The Individual Case Study presentation will be accompanied by a PowerPoint created using the following slide guide:
Slide 1 – Title page including the module topic and presenter’s name
Slide 2 – Detailed description/summary of the case study – this slide should contain key points from the case study that
the student presenter will then expand on.
Slide 3 – Identify at least one ethical dilemma(s) that breaches each of the 4 ethical principles: Beneficence, Non-
maleficence, Autonomy, and Justice/Fairness.
Using the Four Topics Approach:
Slide 4 – Outline the Medical Indications as related to the ethical dilemma(s)
Slide 5 – Outline the Patient Preferences as related to ethical dilemmas
Slide 6 – Outline the Quality of Life as related to ethical dilemmas
Slide 7 – Outline the Contextual Features as related to ethical dilemmas
Slide 8 – Reflect and explain your Original and Alternative Perspective(s)
Slide 9 – From the ANA Code of Ethics, choose 1 that applies to your ethical dilemma(s) and explain your
perspective
Slide 10 – List out and then explain your response to the 2 content-related questions at the end of the case
study
Slide 11 – Explain your personal reflection and takeaways from researching and presenting this case study
11
and ethical dilemmas
Slide 12 – Provide at least 5 questions for discussion to help facilitate your group conversation
Slide 13 – Provide your references in APA 7th edition format
Additional instructions
PPT: You will follow the Four Topics Approach to Ethical Decision-Making (Jonsen, Siegler & Winslade, (2010) as
described in Chapter 2 of your course textbook.
TITLE : MO’s story
Related Content. Ethics in mental Health and public health nursing.
Chapters 10 and 11
Each student will create a PPT presentation with audio incorporation to present.
Mo’s Story
PART 1: Time at Work
Aright, team, nice work. Now, get those reports to me by Friday morning. And see you all at the fundraiser!”
The conference room, filled with men and women in gray, black, and the occasional navy business attire, erupted in mumbling and snippets of conversation as everyone lazily got up from their chairs. Mo remained seated in the back corner of the conference table, observing the office chatter buzzing around him:
“You going to that fundraiser?” … “Yeah! You?” … “Yes, I’m bringing my husband with me, so you’ll finally get to meet him!” … “You’re married?”
Mo looked out the window, away from everyone. He started to feel a bit uneasy, as though he didn’t belong there. He wanted to go home, hide, and sleep. He was so tired and the last thing he wanted to do was to sit at work doing something he hated. He watched a pigeon with muted colors speckled across its wings fly off from a nearby roof and he found himself yearning to be that bird. He yearned to be so free. He blinked and took a deep breath in.
“Mo, are you going to the fundraiser?” Celine, a young intern, asked earnestly.
His thoughts were interrupted. He turned his head slowly, keeping his eyes averted.
“Umn…no,” he mumbled. He started to tremble and felt his cheeks get red.
“Huh?” asked Celine.
“UmmIhavetogo,” Mo said, cramming his response into one syllable. He slowly got up from the conference table, making sure he kept his eyes on the ground. Celine scuttled out of the way as Mo made his way to the door in a panic.
Mo didn’t remember the car ride home, but that didn’t matter. He opened the door to his two-bedroom loft and collapsed onto his chair. He was exhausted, mildly sweaty, and felt that he was going to vomit at any minute.
Am I having a heart attack? he thought, as he struggled to catch his breath.
Mo’s heart started to pump faster and he felt that the room was getting hotter and hotter by the second. He got up, opened a window, and stuck his head outside in an attempt to get a little bit of the cool breeze that had been caressing the warm weather all day.
After a few minutes he regained some of his composure and brought his head back inside. He sat solemnly on his couch.
“I can’t do this anymore,” he said out loud.
“Anymore what?” replied Ray, his brother, exiting from his bedroom.
“Nothing. Work. I just can’t go in…I can’t do this job anymore.”
“Wait, what? Why?”
“It’s hard to explain. But every time I’m there, I feel like I’m going to pass out from being nervous. I hate sitting in meetings. I’ve avoided three presentations now and I don’t even know why.”
“Why are you nervous? And how long have you been feeling this way?”
“I don’t know. And I don’t know how long. Months maybe? All I know is that every time someone looks at me, or talks to me, my mind goes blank, you know? I just stop thinking. My body goes into like overdrive, and I find myself just wanting to hide. And they’re probably seeing all this happen and laughing.”
“No, they’re probably not laughing at you.”
“Yes they are. I’d bet on it. They’re probably making fun of how much I sweat, shake or stutter. They probably think I’m some idiot who doesn’t know how to do this job. Chances are I’m going to get fired soon anyway because of all this, so why don’t I just quit? I’m gonna quit. The thought of even going in tomorrow makes me want to hide. I just can’t, Ray. I just can’t.”
Mo put his head in the palm of his hands and sighed. He had made up his mind: he was going to send in his letter of resignation the first thing tomorrow morning. He couldn’t bear to walk into work one last time and tell his boss in person. The thought of that made him feel dizzy and sick all over again.
“Before you call it quits, Mo, why don’t you go to a doctor and see if they can help?”
“Um. Maybe. Ok. I guess…”
“Cool. I’ll see if my doc can fit you this week.”
“This week? That’s so soon!”
“If you’re this stressed out, why would you wait? I’m going to call first thing tomorrow.”
Question
• Did Mo’s brother, Ray, act in his brother’s best interest?
