Nursing Case Analysis

Nursing Case Analysis: Ms. W and Denial

The case presented for analysis with respect to nursing practice and the American Nurses' Association Code of Ethics (2004) is that of Ms. W, a 55-year-old African-American grandmother diagnosed with advanced lung cancer who has been responding well thus far to radiation and chemotherapy treatments. However, recent tests indicate that Ms. W has experienced a 20-pound weight loss along with metastases to the bone. Her oncologist recommended immediate hospitalization for further evaluation, but Ms. W refused, claiming that familial responsibilities (caring for minor grandchildren, an aging and ill mother, and a wheel-bound adult son) prevent her from leaving the family at the present time.

Further. Ms. W appears disengaged with her own medical condition and treatment needs. While she keeps appointments and takes medication as prescribed, she exhibits avoidant behavior with respect to the severity of her condition, the potential for loss if life if further evaluation and treatment do not occur, and a concomitant determination to receive all possible care to avoid being given substandard care. She is clearly experiencing denial and has not developed meaningful relationships with caregivers, with the exception of the RN on the outpatient oncology team providing care to the patient for 2 years.

At issue in this case are several concerns. First, the failure to secure evaluation leading to treatment presents a direct a

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the oncology outpatient nurse has interacted on any number of occasions with members of Ms. W's family. The nurse is fully aware of the dependency of these family members on Ms. W and the patient's own deep commitment to meeting the needs of her young grandsons and her wheelchair bound son. The nurse is equally aware that Ms. W's son, daughter, and grandchildren who live with her are in fact dependent upon Ms. W. Her illness and her likely decline will have direct and quite serious impact upon these individuals. Though they are not the primary patient in this situation, they also have needs which the nurse has an ethical obligation to address. Specifically, under Provision 5 of the Code of Ethics (2001), a nurse owes the same duties to the self and to others -- duties that include the responsibility to provide integrity and safety. Consequently, it can be argued that because Ms. W has thus far refused to inform her family of the details of her condition, the nurse may be obligated ethically to involve these people in Ms. W's care. While the nurse also has an obligation to respect a patient's right to privacy and confidentiality, she has already been approached by members of Ms. W's family who are confused to their mother

Category: Medical - N