, her mother, believes that the staff discriminates against her and complains frequently to administration. Both the patient and her mother frequently threaten to sue the hospital for neglect and discrimination. Jean admits that she is refusing to eat or help with bathing and positioning. She says she has "had enough" and wants to give up. Most of the staff have already given up and ask why they should try to help Jean when she has been clear about not wanting their help. Today, one nurse was overheard saying, "I'm not going to sprain my back trying to get her to move when she refuses to cooperate. It's on her if her skin breaks down." The nurse manager calls a meeting to explore how the team might more effectively and compassionately respond to the challenges of caring for Ms. Thatcher.

Answer 1

1. The patients needs and desires is to get a quality efficient care with out any discrimination and neglect .

2. The needs and desires of others who are involved is that Ms. Thatcher cooperate with them while providing care .

3. The therapeutic relationship between the patient and health care provider is affected in this situation

4. The institutional factors which affect this situation is the inability to manage such kind of patients , or being unaware of how to mould such patients , unavailability of proficient and confident staffs .