Reference no: EM133387676

Assignment:

Ms. Georgia, exhausted and frustrated, asked her daughter's nurse how she could have an ethical concern addressed. Directed to the office of the hospital ethics committee nurse co-chair, she found an empathic and listening ear as she shared her daughter's story. Her daughter, Mena, now 35 years old, suffered with liver disease among other comorbidities for more than 20 years. A liver transplant 7 years ago brought only a few years of relative well-being. With full knowledge that her transplant had failed and that she was not a candidate for a second transplant, Mena continued to want all aggressive care to sustain her life. Despite multiple admissions to the medical intensive care unit (ICU) over the past year, her overall health continued to deteriorate. A few brief discharges to home only prompted another readmission for complications, and Mena continued to agree to, or even request, transfer to the ICU when sepsis or respiratory distress developed.

Many physician trainees recommended referral to hospice over the past year to Mena, recommendations that she adamantly rejected. Ms. Georgia reported that this last episode infuriated her daughter and that her daughter felt "bullied" by these repeated, and at times strident, recommendations for referral to hospice rather than aggressive care and transfer to the ICU. She noted that the nurses witnessed these discussions yet did not weigh in with their perspective.

Ms. Georgia shared that she did not understand how her daughter had the strength to continue; if it were she, she would have refused life-­ sustaining therapy months ago. As her mother, she felt she needed to support her daughter's wishes, values, and preferences. Thus Ms. Georgia initiated a formal ethics consultation for her daughter with the question to the consultant: "Can you make these physicians stop pushing hospice referral?"

Questions:

1. Is there a primary patient and family centered care challenge in this scenario?

• If so, what is it?
• If not, then what elements in this scenario are patient and family centered?
• If not, what do you think the challenges could be if the patient and family centered elements were missing?

2. Is the challenge with the patient, the family, or a health team member? Explain why.

3. Who is responsible for creating the challenge?

4. Who is responsible for making the necessary changes to address the challenge?

5. What opportunities are available for successfully addressing this challenge?

6. What resources (human, financial, time, other) will be needed?

7. What barriers might prevent a successful outcome?

8. What do you believe a successful patient and family centered care outcome looks like?