2805NRS Legal and Ethical Principles in Healthcare Trimester 3 - Management Assignment Help

2805NRS Legal and Ethical Principles in Healthcare Trimester 3

Case Scenario

Doreen Richmond was a 68-year-old woman with chronic respiratory problems from her years of
smoking, was obese and had diabetes. She’d had a particularly troubled life, and after getting
involved with the ‘wrong crowd’ in her early 20s a substantial criminal history. Doreen’s last crime
was an attempted burglary. Unfortunately, things went wrong. Doreen shot and killed a shop
assistant, and then an attending police officer. Doreen was sentenced to life imprisonment. Doreen
had been an inmate at the Queensland Correctional Facility (QFC) ever since. Vera Bennet was the
Prison Governor at QFC and a Justice of the Peace.

Doreen’s chronic illnesses meant that she frequently visited the prison doctor. At one of the last
consultations, the doctor recommended that she complete an advance health directive, so that
should anything happen, Doreen’s wishes could be considered. Doreen had always hated the idea
that she might not be able to take care of herself in prison, so she completed the AHD, and had it
witnessed by Vera Bennett. Doreen did not, however, appoint anyone as her enduring power of
attorney. Because Doreen had been in prison so long, she’d lost contact with all of her relatives and
friends on the ‘outside’. She did, however, develop a close friendship with another of the inmates,
Bea Smith. Doreen and Bea made a pact to take care of each other for life.

One Saturday morning Doreen become unwell. She was short of breath, complained of nausea and
was clammy. After being assessed by the prison doctor, Doreen was transferred by ambulance to the
emergency department. In the hospital, Doreen was reviewed by a cardiologist, Dr Rosie Bush, who
diagnosed a serious cardiac dysrhythmia requiring the insertion of a pacemaker. Rosie asked
Registered Nurse Pat, to contact Doreen’s next of kin to get consent for the procedure. Pat rang the
QFC to see who the next of kin was, but Vera Bennet was not sure. Pat described Doreen’s current
condition and the proposed treatment. Vera agreed that the pacemaker was the only option.
Doreen was taken to the operating theatre for insertion of the pacemaker. Her condition
deteriorated intra-operatively and she developed respiratory failure and acute renal failure. The
procedure was abandoned, and Doreen was transferred to ICU for artificial ventilation and renal
dialysis.

When Bea heard what happened to Doreen, she was very upset. She called the hospital and spoke
with the ICU Consultant, Dr Molly Bean. She told Molly that Doreen is her best friend in the world
and that she wants everything possible to be done to get her better. Molly reassures Bea that
Doreen is receiving the best of care and asks Bea if she is aware of what Doreen’s wishes were if she
wasn’t able to fully recover. Bea tells Molly that Doreen has an advance health directive and that she
does not want to be kept alive with machines. Following this conversation Molly documents in
Doreen’s medical record ‘Not for CPR’.

A week later, Doreen’s condition had stabilised, and a tracheostomy was inserted to provide comfort
and assist with weaning her from the ventilator. By this time Doreen was awake and able to
understand simple instructions.

To everyone’s surprise, Doreen continued to rally. Her condition stabilised and improved and 16
days later she was well enough to be transferred to the ward with her tracheostomy tube in situ.
Doreen was again under the care of Dr Rosie Bush. When she first reviewed Doreen, Rosie thought
that it was unlikely that she would ever be well enough to be transferred back to QFC. A few days
later, however, she noted that Doreen was quite stable. She told Doreen that with some
rehabilitation she would be likely to recover. This pleased Doreen immensely because it meant she
would see Bea again.

One afternoon, nurses Ned and Roslyn were caring for Doreen on the ward. They entered her room
to administer Doreen’s regular medication and to attend to pressure area care. Neither nurse had
recently cared for a patient with a trache, or the in-line suction system used to suction secretions
from it, but were reassured by another nurse that ‘there’s nothing to it’. Ned and Roslyn briefly
looked at the system and thought they’d manage it okay.

After administering the medication and turning Doreen on her side, Roslyn left the room. Shortly
after, Doreen began coughing. Ned thought this may have been caused by a build of secretions and
tried to suction them from the trache with an in-line suction system. Being unfamiliar with the setup,
Ned was not aware that it had disconnected from the wall and the apparatus was ineffective. Ned
tried to reattach the suction tubing, but while he struggled to get it working, Doreen was struggling
to breathe. Roslyn heard the commotion and as she entered the room to assist, observed Doreen
becoming quite cyanosed. Together, the nurses placed Doreen on her back and called the Medical
Emergency Team (MET).

The MET arrive promptly, and manually ventilated Doreen via her trache. Despite this intervention,
Doreen’s heart rate dropped to 25 beats per minute, and she stopped making any spontaneous
effort to breathe. At this point, Ned highlighted the ‘Not for CPR’ order in Doreen’s medical record. It
was agreed that no further attempts to resuscitate Doreen should be made. Within several minutes,
Doreen was asystolic and she died.

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