Elder Abuse and Nursing by Carol A. Miller MSN RN-BC

Author:Carol A. Miller, MSN, RN-BC
Language: eng
Format: epub
Publisher: Springer Publishing Company, Inc.
Published: 2016-08-04T12:06:00+00:00

CASE 8.2When There Is a Conflict Between Self-Determination and Safety of an Older Adult

Background

Nurses may experience conflicts between their responsibility to protect their patients from harm and their responsibility to honor each person’s right to choices and decisions. It is important to recognize that safety is not a paramount goal for many older adults, and should not be the sole criterion for decisions about their living arrangements. When decisions have a major impact on a person’s quality of life, questions about safety and risks need to be considered within the context of the person’s values and other influencing factors. When older adults value independence over risks, health care providers can facilitate plans that help reduce the risk while at the same time respecting the person’s right to self-determination.

Clinical Situation

Mr. Cunningham, a 79-year-old patient admitted for a stroke, no longer requires acute care. In addition to the diagnosis of CVA, his admitting diagnoses included dehydration, malnutrition, atrial fibrillation, history of multiple falls, and urinary tract infection. He lives with his two dogs in the house he was born in. He is eligible for admission to a nursing home for skilled therapies, but he adamantly refuses to consider any plan that does not include a discharge to home. He tells Nurse Paulette that his daughter is staying at his house and caring for his dogs but he has no one to care for them after she leaves. Mr. Cunningham’s daughter, Cindy, will be returning to her own home, 800 miles away, in 3 days. Cindy reported that her father’s house was “a shambles when I arrived but I did my best to get rid of the worst of the trash.” She also reported that her father’s dogs looked “like miserable street animals.” Cindy visits about twice a year and has tried to get her father to accept home-delivered meals, housekeeping, and other services, but he has always adamantly refused. Several times Cindy hired a friend’s daughter to help address her father’s basic needs, but he would never let her in the house. Nurses have described Mr. Cunningham as “feisty and determined” and his daughter describes him as “a loner and curmudgeon who has alienated any friends he ever had.” Cindy says she will not challenge his wishes to return home and she respects his right to refuse services, even though the therapists recommend that he be in a supervised setting for his own safety.

What Nurse Paulette Thinks

I have serious concerns about the safety of a plan for him to return to his own home, especially if he refuses any services. Even his daughter said it was a hopeless situation and I should not be bothered. When I reviewed his home-going medications with him, he told me he has no intention of taking “all those new pills you’ve been forcing on me since I was admitted.” Then he closed his eyes and pretended he was asleep so I couldn’t continue with our discussion.

What Nurse Paulette Does

Nurse Paulette talks with Cindy in a conference room to discuss the situation.

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