Background Baby Sherman is a neonate admitted to the NICU at the county hospital where you work as the NICU nurse manager. Sherman had an amniotic...
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Baby Sherman is a neonate admitted to the NICU at the county hospital where you work as the NICU nurse manager. Mrs. Sherman had an amniotic fluid embolus during her delivery, and Baby Sherman experienced anoxia. Consequently, Baby Sherman had an Apgar score of 0 at birth. The baby was resuscitated but remains unconscious. All of the baby's organs experienced hypoxic insult. Baby Sherman was placed on a ventilator, and parenteral nutrition was later initiated. Mrs. Sherman is physically very weak and experiencing grief, along with her husband, over the condition of their infant. They have two other young children, ages 2 and 5 years. Baby Sherman has been weaned from the ventilator but has remained unresponsive. Mr. and Mrs. Sherman have requested that the hospital staff discontinue their infant's nutrition and hydration. The NICU medical, nursing, and social work staff have not previously experienced a situation quite like this one.   

  1. You are meeting with the neonatologists, the NICU charge nurse, the infant's primary nurse, the hospital chaplain, and the social worker in the NICU. What do you contribute to the group's discussion with regard to how you believe the staff should proceed in providing the best care for Baby Sherman and her family?
  2. How do the Baby Doe rules affect this case?
  3. One of the staff RNs comments, "I think the mother and father are being selfish about their request to withdraw nutrition from Baby Sherman. I think it is because they don't want to be bothered with taking care of her at home." How do you address these comments?
  4. Which surrogate decision-making standard should be used in this case? What, if any, influence should the interests of Baby Sherman's siblings have in decision making?
  5. Caring for Baby Sherman and interacting with her family has caused a great deal of moral suffering for the NICU nursing staff. What behaviors might you expect to observe among the nursing staff? What do you do, as the nurse manager, to address this situation?
  6. As would be expected, Mr. and Mrs. Sherman also are experiencing a great deal of moral suffering and grief. How would you handle your personal interactions with Mr. and Mrs. Sherman, and what would you do to help educate your staff in working with families in a situation such as this one? What do you know, or what information can you locate, about the grief parents experience when their infant is extremely impaired and a decision about withholding or withdrawing life support is being made? How would you try to help Mr. and Mrs. Sherman?
  7. As the nurse manager, you contact the chairperson of the hospital ethics committee to make a referral for the Sherman's case. Imagine the nurse manager and ethics committee chairperson during the referral phone call. What information is important to discuss? What questions are important to ask? Remember, the committee chairperson has no information about the case.

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