Dealing With Ethical Issues in Nursing

Marta is my subject for discussion for this week and I preferred her because I have been an ER nurse for several years and can relate to her circumstances. Marta has 25 years experience and is advanced in her practice. The demise of the ER has put her in a very no bargaining quandary. The physicians that have been assigned to the ER are of diverse levels of training and capabilities. The ER staff is challenged with a crashing patient brought in with chest pain and dyspnea. He is deteriorating rapidly into cardiac and respiratory arrest. The physician on duty is very anxious and uncertain of himself. Marta is a very well trained ER nurse that was highly trained to act in situations where no physician was present. Nurses are trained in intubations but most all hospitals refuse to let them intubate per hospital policy. The physician on staff is unable to intubate the patient and is requesting the anesthesiologist be called in from home. This patient's down time is already at a critical point. Is this a good call and can the patient hang on long enough for the anesthesiologist to receive a page and get to the hospital? Marta does not think so and she decides to intubate the patient herself, ignoring policy and orders from her on duty physician. The patient does respond to resuscitation and is alive for discharge five days later. Dr. Andrews was unable to perform in this type of setting, with trembling hands and unsteadiness.

Facilities Ethical Resources

If medical care constitutes incompetent, unethical, or illegal practice, the nurse is clearly obligate to disobey orders. (American Nurses Association, 2001) The nurse would contact the ethics committee on the particular incident outlining the facts. The committee would need to meet with the staff and highlight the actions of each individual that acted in this circumstance. Our ethics committee would have to evaluate the use of unqualified physicians in the ER department. The committee would have to gather the information that led to the placement of untrained physicians in the ER. It is imperative that we have staff in the ER that can respond quickly and appropriately during an emergency. Even though this patient was incapacitated and unable to make decisions for himself, his best interest were the major concern of this team. Of course the nurse went against company policy and this will need addressed, our committee will look at the entire situation and determine its course of actions. The main out look for our committee will be that the patient survived and there is not any chance of a law suit for the actions of the staff. The ethics committee will interview the patient in great detail and have them fully understand the situation and his rights. The staff will have to have several meetings on how to avoid this type of situation from happening again. Because the patient survived the dilemma, the situation is not nearly as complicated as if he would not have lived. The ethics committee will take each department involved in this dilemma and determine how this type of situation can be handled more effectively even in the absence of a physician.

Ethical Consultation

After talking with members of our ethical committee our consultation process would include complete evaluation of the process. Our physician or nurse would have to seek the ethics committee for a consultation. The committee would need to handle the team in a systematic approach to guarantee fair consideration of the views of all parties involved. They would use the systematic change and exchange of perspectives method to determine the process and any changes necessary. First there would be the reflection of the interests of the individual's concerned (patient, doctor, nurses, family, other department members). At this point the patient is alive and well and probably not involved in the ethical dilemma between the staff. Secondly, they would present an analysis of the relationship between the patient and professionals and how this incident has affected them. Thirdly, the committee will need to determine the pertinent social framework such as the team, colleagues, chain of command and interrelated issues that must be considered. Fourthly, the societal and legal circumstances of the treatment as well as the cultural and political context will need thoroughly reviewed. Ensuring that all individuals involved were knowledgeable of the universal ethical principles is another area that would have to be covered. Therefore, I think that the actions of the ethics consultation would be very similar to this week's video program. I as an ER nurse would definitely consider requesting a consultation to avoid a situation like this from ever occurring again. ER staff is constantly faced with critical patients who require quick precise actions. This situation should not have taken place because the hospital should not have allowed untrained physicians to function independently in ER setting.

Alternative Resources

At our facility we have several resources for staff and patients to utilize. We have a chronic conditions clinical portals service to offer patients. This service provides question and answer segments on a secure web site that only authorized individuals have access. This site allows patients to obtain and provide pertinent information and communicate effectively with members of the health care team. We also offer a family resource center which provides a serene environment to our patients, family and staff. It is a place for them to relax and unwind and access internet with email, and even conduct personal business. This is available for those who have a loved one that will be in the hospital for a long period of time and the family lives at the hospital. Next to ethics committee is a department called patient services and this affects the improvement of the care of patients throughout the hospital stay. The patient services department works closely with all the other departments to ensure complete autonomy with each patient. Our facility also offers support groups for all members of the families with special needs or difficulty coping. We do offer our public a lot of services and we are a magnet hospital so our goal is to always increase our services and extend our programs out to our public.

Resources I have Utilized

During my rotation in the emergency and critical care pool, I have had the opportunity to utilize a few of these services. Most of the time in my line of work, I see a lot of suffering and ineffective coping. Our support groups and patient services are very good at attending POC and determining their capabilities with this family or patient. During the care of a critical patient whose family has been basically living at the hospital, I have offered the family resource center for a little more relaxing environment to pass the time in. Our patients are given a packet of services that are available to them at admission. Sometimes when there is a lot of chaos going on, the families forget what is available to them and it is important that we remind them of such benefits.

Benefits to nurses

I believe that our facility provides us with several alternative services and never lets us feel like we are out there by ourselves with no paddle to come back in. We as nurses are accountable for a lot of issues and it is our responsibility to utilize all resources available to us.
References

Burkhardt, Margaret A. & Nathaniel, Alvita K. (2002) Ethics & Issues in Contemporary Nursing 2^nd Edition.

Fontana, Nicholas A. (2005) Ethical Moment, How do I Respond to my Senior Partner;s Unprofessional Demeanor?

Fletcher, James J. & Sorrell, Jeanne M. (1998 ) Whistleblowing as a Failure of Organizaitoal Ethics. .Online Journal of Issues in Nursing.