AUTONOMY

Ethical Dilemmas in Nursing

Case 2 (AUTONOMY)

The Registered Nurses and Licensed Practical Nurses staffing a rural nursing home must weigh the ethical considerations involved in deciding whether to apply mechanical and chemical restraints against the apparent wishes of their residents. 

.

Description of the Case

Olive is 88 years old, alert but forgetful, and unsteady on her feet. She has fallen in the past, and the nurses have become increasingly concerned that she may injure herself so seriously (breaking her hip, for example) that she might never walk again. The nurses’ requests that Olive call them to walk with her have not been successful. Now they suggest that Olive wear a belt tied around her waist and around her chair in order to remind her not to get up without someone to walk with her – and to prevent her from getting up unaided. Olive objects. She is unwilling to give up her ability to move about the home as she chooses. Though her nurse, Sharon, persuades her to accept the belt on a trial basis, Olive is clearly unhappy. 

In another scene, the staff are discussing a different resident, Helene, who is able to walk well, but is quite confused. Helene has been admitted at the request of her family, who live several hundred miles away, and whose efforts to have Helene live with them failed when she wandered away from their home several times. 

Helene has been living alone. Because of her increasing senility and her physical needs, the city Social Services can no longer adequately support her at home. She arrives at the nursing home malnourished, poorly clothed and unwashed. The home has agreed to accept Helene on a trial basis but, despite her confusion, she is clearly unhappy there, and she objects loudly to the mechanical restraints which would keep her from wandering off the grounds and getting hurt or lost. She has also created a serious disturbance for the other patients, because of her screaming and wandering into their rooms. Thus she must be constantly attended by nurses or aides. 

The nurses wonder whether they should try chemical restraints (medication) which might calm her down and make it possible for her to stay. They are concerned about her safety if she returns to living alone, or if she is admitted to a state mental health facility, yet they are also concerned about having to keep her in the nursing home against  her will.

Questions for Discussion:

How would you deal with the situation Sharon confronts? Do you feel it is right to restrain Olive under these circumstances? If Olive were to fall when unrestrained, would you consider the nursing staff responsible?

Do people have a right to determine their own behavior, even if it may result in harm to them? What about behaviors like the use of alcohol and tobacco? What about suicide? 

Are there any other ways to deal with Olive’s situation besides physical restraint? What about round-the-clock care: would that be better or worse for the patient? Would it increase her autonomy or merely decrease her privacy? Is such care realistically possible? 

In the second part of this case, nurses must consider the use of chemical restraints, which may cause personality changes and other side effects. Do you think this is justified? In what kinds of cases do you think it is or is not justified? 

In Helene’s case, a balance must be drawn between her rights and those of the other patients she is disturbing: can you think of other situations where one person’s rights must be weighed against those of another? 

Would the use of behavioral modification programs for either Olive or Helene be a morally better solution? Why or why not, and under what conditions?

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.