Page 551 - alligood 8th edition_Neat

532 UNIT IV Nursing Theories

CASE STUDY Analysis
Alvin, 66 years of age, has been in the hospital for n Autonomy: Alvin’s desires should be given
12 weeks with multiple trauma following a motor priority over his family members’ desires.
vehicle accident. His condition worsens each day, n Freedom: Not to honor Alvin’s wishes is a
and his prognosis is very grave. He is not alert, but violation of his freedom.
he grimaces and withdraws from stimulation. n Objectivity: The subjective feelings of two
Prior to his injury, Alvin signed a living will and family members are in conflict with objective
discussed with his family his desire not to be kept reality. Only the patient’s feelings are consid-
alive in the event he was ill or injured and recovery ered in ethical decisions.
was not possible. The health care team tells his n Self-assertion: It is not justifiable to substitute
family that, despite aggressive treatment, many of family members’ values for the patient’s.
Alvin’s body systems are failing. Even if Alvin sur- n Beneficence: The patient’s goals cannot be
vives, there is no hope that he will be able to live obtained by aggressive treatment; however,
without a ventilator because of extensive lung aggressive treatment may well cause the patient
damage. The team suggests supportive care for further harm.
Alvin and a do-not-resuscitate order. Most of n Fidelity: The health care professional’s agree-
the family members express the desire to ensure ment with Alvin was to act as his agent in
Alvin’s comfort. Two family members believe pursuing goals that are possible to attain.
Alvin will survive and recover. They refuse the
team’s suggestion and demand that Alvin receive
every available treatment to keep him alive.

CRITICAL THINKING ACTIVITIES

Using the Husted model, analyze the following ethical 3. Johnny, 7 years of age, is a psychiatric inpatient
situations from an ethical perspective. with a diagnosis of trichomania (hair pulling).
1. Christina, 46 years of age, has been in the hospital for His parents are very concerned about stopping his
2 weeks following a traumatic injury. Her condition destructive behavior and have developed a series
was very grave, but she is beginning to show signs of of punishments for incidents of hair pulling.
recovery. The health care team suggests that a blood Johnny has been seen pulling his hair out several
transfusion will provide the necessary support to times during the day. His parents arrive and ask
continue her improvement. Christina and her family how many times Johnny pulled his hair. What
practice a religious faith that does not permit blood should the nurse say?
transfusions. Christina’s husband and religious leader 4. Eugene, 47 years of age, has several chronic
insist that she not be given the transfusion regardless illnesses. Despite education and support, he
of the consequences. When the visitors leave, declines to adhere to prescribed health care
Christina tells the nurse that she would like to receive practices. Mark, a home health care nurse,
the transfusion, but only if it could be kept secret has been seeing Eugene for several months and
from her family. What should the nurse do? has made no progress in helping Eugene to
2. Angela, 34 years of age, is dying of lung cancer. improve his health. While discussing the situa-
Despite counseling and support, she is very tion, Eugene tells Mark that he has no inten-
frightened. When her death is imminent, she tion of changing any of his behaviors. Is Mark
screams over and over, “Don’t let me die! Don’t let justified in asking the physician to discontinue
me die!” Despite all efforts, Angela succumbs be- home health visits?
fore her husband arrives. He asks, “How was she? 5. Agnes is a nurse on a busy medical nursing unit.
Was she afraid?” What should the nurse say? Mr. Brown frequently asks Agnes to interrupt her