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Given Mrs. B's hostility to the medical system, this would likely be the result. Also, there might not be room, as priority is given to patients who cannot be treated with at-home care.
3. Make a choice. Implement your choice.
The hospital did not wish to intervene further, so the nurse herself attempted to act as a social worker, and inform the husband of the severity of the wife's problem. This seemed like the least hostile action to take, and the least likely to create further tension between both Bs and the medical system. Also, the woman was mentally competent, even though she did not appreciate the full severity of her condition, or the necessity of accepting antibiotics.
The ethical principle applied in making this decision was that of allowing patient's free choice, and not imposing one's personal values upon patients, even when the nurse thinks the patient is making the wrong decision.
Unfortunately, the woman still refused treatment and did not recover fully from her injuries.
5. Consider the feedback issue.
Early on during her treatment, when the B's hostility and confusion over the patient's condition became evident, nurses and social workers within the hospital environment should have made the couple cognizant of the need for extended care, after discharge. This highlights the need to anticipate after-care treatment, and also to take into consideration the entire family environment when issuing post-discharge orders.
6. Personal Evaluation:
Decision-making is a series of steps, not a single step. Because of faulty decision making early on in the treatment process in when psychologically assessing the patient and her husband, the decisions open to the nurse later on were very limited and unsatisfactory.
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