Psy 220 Week 9 Final Paper

However, poor communication was not only the fault of the physicians but also of the nursing team. Despite knowing what needed to be done for the patient, the nurses did not know how to approach the situation after the physicians were dismissive. Nurses need to exercise rights to serve as patient advocates and “challenge erroneous decisions of seniors in anesthesia. (Beament, Mercer 2016) All physicians involved lost control of the situation and did not effectively share with one another to manage the damage. Safe and effective delivery of healthcare require communication between individuals with different roles however status of staff (whether junior status or different roles such as nurse) makes it difficult to speak

Part 1:  Please respond to each question briefly and concisely, but as completely as you can.

The three professional considerations that pertain to this case are similar to the ethical considerations. It was unprofessional for the nurses to call off, leave patients un-attended, and also breaking the patient legal duty to provide proper service to patients. According to (makely), “enhancing professionalism has become a major challenge for healthcare educators, employers, and personnel” (2009).

The ethical dilemma encountered by the nurse involved a 69 year-old female patient. This patient had cancer that had metastasized to the bones and brain with a diagnosis of approximately one week to live. This patient was alert and oriented times four but very weak and lethargic. The patient was having difficulty swallowing pills, fluids and food. Therefore her intake was very little. She had no advance directives but was of sound mind and could make her own decisions. The patient’s pain level was 10/10 on a pain scale of 0-10 with 10 being the worst pain. “Even before end of life, nearly half of patients with cancer report moderate to severe pain; up to 30% report the pain as severe; and an estimated 25% will die in pain ("End-of Life Care," 2015)”. The patient’s family did not want the patient to take her pain medication during the day because it would sedate the patient. They wanted to spend every waking moment with their loved one. “Often family members of the dying patient cannot make end-of-life decisions or have conflicting desires about the care that should be provided (Blais &

“Nurses intervene, and report when necessary, when others fail to respect the dignity of a person receiving care, recognizing that to be silent and passive is to condone the behavior” (CNA Code of Ethics). During this situation I recognized the vulnerability of the patient as well as what I felt was inappropriate behavior on behalf of the registered nurse and there for intervened because I did not agree with the situation that was

The legal ramifications of this case include medical malpractice from the nurse, physician, and the hospital, a wrongful death lawsuit, and possible revocation of licenses of the involved parties. Basing on the Components of Professional Negligence as stated on Table 5.3 by Marquis and Huston (2015), the nurse and the physician are both guilty of malpractice. The physician wasn’t able to provide the best care, failed at meeting the standards of care, disregarded the possibility of the patient bleeding out after numerous attempts by the primary caregiver to inform her of the abnormals, and the patient died as a result of failure to assess the patient on a timely manner. Assuming that the nurse followed the physician’s orders and documented all of her observations and the physician’s responses to every inquiry the nurse made, he or she should have notified the charge nurse of the situation and follow the hospital protocol regarding instances like this. According to the components, the nurse is guilty because her failure of not acting on the perceived threat to patient safety has resulted in demise. Although the learning exercise did not mention any other available employee that could’ve helped prevented this case, the charge nurse, nurse supervisor, or nurse administrators who have not physically provided care for the patient may also be included in malpractice claims as a result of lack of leadership (Cooper, 2016).

The nurse should have contacted the nursing supervisor to ask for a person certified to do conscious sedation to come and monitor the patient. This alone would have prevented many of the other errors that occurred. The patient would have been placed on the monitor and oxygen would have been delivered prior to

I received report from the night nurse stating that S.D. had not had the best night. She was a twenty-two year old female post op day one, status post appendectomy. It was her first surgery so in addition to her uncontrolled pain she was also very anxious, as was her mother. I was told she had not dangled her legs on the side of the bed nor ambulated since returning from surgery. I knew this was not acceptable. When I did my morning assessment I could tell she was still in quite a bit of pain despite receiving frequent pain shots the entire night. Obviously, no one had taken the time to ensure that the medication was working for her. I asked her if she had gotten any relief and she stated, “no”. I immediately paged the resident, explained her situation, and answered all questions regarding her status. This particular situation not only demonstrations collaborative practice but also is an example of professional communication. “It is

Shauna, I agree with your argument. The nursing staff definitely did not advocate for the patient’s rights. Instead of thinking about the wishes of the patient, the staff were stubborn in their ideas and sense of ethics. It is questionable as to why did doctor ignored the request to stop resuscitation and continued to coerce the patient’s guardian into allowing the procedure. It appears there was an incident before this video that caused the staff to act in this way. Perhaps the healthcare staff had connected personally with the patient and did not want her to die. Even if this was the case, I agree that the staff did not practice appropriate clinical judgement. They should not have let their emotions and thoughts influence their behavior in

