Question

Case study 1

Janine works as palliative care nurse at a regional health facility and relates the following conundrum. Janine describes looking after Jack who recently returned to the palliative care service after a further unexpected exacerbation of his respiratory lung cancer. Jack is rapidly deteriorating with little tolerance for any activity and cannot undertake any activities of daily living. Shirley, his wife is constantly at his side offering as much support as possible. Jack is highly dependent and has several HCP ‘s attending to him including physiotherapists, doctors, nurses, occupational therapist and other allied health workers including kitchen and cleaning staff. Jack received care for the past 6 days at which time he was in and out of consciousness and his lucid moments were characterized by confusion due to his severe low oxygen saturation rates. Whilst confused he tried to leave or get out of bed and required constant supervision, and at night restraint. Shirley was at his bed side frequently. Shirley in conversation with Janine, complements her and the team on the care that Jack has received, and reminisced with her and over the last few weeks they had spent together on a cruise to New Zealand and surrounding Islands. Janine realize that cruise was associated with a severe outbreak of COVID19. Janine asks Shirley, “why didn’t you let us know of your trip”? Shirley states that if she did, she might not have been allowed to see Jack. Subsequently, Shirley was not allowed to visit Jack, Jack died 2 days later. His pathology result was positive for COVID 19. Janine has explained the issue to all the staff associated with the care of Jack. The paramedics who cared for of Jack were also informed of his infective status prior to his death.

Related to this case study now analyses and apply ethical concepts, principles and professional standards.

Answer 1

Jacks's pathology results was positive for COVID19.

The following ethical concepts and priciples are applied.

1. Justice - Janine was taking good care of Jack and there were no complaints registered against her.
2. Beneficence - All HCP's did good and right thing for the patient and COVID19 was properly identified to take necessarry action.
3. Non- maleficence - Jack was treated wihout any harm
4. Fidelity - all HCP's were took good care of Jack
5. Veracity - Janine was truthful with Jack and his family

The following professional standards are carried out in order.

Step 1

First thing is to determine all individuals who had close contact with Jack. A Close contact is defined as any individual within six feets from the person who tested positive for COVID19 atleast 15 minutes.

It is clear that Jack had close contact with the following persons

1. Shirley - Jack's wife
2. Janine - Palliative Care Nurse
3. Other HCP's - Physiotherapists, Doctors, Occupational therapists and other allied health workers including kitchen and cleaning Staff.

Furthermore we have to identify, whether there are more close contact individuals other than the above. This can be done by tracking the route map of Jack and Shirley from the trip to their home back. It is very important to identify all close contact individual with confirmed positive person during the exposure period. Exposure period starts 2 days before Jack had symptoms and end at which he was confirmed positive for COVID19.

Necessary informations are collected of all the individuals who have been identified as close contact such as:

• Name
• Age
• Address
• Phone Number
• Last visited Place
• Languages Spoken
• List of all individuals who are in close contact

Step 2

All identified individuals are advised to take a full 14 days quarentine starting the day Jack was diagnosed with COVID19 and in contact with the respective person(which is within the exposure period). Close contacts who are diagnosed with symptoms of COVID19 are immedietely taken for test. Close contacts who do not show symptoms were not tested intially, but a test should be carried out for every 7 days and even if the result came negative they have to comlete a full cycle of 14 days isolation.

All persons who are tested positive and showing severe symptoms is immedietely treated with fever reducing medication and continously monitored for improvement. If they are not showing symptoms, they are instructed to follow the general isolation protocol until their test results return negative.

Step 3

All identified individuals who are NOT close contact are advised to self monitor the symptoms for 14 days and if they may develop symptoms they have to contct their health care personnels.

Step 4

All cases are reported and documented for future references and should be maintained confidential abiding the law. Any death, critical conditions and recovery should be properly reported to maintain a good practice of record keeping.

Step 5

Jacks's home, his room when he was admitted to the hospital and the neighborhood is advised to disinfection and any further transmission is prevented by using PPE's, practising social distancing and using sanitizers.