CASE SCENARIOS
SELECT ONE CASE SCENARIO:
Case Study 1 Mr. Alphonse
Mr Alphonse Martinez a retired Italian man, married, his wife also retired and they have two grown up sons who still live at home. They are a close family who go to church every Sunday. Mr Alphonse had just recently made an Advanced Health Directive (AHD) that stated if he had another serious heart attack that he was not to be resuscitated. His wife and two sons were opposed to his Advanced Directive and instructed the staff to take no notice of the AHD.
Alphonse has been discharged from the coronary care unit (CCU) and placed in a step-down cardiac ward following his myocardial infarction (MI). While he had been in CCU the staff had felt that he had exaggerated his chest pain. That is, when they asked him to rate his pain from 0 – 10 he sometimes stated that it was 12 or 14. In response staff reacted in a rather disapproving manner.
During the first evening on the cardiac ward Alphonse asked Mark, one of the student nurses on clinical practice, to contact the hospital priest to come and see him and give him the last rites. Mark did so immediately and then went back to sit with Mr Alphonse.
Later Mark’s clinical supervisor (RN) called him to one side and asked why he was sitting with Mr Alphonse. Mark (student nurse) replied that Mr Alphonse was anxious and so he was sitting with him. The RN asked Mark “do you think you could be making him more anxious by sitting with him?” Mark replied that he didn’t think so, and he was only doing so until the priest came.
The RN then asked why the priest was coming, and Mark said that Mr Alphonse had asked for the priest, and so he had contacted him to come. The RN then said to Mark, “did you not think you should have told me what you had done” With that Mr Alphonse’s buzzer went and, turning to go back into the room, the RN and Mark saw Mr Alphonse have a cardiac arrest.
Despite vigorous and sustained effort Mr Alphonse could not be resuscitated.
Case Study 2 Miss Mary-Jane
Mary-Jane is 14 years old; her parents are newly separated and they both work. She has three younger siblings and Mary-Jane does a lot of the child minding. She has been complaining of abdominal pain, moderate now severe and has some vaginal spotting (bleeding) for the past 24 hours. She presents to the emergency department at her local hospital with her parents who are concerned that their daughter is so unwell. Mary-Jane is looking pale, sweaty, light headed, nauseated and has some stomach bloating. You have taken her base line observations on admission and they are: temperature 37.8C, pulse 118bpm, BP 90/50, Respirations 28bpm, shallow breathing. A possible diagnosis would be an ectopic pregnancy, and to rule this out a pregnancy test is essential. As the student nurse together with the Registered Nurse caring for Mary-Jane consider the legal and ethical issues, one being consent and the other confidentiality, these and others will need to be considered for Mary-Jane.
What are the rules surrounding mandatory reporting of sexual abuse?