The attending physician also had the responsibility of ensuring that questions and concerns from both the mother and nurse were fully addressed with explanations before leaving the bedside. Twedell and Pfrimmer (2009) admit that although the medical hierarchy intimidates some from speaking up, “effective leaders create familiarity and flatten the hierarchy, making individuals more comfortable about raising concerns” (p.294). Choosing not to make care changes revealed a disregard for fetal safety. Choosing not to question the nurse further and alleviate all concerns with thorough explanations revealed disrespect for staff and disregard for safety. The attending physician then continued their disregard for safety and lack of respect for the team when in transit to the operating room they disappeared without communicating and had to be paged back to the operating

This is the breach of care. There were no records of any intervention for julienne and any outcome from it. These are the things, which caused the outcome. They could have prevented it. On November 11th when Julienne’s older sister called Julienne was very disturbed and was panting she couldn’t talk properly, her speech was halting. Julienne also complained of pain and didn’t want to see anyone. On the same morning Dr Ahmad had written in a progress note that the patients was stable. Which is inaccurate. Therefore this shows the negligence of duty and not being able to identify the sign of deterioration. Again at one event julienne’s pulse reading was over 130, which was satisfied for MET call criteria but Met call wasn’t called at the event. This shows the nurse breached her duty of care. There are many document that help nurses comprehend the standard of care they are expected to deliver (Crisp & Taylor 2008). When a patient fails to progress as expected, the nurse should revises the patients plan of care and priorities the patients needs states (Crisp & Taylor 2008). This falls under the ethics the nurses are compel to perform. However in the case study nurses fail to do

I agree with your point on nurse’s role as sentry and collaborators. As we discussed in class, nurse as a sentry should watch over and protects the patient. However, in the scenario, the nurses failed to protect the patient when they let the physician to go against the patient’s wish and disregarded the do not resuscitate order. As collaborators, the nurses should work together to provide the best care possible for the patient. “..collaboration involves a partnership characterized by mutual goals and commitments in which participants willingly become involved in planning and decision making” Henneman et al. (1995). In this case, the nurses and the physicians did not cooperatively solve the issue together and instead, letting the physician to make his own decision to resuscitate the patient. In addition, I also agreed with your point on the physician who forced a difficult decision upon the patient’s family. To start, it must be very hard for the family to accept the fact about the patient’s death. Yet, the decision that the physician made negatively impacted the family’s grieving process because it gave the family false hope when they have finally accepted the patient’s fate.

The doctor’s and the nurse’s intentions were to do what was best for their patient and believed that signing a DNR was the best decision. This describes the ethical principle of beneficence in that; the doctor and the nurse were performing their professional duties by doing what was best for their patient. However, though the doctor and nurse were acting with good intentions, they both failed to properly educate the patient’s husband on the information stated in the DNR paperwork. They also did not make sure that the patient’s husband was in the proper learning state. They did not make sure he could read the information, nor did they check for understanding of the information. Had the doctor or nurse implemented these things, the patient’s husband would have been fully aware of the documents he was signing. This describes the ethical principle of nonmaleficence; which is defined as the duty to prevent or avoid harm, whether intentional or unintentional. The doctor and the nurse did not have the intention of having the patient’s husband sign a DNR that he did not understand. However, their lack of education and assessment of successful education led to a decision that could end his wife’s life. Though the husband was not aware of the repercussions of signing the DNR for his wife, the nurse and doctor are forced to honor the actions stated in the signed document. This ethical principle is known as fidelity;

I felt it was abuse of role by some nurses, and illegal to seclude that man. It was inhuman. A difference of opinion between a health practitioner and a mental patient is not reason for 3 condemning the patient to seclusion. The January 2008 incident and other similar ones that followed resulted from nurses provoking patients over trivial matters and when patients stood their grounds, they were muzzled and punished by being locked away. These were emotional and personal seclusions rather than seclusions for clinical reasons. I didn’t like nurses from the west ward, but I wasn’t bold enough to challenge them because some had been in the service many years, while some were more learned than me.

The first ethical principle that was breached is beneficence. Beneficence is to act in ways to promote the well-being of your clients. However, as she was just transferred from the acute critical to the surgical-medical care unit, she was still new to the clinic settings and should have sought advice from a senior staff nurse. Hence she did not promote the well-being of the patient and put the patient’s life in danger.