Informed Decision Making Case Studies

As adults and human beings we have certain inalienable rights to make decisions regardless of whether they are deemed as poor or inappropriate by others. One must take into consideration the level of understanding and competence a patient possesses to assure they are informed of all options and repercussions; the other must be whether the individual is harming anyone other than themselves by making said decision. Once those issues have been taken into consideration there must be an allowance for an individual to make their own well-informed choice, even though as a practitioner, we may feel it is not in their best interest.
Case 4-2 presents an interesting scenario regarding Mrs. Jenkins (Fry, T., Veatch, R.M., & Taylor, C., 2011, p. 85),
Jenkins may be competent, lazy, and a poor housekeeper, the landlord is looking at a building wide health threat with the cockroach infestation and mold permeation, the tenants may be concerned not only about their health but, about the shape of their living environment, and finally, the nurse is having to differentiate a slob from a person incapable of making sound health decisions. The tenants may not only be at risk health-wise but, also may not be tolerant of the living next to a permeating stench. Finally, the nurse is having to differentiate between the patient’s personal preferences and lack of mental stability to make sensible decisions. As a nurse, it is outside of her scope to diagnose a medical condition of this magnitude. A doctor specializing in geriatrics and dementia needs to be consulted to determine if she is mentally capable of caring for herself or if there is an undiagnosed depression or mental illness affecting her cognitive judgment. If Mrs. Jenkins proves, after all diagnostic testing, to be of sound mind and body then, it is no longer (at this point anyway) a situation requiring medical intervention by a doctor or community nurse. It may be advantageous to assign a social worker, if appropriate, or to leave the situation to the hands of the building
However, there is a fine line between advocating for a patient and undermining personal liberties in regards to health if the patient is competent. The one area where the nurse and/or doctor may be able to exert some pressure is with the cockroach and mold infestation as it presents a public health issue. Her fellow tenants may not approve of her personal hygiene but, it is not for a nurse to determine or force however, a social worker or psychiatrist consult may be beneficial because these specialties are better equipped to diagnose and address self-care ability. Perhaps the community health nurse could put a spin on the discussion with the patient, stating that cleaning up her apartment and exterminating the cockroaches would be of great benefit in that scenario. If the nurse educates on the dangers of mold and insect infestation along with the fact that this is not only a personal but public health risk she may in fact be able to persuade the patient to making choices that benefit all