Think as a nurse ethic

THINK LIKE A NURSEEthics and Legal
N222 Spring 2023
EXERCISE – 45 points
Requirements: Full credit for this exercise will be based on the following:
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Adhere to the information in the scenario.
Concisely answer the questions.
Provide at least one paragraph for each question.
Remember a paragraph has at least 3 statements.
Responses must be well researched & provide nursing rationale.
There must be references for each answer.
References must be in APA format.
You are the charge nurse on a skilled nursing unit at the local long term-care facility caring for Mrs.
Charlotte Boyer, an 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 PEG tube for
enteral feedings to maintain an 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. Now 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 not have wanted any artificial measures, including a feeding
tube, to keep her alive. In addition, she feels that her mother’s decision to refuse food indicates an
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 states, “We need a tie-breaker, as we are at odds as to
what to do.”
1
Discuss how each of the following concepts is integral to this patient care situation:
Autonomy; Nonmaleficence; Beneficence; Veracity (8 points)
Answer Autonomy
Nonmaleficence
Beneficence
Veracity
2
Using the assessment/analysis step of the nursing process, describe the problem and
alternative approaches for this situation. (3 points)
Answer
3
Use the MORAL Model to work through the situation to come up with alternative
approaches for this family situation. (5 Points)
Answer
4
As an advocate, your first priority is the patient. You have identified the nursing diagnosis of
Moral Distress for this patient. What defining characteristics are present in this situation? (3
points)
Answer
5
The outcome of Personal Autonomy is identified. Discuss your role as patient advocate in
this situation and determine appropriate interventions that encompass the needs of both the
patient and family. (4 Points)
Answer
Legal:
Clinical practice is a process closely regulated by legal parameters to ensure safety of both the paitnes
and the practitioners. Knowledge of the laws and regulations is vital to every nurse in practice to
protect all parties involved in our complex healthcare delivery systems. The parameters that guide
professional practice also guide your practice as a nursing student.
Betsy Sellars, a nursing student, has been assigned by the clinical instructor to assist in the care of the
following patients during her clinical rotation in the Emergency Department at the local hospital:
• 42-year-old female who is unresponsive secondary to a narcotic overdose
• 2-month-old female with scald burns to lower extremities
• 91-year-old male with urosepsis/malnutrition
• 24-year-old female with suspected ectopic pregnancy
6
Discuss the importance of each of the following regulations in the provision of care to
patients in this setting: HIPAA; EMTALA; PSDA (6 points)
Answer Health Insurance Portability and Accountability Act (HIPAA)
Emergency Medical Treatment and Active Labor Act (EMTALA)
Patient Self Determination Act (PSDA)
7
Which of the admitted patients should be considered within the mandatory reporting laws?
Discuss your rationale for your choice(s). (4 points)
Answer
The 24-year-old is an acquaintance Betsy knows from church and she is surprised to see the admitting
diagnosis. Beginning the admission assessment with the assigned RN, Betsy comments, “Hi Kelly, we
are here to assess what is happening so that you can get the best care. It doesn’t matter what the
diagnosis is, and I was telling the nurse here that you are not that kind of girl.”
8
Discuss whether the elements of defamation of character are present in this situation. (2
points)
Answer
The patient admitted with urosepsis and malnutrition is slightly confused. He knows who he is and why
he is in the hospital, but not what day it is. He wants to go home and does not see that it is necessary
for him to stay. He has been stabilized and is scheduled for admission to the medial unit. He frequently
attempts to get up off the ED bed and the staff is concerned for his safety. The orderly, showing a waist
restraint to the patient says, “Mr. Wells, if you continue we are going to have to put a restraint belt on
you and tie you down so you can’t get up.”
9
Can this action by the orderly be interpreted as an intentional tort in a court of law? Why or
why not? (4 points)
Answer
Orders are received for the care of the 2-month-old with burn injuries. The skin is cleansed and dressed
per protocol and the child is to be admitted to the pediatric nit. The parent has decided against
admission for the child and communicates to leave AMA (against medical advice). The parent states
that she is able to care for the child at home and requests instructions for care of the burns.
10
How should the nurse handle this situation including aspects of informed consent regarding
leaving AMA? Consider the elements of informed consent normally used in the healthcare
setting. (4 points)
Answer
References APA (2 points):