Problem:
82-year-old Mr. Wu has been hospitalized with a stroke that has left him severely incapacitated - he can transfer to a wheelchair with assistance, but needs help for toileting, feeding, bathing and dressing. He has expressive aphasia so it is difficult for him to speak clearly and it is uncertain how much he understands in a conversation. Prior to his stroke, the widowed Mr. Wu lived with his daughter Sophia and her family (husband Marc and their three small children). He was a supportive and helpful member of the family, providing occasional child-care and helping with small household tasks. The physician feels Mr. Wu is ready for discharge and is being pressured by the hospital administration to free up bed-space. The physician has suggested that Mr. Wu go to a nursing home and she has asked the nurses to try to talk the family into it.Sophia has told you on a previous occasion that she feels she should take him home with her because her faith and culture say she should provide care for her parents. She is the eldest in the family and her siblings live far away, so she feels it is her duty to care for their father. But the Wu family house is small and Mr. Wu can no longer manage stairs, so they would need to add a bathroom to the ground floor. Sophia also has concerns because she works full time. Sophia has considered quitting her job in order to care for her father, but the family needs her income because her husband's work is seasonal. They cannot afford to hire a caregiver during the day when Sophia is at work. You overhear Sophia and her husband in the hallway outside Mr. Wu's room. Her husband is speaking very firmly: "I just don't see how we could possibly do it. It is too much for you to take on with all the other things you do. And I wouldn't know how to take care of him. Looking after the old folks was not something we did in my family."Sophia replies, "I don't know what to say. I just want to do what's best for Dad. When he came to live with us I promised him - we promised him - that he'd always have a place with us." Marc replies, "But he doesn't remember that promise. He doesn't remember anything."
The Discussion Board questions about this scenario are as follows:
Q1. What are your own values in this situation? (Imagine this were your own family.)
Q2. How might your own values affect your actions as a nurse?
Q3. What might the patient's and family's values be in this situation?
Q4. Is there a values conflict here? If so, how might you begin to resolve this conflict?