An ethical dilemma exists when the right thing to do is not clear or when members of the health care team cannot agree on the right thing to do (Potter, Perry, Stockert, & Hall, 2011). S. Z. is a 65-year-old Hispanic man who was admitted to the hospital for the third time in 6 months, for hyperglycemia. He is now scheduled to be discharged but his daughter pleads with the nurse that she does not want her father discharged because he is non-complaint with his medications and diet at home.
She says she has small children at home and can’t be responsible for him, too. She is worried sick that he is doing this on purpose because he has been so depressed since her mother, who did everything for him, passed away. She says that her father has been seeing a curanderos, who treats him with traditional methods and that he refuses to take his medicine and only follows what the curanderos tells him to do.
She does not agree with this and confides that she hopes to find a way to prevent her father from seeing this person and wants to know if the nurse can have her father’s discharge canceled and to ask the doctor to admit him to a nursing home where they can ensure he eats right and takes his medicine and not the herbs he has been using. Then she pleads, “Please just tell the doctor he won’t take his medicine. ” Many years ago he was diagnosed with Diabetes Mellitus Type II and has been on insulin for two years.
His blood sugar on admission was 589. He is retired and was widowed one year ago. He’s active in his church, gardens, and likes to work on small projects around the house. His medical history includes Diabetes Mellitus Type II, insulin dependent, Hyperlipidemia, and Osteoarthritis.
The three possible scenarios I came up with are 1) to discharge S. Z. from the hospital and go home, 2) to discharge S. Z. to a nursing home, and 3) to delay the discharge and have an in-depth meeting with S.Z. , his daughter, his doctor, his nurse, and a social worker in order to come up with the best solution following his discharge from the hospital, When it comes to a situation that pertains to a patient’s safety, personal lifestyle, habits, and their health post-discharge, it’s best to bring the patient, his family members, his doctor and nurse, and a social worker together to discuss the best possible solutions for post-discharge care.
With the 1st scenario of discharging S. Z.to go home; his daughter may feel responsible for him after he is discharged and may end up resenting him if she is unable to meet his medical care needs due to her own family issues and daily responsibilities. S. Z. may feel like his daughter doesn’t want or need him around which may cause a lot of anxiety. With the 2nd scenario of discharging him to a nursing home; this may make S. Z. feel more depressed due to a loss of independence. He may even start to feel isolated because he will unable to attend his church, tend to his gardens, or work on small projects around his house.
All these things help to keep him in touch with the world as well as keeping his body, especially his hands, nimble. With the 3rd scenario of holding off on the discharge and calling to order a meeting of the minds to further discuss S. Z. s discharge outcomes. There are 5 signs an older person shouldn’t be living alone. The first sign is that the older person is healthy, but cannot safely live alone. Even the healthiest people are prone to slips, trips, and falls, especially when taking certain medications.
Older people have a much higher risk of bone fractures due to progressive loss of bone mass (Scheve, 2013). The second sign is the early signs of Alzheimer’s. This disease commonly presents itself in those who are retirement age and older. The third stage deals with physical impairment or a disease that the family members are unable to provide care for (Scheve, 2013). Some diseases require care that family and friends just aren’t capable of providing for. The fourth stage is a change in personality or lack of proper hygiene.
Difficulties in daily life such as incontinence, changing their own clothes, and fixing their meals can be very daunting and frustrating (Scheve, 2013). The final sign an older person shouldn’t be living alone is when he/she gets to be too great of a burden on the family (Scheve, 2013). The average family is juggling their daily activities and aging parents require demands that outweigh the logistical and financial resources available.
With the 1st solution, the doctor feels confident enough to go ahead and discharge S. Z.to go home and go about his regular routine of going to church every Sunday, tending to his gardens, working on small projects around his house, and even conferring with a curanderos. However, since S. Z. s daughter is adamant about this discharge procedure, we must move on to another discharge solution. The 2nd solution I had for S. Z. is to be discharged to a nursing home.
Having to move into a nursing home can be one of the most difficult times in a person’s life (Harker, 1997). It can be extremely difficult for the patient because they may feel that they are being “put away” which can be very difficult for the family as well.
There’s the worry that their loved one may not be get the loving care they feel they should have. S. Z. may end up feeling isolated because he will no longer be involved in his daily activities of going to his church, seeing his friends, gardening in his gardens, etc. I chose the 3rd solution to delay discharging S. Z. from the hospital and to set up a meeting with S. Z. , his daughter, doctor, nurse, and a social worker so they can put their heads together to come up with a solution for S. Z. following his discharge.
This way, everyone will have the chance to speak their peace while getting pertinent feedback from the rest of the key players. Since S. Z. is capable of understanding his own medical needs and issues, then he should be involved with the decision making process of moving into a nursing home or going back to his home. The Code of Ethics for Nurses helps to answer scenarios like this one. It identifies four primary obligations you must meet to fulfill the contract between nursing and the public (Lachman, 2013).
The four primary obligations are respecting the patient’s privacy and protecting confidentiality, communicating honestly all aspects of the patient’s diagnosis, treatment, and prognosis, conducting an ethically valid process of informed consent, and advocating for the patient’s interests (Lachman, 2013). The best way to decide what’s in the best interest for S. Z. is by taking all these aspects into consideration during the discussion with S. Z. , his family, his doctor and nurse, and the social worker.
The Code of Ethics serves as an excellent baseline to use for collaborating patient information, needs, and desires, the family’s needs and desires, their medical information as coming from the doctor and nurse, and information the social worker can bring to the table. The nurses and other healthcare professionals rely on the code of ethics to assist them when conflicts arise. I believe that having a well thought-out discussion with all those involved and coming up with a solution before discharging S. Z. is in his and his daughter’s best interest.
Harker, J. (1997). Help me: Coping with the nursing home decision. Retrieved form: http://www. alharris. com/harker/helpme. htm Lachman, V. (2013). Making Ethical Choices: Weighing Obligations and Virtues. Retrieved from http://www. nursingcenter. com/pdf. asp? AID=817321 Potter, P. , Perry, A. , Stockert, P. , & Hall, A. (2011). Basic Nursing (7th Ed. ). St. Louis, MO: Mosby Elsevier. Scheve, T. (2013). 5 Signs an Elderly Person Shouldn’t be Living Alone. Retrieved from: http://health. howstuffworks. com/wellness/aging/elder-care/5-signs-elderly-living-alone. htm.
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