Read the Case Studies: Walking The Tightrope

Read the Case Studies: Walking The Tightrope

Read the Case Studies: Walking The Tightrope

Linda Johnson, ACSW, and Robert Potter, MD, PhDUndermanaged Pain Makes for an Unattractive Patient

An eighty-five-year-old widow has been in a long-term care facility for six months. She was admitted with severe osteoarthritic and osteoporotic pain. Her family initiated her placement because she was overmedicating herself at home, confusing her medications, and not eating adequately. She has been a “complainer” for years, the family reports. The family and physician are reluctant to give her strong pain medicines; they don’t want her to be “doped up” like she was at home. She currently takes two Tylenol every four hours which does not adequately control her pain (and risks liver and kidney toxicity). She is in too much pain to walk, but quickly becomes uncomfortable in the wheelchair. So she requests bed rest and frequent repositioning. Staff feels she is demanding and hard to please. She has a son who calls and tries to visit once a week, but who becomes tired of hearing her constant complaints of pain. Her daughter lives out of town, and calls weekly.

The son asks the doctor to make her more comfortable and assuage her complaints. But the son also requests that the doctor not give her whatever she received six months ago (at the time of admission) when she drooled and was unable to sit up or eat.

Her sister has called the state regulatory agency to complain that the facility staff is neglecting her and not taking care of her pain.

The doctor agrees to try Nalfon, a nonsteroidal anti-inflammatory drug (NSAID). After two weeks, she has dark, tarry stools, suddenly vomits blood, and is hospitalized for a severe gastric bleed.

Write a paper in which you:

Summarize the case, explaining the legal and ethical aspects of it.

Research and explain any laws that pertain to the situation.

Define and explain the ethical principles that pertain to this case.

Determine if the legal and ethical responsibilities are in alignment with each other.

Explain how you would recommend this care team resolve the situation by answering the following questions:

What specific details of the case require resolution?

What specific actions should the organization or nurse take to ensure an appropriate outcome?

What resources and dependencies exist for your recommendation?

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.