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The Community Nurse and the Obstinate Patient: Limits on the Right to Nursing Care             Mr. Jeff Williams, a staff nurse with AppleTree Home Care Services at was preparing to visit Mr. Rufus Chisholm, a 59-year-old patient with emphysema who was recently discharged from the hospital after suffering pneumonia.  Well known to the health department, Mr. Chisholm was unemployed as a result of a farming accident several years ago and was essentially homebound.  Hypertensive as well as overweight, he was also a heavy cigarette smoker of long duration despite his decreased lung function.  Mr. Williams parked his car in front of his patient’s house, he could see Mr. Chisholm sitting on the front porch smoking a cigarette.  He experienced a flash of anger as he wondered why he continually tried to teach Mr. Chisholm the reasons for not smoking and why he took the time out from his busy home care schedule to follow up on Mr. Chisholm’s health. This patient certainly did not seem to care about his own health, at least not to the extent that he would give up smoking.             During the visit it was determined that Mr. Chisholm had discontinued the use of his antibiotic before the full course of treatment was completed and that he was not taking his expectorant and bronchodilator medication on a regular basis.  In addition, his blood pressure was 210/114, and he coughed almost continuously.  Although his lung sounds were improved. Mr. Chisholm said he tired easily and had no appetite. He politely listened to Mr. Williams’s concerns about his respiratory function and the continued use of his medications, but he did not seem to be taking any responsibility for his health status.  Mr. Williams told Mr. Chisholm that he would visit him again in 3 days.             As he drove to his next appointment, Mr. Williams wondered to what extent he was obligated as a nurse to provide care to patients who took no personal responsibility for their health. He also wondered if there was a limit to the amount of nursing care a non-cooperative patient could expect from a community health nurse. Commentary Employed by a healthcare system whose goal is to provide nursing care services at public expense for those who need and desire them, the nurse is confronted with the occasional patient who fails to follow the recommended healthcare plan. When this happens, the nurse may experience moral conflict. The nurse who personally values health and the provision of quality nursing care may view the patient who continually engages in health-risky behaviors as a waste of personal time, professional skill, and public monies. Yet the nurse may also feel there is a professional obligation to provide nursing care in response to the patient’s right to healthcare services. One approach to this issue is to regard patients like Mr. Chisholm as having a limited claim on nursing care services. His claim may be limited because other patients have a claim on Mr. Williams’s time and nursing services. In this case, benefits to others must be balanced against the benefit of nursing attention and care for Mr. Chisholm. His claim may also be limited because he has failed to fulfill his part of the contractual relationship between patient and nurse. Failure on his part thus releases the nurse from the duty to provide care that would normally be required. But there is one other reason why the patient’s claim to care may be limited. It may be that personal interests of the nurse—to take a continuing education course or to receive a visit from a health product salesperson—may take precedence once certain levels of healthcare services have been provided. This may be true even when no failure in the contractual relationship on the part of the patient exists. But who sets the limit on how much nursing care a patient is entitled to receive, and who is to say when the nurse has fulfilled his or her obligations to the patient? It is the question of who has ethical authority in defining the moral requirements and moral limits of the practice of nursing. Using the above information, apply this scenario to the ethical decision-making framework: Individually Reflect on the case and the commentary. Write down your initial thoughts/reactions. THEN as a team answer the following questions and submit to this submission portal: Determine who is involved in the case. Name all the parties and their relationship to the patient. Describe the issue. What exactly is the problem or issue to be solved?
SCIENCE
HEALTH SCIENCE
NURSING

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