Case Study Mary is 78, just home from the acute care hospital and the rehabilitation unit at the local extended care facility for treatment of a cerebral vascular accident (CVA). She has come home with a feeding tube, placed at the urging of the hospital staff when she was unable to take solid foods. Mary’s daughter Sue is the POA/HCR (power of attorney/health care representative), the only remaining child, because her sibling had died 2 years prior. Mary was widowed 10 years ago. Sue had been distraught when she received a call from Mary’s neighbor that her mother had called 911. When Sue arrived at the hospital, Mary was in the ER and was subsequently transferred to the ICU. Mary was minimally responsive, and therefore unable to speak, nor able to make her needs and wishes known. IV nutrition and hydration were implemented. Although Mary had an advance directive, indicating no use of tubes, her daughter Sue acquiesced to the physician’s statement that “Starving to death is a terrible way to die…. I would not want that for MY mother”, and agreed to the placement of a G-tube. Mary survived and underwent a few weeks of rehabilitation therapy. She regained some abilities, but the not the ability to speak or swallow without significant aspiration. Sue noted that Mary seemed very angry, sullen and withdrawn and that Mary was angry with Sue about the feeding tube placement against her wishes. Sue’s attempts to explain the rationale for the feeding tube placement did not make Mary less angry. Sue was able to learn that Mary wanted the tube removed and she contacted the primary care physician to help with this. The physician contacted the visiting nurses agency for an evaluation of the situation, Mary’s frame of mind and assistance with determining the ongoing plan of care for the patient. Cover the following in your analysis: 1. Determine if Mary would be an appropriate patient for hospice care. 2. Evaluate how the situation could have been avoided, including discussions between the two women. 3. Assess whether Mary should have had Sue at her meeting about the advance directive and if Sue should have a copy with her or available and whether a family conference would have helped. 4. Determine if the ethics committee should have been notified. 5. Analyze how the nurse could have Sue through the situation when the physician pushed for tube placement by virtue of the advance directive. 6. Describe any planning you have made for your end of life care and whether you have discussed you wishes with your family members
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