Jenny Abrams serves as the health care administrator at Brookside Hospital, a privately owned,250-bed facility located in a rural town in West Virginia. It is 7:00 a.m. on a Thursday, and Ms.Abrams has received an emergency call from the hospital director of security, just as she is preparing to leave her home for her 20-minute commute. Apparently, there has been a disturbance in the ICU waiting room involving family members of a new patient admitted through emergency services during the night. Security is attempting to de-escalate the situation and 911 has been called with law enforcement on the way.When Ms. Abrams arrives, she is met in her office by the director of nursing services and director of security for debriefing on the situation. The family members have been somewhat calmed and are located in the ICU family waiting area and the cafeteria of the hospital with security officers present. The daughter of the patient has demanded to meet with Ms. Abrams immediately.

Back Story

Joseph and Barbara Nichols have been married for 56 years. They have two children and five grandchildren. Both are in their late 80s and currently reside in a small home they purchased 30 years ago. Their home is located in the same suburban Pennsylvania neighborhood as their daughter, Mary, and her family. Mrs. Nichols suffers from advancing dementia and is easily upset and confused, but she is otherwise in good health. Mr. Nichols has suffered two heart attacks yet is still able to care for himself and his wife with help from his daughter and a housecleaning and lawn service. Neither drives. Both are very independent individuals and have made it clear to their children that they wish to live out their lives and die peacefully in their own home. This has been an issue between Mary and her brother, John, who resides in West Virginia. Mary defends her parents' independent living choice and plans to help with securing increased home care as needed. Her brother repeatedly argues that it is in everyone's best interest,especially with his mother's dementia and father's medical history, that the house be sold and his parents placed in a senior care living facility. At their parents' request, Mary is designated as health care agent if needed, and they both have living wills. Both Mary and John are aware of their parents' advance directive wishes. The couple relies on Medicare coverage for their medical needs and do not have long-term care insurance. Their source of income is adequate and includes social security and Mr. Nichols' modest retirement pension. Neither are veterans.Three days ago, Mary and her family left for an annual vacation to New York. They dropped off Mr. and Mrs. Nichols at her brother's home to visit with his family for the week. As always, Mary left contact and medical information in a file with her brother.On the evening prior to Jenny Abrams's early morning call, John and his wife had gone out,leaving their 14-year-old daughter at home alone with her grandparents. At 10 p.m., after retiring for the night, she was awakened by her grandmother crying out in the hallway, frantically searching for her husband. She was also highly agitated and confused about where she was.Together, they found Mr. Nichols unconscious on the bathroom floor. The granddaughter called 911 but was unable to reach her parents directly. The emergency personnel arrived to chaos,with both women hysterical. Mr. Nichols was treated by paramedics and rushed to the Brookside emergency department, where it was determined that he had suffered another heart attack and was placed in the intensive care unit. Mrs. Nichols and her granddaughter were escorted to the hospital by the local police. 2 When John and his wife finally checked their phones, they rushed to the hospital to find Mr.Nichols unresponsive and on extensive life support. Mrs. Nichols and her granddaughter had been unable to communicate medical history. Neither remembered or mentioned the daughter Mary during all of the disturbance and emotional confusion. Mr. Nichols' advance directives included a do-not-resuscitate (DNR) order, a do-not-intubate (DNI) order, and his stated preference for no life-sustaining equipment or devices.After John called to give her the news, Mary and her family immediately drove straight through the night to the hospital. Upon their arrival, everyone in the family was stressed, afraid, hungry,and overtired. When Mary spoke to the charge nurse, she was short and curt, informing her that she would have to wait until after the shift change to get complete information and speak with an attending physician. Mary then discovered her father on life support and was unable to control her fear and frustration, lashing out in anger toward her brother.Just as the nursing change of shift meeting began, a loud, verbal argument between Mary and John erupted in the ICU waiting area. The charge nurse briefly attempted to calm the families but called in security, as the argument appeared to be escalating toward physical violence between Mary's husband and her brother John.Security has calmed the family and Mary is impatiently waiting to speak to Ms. Abrams, the Brookside administrator, as she cannot understand how her father's wishes were not respected and blames the facility for not taking more extensive efforts to research her father's medical history and paperwork further. She also plans to lodge a formal complaint against the charge nurse for what she considers rude and unethical behavior toward her.Post Script Two weeks later Mr. Nichols has gained consciousness and is on minimal life support at Brookside Hospital. However, without the life support, he is expected to live no more than a week or so. He is requesting to return to his home in Pennsylvania. His children and wife are divided and conflicted the over next steps to be taken. His daughter Mary is distraught. She feels that if her father is not taken home, he will not experience the death with dignity he wishes and deserves. She has taken a leave of absence from her job and is staying at her brother's home with her mother to enable them to be at Brookside each day. This is straining her family's finances and emotional well-being. She is also shouldering a burden of guilt for being on vacation when crucial decisions were made that compounded the situation. Her brother, John, is very frustrated and angry, as he feels that it is more appropriate to move his father to a hospice facility. He is increasingly vocal and adamant about selling the house and securing an appropriate placement for his mother. With all the stress and disruption, Mrs. Nichols' level of confusion and anxiety has increased significantly, and she is unable to fully understand.

