What is the Dilemma?
Michelle Minard is a nurse and intravenous IV specialist with Alaska Rural Health Services (ARHS), a small healthcare provider service located in Nome, Alaska. She has been with ARHS for just over seven years and is well respected among her peers and patients. 24-year-old Michelle has been treating Greg throughout the last four years at a RHS. She has known Greg since she was 12 years old. Greg is an intelligent young man who aspires to be a physician despite his diagnosis of leukemia. Greg’s courage and positive attitude have been an inspiration to the staff and other patients who have met him over the years. When Michelle sees that Greg is coming in for another blood culture, she is saddened and hopes that he doesn’t have any significant infection or sepsis. With his disease, something like this could be life-threatening.
When Greg arrives, Michelle can see immediately that he has deteriorated. It’s very bad. He’s lost his color as well as significant weight. Michelle walks into the room and Greg opens his eyes. The whites of his eyes are yellow.
“Morning,” Greg whispers.
“Back at you,” Michelle says softly. “I have to get a draw for a culture.”
Greg shakes his head. “Not this time.”
“Come on. Just let me get in there really quick. You know it will just take a second.”
Greg’s breathing is labored. He looks at Michelle and says, “No.”
“Greg, you know I have to ask you this. Are you refusing to let me draw this culture?”
He stares at Michelle and says, “Yes.”
With tears in her eyes, Michelle nods and whispers, “Okay, Greg. Okay.”
Barely able to speak without crying, Michelle leaves the room and addresses the medical resident who ordered the test to let him know what Greg said.
The resident, with an accent that Michelle can’t place, says, “I don’t care what he says. Go get that draw. Go do your job.”
Michelle, taken aback, shakes her head. “I’m sorry, but the patient was very clear about his wishes. He declined the test.”
The resident gets agitated and shakes his finger in Michelle’s face. “What’s wrong with you? Are you
deaf? You need to do what I tell you to do. Go get that blood draw now.”
Michelle keeps her even tone. “He is 19. He doesn’t give permission for treatment.”
The resident’s voice is escalated. “He’s just a kid. He doesn’t know what he’s doing. We have to make those decisions for him. He is incapable of deciding. Now go back in there and draw the culture.”
Michelle refuses to draw the blood from Greg. She comes to you as the manager of the unit for help with what she should do next.
Written Assignment
1. As the manager, what would you advise Michelle to do? What about the resident?
2. Are there other issues at play? Are there issues of diversity, communication, or power being demonstrated in this scenario?
3. What are your recommendations for addressing this issue? Substantiate your recommendations using appropriate substantive support and literature.
