J.E. is the Chief Nursing Officer (CNO) of a mid-sized regional hospital.
J.E. is the Chief Nursing Officer (CNO) of a mid-sized regional hospital. One evening, an older person was found unresponsive at a nearby long-term care facility, placed on ventilator support, and transferred to J.E.’s hospital. This person is awake and alert and has end-stage chronic obstructive pulmonary disease and severed rheumatoid arthritis with little likelihood of being weaned from the ventilator. Due to the patient’s long-term chronic diseases and limited prognosis secondary tot he illnesses, the lifetime Medicare reserve days are nearly exhausted.
J.E. has been informed that the prior long-term care facility has no beds for readmission and that other hospitals or long-term care facilities in the geographic area are reluctant to accept transfer of this patient Additionally, there is no family willing to care for the patient at home; the only living family members are two stepchildren who live in another state. They have requested that the patient be transferred to a facility that provides ventilator care. The physician assigned to provide care said, “The most humane plan of care is to take the patient off the vent and allow a peaceful death through comfort care after extubating.” It is anticipated that discontinuation of ventilator support will result in death likely within a week.
J.E. believes there are only two options: 1) extubating as suggested by the hospital physician or 2) continuing care for the patient with the ventilator until death. The stepchildren call the case manager, who refers the call to J.E. The stepchildren are informed about the patient’s status and the two options. J.E. tells the stepchildren that the physicians are concerned the patient has no quality of life. Although J.E. requests consent to extubate, the stepchildren will not consent, stating they want to wait until December 26 to decide. When J.E. asks why they desire to wait and possibly prolong suffering, the stepchildren reply that they do not want to associate the memory of the patient’s death with a holiday. The stepchildren ask how to get someone else appointed to make decisions. J.E. had been informed by the case manager that if a state agency appointed a legal guardian, the stepchildren could not have a say in funeral arrangements. J.E. relays this information to the stepchildren who are upset about no input regarding the funeral, but they ask no other questions.
The stepchildren later call back and consent over the phone to withdraw if support and request to be informed when the patient dies. J.E. is concerned about the phone consent and decides that a consent form would be worded as follows: “We ______ (name) and _____________ (name), understand that if the ventilator is removed, death will likely occur soon, but this is in the best interest of __________ (name of patient).” This consent form is sent electronically to the stepchildren, who sign the form and return it. J.E. then asks the case manager and the primary nurse to sign as witnesses on the form However, the case manager says that the signing had not been witnessed and asks J.E. if a notary should have been involved and a hard copy of the form sent by mail. J.E. replies that electronic consent forms are part of the healthcare world if two people are present. The case manager and primary nurse express concern that the consent could have been coerced and provide for the physician to end the patient’s life. J.E. asks another case manager and nurse to sign as witnesses for the consent form, and they agree. However, the patient’s case manager and other nurses on the patients unit begin discussing possible legal and ethical implications of these actions and ask if a line has been crossed (Morris & Faulk, 2012).
Morris, A. & Faulk, D. (2012). Transforming learning in nursing: A guide for nurse educators. New York, NY: Springer.
Case Study Questions:
1. What factors initially contributed to the development of this situation?
2. Do you believe there were other options besides the two presented? Explain your thoughts.
3. Describe the ethical concerns for each of the following: a) the patient, b) the family members, c) the primary nurse, d) the case manager, e) J.E., f) the physician(s), g) the case manager and nurse who signed a witnesses, h) the hospital as an organization, and i) the healthcare delivery system
4. Who was the advocate for the patient?
5. Was a consideration related to the patient’s condition not discussed?
6. What would you have done if you were J.E.?
Case Study Analysis Rubric
Case Study Analysis Rubric
Criteria Ratings Points
Description
view longer description
Exceeds Expectations
Provided a brief background description of the situation that is being examined and framed the key issues in relation to the participants and stakeholders involved
15.1 to 20 pts
Proficient
Provided a brief background description of the situation that is being examined and framed the key issues
10.1 to 15 pts
Average
Provided a brief background description of the situation that is being examined
5.1 to 10 pts
Novice
Provided a brief summary that did not aderquately describe the depth of the situation
0.1 to 5 pts
Not Achieved
Did not provide a brief background description of the situation that is being examined
0 to 0 pts
/20 pts
Contributory factors
view longer description
Exceeds Expectation
Identified many contributory factors or root causes of the problems consistent with the key issues previously identified, and noted the inter-dependencies between those factors
15.1 to 20 pts
Proficient
Identified many contributory factors or root causes of the problems consistent with the key issues previously identified
10.1 to 15 pts
Average
Identified possible contributory factors or root causes of the problems
5.1 to 10 pts
Novice
Identified some of the possible contributory factors, but missed the most obvious or critical ones
0.1 to 5 pts
Not Achieved
Did not identify the possible contributory factors or root causes
0 to 0 pts
/20 pts
Analysis
view longer description
Exceeds Expectations
Analyzed a number of contributory factors. Used an analytical approach that considers either risk analysis, cost-benefit analysis, or SWOT analysis (strengths, weaknesses, opportunities, and threats)
15.1 to 20 pts
Proficient
Analyzed contributory factors and determined lessons learned and best practices. Considered one or more possible outcomes
10.1 to 15 pts
Average
Analyzed contributory factors and determined lessons learned and best practices
5.1 to 10 pts
Novice
Analyzed some contributory factors, but did not determine lessons learned or best practices
0.1 to 5 pts
Not Achieved
Did not analyze any contributory factors
0 to 0 pts
/20 pts
Recommendations
view longer description
Exceeds Expectations
Offered recommendations or practical courses of action based on the conclusions of the analysis. Considered possible barriers to implementation and ways to overcome them. Considered the potential ramifications associated with the recommended courses of action
15.1 to 20 pts
Proficient
Offered recommendations or practical courses of action based on the conclusions of the analysis. Considered possible barriers to implementation and ways to overcome them
8.1 to 15 pts
Average
Offered recommendations or practical courses of action based on the conclusions of the analysis
5.1 to 8 pts
Novice
Offered recommendations that were not practical, or were not in alilgnment with the factors in the case study
0.1 to 5 pts
Not Achieved
Did not offer any recommendations or practical courses of action based on the conclusions of the analysis
0 to 0 pts
/20 pts
Mechanics
view longer description
Exceeds Expectations
Submitted an outstanding written product using proper terminology, grammar, sentence structure and APA format with NO errors. Avoided very long paragraphs and were logically divided. The syntax and tone of the narrative was consistent throughout the work.
15.1 to 20 pts
Proficient
Submitted an well written product using proper terminology, grammar, sentence structure and APA format with 1-2 errors
10.1 to 15 pts
Average
Submitted an well written product using proper terminology, grammar, sentence structure and APA format with 3-5 errors
5.1 to 10 pts
Novice
Submitted an poorly written product containing greater than 5 terminology, grammar, sentence structure and APA format errors
0.1 to 5 pts
Not Achieved
Submitted a very poorly written product that does not meet the minimum standards of a college scholastic work
0 to 0 pts
/20
NOTE APA FORMAT WITH LESS THAN 5 YEAS REFERENCESS
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.
