Read each Physical Therapy case scenario and answerer each question for each case, in your opinion Case 1: Gloria Carpenter is 68 years old and in…

Question Answered step-by-step Read each Physical Therapy case scenario and answerer each questionfor each case, in your opinion Case 1:Gloria Carpenter is 68 years old and in the early stages of Alzheimer disease. She lives at a skilled nursing and assisted living facility. Sandra is one of the physical therapists at the facility, and she has developed a friendship with Ms. Carpenter. Following Ms. Carpenter’s admission, Ms. Carpenter’s son, Adam, initially visited her three to four times a week, but slowly the visits tapered off to approximately once a week. On the week of Sandra’s birthday, Gloria gave her a check for $40 as a birthday present. Gloria instantly thanked her, but stated that the staff was not allowed to accept gifts from patients. She said this knowing that, in some circumstances, if the amount was small and if it is reported to the head of the department, gifts were sometimes allowed on a case-bycase basis. But the “never accept a gift” policy was just so much easier to defend that Sandra felt justified in using it, as she had done in the past with other patients. Ms. Carpenter was adamant. She pointed out that she could not get out to personally buy her a gift, and it was a small amount of money, given that she had a small fortune in savings. Seeing how hurt Ms. Carpenter looked, Sandra thanked her and promised to buy herself something special with the money. About a month later, when Sandra approached Gloria’s room, she overheard Adam addressing his mother in an angry tone. Sandra discovered Adam told Gloria that he was selling her house because there was no money left to take care of her. As her conservator, Adam had the legal right to liquidate real estate holdings to pay for her care. Sandra asked her about the “small fortune” she had mentioned earlier. Gloria said she had no idea what happened, but now she suspected that Adam had used it to “tide himself over” through prolonged unemployment. Sandra had seen family members “borrow” from clients before, but this time it passed over a threshold of reasonableness that she could not witness silently. However, because of the unreported gift and her patient’s Alzheimer diagnosis, she was unsure how to proceed. Points to consider: [The content offered is not intended to be complete. These are merely ideas to help stimulate options that are more creative.1. Moral reasons: What are the obligations and virtues that this case brings into focus? Sandra’s duties are guided by both her role as a provider and as a friend to Ms. Carpenter. Ms. Carpenter’s rights spring from her role as a patient, a parent, and a person in need of extra protection. 2. Facts: What are the morally relevant facts in this case? Who are the major stakeholders? What are the applicable federal, state, or local ordinances that might apply? Gloria violated the institution policy by not reporting the gift. Ms. Carpenter may be correct about having a small fortune, and she would not know how it was being diminished if her son had left her account open to both of them but with bank statements going to him only. She may also be simply mistaken and may be remembering a time years ago before the recession. 3. What are the realistic options, and what are the likely outcomes for each one? Sandra might consider the following options. a. Report her concerns to her department chairs and hope the gift does not surface. b. Report to Adult Protection Services and provide what documentation she can in terms of conversations and events she has witnessed. c. Remain silent and hope for the best. d. Have Sandra reported for not disclosing the gift and explain Sandra’s concerns for Ms. Carpenter. e. Report anonymously to Adult Protective Services. 4. Deliberate and make a decision: On balance, which option will most reasonably balance and integrate moral reasons? 5. Take action. 6. Review the process and outcomes and look for ways to improve the process Case 2Vanessa Hardgrove has four children ranging in age from 3 to 14 years and a husband who is a successful but underpaid account executive. Vanessa is a registered nurse and, in addition to her duties as a mother, she works a full shift each day. Vanessa has spoken with her husband on several occasions about how overwhelmed she feels with the demands of the house, children, and work. She has suggested a housekeeper once weekly and a babysitter one night a week to give her some rest and relaxation time. He responds that he feels certain he will receive a substantial raise in the near future, but now they simply do not have enough money. Vanessa’s work performance takes a slow but steady turn for the worst. Her peers mention to each other that she looks exhausted all the time. She has begun to forget commitments she makes to her children. She has forgotten to give medications to patients. She has dull migraine headaches. Out of desperation, she starts taking pain medications intended for patients. She records the medications as given to patients and then takes them herself or takes them home for later use. Her work performance improves. She sleeps well at night, and the migraines are under control. Her peers talk about her improvement in attitude and patient care. Howard is the physical therapist for the floor where Vanessa is a nurse. Some of his patients do significantly better in their therapy if they