Question

Tom Denton, a young adult male, is brought into the emergency department with a GI bleed. He is vomiting blood, hypotensive, pale, and diaphoretic, and his pulse is weak and thready. He is alert enough to hear Sharon Hynes, the ED physician, order a type and cross for four units of blood. Mr. Denton interrupts and states that he does not want the blood transfusion because of personal beliefs. Dr. Hynes orders volume-expanding agents to be used instead. Mr. Denton’s wife Melissa arrives not long before he loses consciousness, and they discuss the use of the volume expanders versus blood transfusions. She agrees with his decision and tells him she loves him. He tells her he loves her also.

Mr. Denton has slipped into a coma. Mrs. Denton is crying and begging her husband not to leave her. The staff members continue to treat the client with the volume expanders, but there is no significant improvement. Dr. Hynes speaks to Mrs. Denton and asks whether she has changed her mind.

Mr. Denton’s minister arrives, and Mrs. Denton and the minister discuss the situation. They agree that the situation has been handled according to Mr. Denton’s beliefs. Mr. Denton dies, and Mrs. Denton states, “He died as he believed; God’s will has been done.” Members of the ED staff are overheard saying things like “He was too young to die” and “If only they had allowed the blood transfusion.”

Question 1

What should the nurse do to help Mrs. Denton now?

Question 2

What resources are available to help Mrs. Denton?

Question 3

What should the staff members do to help deal with their own feelings?

Question 4

If the client in the case study had been 10 years old and the parents had made the decision to treat with volume expanders only, with the same results, what would have been the staff’s responsibility?

Question 5

What ethical and legal issues would be involved in the decision-making process in this situation?

Question 6

How would you assess the needs of the young client and his family?

Answer 1

Que 1: What should the nurse do to help Mrs. Denton now?

Answer:

As we know the lovable bond shared by Mrs. Delton with her husband from the given data, it was a very sensitive and devastating situation for her to accept her husband's death. Whenever a nurse is undertaking the care of a patient, her/his primary commitment is with the patient and the patient's family too.

In such a scenario, the nurse should try to calm her down first. After giving some time to her to accept the fact, it is preferred to provide counseling therapy based on her response. The nurse should try to give her emotional support in the form of empathic understanding, clear and honest communication that death is inevitable, we can't help it. Whatever was possible, we tried it. She should ask her about other family members if they have any so that they will help her emotionally and mentally.

Que 3:What should the staff members do to help deal with their feelings?

Answer: Being in the medical profession, it is common to see someone's death. But humans being an emotional creature, it is not abnormal to feel emotional in such a deadly scenario of her husband's death.

The nurse might have these feelings in their mind. First, Mr. Delton could be saved if they would have allowed for blood transfusion. Secondly. the patient they were treating is no more.

When we talk about the Codes of Ethics mentioned by ANA, amongst the nine provisions, one provision suggests respecting patient's beliefs and attitudes is a must and the nurse did it too.

Another provision suggests that the nurse should be physically, emotionally, and mentally strong person to treat the patient effectively.

So for such a situation, the nurse should be mentally prepared so that he/she can support Mrs. Delton.

Question 4

If the client in the case study had been 10 years old and the parents had made the decision to treat with volume expanders only, with the same results, what would have been the staff’s responsibility?

Answer:

It is must respect the beliefs and attitudes of the patient but it is also necessary to mention what would be the consequences of these beliefs if upheld. If parents are not ready for blood transfusion and convince for volume expanders, healthcare professionals must tell them all the possibilities that can happen. After providing volume expanders with no improvement, parents should be asked again for their decision. They must be counseled and made them understand that child is too young, we can save his life just by a change of one harmful belief. Even after explaining this to parents of the patient, they are not willing for blood transfusion, then it is the healthcare professional's duty to respect the parent's decision.

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