Ethical situation

Description

ethical clarification Posted on: Wednesday, July 29, 2020 8:23:25 PM PDT

Identify a situation you have encountered in the workplace that has an ethical component. Integrate the reading material (chapters, Code of Ethics, article) in your response.  Describe the ethical situation and respond to the following questions: Who are the key individuals involved? If you were the nurse involved . . . what did you do or would you do? What guidance can be provided by the application of ethical principles/theory and the nursing code of ethics to this specific situation? Identify resources available to nurses to assist and support them through this type of situation.

Ethical situation information and extension

Posted on: Friday, July 31, 2020 8:03:05 AM PDT

Hello Students,

  I spoke with the MSN coordinator regarding the difficulty with the Ethical assignment. I have examples of ethical situations below you can use or you can present an ethical situation of your own. I know most of you have emailed me with ethical situation ideas. Feel free to use the situations you presented to me or you can change to one of the examples below.  I would also like to extend the deadline due date to August 15th.  Hope this helps

Case #1

– Pain in a Drug Abuser A middle aged man was involved in a motorcycle accident and suffered multiple injuries, such as broken ribs, clavicle, scapula, and arm. While in the ER, the patient had a heart attack, which turned him to cardiac intensive care patient, not just a trauma patient. Right before coming to the intensive care unit (ICU), he was sent to the Cardiac Catheterization lab, where two of his vessels were stented (to keep them open and blood flowing).  He arrived in agonizing pain at the ICU.

The facility is a teaching hospital and there are typically interns making the decisions, with some oversight from the residents and fellows. This is especially true during the night shifts, when the attending physician is not available. The patient had a history of drug abuse, which made him opioid tolerant. As a result, the interns would question the authenticity of his pain and would downplay it.

The nurse had never before given so much pain medication to a patient and not see any alleviation of symptoms. The patient was screaming and yelling for the entire shift.  But many interns and even staff nurses still questioned whether the patient was really in pain. The nurse understood that there are “drug seekers” out there, but critical thinking skills help to evaluate the pain experience.  A patient who presents with multiple fractures and broken bones should be mediated for pain accordingly, regardless of his current drug abuse history.  Interns or new physicians can be extremely cautious when prescribing pain medication.

The patient’s vital signs were good and there were no signs of respiratory depression (a complication of narcotic medications). There were no real contraindications to increasing pain management and the patient was in so much pain that his overall condition was being affected. Usually nurses can contact the nurse supervisor and even the immediate subordinate of the residents, but this nurse, in order to better advocate for this patient, skipped the hierarchy levels and woke the attending physician at 3am to request more aggressive pain management.

Case #2 –

A Surgical Mishap

An attending physician was performing a routine cesarean section delivery in the operating room (OR). During the c-section the physician nicked the patient’s uterine artery. The physician did not immediately report a problem in the OR. The scrub nurse had been trained to scrub a c-section but was inexperienced so did not know what was going on. The physician repeatedly asked for more and more sutures but did not indicate that additional help was needed. The physician was trying to repair the nicked artery on her own but was ultimately unsuccessful. The circulating nurse asked the physician if she needed help several times since she knew this procedure was taking too long. Eventually the physician requested that the on-call Gynecology-oncology physician be called to assist with the repair. The assisting doctor was unable to repair the artery and ultimately a hysterectomy was performed. The patient lost a lot of blood and received multiple blood transfusions. The patient was young and this was her first pregnancy.

Although all surgical procedures incur risks and patients are counseled to that fact during the process of obtaining informed consent; the physician covered up the fact that artery was damaged in the surgery. After the patient was out of the OR, the physician spoke with the patient and told the patient that she hemorrhaged to the point where the only option was to remove her uterus in an effort to stop the bleeding.  Furthermore, the physician told the patient that her life was saved by performing a hysterectomy. The patient had no idea that the hemorrhage occurred because of the nicked uterine artery. Consequently the lack of disclosure by the physician put all the nurses in a difficult position and stained the relationship between the nurses and this particular doctor.

Case #3

– Pain Medications at the End-of-Life A terminally ill elderly lady who had a Do Not Resuscitate order was deteriorating throughout the shift with the family at the bedside. The nurse administered morphine to alleviate pain per the physician’s orders, however the medication was affecting the patient’s vital signs and the nurse administering the medications felt guilty and uncomfortable about this. The nurse felt that she was in some way causing the patient to deteriorate faster than if the medication was otherwise not administered. Although the pain medication was affecting the patient’s vital signs, the patient request for pain medication and the physician’s order must be granted. The physician had previously consulted with the patient and the family regarding pain relieving treatments and the effects of such treatment. Also, the nurse had provided education to the patient and the family regarding side effects of medications administered to the patient with both the patient and family verbalizing understanding of the teaching.

Case #4

– Secret Diagnosis An 18 year old and was complaining of severe shortness of breath.  He did not travel outside of the country and denied involvement with illegal drugs.  The physician discovered a mass in the patient’s lung and diagnosed him with a severe case of lung cancer.  The family spoke to the doctor privately and did not want their child, (the patient) to know about the cancer.  The family was from a different culture and in that culture it was typical to hide a poor prognosis from the patient.  Case #5 – Sick Peer A senior nurse with 20 years of experience is working the night shift in the Labor and Delivery unit.  She has been having problems at home.  One night her peers notice that she has been gone from the unit for a long time.  They are keeping an eye on her one patient in labor. After an hour, one of the nurses goes looking for the missing nurse.  She is found in the hospital stairwell curled up in the fetal position.  The nurse is escorted back to the unit and the shift ends shortly thereafter.  The L&D nurses advise the manager the next day of what occurred.  The senior nurse takes a medical leave of absence.  When she returns things seem better with her mental health, but then one night she goes missing from the unit again.  Her peers cover the patients and report the situation to the manager.

Dr. Keel

Posted by: Cheryl Keel

Posted to: Concepts Prof Nsg Prac BSN302-175_2206_31206