Question

Mr. D is scheduled for discharge from the unit. He has a history of schizophrenia and depression. He is homeless. He is morbidly obese and is in an electric wheelchair because of paraplegia. The Case Manager is attempting to find him housing but he says he does not want to spend his money on anything but prostitutes.

Ethical Discussion

Using Scenario Seven, what should the Case Worker do in this situation? What is the ethical dilemma of this situation? How can you intervene as the RN?

Answer 1

SEVEN STEPS IN ETHICAL DECISION MAKING

1. State the problem.
2. Check the facts
3. Identify relevant factors (internal and external factors)
4. Develop list of options
5. Test the options
6. Make a choice based on steps 1- 5
7. Review steps 1-6

PROBLEM SOLUTION

1. Stating the problem - Finding house for Mr. D after his discharge from the hospital
2. Checking the facts - Mr. D who has been suffering from schizophrenia and depression is reluctant to spent money for home stay
3. Identifying relevant factors-

• Internal factors- Schizophrenia & depression, paraplegia, obesity,
• External factors - homeless, using wheel chair

      4. Developing list of options -

• Seek help right away - seek assistance from social agencies who take care for patients at home.
• Promote independence - consider patients likes and dislikes
• Be collaborative - encourage the participation of volunteer agencies, social agencies, community nurses, home nurses
• Encourage self Help - encourage the patient to identify his needs and make solutions of his own in a socially acceptable manner.

       5. Testing the options - the list of options are tested one by one and effective one is applied

       6. Making a choice based on steps 1- 5 - A collaborative approach from the different personnel in the health care agencies is found to be effective.

       7. Reviewing steps 1-6 - if not found effective testing the options once again and continue the procedure.

The main dilemma is that the patients wish is to not to spend money after his discharge but due to discharge the continuity in care is to be maintained either at home or at places where patient can stay comfortably.