Scenario: 61 year old male (Mr.
Smith) who is status post MVC. Patient suffered from multiple rib fractures,
fractured leg, and a fractured forearm. Upon arrival patient GCS 15, with
labored breathing. It was discovered that this patient developed a pneumothrax
from rib fractures.
Within 2 hours, patient
deteriorated and required mechanical ventilation. After 3 days, patient was
downgraded from mechanical ventilation to bipap, then vapotherm (heated
high flow nasal cannula) on day 7. During the morning of hospital day 8, while
on vapotherm patient’s oxygen saturations decreased to 50%, his heart rate
dipped to the 20s, and eventually stopped.
After code blue situation, patient
was intubated and placed back on mechanical ventilation. He was weaned on day
10, then was on vapothem by day 14. Patient still GCS 15 was told by his nurse
practitioner that the only course of action for him was longterm ventilation
and wanted permission to perform a tracheostomy. The patient asked the nurse
practitioner for clarification on the procedure, the outcome, and prognosis.
Once he heard that he may require mechanical ventilation indefinitely, he asked
about initiating a DNR/DNI. He did not want another code blue situation. When
the nurse practitioner explained that with DNR/DNI and his refusal to allow the
tracheostomy, they did not believe that he could breath independently.
The patient asked to be transferred
to palliative/hospice care so that he could pass away in comfort of his home
rather than in the hospital setting.
The patient’s family didn’t agree
with Mr. Smith’s decision and attempted to obtain power of attorney so that
they could override his decision. Mr. Smith made his wishes clear and his
family spent many hours discussing with attorneys, hospital chaplain, and the
nurse practitioner to get Mr. Smith to change his mind or to have him deemed
Conflict– This nurse practitioner must discuss Mr.
Smith’s request with the family and help them understand that Mr. Smith
considered all of their feelings, but chose quality of life rather than
simply being alive. Further, because Mr. Smith is of sound mind, the ultimate
decision is Mr. Smith’s to make.
Style of conflict
S. (2005). Build a framework for conflict assessment. Nursing Management, 36(4),
Assignment status: Solved by our experts