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NR 341 Case 5 Complex Adult Health Communicator

ATI the Communicator: Case 5 – Ms. Lonely

In this communication case scenario, Nurse Morgan is assigned to care for Ms. Lonely, a patient nearing the end of life. The patient’s family, including her daughters, aunt, and other relatives, are at her bedside. While watching the video, there was one particular scene where I would change my clinical practice. The patient exhibited signs and symptoms of pain, and her daughters expressed their opinion to the nurse that their mother did not want any medication for pain relief. In this situation, the nurse should have educated the family, explaining why pain medication could help alleviate their mother’s discomfort. It is essential to respect the patient’s autonomy whether and when they want pain medication, especially if they are alert and oriented to person, place, and time.

The daughters should not have the authority to decide about pain medication for their mother unless they have legal documentation, such as a living will, granting them the power to make medical decisions on their behalf. Instead of solely relying on pain medication, the nurse could have explored alternative pain management methods, such as guided imagery, therapeutic touch, or massages. These non-pharmacological interventions can provide comfort and support in managing pain.

NR 341 Case 5 Complex Adult Health Communicator

By offering education on pain management options and involving the patient in decision-making, the nurse can empower the patient to control their care. This approach promotes patient-centered care and ensures the patient’s wishes and preferences are respected. Additionally, exploring alternative pain management strategies can provide a holistic approach to addressing the patient’s pain and promote their overall well-being.

Texas Board of Nursing

Texas State Board of Nursing, the nurse’s role in addressing a patient’s pain is paramount. Chapter 228, the primary objective of pain management is to effectively treat the patient’s pain in the context of their overall health, which includes considering physical function, psychological well-being, social factors, and work-related aspects (Texas Administrative Code, 2013).

NR 341 Case 5 Complex Adult Health Communicator

In addition to this overarching responsibility, nurses must appropriately address and manage the patient’s pain based on a thorough assessment. This involves documenting the patient’s description of their pain and evaluating the effectiveness of any medications or interventions employed. The nurse must accurately record the impact of the prescribed medicines on the patient’s pain relief or overall condition. Texas nurses contribute to providing optimal pain management for their patients by adhering to these guidelines. Documenting pain assessment and treatment outcomes is vital in tracking the patient’s progress and ensuring their pain management plan is tailored to their needs.

Incapacitated and Next of Kin

According to the Texas Health and Safety Code-313.004 Consent for Medical Treatment, an incapacitated patient in Texas is defined as someone who, based on reasonable medical judgment, cannot comprehend and appreciate the nature and consequences of a treatment decision. This includes understanding the proposed treatment’s potential benefits, harms, and inexpensive alternatives (Health and Safety Code, 2017). Incapacitated patients can be comatose, mentally or physically incompetent, or unable to communicate their preferences.

NR 341 Case 5 Complex Adult Health Communicator

Once a physician determines that a patient is incoherent, an adult surrogate is selected following a specific order of priority. The first choice is the patient’s spouse, followed by an adult child of the patient who possesses the necessary waiver and consent from all other eligible adult children to act as the sole decision-maker. If there are no eligible adult children or their consensus cannot be obtained, the decision-making responsibility falls to most of the patient’s available adult children. Lastly, if no adult children are available or in agreement, the patient’s parents are authorized to make health decisions on behalf of the adult patient. In the event of any conflicts arising among potential surrogates, Texas law allows for resolution through the court system (Health and Safety Code, 2017).

This information is crucial for healthcare providers when caring for an incapacitated patient who lacks a living will or do-not-resuscitate (DNR) directive, as it establishes the legal framework for determining who can. Understanding these guidelines ensures that the patient’s best interests and preferences are respected and upheld.


DeMartino, E. S., Dudzinski, D. M., Doyle, C. K., Sperry, B. P., Gregory, S. E., Siegler, M., Sulmasy, D. P., Mueller, P. S., Kramer, D. B. (2017). Who Decides When a Patient Can’t? Statutes on Alternate Decision Makers. The New England Journal of Medicine, 376(15), 1478-1482. Health and Safety Code. (2017). Retrieved November 11, 2018, from


Texas Administrative Code. (2013). Retrieved November 11, 2018, from


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