Case Scenario 1:
Faisal is a 95 year old male patient who has been residing in anursing home care facility for the past 8 years. Faisal is adementia patient and can occasionally only recall few members ofhis family every not so often. Faisal has a Foley’s catheter andhas been having bloody urine for the past few days. Faisal wastransferred to the hospital and with further investigations, he wasdiagnosed with severe urine infection. His urine infection wastreated with antibiotics and he was returned to his nursing homecare facility. Faisal’s urine infection returned less than a monthafter treatment. The physicians in the hospital thinks that it’sdue to poor Foley’s catheter care. Faisal was transferred again tothe hospital for treatment of what seems a chronic urineinfections. Faisal has been very aggressive during his stay at thehospital with all the physicians and nurses as he prefers hisnurses in the nursing home care facility. He has now developedantibiotic resistance and is under treatment. Faisal was treatedand sent back to the nursing home care facility where he developedanother infection after two weeks. The hospital physicians’ teamhave recommended that the investigations and treatment are donewhile he is in the nursing home care facility and that there is noneed for his transfer to the hospital as he is becoming veryagitated during his hospital visits and his hospital experience wasvery stressful for him and for the hospital staff. The nursing homecare facility management team discussed the hospital’srecommendation with Faisal’s family and discussed the consequencesof the different decisions. After that, a decision has been madethat nothing would be achieved by another hospital admission thatcould not be achieved by the nursing staff at the nursing homefacility. The staff and his family claimed that the right thing todo is not going for further hospital admission and therefore, hiswelfare would be maximized by staying in the home care facilityrather than being transferred to the hospital again.
Q1.What are the relevant contextual factors?
o Age, lifestyle of patient, family relationships.
o Setting of care (home or institution)
Q2. Is the patient capable of decision making?
o Legally incompetent?
o Level of consciousness?
o Diminished mental capacity?