get mild pain medications prior to treatment. Some inevitably say they have not received medications when in fact they have. The effects of the hospital-unfamiliar faces and schedules, side effects of the medications-often make patients unreliable. But even with these allowances, Howard notices that the complaints of pain and the denials that they have received their medications are significantly higher on this floor, and almost all of the complaining patients are under Vanessa’ s care. Howard reports his suspicions to his boss, Andreas, who talks with the nursing supervisor, Lynn. Lynn responds that it is probably just a coincidence, but nonetheless agrees to talk with Vanessa. Lynn calls Vanessa into her office and tells her the observations that have been brought to her, including the suspicions that she is taking patient’s medications for her own use. Vanessa immediately breaks down and cries. She says she knew it was wrong but she was so desperate for something to make the stress bearable that she made a terrible mistake. Lynn tells her about the employee assistance program, which offers a drug rehabilitation program, and asks her if she would like to enroll. Vanessa agrees. Lynn goes on to explain that Vanessa will be suspended without pay until she completes the program. The following week Lynn talks with Andreas about what occurred and the course of action she has taken. He seems to support her, but the next day Andreas contacts the chief executive officer, the head of human resources, and the head of the legal department to discuss Lynn’s decision. Andreas explains that what Vanessa did was illegal and should result in permanent dismissal and that a report should be made to the licensure board for nurses for additional remedy. Lynn responds by saying that the policy manual makes the employee assistance program available to all employees. Andreas responds that the same policy clearly states, in compliance with state law, that rehabilitation programs do not have to exclude other disciplinary actions, including dismissal. Lynn says that she sees this problem from the perspective of a disease. Vanessa should be protected by the Health Insurance Portability and Accountability Act as well as by state law, which binds an employer from giving out confidential information. Andreas restates his position that nothing in policy prevents dismissal and, at a minimum, dismissal is the only defensible course of action. The hospital’s primary responsibility is to its patients, not its employees, and patients either were or could have been seriously harmed. Lynn responds that the hospital had dual commitments to patients and employees and this requires a balanced course of action, which is what she pursued.Points to consider: [The content offered is not intended to be complete. These are merely ideas to help stimulate options that are more creative.] 1. Moral reasons: What are the obligations and virtues applicable in this case? Vanessa’s duties to her patients and their reciprocal rights are critical. However, employers have duties to employees as well as expectations for employees to honor their rights as employees. An understanding of the nature of addiction as a behavior choice or as something more complex with components that make a person less than competent are at the core of this case. 2. Facts: What are the facts in this case? Who are the major stakeholders? What are the applicable federal, state, or local ordinances that apply? Vanessa admitted to taking drugs intended for patients and using them for herself. The physical therapist reported his suspicions because of poor patient performance secondary to pain levels that could have been avoided with proper medications. The head of physical therapy perceives this as a legal violation justifying dismissal and a report to the licensure board. The head of nursing sees this as a medical condition with rehabilitation as the desired outcome. 3. What are the realistic options, and what are the likely outcomes for each one? a. Report Vanessa to the licensure board and to the police, and dismiss her from employment. (This will certainly end her nursing career and may result in criminal charges and civil charges if patients charge that they were harmed.) b. Let Vanessa enroll in the employee assistance program and dismiss her from employment. (Because her participation in drug rehabilitation will be protected by most states’ laws and as employers have duties of confidentiality about employees, Vanessa will probably be free to seek employment elsewhere without obstruction. The next hire to replace her may be someone in an identical situation.) c. Enroll Vanessa in the employee assistance program and suspend her without pay until the program is completed; then reinstate her under probationary conditions that include random drug testing. (This may protect patients and salvage her professional career.) d. Enroll Vanessa in the employee assistance program and keep her employed with closer supervision. (This demands fewer organizational resources, but it might not offer a completely safe environment for patients.) 4. Deliberate and make a decision: On balance, which option will most reasonably balance and integrate moral reasons? 5. Take action. 