• Is Mo’s opinion of his colleagues reactions to his behavior accurate?
• Were boundaries between patient and provider clearly identified?
Part II – A Visit to the Doctor
Before Mo knew it, he was sitting in a tan and oak room, which Mo found slightly mismatched. He tapped his fingers on the arm of his chair, breathing heavily, his heart punishing his chest.
“Mo?” A petite nurse called his name. “Hi Mo. C’mon back. You’re going to be in this room, right here.”
Mo followed the instructions silently and then sat quietly as the nurse made small talk. He responded aloofly and curtly. Then the nurse left the room. Mo felt so nervous; he felt as though he was getting tunnel vision. Everything was becoming farther away. He felt so detached.
After a few minutes, the doctor walked in. He was about 50 years old and had brown hair peppered with gray. His eyes looked as if he had read too many books in the dark and his mouth naturally curved downward, as though he had given too many people bad news. Mo’s anxiety increased.
“Hi, Mo. I’m Dr. Abbot. Could you verify your age for me?”
“I’m 28.”
“Thanks. So, what brings you in today?”
“Well, um, I just, I just, get these feelings of…of anxiety? It happens every time I’m around people, or am expected to give presentations, or do anything social,” Mo said exasperatedly.
“What exactly do these feelings of anxiety feel like to you?”
“My heart rate speeds up, I start sweating, and I just feel like I’m gonna faint.”
“And how long has this been going on?”
“I don’t know. Maybe like, maybe, um, … eight months?”
“Sounds like you’ve been dealing with this for quite some time….”
“I just need this to stop. I really do. But I don’t want to be seen as crazy. I’m not crazy!”
“Let me assure you that you aren’t crazy, Mo. Your symptoms are more common than you think. One of my colleagues, Dr. Tolgin, specializes in anxiety problems, so I’d like to refer you to her so she can make an accurate diagnosis and then get you the help you need. Does that sound okay to you?”
“Okay, as long as I’m not crazy. Yeah, I definitely want to get this figured out before it completely ruins my entire life. I just can’t go on like this, Doctor.”
Over the next few weeks, Mo schedules several appointments with Dr. Tolgin. During the clinical interview they discuss Mo’s background, experiences, thoughts, and feelings. Mo continually uses the phrase “am I crazy,” which concerns her as she connects this to his story about growing up with his uncle, who was diagnosed with Schizophrenia. Mo is also given a complete physical exam to determine if there are medical issues causing his symptoms. In addition, Dr. Tolgin gives Mo several psychological tests.
During his testing sessions, a family history is completed where Dr. Tolgin realizes several family members have been diagnosed with a variety of mental health disorders, but what stands out is the similarity in mental disorders related to emotional thinking, attention and memory. She asks his permission to test for the CACNA1C gene, which has been linked to mental disorders such as bipolar, schizophrenia, and major depression. Dr. Tolgin requests a genetic counselor be present to go over this test with Mo, the associated risks and benefits, and available treatment options if he receives a possible result.
Based on the physical exam, psychological test results, and interview information, Dr. Tolgin is able to make a diagnosis. The genetic test came back negative for the CACNA1C mutation, which helps to rule out some of the more severe mental disorders, and his physical symptoms does not meet the DSM-IV criteria for a diagnosis of Schizophrenia.
Several weeks after their initial meeting, she and Mo have an appointment to discuss the diagnosis and possible treatment options.
“Good to see you again, Mo,” says Dr. Tolgin.
“You, too, Doctor,” replies Mo. “So, am I crazy?”
“No, of course not, Mo. I want to assure you again that many people have the symptoms you’re having, so you’re not alone. You have what’s called social anxiety disorder, which is actually the most common type of anxiety disorder. The good news is that there are effective ways to reduce these symptoms so that you can lead a life with much, much less anxiety. Today I’d like to talk with you about different forms of treatment. How does that sound to you?”
“It sounds good. I just can’t let this anxiety continue to ruin my life.”
“I really like that you’re open-minded about getting treatment, Mo. That’s a very good sign. It’s also a good sign that your answers on one of the surveys indicate that you don’t appear to have clinical depression. Anxiety and severe, debilitating depression often occur together, but for you the issue is social anxiety, not depression. That’ll likely make it easier to treat your anxiety. So, let’s talk about some treatment options.”
Questions
• Was Dr. Tolgin’s response to genetic testing appropriate in this situation? Could it have been phrased differently? Why or why not?
• Was Mo receptive to her suggestions for treatment?
• Were any lines blurred between patient and provider?
Let’s Apply it! (Question for the Leader)
Question 1
A patient with depression has been scheduled for electroconvulsive therapy (ECT) and has signed a consent for the procedure. Just before the patient is about to leave for the procedure, she begins crying and says she will absolutely refuse to have the procedure. After notifying the physician, what action should the nurse take next? Explain (1) ethical and (1) unethical approach the nurse can take in this situation. Make sure each response is supported by a credible reference.
Question 2
A celebrity patient is admitted to a psychiatric unit for treatment of a substance abuse disorder. The media calls the unit and asks the nurse for information regarding the patient’s status. The nurse provides the information and hangs up the phone. After the information makes it to the media, the nurse manager and administrators meet with the nurse who ‘allegedly’ provided the patient’s protected health information to the media. Explain (1) ethical and (1) unethical approach the nurse can take in this situation. Make sure each response is supported by a credible reference.
