3. A Case study on Nursing Care Standards and Patient’s Autonomy…

Question 3. A Case study on Nursing Care Standards and Patient’s Autonomy… 3. A Case study on Nursing Care Standards and Patient’s AutonomyBill Z., a 6-foot and 3-inch, 135-pound, 76-year-old retired college professor was admitted to a medical unit in a large metropolitan hospital. He had been diagnosed 6 months previously with metastatic cancer that had spread from his lungs to the liver, gastrointestinal (GI) system, and bones. He had received some chemotherapy but with little effect. He was admitted to the hospital because he had become too weak to walk or care for himself at home and because the large doses of oral narcotic medications were having little effect on his generalized pain. His physician had decided that further chemotherapy would be useless and ordered Mr. Z. to be kept comfortable with medications. A continuous morphine sulfate intravenous (IV) drip was started to help control the pain. Although he was talkative and friendly by nature, as Mr. Z. ‘s cancer spread, he would cry out and beg the nurses not to move him. Because he was very tall and underweight, his bony prominences quickly became reddened and showed signs of breakdown. The facility standards of care for bedridden patients required that they be turned from side to side every 2 hours. Mr. Z. yelled so loudly when he was turned that the nursing staff wondered if they were helping him or hurting him.To decide what should be done, a patient care conference was called by the nurses most often involved in providing care for Mr. Z. The head nurse of the unit stated very clearly that the facility standards of care required that he be turned at least every 2 hours to prevent skin breakdown, infections, and perhaps sepsis. In his already weakened condition, an infection or sepsis would most likely be fatal. Melanie F., who had been a registered nurse (RN) for 15 years, disagreed with the head nurse. Her feeling was that causing this obviously terminal patient such extreme pain by turning him was cruel and violated his dignity as a human being. She stated that she could not stand to hear him yell anymore and refused to take care of him until some other decision was made about his nursing care. Susan B., a new graduate nurse, felt that the patient should have some say in his own care and that perhaps some type of compromise could be reached about turning him, even if less frequently. Ellen R., who had worked on the unit for 2 years, felt that the physician should make the decision regarding turning this patient and then all the nurses would have to do was follow the order. This last suggestion was met with strong negative comments by the other nurses present because patient comfort and turning are nursing measures. What should they decide in this case? Violation of a standard of care can leave a nurse open to a lawsuit. What about the patient’s right to make a decision when this violates a standard of care? Are there ever any situations where a nurse might legally and ethically violate a standard of care? What are the consequences? What are the sources? List the possible alternatives and consider the ethical principles and values.  Health Science Science Nursing Share QuestionEmailCopy link Comments (0)