CLM 353 – Ethics in Health Services Management Case Study #2 Student Learning Objectives: SLO 1: To apply knowledge to actual situations. (Blooms level 3, Application) SLO 2: To compile component ideas into a new whole or propose alternative solutions. (Blooms level 5, Synthesis) SLO3: To make and defend judgments based on internal evidence or external criteria. (Blooms level 6, Evaluation) EEQs: Principled & Ethical • Approach/analyze ethical issues through the application of sound problem-solving methods. • Identify the ethical problem- solving resources (ethics committees, standards and regulatory committees, infant care review committees, institutional review boards, etc.) and how they can be employed to assist others in managing ethical problems. Using your textbook, lecture notes, weekly presentations, and at least TWO external sources: 1) Describe and discuss the ethical arguments in this case within the framework of the ethics concepts and principles we have studied, including those of the “Big 8” philosophers. 2) What changes would you make to the skilled nursing facility to improve patient-centered care? Frame your changes in terms of ethical principles and concepts. 3) What changes would you make to the U. S. healthcare system to improve patient-center care? Frame your changes in terms of ethical principles and concepts. Prepare a 3 to 5 page essay double- spaced using APA format. A cover page, resources section, and abstract are required. You must use a minimum of 4 resources – including TWO, which must be external to the class. Be sure to cite your sources in the text and the resources section. Be prepared to discuss your paper in class. The full rubric will be posted in Canvas. Content Readability and Style Mechanics 30 points 5 points 5 points Dementia and Patient-Centered Care Kate Jones was a vibrant, active, intelligent female in her mid-60’s when she developed symptoms indicative of dementia. At the time, she was married and had a loving husband who was a disabled military veteran. They moved to an assisted living apartment so she could live close to neurologists and other specialists to get specialized medical care. Jones had an adult daughter who worked full-time but could assist the couple before and after work. As her illness progressed, Mrs. Jones started having difficulties swallowing and became incontinent. She began to develop frequent urinary tract infections and substantial confusion. One day, she fell in her apartment. In acute pain, she was taken by ambulance to the local emergency department. She was left in the waiting room for seven hours before being seen. Once the x-rays were read, the emergency room physician diagnosed three fractured vertebrae in her spine. She was taken to an inpatient room to wait until surgery could be scheduled. The surgery was done two days later. Following her vertebroplasty procedure, her orthopedic surgeon talked with her family. He explained that this was a difficult time in her life, and he was right. Although the procedure was successful, Mrs. Jones forgot how to walk. She was discharged from the hospital to a skilled nursing facility for medical rehabilitation. It was the only skilled nursing home with an available bed. The hope was that she would get physical therapy to regain her mobility so she could return to her apartment. She had to be ambulatory to qualify for the assisted living apartment. Her condition deteriorated at the skilled nursing facility. She became more confused and began to lose weight. Mrs. Jones could no longer talk or feed herself. The nursing home medical director was hard to contact when the family had questions. Her nurse practitioner ordered a pureed diet. She also ordered nutrition drinks in hopes that Mrs. Jones could gain some weight. A nutrition consult was never suggested, “because she had dementia.” She continued to lose weight and was labeled as “failure to thrive.” Mrs. Jones’s daughter and husband came to the nursing home every evening to feed her dinner and help get her ready for the night. Frequently when they arrived, she would have pureed food on her face, in her nose, in her fingernails, and on her clothing. They observed staff feeding other residents in a rushed and forceful way. The pureed food was bland and unappealing visually, and condiments such as butter, salt, and ketchup were frequently unavailable. Although her family served thickened liquid drinks to her with a straw, staff members told them she did not know how to drink from a straw. Instead, they said they “poured drinks down her throat.” Her family members were afraid to complain because they feared she would be the target of retaliation. The family had her placed on the waiting list of higher-quality nursing homes in town. One of the nursing homes had 50 residents on the waiting list ahead of Mrs. Jones. Initially, physical therapists worked with Mrs. Jones to help her walk. Some days the physical therapy made her smile. They ordered a footboard for her wheelchair, to position her feet when sitting. Frequently, the family arrived and the footboard would be missing. For weeks, her name was misspelled on her wristband and food trays, despite the family calling attention to the errors. The facility was frequently short-staffed which meant that residents did not get baths, food, or diaper changes on schedule. Mrs. Jones was never taken to group activities. Her labeled clothes were often missing from her closet. One day, the evening shift floor nurse called her daughter to talk about lab results. Mrs. Jones’s thyroid test was too low. They needed to increase her medication. Jones had been taking the same level of thyroid medication for years without any problems, so her daughter asked for a copy of her medication dispensing records. A copy was finally provided. Even though she was supposed to take her thyroid medication first thing each morning, the record did not show her receiving any doses. The daughter asked to speak to the head nurse who did an investigation. The head nurse said the morning medication nurse stopped giving Mrs. Jones her thyroid medication because she had difficulty swallowing and she said there was not enough time to crush the medication and give it in a spoon of pudding. The thyroid medication was not given later in the day either. The head nurse said she would see that Mrs. Jones received her medication as ordered. However, medication problems continued. One day, her daughter found that Mrs. Jones had two Excelon medication patches on two different dates. The morning medication nurse was supposed to remove the old patch and replace it with a new patch each day. The package insert cautioned that this practice could lead to a medication overdose. However, the nurses stated that it would not cause her any harm. This happened several times. The daughter complained to the head nurse about the patches, but no feedback was ever provided. Mrs. Jones continued to lose weight and decline. She died in the nursing home after 364 days.

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