Case Study: Nursing

Case Study 1
Helga Wanglie, an active and well-educated 85-year-old woman, tripped on a rug and was hospitalized for a bro-ken hip in 1989. During her hospitalization, she sustained several cardiac arrests, was placed on life-sustaining measures, and was eventually diagnosed as being in a persistent vegetative state. The health care staff caring for Mrs. Wanglie sought to withdraw her life-sustaining support measures. Her case became nationally known when her 87-year-old husband refused to consent to the withdrawal of life-sustaining treatments and her attending physicians requested that a judge name an alternate guardian based on the belief that her continued life-sustaining treatments were futile. The judge declined to name an alternate guardian, resulting in her continued use of life-sustaining equipment and care. Despite these continued measures, Mrs. Wanglie died when further resuscitative efforts failed.
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1 What are the compelling ethical rights that this case addresses?
2 Whose rights should take precedence.
3 How might the institutions' organizational ethics policies have impacted the outcome of this case?
4 Leaving any legal issues aside, how would you have used ethical principles to decide the outcome of this case, if Helga Wanglie had continued to survive relying on life-sustaining measures?
By examining the same Helga Wanglie scenario from the perspective of health care policy.
5 How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy?

Case Study 2
Mrs. R., an 87-year-old patient, has a history that includes coronary artery disease, a previous stroke, and advanced Alzheimer’s dis-ease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family members visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days but can be contacted should any change in Mrs. R.’s condition occur.
Her primary physician has practiced in this community for multiple years; he is well-known for his reluctance to discontinue any type of life-support for any patient. When questioned, Dr. G.’s consistent response is that, if this were his frail 92-year-old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major-medical center, where she can receive more advanced care, including vigorous rehabilitation and physical therapy, so that she may eventually return to a long-term nursing care facility. How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff and what are the positive actions that the nurses might begin to take to prevent moral dis-tress?
6 How might the nurses in this scenario respond to the physician's request?
7 How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
8. Create a proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.