Provide a culturally congruent resolution to one of the case studies presented on pages 329-330 of y. Question
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Provide a culturally congruent resolution to one of the case studies presented on pages 329-330 of your Joel textbook.
This activity will be graded using the Assignments Rubric in your syllabus.
Instance 1
You have arranged to meet with family members of your patient, an older woman in the medical intensive care unit (ICU). The woman resides in a nursing home, and this is her third admission in recent months, all for the same indication: shortness of breath caused by chronic heart failure. She is now resting quietly without apparent distress.
The consensus among her professional caregivers is that the goal of care from this point forward should be comfort, including either return to the nursing home with a care plan that includes a “Do Not Hospitalize” order and appropriate medications to treat dyspnea, or to the home of a family member on hospice.
The nursing home staff members have documented that the patient has not completed an advance directive or otherwise expressed preferences about care at the end of life. Based on experience from this and previous admissions, you (and others on the team) expect that the principal family members accustomed to making decisions on behalf of the patient will resist the team’s recommendations.
Instance 2
A pulmonologist consulting on Instance 1, but not involved directly in team discussions about the discharge plan, corners you in the hallway. With obvious annoyance, he declares that you “have no business” initiating a family meeting about a treatment plan. You reply that you are recommending a treatment proposal representing an interdisciplinary consensus. He counters, “That is a job for a physician!”
Instance 3
You have had a subsequent meeting with the pulmonologist. In your opinion, this attempt to reach an understanding has failed. You decide to alert the director of nursing. She tells you that this physician has made similar complaints before and that she has “had some success in calming him down.” You leave her office thinking that you did the right thing by alerting her to the conflict with him.
Later, when reminiscing about your visit to the director’s office, you feel disappointed. Thinking more about it, you conclude that the director’s response to you was inadequate. You decide that simply “calming him down” is not enough, either for you or for the professional staff as a whole. This physician is widely viewed as a disruptive presence on the med-surg floors. Apparently, the medical staff leadership has long been aware of the problem but has not taken effective action.
You believe that trying to stimulate more effective action by the institution would be professionally responsible. You also remind yourself that doing so would be at least uncomfortable, if not risky, for you.
These three instances illustrate three distinct kinds of conflict situations common in the experience of APNs.
• Instance 1: conflict with one’s own patients or their families
• Instance 2: conflict with another professional
• Instance 3: conflict with administrative leaders and/or institutional procedure
SCIENCE
HEALTH SCIENCE
NURSING
Provide a culturally congruent resolution to one of the case studies presented on pages 329-330 of y
