You are the nurse coordinator of the Neurology ICU at Metropolitan Hospital. Last week, a homeless patient was admitted after he was found unresponsive outside of the hospital emergency room. He had experienced a stroke and was in need of non-emergency surgery to stop the bleeding. The doctors performed the surgery and the patient was improving, but the patient had a long road of recovery ahead and the doctors did not know whether the patient had any support system available or whether they had done the right thing by operating.
The following week, a pediatric patient underwent a risky procedure that doctors didn’t think was advisable at the request of the child’s parents. The child is in the ICU, and has not been responsive since the surgery. Doctors on the unit are upset about both situations and would like more guidance on how your ICU is going to handle such events in the future.
Your task is to give a presentation to the Neuro ICU that addresses these two scenarios where an incompetent patient requires non-emergency neurologic surgery. Assume that the providers in your ICU know absolutely nothing about the ethics of decision-making.
Using what you have read this week, craft a brief PowerPoint presentation (10-15 slides) providing step-by-step instructions for dealing with decision-making in the cases below. Keep the slides succinct and text-light. Use the notes section of the slides to expand on the presentation and explain your thought process (similar to an oral presentation).
A homeless patient without a surrogate, living will, or family members who is unable to express his preferences about surgery;
A pediatric patient undergoing care in which the team is divided about its medical appropriateness but the child’s parents are demanding it.
In each of these cases,
Who ultimately should decide what type of care the patient gets and why?
What standard is being used: best interests or substituted judgement?
Does the severity of the condition or length of recovery matter?
Are there limits in each case in terms of whether we can know, for certain, that we are respecting the wishes of the patient?
Are there other alternative decision-makers? (different from #1)
These are both difficult cases that stretch out ethical guidance but they are not uncommon in a clinical situation. Think creatively and do your best to fuse the information you have learned this week into a cohesive presentation.
***Course materials must be reflected in your work, as applicable. Ethical concepts introduced in the course (particularly in week 1) must be used in your answers. All sources, including course materials, must be cited in text in APA style (7th edition) and included in a reference page-style list at the end of your work.***
