The Patient who did not want to be clean
Marion Downs, a community health nurse, must decide whether to refer her patient, 72-year-old Sadie Jenkins, to the community fiduciary for consideration of conservatorship and guardianship. Miss Jenkins has no living relatives and lives alone in a one-room apartment furnished with a bed, refrigerator, table, chair, lamp and small sink. With the support of her Social Security check and food stamps, she has adequate money for her needs and has lived for more than 10 years in these arrangements. She is in good physical health.
Ms. Downs has made three home visits to Miss Jenkins to check her vital signs and the effects of medication following recent treatment in the health center’s hypertension clinic. Although Miss Jenkins has made excellent progress and visits from the community health nurse are no longer warranted, her landlord, the other residents of her small apartment building, and her immediate neighbors are urging the nurse to “do something” about Miss Jenkins. Admittedly, Miss Jenkins’s apartment has a strong odor from the long-term accumulation of dust, dirt, and mold. Cockroaches can be seen in the apartment and an unemptied bedpan is often sitting next to Miss Jenkins’s bed. (It is “too much trouble” to walk down the hallway to the bathroom shared by Miss Jenkins and two other tenants.) Ms. Downs has noticed that Miss Jenkins has worn the same soiled clothes every time she has been to her apartment. It is also obvious that Miss Jenkins has not bathed nor washed her hair for a long time, and she apparently does not clean her nails and dentures. In addition, her toenails are so long that they have perforated the canvas of her tennis shoes, apparently the only shoes that she likes to wear.
Yet, Miss Jenkins is comfortable with her lifestyle and does not want to change her living arrangements. Although Ms. Downs has offered to contact agencies to help Miss Jenkins –homemaker services, counseling professionals, and senior citizens’ groups—Miss Jenkins says that she is comfortable and does not want (or need) help from anyone. Moreover, Ms. Downs is aware that she has several other patients who have severe needs for nursing care in the more traditional sense. She knows that if she interrupts her schedule of visits for the day to help place Miss Jenkins, she will not be able to use her skills as a nurse for these other patients as well as she might.
From your readings about the patient who did not want to be clean- Using the problem solving process according to Kirsch, identify the ethical
issues, analyze the concepts in nursing care and ethics and suggest how to solve the problem- Use a concept map to show how you visualize the
concepts, how they fit together, and what is involved in solving the problem (bubblus is a good tool)-