Case Studies from 
Dr. Katie Callahan, RN:

 Huntington Consultant Firm

Comments submitted by Web visitors:

 

Case # 1

January 18, 2002 From: an ADN Generic Student from Victoria College, Texas
     Verna is faced with a difficult problem. I think she should have confronted the doctor and tried to get him to explain the reason why he did not want Mrs. Rogers to know about the specialized facility. If she did not give her the information she needed or denied her information, I would have taken it to the ethical committee, to see what could have been done about the situation.
    In my opinion the situation was not resolved because Verna did not investigate the situation at all.
October 25, 2001 From: a student
      Kathleen has autonomy. Kathleen needs to inform the doctor of Mr. Mohan's request to be left alone.  She can also remind the doctor, as care providers, that they should work together and avoid causing harm to their patient.  Mr. Mohan's culture is a complication, the best thing to do is to find someone that can explain Hindu procedures in a situation like this.  They may also consider contacting family members listed by Mr. Mohan in his medical records.  They could be great in providing emotional support to Mr. Mohan and very helpful in providing the doctor with the information he needs.
July 5,2001 From: A Transitional Nursing Student 
       I feel  that she did the right thing by not telling the patient about the other facility that may help the patient because she does not know the encounter between the doctor and the patient. She may also damage the relationship of trust between the doctor and the patient on what decision he makes for her and also his judgment.
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July 2,2001 From: A Transitional Nursing Student 
      Do you see a moral failing in Verna's action? Yes, I do because she is faced with a moral conflict. Verna feels that Mrs. Rogers should know about this hospital that has successfully been treating patients with the same condition as Mrs. Rogers'. On the other hand, Verna is following the principle of "respecting authority-patient relationship" taught by her parents.
      What was the failing attributed to from a cultural aspect as well as from an ethical aspect of the case? The failure was attributed the the beliefs that Verna's parents put on her as she was growing up. This could be due to the cultural belief in "paternalism" at that time. Ethically, Verna failed to allow Mrs. Rogers the right to the principles of autonomy ( a right to make decisions), veracity ( to tell the truth), and justice (fairness). Verna on the other hand, might of thought about the principles of nonmalificience (not to cause harm) and beneficence (prevent harm) to her patient.
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June 25,2001 From: A Nursing Student 
     I think the case study of Verna and Mrs. Rogers was really very interesting. I think a third party statement by Verna to Mrs. Rogers would be in order. The third party statement could not directly influence Mrs. Rogers, and to save face with the physician. To say nothing of reducing Mrs. Rogers' ability to procure possible life saving therapy, which would be against both the Physician's and the Pt's professional oath.
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July 5,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class
     In my opinion, Verna, the physical therapist, should try to convince the patient's physician to give him the best treatment. Since there is a specialized hospital for the patient's disease, why not give him a specific treatment? Verna is very ethical by following the physician's order, but she should clarify the physician's reasons for not telling the patient about the specific hospital.
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July 5,2001 From: A Generic  Nursing Student F/T-Dr. Petrozella's class
     Verna should have found out why the physician did not want the information to be discharged; after, Verna should be free to decide whether the patient should or should not know about the place in question.
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Case #2

January 18, 2002 From: two ADN Program Students from Victoria College, Texas
       Rachaela's culture did not believe in bringing to light the advent of death, and Ken is afraid of dying. Rachaela's cultural beliefs should not interfere with her nursing obligations.  Since Rachaela and Ken are friend, it should be easier to talk to Ken about the severity of his illness.
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July 16, 2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class
       I think that Rachaela should never include her culture in her nursing practice because all patients are entitled to receive nursing care with no particular restrictions. Her friend, Ken, is dying, it is her duty to tell him the truth if he asks for it. There is no confidentiality issue in this case, it is unethical to keep info from a patient. Her friendship should be a positive thing in this case, there will be less barriers which will be beneficial to Ken. The two moral dilemmas in this case are: tell Ken the truth ignoring her culture, or follow her culture by not telling Ken which will also be against the principle of veracity.
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July 12,2001 From: A Generic  Nursing Student F/T-Dr. Petrozella's class
      Rachaela, the Cuban nurse, is in a dilemma between veracity and confidentiality. In her culture confidentiality is the main point even if the patient is a good friend. But, as a nurse, the personal culture should not interfere in any ethical decision making. On the other hand, she knows that the patient is terrified about his illness. He might have an unexpected reaction after telling him the truth, which can worsen his physical condition. Their friendship should count for Rachaela to take the best care of Ken and help with his needs. The veracity of Ken's illness should be up to the physician to tell him not the nurse.
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July 5,2001 From: A Generic  Nursing Student F/T-Dr. Petrozella's class
       I believe that Rachaela is in between two dilemmas. One of them is to follow the principle of veracity (to tell the truth) to her patient. The other one is her cultural values of not telling the patient about his end stage life condition. If Rachaela does not tell Ken about his condition, she will be depriving him of his right to autonomy, veracity, justices etc. But, as a nurse, she also should think about the principles of beneficence and nonmalificience. In my opinion, Rachaela should not deprive Ken about his condition state if he wants to know or if he asks questions about his treatment. There could be important things that Ken would like to leave ready before "that time". After all, the patient has a right to self-determination!
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Case #3

July 5,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class
    Kathleen is struggling with her inner thoughts to decide who to satisfy, that is whether to please the doctor or upset the patient more, or support the patient and risk the wrath of the doctor. I feel in this case the patient is who matters more. Kathleen needs to stand up and be a patient's advocate in every sense of the word. She needs to tell the patient that she is giving him a little more time and privacy to cope with his recent ordeal even if it means standing up to the doctor. Also, she must remind the patient about his cultural obligations. The patient is quite vulnerable at this juncture and her beneficence is of dire importance. Even if it means saying to the doctor, "I understand at hat a decision needs to be made regarding Mrs. Mohar but, please give the patient a little more time to pull himself together." If the doctor is in a rush then he needs to be informed that he could do the honors.
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July 5,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class
        If I was the nurse I would explain to the doctor that the patient is upset and has requested time alone. The nurse should do no harm and by entering the room to discuss burial options or needs, this will obviously upset the patient and might hinder recovery. I would call in someone from social work or pastoral care to discuss options with the patient. I would let him handle the situation because I'm sure that they have handled this kind of situation before with tact and gentleness. I would let the doctor know that I was going to call in a referral and I would give him the information as I receive it. Mohan's culture is going to effect the way he grieves, behaves, and reacts to his spouse's demise. All efforts should be made to respect and facilitate any needs that he might have.
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July 5,2001 From: Generic  Nursing Student F/T-Dr. Petrozella's class
       Kathleen is struggling with an issue of privacy and beneficence. She has the patient, which to me is second to none-including the doctor. The patient has just suffered a devastating loss and wants to be alone. Kathleen's duty is to the patient and to cause no further grief. Here I believe she should comply with the patient and if the doctor can't see this then the nurse should discuss it with the doctor and maybe he can decide if he wants to disturb the patient himself by going in personally and asking for the information himself. Privacy is very important and it should be offered at the moment the patient asks for it. One can wait for a while and then try to gather the necessary info. The doctor's position of asking Kathleen to go against the patient's desire is wrong. Mohan's culture complicates the situation because no one knows anything about Hindu procedure, however an effort to find someone that does should be made. This effort could find someone that could help clarify a great deal without having to bother Mohan.
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