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Rock Street, San Francisco

Emilio is a 65-year-old Hispanic man who was admitted to the hospital for the third time in 6 months, for hyperglycemia. He is now scheduled to be discharged but his daughter is telling the nurse that she does not want her father to be discharged because he is non- compliant with his medications at home. She says she has young children at home and is incapable of being responsible for him as well. She’s also worried that he is depressed since her mother passed away and left him at home alone when she did everything for him. Emilio has been seeing a curanderos who treats him with traditional methods, and she thinks that he refuses to take his medication because of this. She tells the nurse that she wants her father to go a nursing home so they make sure he gets his medication and not the herbs he has been using. His blood sugar on admission was 589. He is retired but still active in his church, garden, and likes to work on small projects around the house. His medical history includes type II diabetes, insulin dependent, hyperlipidemia, and osteoarthritis.
An ethical dilemma exists when the right thing to do is not clear, or when members of the health care team cannot agree on the right thing to do for a patient.
Three ethical principles I came up with from this case are, to discharge Emilio from the hospital and go home even though he may not be compliant with his medication. Second, his daughter trying to prevent him from seeing a curandero because she doesn’t agree with this way of treatment. Lastly, admitting him to a nursing home where the nursing staff with administer his medication.
Following through with the first option, would have Emilio at home following his preferred medical treatments. This may lead to his daughter resenting him because she may not be able to meet his medical care needs due to her own daily family responsibilities. Second case would send him to a nursing home where he may feel more depressed due to the loss of his independence. He will lose the ability to stay active in his garden, church activities, and the small projects he enjoys at home. The third solution is to hold off on discharging Emilio and set up a meeting with him, his daughter, physician, nurse, and a social worker in order to discuss the best option for him post discharge. The solution that makes the most sense to me would be discussing the situation with everyone involved so everyone has a chance to express their thoughts and opinions about each option.
When it comes to a situation that pertains to a patient’s safety, personal lifestyle, and their health after discharge, it’s best to discuss with the patient, his family members, his physician, nurse and a social worker together to decide the best possible solution.
Since Emilio is capable of understanding his own medical needs and issues, then he should be involved with the decision making process of moving home or into a nursing home. His culture plays a role in the importance of staying home as people of Hispanic descents value family and traditional healers highly, so leaving the home that is full of his family memories would mean a great deal to him. Education would be a big selling point for Emilio to stay in his home. Due to his culture, time would need to be addressed as he may view time as circular, meaning he will take medication when he goes inside for lunch rather than keeping a strict schedule and take the medication at the same time each day. This can be a sensitive topic, however there are simple changes to be made to help. Such as keeping an up to date calendar or setting alarms to notify him when and for what medication is due.
The American Nurses Association developed the Code of Ethics for Nursing that help guide us to determine what the right thing to do is for a specific situation. Emilio’s daughter has asked for the physician to sign off for admittance to a nursing home despite knowing he is well enough to go back home. A person’s independence is described by autonomy, this is a principle that represents an agreement to respect a patient’s rights to make choices regarding care and treatment. Having Emilio part of the conversation is only fair, as this is his future that is being discussed. It’s not uncommon for a patient to suffer from depression and loneliness when they move into a nursing home, because they may feel like a burden to their family. So with the collective group communicating honestly and advocating for Emilio’s best interest prior to discharge is the most ethical solution.
Being competent is a valued aspect of being an informative nurse. The ability to stand by the patient when they are able to make decisions for their own healthcare, is described as being an advocate. All aspects of Emilio’s diagnosis, treatment and prognosis should be considered when discussing his best interest. Its’ important that the nurse understands and supports the patient’s wishes and provides education on the outcomes from whatever they have decided, in order to say that the patient had all the information to come up with their conclusion.
A social worker can bring a lot to the conversation, as they have a strong understanding of the core values in order to make ethical decisions. The Code of Ethics is also a great resource as it provides specific guidelines to assist with making the best decision for that patient.
Ethical decision making is a process that can be used in addressing any ethical dilemma. Respecting a competent patient, such as Emilio, means he is valued and has the right to make choices regardless of others opinions. By collaborating with Emilio and his daughter, we hear about the families needs and desires. From the physician and nurse, the medical information is brought to the table. The logical information the social worker can bring is key to solving the ethical issue about discharging Emilio and finding the solution that has his best interest in mind.

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