Fun with ethics
September 1, 1999 2 minutes read
Fun with ethics
Role-playing can clarify issues
Role-playing is a useful tool to help case managers understand how their actions affect the patients in their caseload, says Carol Taylor, CSFN, PhD, MSN, RN, assistant professor and ethicist at Georgetown University School of Nursing in Washington, DC. "Case managers literally hold human well-being in [our] hands. For our patients, their illness or injury is a once-in-a-lifetime experience. How we respond, how we treat our patients, affects the public trust in the entire health care system. If I treat my patient poorly, my patient will not react well to the next case manager, or nurse, or physician, or therapist they encounter. If we don’t convince the public that we are worthy of their trust, then it’s buyer beware," she cautions. (For more suggestions for teaching accountability and ethical case management, see p. 139.)
Here are three role-playing scenarios Taylor uses in an ethics and accountability exercise. First, role-play the scenarios below with your colleagues and then discuss how the case manager responds, or fails to respond, is likely to influence the patient. It’s also helpful to discuss both how you think case managers in your practice would respond to this type of situation and how you think they should respond, notes Taylor. "If the would’ and the should’ differ, discuss why."
Scenario one: You are making the first home visit to a 60-year-old man with early Alzheimer’s disease who has just returned from a rehabilitation stay following a surgical hip repair. He is fiercely independent and seems to have mastered good self-help behaviors. His wife, on the other hand, seems totally at a loss and confides to you that she is terrified to have her husband home and has no idea how to cope. She asks you if it is at all possible to get him admitted to a nursing home. You suspect that her request is premature and feel certain her husband would not want to leave home.
Scenario two: Another nurse tells you that she’s utterly frustrated because the doctor refuses to talk with a patient about advanced directives because "it might depress her." You share this nurse’s belief that the patient wants to participate in decision making and that it is very possible that she will lose the ability to do this soon.
Scenario three: You are making a home visit to a 62-year-old man with end-stage AIDS. He tells you that he is tired of fighting, has no money, and no longer wants to be a bother to his friends. He asks you what he can do to end his life.
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