Week #2
1. Read Critical Thinking Exercise,page 145, and discuss the following: a) What are the important data in relation to this situation? b.) State the ethical dilemma in a clear simple statement (right vs. right) c.) What are the choices of action and how do they relate to specific ethical principles? D.) What are the consequences of these actions? e.) What decision would you make? (Please use principles discussed in Chapter 7 to answer this question.)
A. What are the important data in relation to this situation? Base of the situation presented in the case, upon seeing the patient in the emergency department, as a nurse you will first assess the patient. Apply the ABC’s in assessing patient because this …show more content…
is the foremost important of all. Then need to get patient’s vital signs, blood pressures, heart rate, respiratory rate, oxygen saturation and the pain level as this is considered the fifth vital sign. Then assess the injury sustained by the patient. You need to get the present history of illness or injury. The patient had a minor head injury, twisted ankle and a bruised arm from a fall from his roof. Also important is the past medical history, in which the patient had a history of asthma and smoking. It was not stated that the asthma is controlled, what was the medications taken. When the patient became cyanotic, dyspneic and became semiconscious, the emergency nurse did prepare the patient for possible intubation and admission to medical intensive care unit. But did he assess the patient very well? Is oxygen therapy was give since the patient is cyanotic and dyspneic? Did they assess the O2 saturation? Did they institute a laboratory test like ABG ( acid blood gases) ? When the resident physician came in to evaluate the patient, did he assess the patient completely and accurately? And what was the indication to do an emergency tracheostomy rather than doing the endotracheal intubation? The procedure that the resident performed just aggravated the patient’s condition since a major blood vessel was severed and the patient bleed profusely. Did they assess the proper placement of the tube? Did they request Xray and ABG? Did they continuously monitor the vital signs, since patient condition was not improving after that procedure? And lastly, why nobody in that emergency department that the oxygen tank that the client had been connected to was empty? Who’s responsible in maintaining and assuring that the needed equipments are ready in case of emergency? In fact it is an emergency department, and those emergency safety measures should have been done.
B. State the ethical dilemma in a clear, simple statement (right vs. right). The nurse in the emergency department (ED) was in dilemma to tell to the client’s wife what really occurred during the patient’s stay in the ED, the mistakes that were made in the treatment of her husband. He would like to relate what was happened but was in dilemma if this is the right time to do it and how can he tell that in fact he’s one of the staff involved during the treatment. The nurse doesn’t know what to say or act because it will create an aggravated condition for the client’s wife, the hospital and the staff. It is right to tell what was happened but it is also right to remain in silent and let the higher authority in the hospital initiate the proper action in dealing with the case? The emergency nurse also thinks of what would be the consequences of informing the client’s wife of the truth and what are the consequences of not informing her.
C. What are the choices of action and how do they relate to specific ethical principles? If Bill will choose to inform client’s wife what had occurred during the treatment of her husband, will Bill still responsible for the said incident?
This involves the principle of veracity, truthfulness. Will Bill would take the risk and just take what consequences it may arise by telling the truth. I know the license will be jeopardize if the client’s wife will take action and bring the case to legal action. Also, if Bill will tell the truth, is he willing to sacrifice his job in the said facility? Even if the client’s wife will not take a legal action, the higher authority in the hospital would know if the there is such action done by their employee without first notifying the proper authority in the hospital. If Bill will remain in silent, will it be possible to work and attend to the duties if you have those guilt feelings in yourself? Under the ethical principles in nursing, we should incorporate and apply the principle of beneficence, because the primary goal of health care is doing good for the patient and providing a competent care for the patient. Did Bill and other health team in the said facility apply that …show more content…
principle?
D. What are the consequences of these actions? As I have said, there are a lot of consequences such as, the client’s wife may take legal action and the RN will be jeopardize not only the nurse but the other health team that were involved in providing treatment and care for the patient. Another, the competence will be also affected because with that simple act for not knowing that the Oxygen tank is empty and not knowing the parameters in assessing patient’s condition, and not applying the ABC’ of life support will be a big burden. Will the facility take you again as their employee, a competent and a responsible one? The present job or work will be jeopardize, they may fire you out or suspend if not firing out, but the impression will not be the same after that incident. If you will be fired out, will other facility hire you if you have that experienced? It is really difficult to choose what actions you will do because for not telling the truth, your conscience will hunt you back and it will have an effect in your work. How can you work competently if that incident is bothering you?
E. What decision would you make? Now I am in a big dilemma if I was Bill and that happened to me. First, I will addressed it to my to superior what happened in the emergency department. I will also ask their opinion if it is right to tell the whole story to the client’s wife. If they will agree to inform the client’s wife what was really occurred during the treatment and care of the patient and if they will back up me in case a legal action will come, then I will do it and will try to explain it to client’s wife. I know the condition was aggravated because of lack of oxygen but in the first place, the severity started when a procedure was done by the physician that causes the patient to bleed profusely. But then, as a health worker it is the responsibility of the health team to ensure patients safety and do good to patients.