• Ethical Case Study EvaluationResources
  • Ethical Case Study Evaluation Scoring Guide.
  • Turnitin.
  • BUS4121 Library Guide.
  • Case Study Scenario [PDF]
  • Ethical Case Study Evaluation Template [DOC]
  • Using the Scoring Guide to Enhance Learning [PDF]
• For this assignment, you will evaluate a case study based on a hypothetical scenario involving health care management, patient care, and end-of-life considerations. You will utilize a formal decision-making process to evaluate this scenario based on the concepts and principles you have studied in this course and perhaps your own personal and career experiences.Preparation
  • Read the Case Study Scenario (linked in the Resources) to complete this assignment.
  • Review the Ethical Case Study Evaluation Scoring Guide prior to beginning your work.
  • A template is provided in the Resources for this assignment.
• Scenario and ChallengesJenny Abrams, the health care administrator at Brookside Hospital, is faced with three overall challenges in the Case Study Scenario:
  4. Ms. Abrams must initially use excellent communication, investigative, critical thinking and decision-making skills to immediately assess and deal with the situation she is facing in her office when she arrives.
  6. She will then need to investigate and evaluate the validity of the claims related to medical procedures performed and ethical behavior of staff to appropriately address them with the family and within her facility.
  8. Finally, as an ethically minded manager and individual, Ms. Abrams must be sure that Brookside Hospital provides Mr. Nichols and his family the discharge and end-of-life support they require.
• Imagine yourself in Ms. Abrams's position, and work through steps outlined below for each of these challenges.StepsFor your evaluation of this case study, use tools and knowledge gained in your studies to gather and evaluate relevant facts, and recommend actions for Ms. Abrams to take to address the situation in an ethical manner.Refer directly to Step 1: Gather the Facts, on pages 111-113 in your Ethics and Professionalism for Healthcare Managerstext to perform and discuss the fact-gathering tasks for this section of the case study.
  • Clearly define the problem.
  • Determine whether the decision involves an ethical conflict.
  • Ascertain boundaries or ownership of the situation or problem.
  • Determine the internal and external stakeholders.
  • Identify the person who should be the decision maker.
  • Gather data.
  • Identify and list the ethical principles and the non-moral concerns of the situation or problem.
  • Revisit the definition of the problem to assess its accuracy and precision.
  • Identify several possible options.
• Helpful Resources and TipsBUS4121 Library GuidePlease refer to the BUS4121 Library Guide for valuable resource material on writing, referencing, and researching on the Internet and in the Capella library.
• TurnitinTurnitin is recommended for use as you prepare your assignment. Submit your paper as a draft in Turnitin. Review the matching score and the Originality Report to be sure that you have cited and referenced all outside material and that your paper is primarily written in your own voice. Make any needed revisions and submit your final paper for review prior to submitting in the courseroom. A Turnitin tutorial is linked in the Resources.