Question

Provision 2: “The nurse’s primary commitment is to the patient, whether an individual, family, group or community.”

In a changing medical world that is continually advancing and demanding more from all involved, priorities can get mixed up and patients can be forgotten. Consider the following two scenarios.

Scenario 1: A 10-year-old child has suffered a motor vehicle accident. Due to multiple traumas associated with the injury, the patient is now ventilator-dependent, G-tube dependent, and shows little activity on the EKG beyond consistent seizures. (This means the patient cannot breathe on his own, cannot eat on his own, and brain testing shows little activity, but confirms frequent seizure activity). The mother of the child is ready to withdrawal care for palliation purposes. The father is committed to providing every medical intervention possible to sustain the child’s life.

Question #1 Who is the nurse responsible for in this scenario, the patient, the parents, or both? Who is “right” in this scenario, the mother or the father? You must pick a side and build an argument to support your answer, credit will not be given if you do not pick a side, and there is no middle ground. Can the nurse be truly objective in this situation? How could the emotions of the nurse affect patient care?

Scenario 2: A 17-year-old patient has Duchenne muscular dystrophy complicated with multi-organ failure. The patient is neurologically alert but again has entered multi-organ failure. From a medical perspective, there is no way to save the patient’s life. The 17-year-old patient will die soon. The parents have decided to not tell the patient about the decline in his condition. Instead, they have asked the medical staff to stay upbeat and optimistic, encouraging the patient to work toward getting better.

Question #2

Is the nurse ethically obligated to tell the patient about the decline in his condition, or is the nurse ethically obligated to honor the parents’ wishes? Again, pick a side, build an argument, and articulate your perspective.

Answer 1

SCENARIO (1)- QUESTION # 1:

A)The nurse in this scenario is responsible for the patient, because the 10 year old child cannot breathe on his own without a ventillator support,and fully depend on the nurse to meet all his needs like feeding ,hygiene,positioning etc.

B) The father is right in this scenario; because

ARGUMENTS:

* The child is 10 years old and his brain is not completed development,brain development will continue up to around 25 years ,SO THERE IS A CHANCE FOR THE CHILD TO RECOVER AT LEAST PARTIALLY WITH GOOD CARE.

* .His brain testing shows little activity which may improve later on  time and frequent seizure activity shows there are electrical impulses generated from brain cells ( it can be good or bad sign ).SHOWS HE IS NOT BRAIN DEATH).

* As the mother suggested ,if we withdraw the care like ventillatory support the child will die immediately and it is like not given a chance for him to try.

* It is not ethical to withdraw the life saving support like ventillatory support and other care,the patient has all the right to get all possible care since he is only 10 years.

C) The nurse cannot be fully objective in here

D) The emotions of the nurse will surely affect the patient care;

* Many times it is seen that when the patient is unconscious and the nurse who takes care is really with positive attitude and determination for taking care of that particular patient,surely it will bring positive result and improvement.

*When taking care of patients like this ,if the nurse is really feels empathy and concern for the patient,can provide better care and easily and immediately identify even mild improvements in patient like moving extremities,eyeballs etc .It will further give hope for continuing care.

** SO PROVIDING EVERY POSSIBLE MEDICAL AND NURSING INTERVENTION MAY HELP THE CHILD TO LIFE WITH SOME IMPAIREMENTS.

*If the nurse feels taking care of this child will not produce any positive result,and give care there is no chance of improvement.

SCENARIO 2)

QUESTION # 2)

* The nurse is ethically obligated to tell the patient about the decline in his condition.

Argument:

*The patient should be told it is disease with no cure and only sympomatic relief.

* The patient is 17 years old and able to understand his state of health.

* He has the right to know about his health issues.

* Even if the medical staff is encouraging him to work towars getting better ,the disease has progresed and reached to a multi-organ failure and it is not possible to cure.

*Explaining about his condition and helping him to accept it is better than hiding.

* Once he is aware and understand his condition ,it is easy to live with and accept it and he can be prepared for a hospice care .

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