Assignment

Unit I Case Study Providers, patients, and caregivers are often faced with very difficult healthcare decisions. For the Case Study, you will review and respond to the below case.

Walking The Tightrope

Linda Johnson, ACSW, and Robert Potter, MD, PhD

Undermanaged Pain Makes for an Unattractive Patient

An eighty-five-year-old widow has been in a long-term care facility for six months. She was admitted with severe osteoarthritic and osteoporotic pain. Her family initiated her placement because she was overmedicating herself at home, confusing her medications, and not eating adequately. She has been a "complainer" for years, the family reports. The family and physician are reluctant to give her strong pain medicines; they don't want her to be "doped up" like she was at home. She currently takes two Tylenol every four hours which does not adequately control her pain (and risks liver and kidney toxicity). She is in too much pain to walk, but quickly becomes uncomfortable in the wheelchair. So she requests bed rest and frequent repositioning. Staff feels she is demanding and hard to please. She has a son who calls and tries to visit once a week, but who becomes tired of hearing her constant complaints of pain. Her daughter lives out of town, and calls weekly.

The son asks the doctor to make her more comfortable and assuage her complaints. But the son also requests that the doctor not give her whatever she received six months ago (at the time of admission) when she drooled and was unable to sit up or eat.

Her sister has called the state regulatory agency to complain that the facility staff is neglecting her and not taking care of her pain.

The doctor agrees to try Nalfon, a nonsteroidal anti-inflammatory drug (NSAID). After two weeks, she has dark, tarry stools, suddenly vomits blood, and is hospitalized for a severe gastric bleed.

Questions for discussion

• Is the patient's autonomy being respected by involving her in the decision-making process?

• How could a meeting of all parties involved have been more effective and/or ethical than piecemeal decision making?

• Are the pain treatment policies of the facility meeting the standards set by regulators?

• Does the nurse have a moral responsibility to be more assertive in advocating for the patient's relief?

• Given that the doctor is likely to see the resident only every two months, what role should the doctor take in assessing and monitoring the pain and its treatment?

• What ethical theory or principle can function as a basis for good pain management?

• What other issues do you think this case explores?

Read the case study. Using the questions at the end of the case study as guide, describe the ethical dilemma faced by the participants. As you explain the ethical issues, provide possible resolutions and your opinion on the scenario. Make sure you apply one of the ethical decision-making models discussed in this unit.

You are not to just answer the questions presented, but use those questions to walk through the ethical dilemma and present your analysis and conclusion.

Your response should be at least one page in length. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations

The Center for Practical Bioethics. (n.d.). Case studies.

Health care law

1. Provide an example of an ethical situation, regarding health care, that you faced in either your professional or personal life. How did you handle it? What, if anything, would you do differently if you faced this situation again?
Response should be at least 200 words

2. Contrast and compare the bioethical principles of autonomy, beneficence, and nonmaleficence.

3. Describe the seven-step model for evaluating an ethical dilemma. Provide examples.

4. Describe Dr. Lo's clinical model. Also, provide an ethical dilemma that supports this model as you explain each step.

5. We have read about medical etiquette standards and ethics. What is the difference between medical etiquette and ethics? Provide examples and explain why it is necessary to understand this distinction.

Fremgen, B. F. (2016). Medical law and ethics (5th ed.). Upper Saddle River, NJ: Pearson.

Development Health Care

1. Compare and contrast the analytical view of strategic management with the emergent learning approach. How can these views be combined for a successful and responsive health care organization?

2. Differentiate between strategic management, strategic thinking, strategic planning, and managing strategic momentum. Relate each of these concepts to health care organizations.

3. What are the four key levels of strategic management in health care organizations? Summarize the links between these different levels of strategy within a health care facility.

4. How are small employers and large employers being affected by the changes implemented under the Patient Protection and Affordable Care Act (PPACA)? As CEO of a small company, how will you plan to cope with PPACA implementation? As CEO of a large company, how will you plan to cope with PPACA implementation?

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2013). Strategic management of health care organizations (7th ed.). San Francisco, CA: Jossey-Bass.