Ethical question
Description
Consider the case, Nurses caught between a rock and a hard place.
Nurses at Memorial Hospital, a 40 bed rural community hospital, are faced with what seems an impossible dilemma. Their best efforts to advocate for patients are routinely blocked by the hospitals physicians and senior leadership. Two recent examples: When Mr. Rodriguez, a seasoned surgical nurse, requested time to administer an analgesic before a patients painful wound debridement, he was told by the surgeon that no pain medication was necessary. The patient was clearly in distress while the debridement was performed and so was his nurse. When Mr. Rodriguez reported this experience to the supervisor he was told that the nurses job is to do what the physician orders.
On another occasion, a woman presented to the emergency room with a fractured distal radius. Because a family member with a similar injury had unsatisfactory results (deformity and pain with movement) when treated by the doctor on call that evening, the woman and her husband requested transport to a larger hospital. The doctor on call insisted that it was important to set the fracture as soon as possible and convinced the couple that he could competently perform the procedure. The nurse had reservations about the doctors competence and wanted to counsel the couple to be persistent in seeking transport to another facility, but knew that her job was on the line if she did. When she reports this to her supervisor she is told that her job is not to advocate for patients but to be a loyal employee.
Repeated efforts by nurses to address these sorts of challenges have resulted in the persistent message that they can accept the status quo or leave. The nursing supervisor is tightly allied with medical director and Chief of ED (CEP). The problem for the nurses is that it is a 2 hour drive over the mountain to the nearest hospital and there are no other employment options.
Answer the following questions: 1) Which ethical principles are being violated in this scenario according to the ANA Ethics Definitions? 2) Which Code of Ethics provision best describes the nurses dilemma in this situation? 3) Where might the nurses at Memorial Hospital find resources to help in intervening to resolve their moral dilemma?
Key Points:
| Ethical principles identified. |
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| Use of the Code of Ethics | |
| Resources to help in intervening to resolve a moral dilemma. |
References:
Nursing Standards
Nursing and Midwifery Board of Australia. (2018). Code of conduct for midwives. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Clinical Guidelines
Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf
Living Guideline
Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E
Evidence-based practice
BMJ Best Practice
Goldfarb, S., & Josephson, M. (2020). Cystic fibrosis. BMJ Best Practice. https://bestpractice.bmj.com/
Schub, T., & Cabrera, G. (2018). Bites: Head lice [Evidence-based care sheet]. Cinahl Information Systems. https://www.ebscohost.com
Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf
JBI: Evidence summary
Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global
JBI: Best practice information sheet
Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.
Cochrane Database of Systematic Reviews
Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2
Drug Information
Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au
Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm
Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml
Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html
Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/
Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html
Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis
Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia
Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367
NCBI Bookshelf
Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/
Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au
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