Reference no: EM133855170

Case study 1: Talking About Death

Mitch is a 10-year-old with leukemia, which, after considerable treatment, is now considered a terminal condition for him. In the 2 years since his diagnosis, his parents and other family members have focused on being optimistic around him and have asked his healthcare professionals to do the same. No one has discussed with Mitch the possibility that he might not survive his leukemia. Registered Nurse Teresa is Mitch's primary nurse during his current hospitalization for an infection. Teresa has developed a good relationship with Mitch and his family during previous hospitalizations. Mitch now seems depressed and uncommunicative. His family is still avoiding directly talking with Mitch about his deteriorating condition and impending death. Teresa asks Mitch's mother about the circumstances surrounding Mitch's decreased communication. His mother responds, "Do you think he knows he is dying?"

Case study 2: Withdraw Nutrition and Hydration?

Baby Sherman is a neonate admitted to the neonatal intensive care unit (NICU) at the county hospital where you work as the NICU nurse manager. Mrs. Sherman had an amniotic fluid embolus during her delivery, and Baby Sherman experienced anoxia. Consequently, Baby Sherman had an Apgar score of 0 at birth. The baby was resuscitated but remains unconscious. All of the baby's organs experienced hypoxic insult. Baby Sherman was placed on a ventilator, and parenteral nutrition was later initiated. Mrs. Sherman is physically very weak and experiencing grief, along with her husband, over the condition of their infant. They have two other young children, aged 2 and 5 years. Baby Sherman has been weaned from the ventilator but has remained unresponsive. Mr. and Mrs. Sherman have requested that the hospital staff discontinue their infant's nutrition and hydration. The NICU medical, nursing, and social work staff members have not previously experienced a situation quite like this one.

Questions for case study 2

1. You are meeting with the neonatologists, the NICU charge nurse, the infant's primary nurse, the hospital chaplain, and the social worker in the NICU. What do you contribute to the group's discussion regarding how you believe the staff should proceed in providing the best care for Baby Sherman and her family?

2. How do the Baby Doe rules affect this case?

3. One of the staff RNs comments, "I think the mother and father are being selfish about their request to withdraw nutrition from Baby Sherman. I think it is selfish because they don't want to be bothered with taking care of her at home." How do you address these comments?

4. Which surrogate decision-making standard should be used in this case? What, if any, influence should the interests of Baby Sherman's siblings have in decision making?

5. Caring for Baby Sherman and interacting with her family has caused a great deal of moral suffering for the NICU nursing staff. What behaviors might you expect staff? What do you do, as the nurse manager, to address this situation?

6. As would be expected, Mr. and Mrs. Sherman also are experiencing a great deal of moral suffering and grief. How would you handle your personal interactions with Mr. and Mrs. Sherman, and what would you do to help educate your staff in working with families in a situation such as this one? What do you know, or what information can you locate, about the grief parents experience when their infant is extremely impaired and a decision about withholding or withdrawing life support is being made? How would you try to help Mr. and Mrs. Sherman?

7. As the nurse manager, you contact the chairperson of the hospital ethics committee to make a referral for the Shermans' case. Role-play with a peer the roles of nurse manager and ethics committee chairperson during the referral phone call. What information is important to discuss? What questions are important to ask? Remember, the committee chairperson has no information about the case.

Questions for case study 1:

Before answering the following questions, research information regarding the psychological care of children who have terminal cancer or other terminal illnesses. What are the recommended tips for helping both the family and child sustain the greatest level of well-being during the illness and dying process?

1. What would be a compassionate response to the mother's question? Based on your research about situations such as this one, what should Teresa know about compassionate care?

2. Because the door has been opened to question what Mitch knows or does not know about his illness, what can Teresa do to help Mitch and his family maintain the greatest well-being during the dying process, which may be either rapid or slow?