Case Vignette 5.1 Lilian, an 82-year-old client with schizophrenia, lives alone. Her psychiatric condition is stable and controlled with medications....
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Case Vignette 5.1

Lilian, an 82-year-old client with schizophrenia, lives alone. Her psychiatric condition is stable and controlled with medications. A psychiatric nurse from the Visiting Nurse Association (VNA) sees Lillian once a week to assess her health and refill her prescriptions. A home health aide assists with ADLs three times a week; during visits, the aide usually cleans. Lillian receives Meals on Wheels; she has no other support. In the past month, Lillian's physical health has deteriorated. She has fallen several times; twice the aide arrived to find Lillian on the floor.

 The nurse has attempted to discuss other living arrangements with Lillian, to no avail. Lillian seems not to appreciate the seriousness of her situation. She states that the VNA should provide daily visits so she can remain at home. The VNA is not sanctioned to provide continuous care. The nurse contacts Adult Protective Services (APS) twice to discuss the circumstances. APS assigns a case manager to investigate; however, it does not rate the case as a high priority. Thus, the case manager cannot visit immediately, or the nurse feels obligated to continue to see Lillian even tries to increase her visits, although she realizes that so violates agency procedure. The nurse and aide believe abandoning Lillian would be unethical. They are torn: they follow procedures outlined by the VNA and client's insurance, which would mean discontinuing visits and forcing to act? Would doing so further compromise Lillie health? Should the nurse keep visiting, citing the need to prescriptions as the rationale, even though doing so would mean using government funding in an unauthorized way?


Reflection and Critical Thinking

• What are possible legal and employment concerns if continues to make extra visits to Lillian? What if the nurse stops visiting? Can the nurse use any alternative strategy?

• What are the responsibilities of and risks to the VNA.

• What would you do if you were the nurse? Defend your actions.

Answered by Expert Tutors

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