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Nursing Informatics: Ethico-Legal Case Analysis CASE BACKGROUND:…
Nursing Informatics: Ethico-Legal Case Analysis
CASE BACKGROUND:
Juana was the driver of a sedan involved in a single-vehicle collision. She stated she was driving at approximately 60 miles per hour on the highway and suddenly lost control of the vehicle and crashed into a light pole. She also stated her head hit the windshield and shattered the glass. She denied loss of consciousness. Upon her arrival in the ED, Juana was alert and oriented to person, place, and time and had a Glasgow Coma Scale of 15/15. Her initial complaints were lightheadedness, weakness, left shoulder pain, and severe abdominal cramping that started immediately following the car accident. She had a past medical history of sickle cell disease and no previous pregnancies. Her lungs were clear bilaterally. Juana’s heart rate was 90 beats per minute (bpm), her respiratory rate was 28, and her initial blood pressure (BP) was 130/80, and fetal pulse rate was 90. Once the cervical spine films were taken and the flat board was removed, her BP reflected orthostatic changes of 100/60 and pulse of 120 bpm. Juana was placed on a 100% nonrebreather mask. Peripheral intravenous lines were started bilaterally to replace fluid loss that was indicated by the change in vital signs. It was suspected that she was bleeding internally into her thoracic or abdominal cavity. Blood specimens were drawn and sent to the laboratory. A hemoglobin of 6 g/dL and hematocrit of 2% indicates internal bleeding. Ultrasound showed blood in the amniotic cavity and Doppler confirmed a fetal heart rate of 90 bpm indicating fetal distress. The patient was informed by the medical team of the critical nature of her condition. The plan of care for her was an immediate blood transfusion and an emergency cesarean section. Matters became complicated when Juana informed the medical team that she was a Jehovah’s Witness and refused the proposed plan of care. The physician then recommended the use of alternative blood products. Juana insisted that this was also against her religion and she refused the alternative treatments being offered. The medical team advised her that Jehovah’s Witnesses could choose certain blood byproducts, such as albumin, cryoprecipitate, and globulin. According to Mrs. J, if she accepted the blood transfusion or blood products she would no longer be a Jehovah’s Witness and would be condemned to hell.
Mrs. J’s condition worsened within 2 hours of admission to the ED and went into shock and lost consciousness. Nurse Morris caring for the pregnant mother, however, is concerned about the infant and Mrs. J’s condition. Unless a consent is given, no treatment will be initiated, significantly reducing the mother and the child’s chance for survival. Nurse Morris then proceeds to persuade the husband and the entire family of the patient to sign the consent form for blood transfusion saying that the mother and child will eventually die. After a lot of deliberation, the husband has decided to sign the consent without the patient’s knowledge. Nurse Morris immediately informed the physician that the patient changed her mind. Mrs. J then received the prompt treatment and went into labor and delivered a stillborn baby boy.
QUESTION:
Investigate, Compare, and Evaluate the Arguments for each Alternative.
(Compare each alternative, give reasoning and arguments for each)
BASE IT ON HERE:
The possible alternatives available include the following:
1.) Nurse Morris could have suggested to Mrs. J the use of intravenous iron and/or tranexamic acid as an alternative for blood transfusion since these are the pharmacological agents that are known to be acceptable for Jehovah’s Witnesses.
2.) Nurse Morris could have discussed with the medical team for the provision of a bloodless surgery.
3.) Nurse Morris could have sought guidance from the hospital’s ethics committee or the legal advisors, or she could have suggested to the physician to make an urgent ex parte application to the courts for the appropriate action/s to be taken.
GUIDE:
Use your problem-solving, decision-making, and critical-thinking skills.
Appraise the relevant facts and assumptions prudently:
– Is there ambiguous information that must be evaluated?
– Are there any unjustifiable factual or illogical assumptions or debatable
conceptual issues that must be explored?
Rate the ethical reasoning and arguments for each alternative in terms of
their relative significance.
– 4 = extreme significance
– 3 = major significance
– 2 = significant
– 1 = minor significance
Compare and contrast the alternatives available with the values of the key
players involved.
Reflect on these alternatives:
– Does each alternative consider all of the key players?
– Does each alternative take into account and reflect an interest in the concerns and welfare of all of the key players?
– Which alternative will produce the greatest good or the least amount of harm for the greatest number of people?
Refer to your professional codes of ethical conduct. Do they support your reasoning?
