Woman in Need of Professional

¶ … woman in need of professional nursing care was discharged from the hospital, but both her husband and the patient herself refused to allow the home health care worker to enter the home to administer the necessary treatment.

The patient's (Mrs. B's) most serious wounds were those of two stage four decubital injuries (commonly known as bedsores) to her sacral (coccyx) area. The patient was paralyzed from the waist down; hence she was confined to a bed at home. At the hospital, the patient's required stitches. The patient, Mrs. B was discharged to her home in the care of her husband. Home health care visits were scheduled for the B's household, to continue the administration of IV antibiotics to treat her infected wounds. However, both the patient and her husband (Mr. B) refused to allow the nurse to enter the home. The patient also refused to go to a nursing home for further treatment.

Specify any alternatives to the problem

Solutions: a. The patient and her husband could receive counseling by a social worker about the severity of the problem and the need for nursing care.

b. A court order could be obtained requiring the entry of the nurse to the B's household.

c. The patient could be readmitted to the hospital for intensive treatment.

a. Pros: The social worker would be the most non-invasive strategy.

Cons: Critical time might be lost if the social worker's entry was also refused.

b. Pros: The court order would allow the hospital to immediately treat Mrs. B, if the court found her unable to make competent decisions.

Cons: Because the woman refused treatment, if judged mentally competent, she would not have to admit the nurse.

c. Pros: A hospital would allow round-the-clock supervision.

Cons: The woman might refuse to go back to the hospital. 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.

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.

4. Implement your choice.

Unfortunately, the woman still refused treatment and did not recover fully from her injuries.