Advocavy Paper: Describe The Clinical Situation Concisely And Descriptively (Case Study Sample)
below were the instructions
Choose a patient-care situation in which the RN should intervene and advocate for the patient. An example of such a situation might be when a patient has not been given complete informed consent.
Include the following in your paper:
Describe the clinical situation concisely and descriptively. It can be an actual situation or a hypothetical one. Apply the Bioethical Decision Making Model Click for more options to the specific clinical ethical situation that you choose. Address each section of the model in your paper. Conclude with a discussion of nursing advocacy in the clinical setting and the nurse's role as a patient advocate.
Mr. Leary is 76-year-old and had his first stroke three months ago. It was severe but he was making progress when he suffered a second stroke. After this, he was quite depressed and aphasic with left-side paralysis. Three weeks ago he suffered a third stroke. While it worsened his physical condition, this third stroke seemed to improve Mr. Leary's mood. He became cooperative and careful, even attempting to assist with his shaving each morning. Although he has no swallow reflex, he has a Keofeed tube in place to administer nutrition and hydration. His physician wrote that his prognosis for survival was probably less than a year due to the probability of continued cerebral events, but he might live as much as three to five years.
Mrs. Leary is overwhelmed. Two nursing homes have been located by the social worker but she refused each, one was too far from her home which is 75 minutes-drive and one was too not friendly, the social worker concurred. In the three months of hospitalization since Mr. Leary's first stroke, he has occasionally had a no code order. However, when his condition stabilizes he is changed to a partial code. Although the discussion was not recorded in the chart, these changes apparently follow the discussion between the physician and Mrs. Leary. The nurses overheard conversations between the doctor and Mr. Leary's wife regarding the appropriateness of aggressive care.
On Thursday, a representative from the hospital business office approached Mrs. Leary to inform her that on Monday Mr. Leary would be decertified by Medicare and that she would be responsible for hospital charges as of that date. On Friday Mrs. Leary called the physician and asked that the Keofeed be withdrawn, something both Mrs. Leary and physician had discussed on other occasions but which Mrs. Leary had previously refused. The physician phoned the unit and left a verbal order to remove the Keofeed tube from Mr. Leary, discontinue feeding, and not to attempt resuscitation. The nursing staff was very upset and called the physician back to discuss the order. He stated that "this is congruent with the patient's stated values prior to the first stroke. The patient asked me not to overdo it." The Keofeed tube was removed from Mr. Leary on Friday afternoon, although the nurses remained very distressed.
On Sunday morning, the patient reached for a glass of water while leaning by the bedside for mouth care apparently from thirst and aspirated. By Monday pneumonia was evident. Over the weekend arrangements have been made to transfer the patient to home to be cared for by his wife. Mrs. Leary was nearly hysterical. She had not been participating actively in her husband's care and now realized that she is physically unable to provide total care including turning, positioning, etc. Mr. Leary was discharged to the home Monday afternoon significantly febrile. He died late Monday evening.
Bioethical Decision-Making Model
In this section bioethical decision-making model will be discussed in regard to the Mr. Leary situation (Levine-Ariff, J. & Groh, D.H. (1990). Mr. Leary was suffering from successive strokes which made his left-side dysfunctional. Even though his condition had stabilized, he needed aggressive care. The nursing staff was in the dilemma on whether to remove Keofeed tube as the physician had directed or not because there was no patient consent. Ethically, the nurse was intervening while advocating for the patient who had not given direct consent (“Introduction to Ethics”, 2018). However, the
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