NUR 4827 Leadership and management in Healthcare
Group Project Case Study
Case Study #1 for Team A and B
Mr. and Mrs. O. are from Sudan and are temporarily living in the United States while Mr. O. is a university graduate student. They have a daughter age 6 and a son age 10. Mrs. O. brings her daughter to the clinic requesting a modified female genital mutilation (FGM), a form of female circumcision. They plan to return to Sudan within 2 years. Dr. M., the pediatrician, is outraged and discusses this with K., his RN, and the clinic social worker, G. He emphatically stated that her request was unethical and a primitive practice. He tells the social worker (MSW) to call the Children’s Protective Service (CPS), because the parents are endangering their daughter’s health. They are in need of counseling, and to an extreme action of placing the daughter in a foster home temporarily until the situation is resolved.
The RN has cared for Mrs. O. during her clinic appointments. In the presence of the MSW, she tries to explain to Dr. M. that the parents are very concerned about their daughter’s “future.” The RN and the MSW are opposed to bringing in the CPS. They believe that the parents are good, responsible parents and are trying to do the best for their daughter. They think that Dr. M. doesn’t understand the cultural issues. They explain that FGM is commonly done in Sudan and the parents will need to have this surgery done or else their daughter will not be “marriageable” and will be forced to live as a prostitute or even a beggar on the streets. The parents desperately would like the surgical procedure to be done as a minimum, minor incision, rather than the major, more mutilating excision. If they return to Sudan without the daughter having surgery, the daughter will be subjected to a more invasive excision (infibulation). According to the mother, it most likely would be done by a nonmedical person under unsanitary conditions using a butcher knife. The dangers of these procedures are severe pain, hemorrhage, infection, damage to adjacent tissue, and poor healing. The long-term effects include recurrent urinary tract infections, infertility, serious complications with pregnancy, and development of excess scar tissue requiring additional procedures.
What are some of the cross-cultural ethical issues occurring with this case?
What should each healthcare professional (RN, MSW, pediatrician) do individually and/or collectively in managing this case?
What are the parents’ rights acting on behalf of their minor child in this situation?
What are the pediatrician’s rights in this situation?
Case Study #2 for Team C and D
Millicent, RN, MSN is a white, 40-ish certified therapist in “Healing Touch.” She has been offering this therapy to her hospitalized culturally diverse post-surgical patients with good responses from them. She is aware that that there is some research suggesting that the therapy lessens the need for pain medication, reduces anxiety, and induces better sleep. Dr. Jones becomes angry when he learns about her doing “touch therapy” on his patients, which he calls “the work of the devil.” He strongly tells Millicent that she cannot do anything to his or his partner’s patients without a physician’s order.
What facts should be known about the RN’s scope of practice?
What are the ethical issues in this case between the RN and the physician?
What should be considered by the RN in relationship to “research ethics”? Patient’s fully informed consent? Cultural beliefs about an alternative therapy?
 
Case Study #3 for Team E and F
Benito F. is a 66-year-old Latino/Hispanic male retired after 45 years as a lineman with the telephone company in a rural community. His wife died from cancer within the past year. He had been a significant caregiver in addition to neighbors. They were married for 42 years and have two grown sons who live out of state. Lately, he has spent a lot of time alone, no longer going hunting with a friend and becoming less involved in activities at the Catholic Church. A concerned neighbor, who was unable to reach Benito by telephone, went to his home to check on him. Subsequently, he drove him to a large public hospital in a city 50 miles from his home. Benito was admitted to the Emergency Room. The nurse’s assessment revealed that he was in a “stuperous state with a strong smell of alcohol on his breath.” His rambling speech included comments about his wife’s death and that life wasn’t worth living anymore.
What are common family beliefs/values of the Hispanic culture and how has Benito’s family structure changed based on these beliefs?
What factors about Benito’s lifestyle might have led to his health condition?
What might be potential medical and mental consequences of Benito’s current lifestyle?
What appropriate patient teaching should be given to Benito in writing on his discharge, and why?
Why should “health literacy” be considered in teaching Benito about his care?
Case Study #4 for Team G and H
Mr. H. is a 59-year-old Arab business executive who lives in Saudi Arabia. His physicians have sent him to a large medical center hospital in the United States for evaluation of a potential heart-lung transplant. He speaks fluent English as do his wife and son, who accompanied him to the United States. On arrival at the hospital unit, Mr. H. stated that he was very tired from the long plane flight and was anxious about his condition. Because of his “status,” his attending physician transferred him to the Medical Intensive Care Unit. While undergoing extensive testing in preparation for a heart-lung transplant, Mr. H. has a lethal pulmonary embolus on Day 2 of hospitalization (physician diagnosis). Mr. H.’s wife and son were devastated.
What cultural information should the healthcare team know about Mr. H.’s beliefs/values about organ allographic transplant? Food practices? Spirituality/religious practice?
What is the general decision-making process in Arab family relationships?
What death care/rituals should be addressed with the family and by whom from the healthcare team? Consider care of the body at time of death, consent for autopsy, grief intervention, return of body to Saudi Arabia.