Mr. M. is a 26-year-old Hispanic man who sustained severe injuries in a high-speed motorcycle accident, requiring admission to the critical care unit. According to his mother, he had previously been in perfect health other than having mild asthma as a child. His most significant injuries are a cervical spine fracture and quadriplegia at the C2 level, and a devastating traumatic brain injury consisting of a subarachnoid hemorrhage and diffuse axonal injury. He has subsequently developed acute respiratory distress syndrome (ARDS), requiring high levels of mechanical ventilation support during the first 3 days of his hospitalization. His prognosis for functional recovery from his brain injury is deemed “poor” by the neurosurgeon, and because of his high quadriplegia, he will remain ventilator dependent for life. Mr. M’s family is Cuban, very close-knit, and religious (Catholic), and it consists of two sisters, his father and mother, and a grandmother who lives with them. Many of them do not speak English well, including his mother who is his designated legal surrogate. All are very tearful and devastated by his injuries but remain hopeful that “God will help him recover and move again.” His 20-year-old sister, in a private conversation with the nurse, states that her brother had told her before that he would prefer to die if he was ever paralyzed “from the neck down.” She is afraid to verbalize these feelings with the rest of the family, because she thinks her mother will accuse her of not loving her brother or of wanting to kill him.
Questions
1. What should the nurse say to Mr. M’s sister? What course of action could the nurse recommend?
2. What resources in the institution would be most helpful to this family at this time? Why?
3. How does the family’s cultural and religious background influence its perspective on this situation?
4. What learning needs does this family have? How could these be most appropriately met?