Case study for Nursing students
Victoria is a 67-year-old woman of Polish descent. She moved to Australia approximately 25 years ago with her family. Her husband died 10 years ago, and she has regular contact with her 4 children who are now adults raising their families.Approximately 3 weeks ago Victoria began to behave in an unusual manner, wandering through her house at night, refusing to eat and convinced that there were cameras inside the television that were monitoring her movements. Following a referral from the GP, the community mental health servicesteamassessed her at home and deemed it necessary to admit her for further assessment within an acute mental health inpatient hospital setting.She has been in the ward for approximately 4 days and is receiving care as a voluntary consumer. During this time she has been isolated, withdrawn and appears frightened of events and interactions around her. Although she has been generally cooperative with staff, this morning she appears to be non-compliant with staffrequests to take her medication that consists of a small dose of an antipsychotic and her regular antihypertensive medication. When staff gently request that she take her tablets she begins to lash out, thrashing and physically hitting the nurses; yellingthat they are trying to hurt her and take her money.Due to the risk of Victoria’s behaviour on her physical safety and the safety of others, it is decided that her legal status should be reviewed under the Mental Health Act and that she should receive intramuscular sedation.Before Victoria is reviewed,a phone order of medication is given to administer a sedative. The team leader directs that the sedation be given without Victoria’s consent due to the possible risk of her hurting herself and others. This directive is completed. During this time the process is noisy and disruptive to the ward and one nurse sustains a laceration to her arm while trying to restrain Victoria. Other patients are visibly upset by this action and one mentions that it is barbaric and they are going to report the nursing staff tothe NMBA.
Your focus should be on the ethical and legal requirements discussed throughout this course. Pay attention to workplace health and safety, legal and ethical requirements, law surrounding decision making and consent. Using the legal and ethical decision-making framework identify and justify the care that will be provided to Victoria. What are your legal and ethical responsibilities and what professional standards and codes need to be considered?
Case study for Midwifery students
Lisa Jones is a 17-year-old primigravida living in Western Queensland. She is an only child and is 37 weeks pregnant. She lives at home with her mother, Ruth, and her stepfather,John. Lisa and her boyfriend, Sam (18), are still in a relationship but they do not live together. Sam is still at school and Lisa has been studying during her pregnancy. Lisa has been receiving antenatal care through the local country hospital.Presenting case24 hours ago,Lisa complained of feeling unwell and having a headache. She stayed at home and took some Paracetamol. This morning Ruth brought Lisa a cup of tea and found her restless and confused. She did not appear to understand what Ruth was saying and was becoming agitated. Ruth called an ambulance and Lisa was brought into the emergency department (ED) at the local hospital then transferred to the maternity unit for obstetric assessment. Sam was called to come into the hospital by Ruth. Initial clinical observations indicate that Lisa may have developed severe pre-eclampsia. Her blood pressure is 170/105, she is agitated and has epigastric pain. Bloods have been sent for analysis. Lisa is stating that she wants to go home and does not want to be in hospital and is becoming aggressive towards the maternity staff. Sam asks why the midwives cannot provide care at home and her mother wants her to stay in hospital.
Your focus should be on the ethical and legal requirements discussed throughout this course. Pay attention to workplace health and safety, legal and ethical requirements, law surrounding decision making and consent. Using the legal and ethical decision-making framework identify and justify the care that will be provided to Lisa. What are your legal and ethical responsibilities and what professional standards and codes need to be considered?
Case study for Medical Science students
Claire is a 28 year old who has lived on the Sunshine Coast in Caloundra for the last 3 years. She is a nurse with emergency and critical care experience. She has spent a number of years working around the world doing short term deployments for Médecins Sans Frontières(MSF) which she has planned to continue doing from her home base in Caloundra.She is in an on again/off again relationshipof 3years withPhillip, an Irish national who she met while on deployment with MSF. He is a logistician with MSF and lives in Geneva when not on deployment or visiting Claire. Claire and Phillip have discussed living arrangements and while not seeing other people they have not formalised their relationship nor settled on permanent living arrangements. Claire is unexpectantly pregnant and organised with Phillip to travel to Australia for her first obstetric appointment. Just before leaving the doctor’s office, Clairehad sent a jubilant text message to her parents. “Guess what?! We’re pregnant!!! “. The first she had mentioned of this to them.Presenting Case:Claire and Phillip were driving home from thisappointment when tragedy struck. Another driver, distracted by an incoming text message, ran a red light and crashed into their car. Both sustained severe injuries.Unfortunately, Phillip is deceased at the scene. Clairesurvives, having escaped injury except for a massive head injury. Her treating teamnow saythat, 3 weeksafter the accident, the prognosis is grim. The outlook is continuation for some time in a persistent vegetative state(PVS).Clairewas pregnant, and unlike most young adults,had thought abouther mortality. She had gone to continuing education workshops about end of life care and advance care planningin the course of her career. She had completed her own advance directives some months ago, before becoming pregnant, as she was deploying into often insecure environments naming Phillipas her power of attorney for healthcare decisions, given she was planning on formalising their relationship in the near future.In her directives she has included a clear, handwritten statement about life prolongation if she were, somehow, “to end up in anything like PVS, from which I am not apt to recover.” In such a conditionshe had written, “I do NOT want my life to be extended by means of medically assisted nutrition and hydration, ventilator, or other life support.”These documents were witnessed by her legal representative.With Phillip now deceased, treatment decisions are left up to Claire’sparents. They both are thoughtful people, both healthcare professionals, who take very seriously their difficult responsibility of acting on Claire’sbehalf. After consulting her treating team, other family members, and even their priest, a decision is made to stop everything except palliative care. Theyhad received a copy of their daughter’s advance health directives and have determined that this is what she would have wanted, what in fact she had conveyed with such prescience. Plans are made to transfer Claireto a palliativeunit in another part of the hospital. Itwould take place the following day.That evening, Phillip’s parents arrive from overseas. They had come to transport his body back to Ireland for burial, a process that had been held up by police and coronial investigations. They had not previously met Claire’s parents and had learned of her pregnancy through friends of Phillip’s only recently. They are devout Catholics and regard life as sacrosanct. They are staunch anti-abortion activists in their home country. They have attended the hospital and demanded that the treating team continue to treat Claire as they wish their grandchild to be born which is now possible due to advances in medical care. At times they have become quite aggressive and the hospital has advised that they may be barred from attending the facility. The treating consultant calls Claire’sparents and says hesitatingly, “We have a bit of a problem here. It appears we may need some legal assistance, perhaps an ethics consultation, and must postpone Claire’stransfer of care.” The doctor explains further what Phillip’s parents are demanding and that the postponement may be for weeks while the issues are sorted out.Claire’sparents had spent a sleepless night anticipating the transfer. It would be the hardest thing they’ve ever done, andyet the right thing in keeping with their daughter’s wishes. Now they can’t believe what they’re hearing.Postpone? Ineffective advance health directives? Continued life support? Did the doctor really say that? That there may even need to be surgery for afeeding tube and a tracheostomy while this legal/ethical glitch is being discussed and gets clarified?Almost in unison, Claire’smother and father protest, “Butour daughter didn’t want this!”
Your focus should be on the ethical and legal requirements discussed throughout this course. Pay attention to workplace health and safety, legal and ethical requirements, issues surrounding decision making and consent. Using the legal and ethical decision-making framework identify and justify the care that has been provided to Claire. What are your legal and ethical responsibilities and what professional standards and codes need to be considered?