Reference no: EM133864940

Assignment:

You are the charge nurse on a skilled nursing unit at the local long term-care facility caring for Mrs. Charlotte Boyer, a 91-year-old resident who had a stroke 6 months ago requiring placement in the facility. She requires assistance with hygiene and mobility needs, is unable to feed herself, has difficulty with speech and swallowing, and must be constantly monitored for aspiration. She has recently had an incident of aspiration pneumonia. Prior to this event she lived independently and was active in her community. For the past few days she has been refusing her meals, becoming agitated and angry during feedings. The primary care provider has recommended placement of a IEG tube for enteral feedings to maintain and adequate nutritional status. Her son is in favor of the feeding tube and states, "Not feeding mother is cruel and the tube is the right thing to do.

Not feeding mother is almost like killing her. I do not think we should play God." The daughter is ambivalent about the feeding tube in that she is aware that her mother would n to have wanted artificial measures, including a feeding tube to keep her alive. In addition, she feels that her mother's decision to refuse food indicates and attempt to be in control of her own life. She states, "I think I know how she feels and it's almost like the golden rule - do unto others as you would have them do unto you." The children share the power of attorney and power of healthcare for their mother. They have asked you to help them work through this decision-making process and the daughter state, "We need a tie-breaker, as we are at odds as to what to do."

Take a moment - Independently from your group mates, identify assumptions and biases that you possess. Identifying assumptions (things taken for granted as true) and biases (lack of impartiality) is a part of critical-thinking that may affect decision-making.

1. Discuss why changes in societal factors have contributed to the frequency of ethical problems for nurses in today's healthcare environment.

2. Discuss how each of the following concepts is integral to this patient care situation:

• Autonomy
• Nonmaleficence
• Beneficence
• Veracity

3. Based on the comments/perspectives of each of the adult children, identify which Kohlberg's stage of moral development is being exhibited by each. Explain.

4. Using the description of the terms, describe your own beliefs, attitudes, and values regarding this situation.

5. Discuss how the moral framework of Ethics of Care would direct your approach to the care issue.

6. How does the American Nurses Association Code of Ethics provide a foundation for ethical decision-making in this situation?

7. Using the assessment/analysis step of the nursing process, describe the problem and alternative approaches for the situation. Next, use the MORAL Model (a good website - to work through the situation to come up with alternative approaches for this family situation.

8. As an advocate, your first priority is to the patient. You have identified the nursing diagnosis of Moral Distress for this patient. What defining characteristics are present in this situation?

9. Discuss your role as patient advocate in this situation and identify appropriate evidence-based interventions that encompass the needs of both the patient and the family.