THE CASE OF MARION AND THE PACEMAKER arion is a 92-year-old patient who weighs 7
ID: 239969 • Letter: T
Question
THE CASE OF MARION AND THE PACEMAKER arion is a 92-year-old patient who weighs 78 pounds. She had poor eating habits for at least 20 years. In addition. Ma had been a heavy smoker all her life and suffered fregu Marion respiratory problems. During the past two years she has beco has been treated for pneumonia. In spite of Marion's protests home and likes the care and the attention that she receives forgetful, has suffered a broken hip as a result of a fall out of bed admitted to a nursing home. However, she quickly adjusts to her quite and IS , she During her third week in the nursing home, Marion d cough, high temperature, and respiratory problems. She is hospital with a diagnosis of pneumonia. The attending in addition to treatment for pneumonia, Marion will also pacemaker inserted to regulate her heartbeat. evelop physician suggests need to ha that Marion clearly explained to her family her wishes not to receive xtraordinary measures to prolong her life. She also signed a living will indicating her wishes. After thoughtful discussions with other famil members, Marion's daughters tell the physician that they do not want to put their confused mother through the surgical procedure and the pain while recovering from the surgery. Further, they are concerned that th mother will not survive an anesthetic and surgical procedure in her frail condition The physician seems to be understanding of this decision. He says that he will place into Marion's chart their request not to have the pace- maker inserted. However, the floor nurses take the daughters aside on several occasions to tell them that this is not a dangerous procedure and that they should sign a permit for surgery. The nurses make the daugh- ters feel that they are not acting in their mother's best interests by no signing the surgical permit. Marion returns to the nursing home without a pacemaker. She lives another four years without any cardiac problerm Ith 1. Were the nurses carrying out their responsibility as licensed care professionals or were they overstepping their role? 2. Were Marion's daughters acting in the best interests of heir mother e they knew that if she had the surgery she could not r to the nursing home where she was receiving good care 3. What should happen when a physician agrees with the fa members and the nursing staff does not? amilExplanation / Answer
1. The nurses were clearly over stepping as the physician and the patient had already decided that they do no wish to opt for the pacemaker procedure, the nurses should only once explain the benefits of the procedure, however in this situation the nurses have approached the daughter in several occasion which is not right as the nurses have no right to force the patient or the family into anything, at the end it is the decision of the patient and the family.
2. Marion's daughters were acting in the best interests for Marion as looking the patient who is 92 years old, is not physically fit to undergo any surgical procedure and the immunity is also very low in case of geriatric patients. Therefore it was best to avoid any surgical procedure.
3. The hospitals or any healthcare clinic works not only by a one profession but it works by team work, simillarly, the physician and the nurses may have clashes every now and then regarding the treatment and care of the patient because the way they are trained and their responsibilities towards the patient, however I being a registered nurse have the full right to protect my patient and provide nothing but only care and treatment which only has benefits and no harm under the principle of nonmaleficence, however if there is something which I do not agree with the physician and it is not the best option for the patient, I will first approach my nursing superintendent or my senior nurse and eventually to the management if need be and put my thoughts and plan of care to them.
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