2. describe an ethical dilemma you’ve faced during the nursing program and identify what decision-making process you used to resolve the dilemma ( see text re: utilitarianism, deontology). If, in reflecting, you did not use a process to resolve the dilemma, discuss how the outcome may have differed if a specific decision-making process had been utilized. If you truly believe you have not faced an ethical dilemma during the nursing program, please discuss one you may have experienced in your life. I have not encountered any ethical dilemma during the nursing program.
But I have encountered an ethical dilemma during my residency program at V. Luna Medical Center in the Philippines. I have a patient on my care presenting a signs and symptoms of cancer. I will not go on details about my patient case, in short a patient a malignant cancer, a metastatic one but the family and relative does not know anything about the patient’s condition. The patient asks our cooperation not to tell the real diagnosis to his relatives especially with her wife and the three little children he has. So as a health provider, it is my duty to agree with the patient’s will but as the days go by the patient’s condition is deteriorating and it was very depressing that the wife doesn’t know anything. Will I tell the truth to patient’s family while the patient is still breathing and suffering from the effects of cancer? But because of the trust the patient with me, I haven’t told anybody in the family about the patients’ condition. I think it would tell the family that the patient’s condition is not good but try to make him happy while he is in the hospital. And when the time comes, I will tell the truth to the family specially the wife that the patient requested not to tell about the real diagnosis because he does not want them to be stressed out about his condition. The patient wants them to be at his side not thinking about a malignant cancer and not worrying how the patient and family will
cope on that situation. But later on, the family needs to know everything about the patient’s case but at least, patient’s will was granted until his time.
3. Discuss what you learned about your own communication style from the Self-Assessment completed in class. Describe a time you experienced a problem with communication in the hospital setting. Using the awareness of your own communication style and the information discussed in class about communication, what factors affected this miscommunication? Reflecting on it now, is there anything you think could have done differently to avoid the communicating problem?
I found my results from the Self-Assessment worksheet quite interesting. I discovered that I am submissive most of the time. I have little confidence in stating my thoughts and opinions in group meetings. Majority of the time, I wait for someone else to volunteer to speak. Also, I rarely address my feelings and ideas to someone in authority, because I don’t feel it as a necessity. However, I sometimes communicate in an assertive way when I feel it is necessary. When I need to confront someone about something importance, I don’t hesitate to confront that person.
Many factors that I observed to be an effect on miscommunication are tone and volume of the voice. When you are giving someone instructions, it is imperative that you are emphasizing what is crucial to the procedure. Changing the tone of your voice will make it easier for the listener to understand what he/she needs to do. When you are talking in monotone, it’s more likely that the listener will miss the important part of your conversation. The volume of your voice is also an essence in communication. It is difficult for the listener to comprehend what you are talking quietly; this can also result to a misunderstanding. You must ensure that you’re voice is loud enough to hear.
4. What is your preferred conflict resolution strategy? Give an example of when this strategy has worked and an example of when it hasn’t. From the information in Chapter 14 and the information presented in class, discuss what you have learned that could help improve your skill in resolving conflict. When there is some sort of divergence, I make an effort to be as patient as I can and listen to the other person’s thoughts and opinions. When I disagree with the other person’s opinion, I share my reasons why I disagree and defend my argument in a respectful way. In the end, we solve this conflict by compromising. When there is a problem during work, I confront the problem head first. I believe that it is important to solve the problem sooner, so the problem doesn’t get worst that it really is.
5. Give an example of a boundary violation you’ve observed in the hospital, health-care setting or college (please keep confidential). Utilizing the hand out given, discuss how the boundary violation might have been avoided/stopped. Reflect on a time when you may have unintentionally violated a boundary with a patient or coworker. How might you now handle the situation differently? During the nursing program, I haven’t encountered or haven’t observed a boundary violation. But I remember during my college days, there was this professor who had a relation with one of his student. The age difference is about 10-12 years and we always noticed in our class that there is something in between them. I know that is a boundary violation, having a relationship to one of the student. And in fact the said professor is a married man. I and some of my friends approach her that this is not the right time and in fact the right man to go with. My classmate just ignores us and told us to leave her alone and mind our own business. So our strategy to talk to her and give advice did not work. The relationship went on and the professor act like it seems there’s no problem at all. We did try to confront the professor and talk to him that he must be the one who knows best for his student; he should be the one giving us the role model not taking advantage with our friend and classmate. But the two of them just ignore us and the relationship went on. We don’t want to step up to call the professor’s wife attention because I know it will ignite a fire in the whole campus. We did talk again to that professor if he is not willing to give up the relationship we might as well tell her wife and will pursue to tell the relationship to the dean of the college. If that would happen he will lost his job and his reputation with the college and his family will be ruin. When we did that act, the professor did follow our advice and he did try to end up the relation with the student but to our dismay, our classmate did not like it and we were amazed that she wanted to continue the relationship because she was pregnant. This is to our dismay, I think if we did the right thing on the first place by reporting the violation with the higher authority that would not happen. Now, the professor is in big trouble with the family and with his job. I and my friends did not go in between them again and just focus in our study. On the first hand we try to talk to one of them but it seems they really love each other no matter what the consequences it might have.