due Jul 29 at 12:59am
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 become very
frustrated and voiced their issues with hospital administration because they don’t feel the
administration is listening to their concerns about the challenges faced on the psychiatric units,
and particularly the challenges they are facing in caring for Rebecca.
You are the PMHNP who is assigned and is managing her psychiatric care while in the acute care
hospital.
1. At this point, can Rebecca make her own healthcare decisions? Why or why
not? What legal risk for the PMHNP could be associated with caring for Rebecca in
the acute care hospital setting?
Clearly this is a tension between autonomy and beneficence, competent patients have a right to
refuse treatment. A psychiatrist evaluation can be used to identify if patient deemed competent
or incompetent. Once this occur, if deemed incompetent a guardian will be appointed for
medical care approval. If patient is deemed competent to make informed care decision, then
there is nothing we do. This idea is supported not only by the ethical principle of autonomy but
also by U.S. statutes regulations and case law (US Constitution, 1990). Competent adults can
refuse care even if the care would likely save or prolong the patient’s life (Cite).1 Basically,
the patient’s opinion about what would be best for her care differed from the physician’s
recommendations about what was most likely to benefit her.
2. How can integrative care be an approach that is utilized with this patient?
Integrative care can be an approach; however there must be a clear understanding of this
patient’s fear, pain or other issues that may be creating barriers to her understanding of her care
plan. According to Mayo clinic, (2020) Integrative medicine can help people with cancer,
persistent pain, chronic fatigue, fibromyalgia and many other conditions better manage their
symptoms and improve their quality of life by reducing fatigue, pain and anxiety. In this case
due to the uncontrolled hypertension and an increase in psychosis and behavioral issues,
integrative care may note be the best approach as this patient needs to be stabilized. What the
PMHNP can do is to have good documentation and the discussion with witness of the
appropriately informed the patient about the risks of refusing care.
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 become very
frustrated and voiced their issues with hospital administration because they don’t feel the
administration is listening to their concerns about the challenges faced on the psychiatric units,
and particularly the challenges they are facing in caring for Rebecca.
You are the PMHNP who is assigned and is managing her psychiatric care while in the acute care
hospital.
1. At this point, can Rebecca make her own healthcare decisions? Why or why
not? What legal risk for the PMHNP could be associated with caring for Rebecca in
the acute care hospital setting?
Clearly this is a tension between autonomy and beneficence, competent patients have a right to
refuse treatment. A psychiatrist evaluation can be used to identify if patient deemed competent
or incompetent. Once this occur, if deemed incompetent a guardian will be appointed for
medical care approval. If patient is deemed competent to make informed care decision, then
there is nothing we do. This idea is supported not only by the ethical principle of autonomy but
also by U.S. statutes regulations and case law (US Constitution, 1990). Competent adults can
refuse care even if the care would likely save or prolong the patient’s life (Cite).1 Basically,
the patient’s opinion about what would be best for her care differed from the physician’s
recommendations about what was most likely to benefit her.
2. How can integrative care be an approach that is utilized with this patient?
Integrative care can be an approach; however there must be a clear understanding of this
patient’s fear, pain or other issues that may be creating barriers to her understanding of her care
plan. According to Mayo clinic, (2020) Integrative medicine can help people with cancer,
persistent pain, chronic fatigue, fibromyalgia and many other conditions better manage their
symptoms and improve their quality of life by reducing fatigue, pain and anxiety. In this case
due to the uncontrolled hypertension and an increase in psychosis and behavioral issues,
integrative care may note be the best approach as this patient needs to be stabilized. What the
PMHNP can do is to have good documentation and the discussion with witness of the
appropriately informed the patient about the risks of refusing care.