6. Review the process and outcomes and look for ways to improve the process Case 3 On July 5, Bonnie was at home cleaning up from the celebration the day before. It was an office party. Everyone had been served great food and there was a firework display visible in the backyard. Bonnie was exhausted. At about 2 p.m., she felt anxious, had shortness of breath, and experienced heart palpitations. She called her husband, who told her that it was probably because she was overtired. Nevertheless, he told her to take no chances and call 911. Within minutes, the paramedics arrived and performed several tests. They could find nothing wrong and told her it was probably an anxiety attack. Two hours later, the same symptoms occurred, so she called her husband again. Again, he said take no chances and call 911. This time the paramedics found her unconscious and not breathing. They performed manual cardiopulmonary resuscitation on the way to the hospital, where she was placed on a ventilator. In the emergency room, she was examined by a neurologist, who pronounced her “brain dead.” Bonnie was transferred to the intensive care unit until her husband arrived. Her husband brought their four children with him to the hospital, and he was soon accompanied by Bonnie’s large family. A second neurologist was called in, and he too pronounced her “brain dead.” However, the message the second neurologist gave the family was that her chances of recovering were not good. Bonnie’s husband decided that they should disconnect the ventilator, but as soon as Bonnie’s family heard this, they talked him out of the decision. After all, the physician had said her chances were not good, but not impossible. Her primary care was being provided by the physician, the nursing staff, and the physical therapy staff. There was considerable conflict. The physical therapists and the nurses believed the physician was not being clear about her prognosis and was giving the family false hope. The physicians kept writing orders for physical therapy, conducting tests, and prescribing medications. Bonnie’s kidneys had begun to fail, as had her liver. The interventions continued to get more and more complex and invasive. The physical therapists pointed out that Bonnie met the Harvard Criteria for brain death: she was not responsive to noxious stimulus; there was no movement and no breathing without the respirator; they could detect no brainstem reflexes; her electroencephalograph was flat; and she remained unchanged for more than 24 hours. The physician claimed he was following the Uniform Determination of Death Act published in 1980 and accepted by the state, which cites only two conditions: either irreversible cessation of the entire brain including the brainstem or irreversible termination of circulatory and respiratory functions. Because her heart was still beating, it meant to him that some part of the brainstem survived, and they should continue treatment. The dissension became so pronounced that the vice president of rehabilitation met with the medical chief of staff to see if some more consistent message could be given to the family. No progress was made. Physical therapists still attended Bonnie, but their notes were consistently about her non- responsiveness. The husband and Bonnie’s family grew more and more antagonistic to each otherPoints to consider: [The content offered is not intended to be complete. These are merely ideas to help stimulate options that are more creative.] 1. Moral reasons: What are the obligations and virtues relevant to this case? There are duties to patients that extend to their decision makers when the prognosis is grim. Beneficence can become maleficent when applied inappropriately. Administrators have duties to patients but also to employees. However, which duties are most important? Are family rights being addressed? 2. Facts: What are the facts in this case? Who are the major stakeholders? What are the applicable federal, state, and local ordinances that might apply? Most reasonable people following the standard of brain death would relay the message that the prognosis was profoundly negative. The surviving family has split concerning preserving life at all costs and terminating life. The medical staff is split over futile care and optimistic care. 3. What are the realistic options and what are the likely outcomes for each one? a. Administration can recommend transfer of the patient to another physician in the hope that the other physician will present a more accurate picture to the family. (Physicians may well stick together and refuse to accept a transfer out of respect for the “offended” physician.) b. No institution is mandated to provide futile care, but that determination will in part be defined by the policies in place. (It appears that no such clear guidance exists in this case.) c. Physical Therapy and Nursing can express their professional opinions in their respective domains without clearance from the physician. They must be careful not to make a diagnosis, but they can describe their history in similar cases. (This may further divide the professional staff, and there is no guarantee the family will coalesce with conflicting information.) 4. The staff can wait for more vital systems to collapse, leading to eventual cessation of all physiologic functions. (This might take time, and the divisions between family members and professional staff may grow even greater.) 5. Deliberate and make a decision: On balance, which option will most reasonably balance and integrate moral reasons? 6. Take action. 7. Review the process and outcomes and look for ways to improve the process Health Science Science Nursing NURSING 300 Share QuestionEmailCopy link Comments (0)