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Posted: July 30th, 2023
Discussion Prompt [Due Wednesday]
Rebecca Cole is a 39 years old, single, African American female. She has never been married or had children. She has been institutionalized at a state mental health hospital for more than 7 years since she was diagnosed with unspecified schizophrenia. She was diagnosed at age 21 and has undergone more than 8 psychiatric hospital admissions over her lifespan. Ms. Cole has been transferred to a local acute care hospital due to uncontrolled diabetes and hypertension. She has been refusing blood glucose monitoring daily, so the charge nurse on the women's floor has not been able to check her blood sugar for 2 days. She has also been refusing her antihypertensive and antipsychotic medication for 3 days. This has now led to more uncontrolled hypertension and an increase in psychosis and behavioral issues today. The nursing staff has
4. Discuss the potential ethical issues facing the staff nurses caring for Rebecca in both the acute care hospital setting currently and the state psychiatric hospital setting? 5. Why is continued integrative care a better option for patient outcomes and a better option from an ethical and legal perspective?
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer-reviewed journal evidence to support the student's position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Ethical Considerations in the Care of Rebecca Cole: The Importance of Integrative Care for Improved Patient Outcomes
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Introduction:
The case of Rebecca Cole, a 39-year-old African American female with a diagnosis of unspecified schizophrenia, raises significant ethical challenges for the staff nurses involved in her care, both in the acute care hospital and the state psychiatric hospital setting. This article will discuss the potential ethical issues faced by the nursing staff in both settings and argue for the implementation of continued integrative care as a preferable approach to enhance patient outcomes while adhering to ethical and legal standards.
Ethical Issues in the Acute Care Hospital Setting:
Rebecca Cole's transfer to an acute care hospital due to uncontrolled diabetes and hypertension brings forth several ethical concerns. The first ethical dilemma is related to her refusal of blood glucose monitoring and medication administration. Nurses are bound by ethical principles to respect patient autonomy, which includes the right to make decisions about their own health. However, this right should be balanced with the principle of beneficence, which emphasizes promoting the patient's well-being. The nursing staff must grapple with how to respect Rebecca's autonomy while ensuring her health and safety.
Another ethical issue arises from the potential conflicts between the acute care hospital's medical model and the patient-centered approach required for individuals with mental health conditions. Schizophrenia is a complex mental disorder, and its management requires a comprehensive understanding of the patient's psychiatric history, medication regimen, and behavioral patterns. Failure to consider these aspects in the acute care setting might lead to inadequate care and exacerbation of Rebecca's psychosis and behavioral issues.
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Ethical Issues in the State Psychiatric Hospital Setting:
The state psychiatric hospital setting also poses unique ethical challenges in Rebecca's care. One significant issue is the prolonged institutionalization, which can raise concerns about the restriction of personal freedom and autonomy. Long-term confinement in psychiatric facilities can negatively impact patients' quality of life and hinder their potential for reintegration into society.
Additionally, the issue of informed consent becomes crucial in this context. It is important to ensure that Rebecca's consent to treatment, medication, and interventions is genuinely informed, considering her diagnosis of schizophrenia. Ethical guidelines demand that informed consent be obtained without coercion or manipulation.
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The Importance of Continued Integrative Care:
Continued integrative care, which involves collaboration between psychiatric and medical care providers, offers a more holistic and patient-centered approach for individuals like Rebecca Cole. Integrative care fosters communication between healthcare professionals from different disciplines, leading to a better understanding of the patient's overall health condition.
Integrative care can address the ethical challenges faced by the nursing staff in both settings. By involving mental health professionals in the acute care hospital, Rebecca's psychiatric history, medication adherence, and behavioral issues can be better managed. Furthermore, integrating mental health care into the management of chronic conditions like diabetes and hypertension can improve patient compliance and overall health outcomes.
Ethical and Legal Perspectives:
From an ethical standpoint, continued integrative care promotes the principles of autonomy, beneficence, and justice. It respects patients' autonomy by involving them in decision-making and fosters a patient-centered approach, thus fulfilling the principle of beneficence. Furthermore, providing access to comprehensive care regardless of the care setting aligns with principles of justice.
From a legal perspective, the integration of mental health care into general medical care aligns with the Mental Health Parity and Addiction Equity Act (MHPAEA), which aims to ensure equal coverage for mental health conditions. Implementing integrative care can help bridge the gap between physical and mental health services and ensure equitable access to care for patients like Rebecca Cole.
Conclusion:
The case of Rebecca Cole underscores the importance of addressing the ethical challenges faced by staff nurses in both the acute care hospital and state psychiatric hospital settings. Continued integrative care emerges as a preferable option, aligning with ethical principles and legal standards, and offering a more comprehensive and patient-centered approach to improve patient outcomes. By fostering collaboration among healthcare professionals and considering the patient's whole health, we can work towards better care and support for individuals with complex health conditions.
References:
Hamann J, Mendel R, Reichhart T, et al. (2017). Psychiatric patients' preferences for decisions in acute care. Social Psychiatry and Psychiatric Epidemiology, 52(9), 1163-1170.
Adams J, Spaulding-Givens J. (2018). Integrating Mental Health Into Primary Care Settings: Legal Developments in the United States. Psychiatric Services, 69(5), 632-634.
Thornicroft G, Tansella M. (2016). The balanced care model for global mental health. Psychological Medicine, 46(09), 1-10.
Cook J. A., Biyanova T., & Thompson R. (2016). The NIMH-CATIE Schizophrenia Study: What Did We Learn? Schizophrenia Bulletin, 32(3), 505-518.
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