Question: Class Discussion 2.2: Similarities and Differences Between Cases

Initial Post Due: Day 4

Reply Post Due: Day 7

Value: 15 points (Initial Post: 9 points; Reply Post: 6 points)

Grade Category: Class Discussions (25%)

For your initial post, compare the cases of Elaine and Mrs. Jabolov in Ulrich Chapter 4 of the Ulrich text.

• Would your recommendations be different for Elaine than for Mrs. Jabolov? Why or why not?

After you have made your initial post, reply to the post of at least one of your peers, using the RISE Model for Meaningful Feedback (PDF).
Your participation in this discussion will be evaluated using the Class Discussion Initial Post and Reply Rubric in your syllabus.

THIS IS AN EXAMPLE OF ONE OF THE CLASSMATES RESPONSE ON THIS

In Elaine's case study, we learn that she has a condition that can be treated with a simple biliary stent placement. However, Elaine is refusing treatment and reports she's tired of medical interventions and is ready to die in peace. Elaine is 96 years old but she is independent and cognitively intact. Her daughter, her HPOA, is ok with her making her own decisions. The dilemma (primary issue) in this case, is whether or not to coerce Elaine into making the decision to get the biliary stent.

In Mrs. Jabolov's case, we are presented with an 89 year old woman with high fevers and an infection that has been unresponsive to antibiotic therapies in the nursing home. She suffers from dementia and is very confused. The doctor wants to transfer her to an acute care facility for investigation and further treatment. However, the nurse in the nursing home is concerned about the distress the hospital setting may cause. She thinks the doctor's plan is too aggressive and that it would be better to leave Mrs. Jabolov in the nursing home to die in peace. Family is not reported to have been consulted. The dilemma the nurse is facing is whether or not to challenge the doctor's decision to send Mrs. Jabolov out for treatment.

In both cases we have elderly women with conditions that require treatments and the healthcare team must make the decision as to how to proceed. In Elaine's case, she is aware of her condition and her choices and has chosen to not proceed with treatment. In Mrs. Jabolov's case, she is confused and unable to make decisions for treatment. No family involvement is reported in decision making. My recommendation for Elaine is to respect her decision for no treatment. She's alert, oriented, and appears to understand the situation. She's aware of the consequences of her decision and if she's at peace with them, the healthcare team should accept that. In Mrs. Jabolov's case, my first recommendation is for the family to be consulted. Her HPOA should be given the opportunity to make the decision of whether to transfer and treat Mrs. Jabolov or not. In the absence of a HPOA, the facility should work with the family to obtain a surrogate or proxy to make healthcare decisions for Mrs. Jabolov. In the interim, I would advise the nurse to not challenge the doctor's plan. The patient requires treatment that is beyond the current facility's capability. Therefore it is appropriate to transfer her to the next level of care. The nurse has good intentions, but it is unethical to withhold appropriate treatment.

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Thanks!

Kat

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