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Prelude to the medical error case study
Ethical framework in nursing practice
Essays on theories and principles of ethics in healthcare
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There are several ethical frameworks to can be used to examine medical error reporting. For example, Stanwick & Stanwick (2016) suggests that members of a society believe that certain responsibilities and duties are required as part of belonging to that society the social contract, known as contractarianism or social theory. In this framework, healthcare professionals have a duty and a responsibility to advocate and protect their patients from harm. Another ethical framework that can be used to explain the lack of willingness to report medical errors as ethical egoism. Ethical egoism is defined by Stanwick & Stanwick (2016) as a belief that individuals with determining how they should act ethically and morally in such a way as to promotes their …show more content…
self-interests first. If a nurse chooses not to report medical errors or to turn a willful blind eye to errors they could be doing so out of fear of being castigated by management, retaliation, or professional and legal ramifications (Firtko & Jackson, 2005).
A few documented cases can be found in the literature that directly looks at the complex issue of medical error reporting. For example, Cleary & Duke, (2017) research demonstrates the nexus of ethical issues present in the case of Bundaberg Base Hospital (BBH) in Australia. In 2004, BBH which is a 136-bed hospital that provides emergency medicine, general medicine, general, to a population of 87,933 in Bundaberg, Queensland, Australia. Director of Surgery, Dr. Jayant Patel, was employed at BBH April 2003 and April 2005, in which time saw 1457 patients, performed approximately 1000 operations, and 400 endoscopic procedures. From May 2003 until April 2005, nurses from several hospital departments reported and raised concerns about Patel's competence. Sighting evidence of post-operative complications, lack of infection control measures, and general decision-making process to perform complex surgeries instead of transferring patients to a more equipped hospitals and specialists. Nurses perused ever possible option available to them for reporting the errors in this situation continually from May 2003 through April 2005 (Cleary & Duke, 2017). The case represents nurses using verbal and written complaints, incident …show more content…
report forms and presented evidence to department managers and senior leaders in the HCO. Despite every attempt made by various nurses, no action was taken by the HCO, in fact, BBH executives and senior officials did not even evaluate Patel's performance or credentials. The BBH Director of Medical Services believed that the increasing number of complaints to be attributed to interpersonal conflict and preconceived the complaints were unjustified. In December 2004, BBH Director of Medical Services extend Patel's contract as Director of Surgery until March 2009 and stated in the document Patel's excellence in achieving extra elective surgical targets and increasing the surgical activity levels. The contract solely documented positive aspects of Patel's performance as indicative of his abilities and did not include any of the formal complaints reported against him. Additionally, management asked nursing staff to provide more evidence, rather than investigate the root causes for concerns (Cleary & Duke, 2017). This reinforced nurses' perceptions that management favored evidence that supported their favored conclusions and that management would have an intense scrutiny over uncongenial evidence. These failed efforts by nurses to shed light on the medical error issues occurring prompted an ICU Unit Manager Nurse, Toni Hoffman to blow the whistle and report the concerns for patient safety to outside law officials. The extended and overwhelming amount of documented complaints related to surgical complications, lack of infection control and Patel's reluctance to transfer seriously ill patients to better-equipped hospitals showed a willfully blind organizational culture (Cleary & Duke, 2017). The evidence demonstrated the Director of Medical Services decision to willfully ignore complaints filed against Patel and filtering information to enabling BBH to reap the financial rewards from the extra elective surgeries, instead of prioritizing patient quality of care and safety. Outside third parties, such as law enforcement and governing medical boards were alerted to the continual lack of response by management at BBH for patient safety. Australia's governing medical board authorities, policymakers, and society, joined together to investigate the situation at BBH and to develop and implement reform to the healthcare delivery system (Cleary & Duke, 2017). A review of the case study presented by Cleary & Duke (2017) demonstrates several different ethical frameworks, simultaneously being represented.
Regarding the healthcare industry society maintains a contractarianism framework, believing that individuals agree to obey and follow societal norms, standards, and laws. The willful blindness of the Director of Medical Services represents ethical egoism framework, not obeying to contractarianism theory because his actions towards self-interest out weighted the duty and obligation to BBH patients. Dr. Patel's performance did not demonstrate the fundamental beliefs held by society within the contractarianism framework, because his actions did not follow societal norms and place patients in harm's way, instead of protecting them. Additionally, the actions of ICU Unit Manager Nurse, Toni Hoffman, demonstrated Kantian framework, which believes that individuals should act in a moral and ethical manner, that they would expect from anyone else in the same situation (Stanwick & Stanwick, 2016). Nurse Hoffman's decision to blow the whistle on the lack of response from internal medial error reporting to improve patient safety and quality of care represents a commitment to the professional oath to do no harm. I believe that Hoffman's actions follow a Kantian framework based on the ethical decision to put the patient's safety above own self-interests and the willingness to endure the repercussions and retaliation for blowing the whistle.
Kant's theory of universal duty in doing what is morally right and accepted is demonstrated by Hoffman's actions and should be encouraged by all HCO organizations (Kant & Gregor, 1998). Kant's theory states decisions should be made in a manner that is rational and that the actions should be deemed morally right if the decision maker were both giver and receiver of the decision (Kant & Gregor, 1998). Organizations that push for a more openness, transparency, and readiness to learn from promoting medical error reporting can decrease the ethical dilemma nurses have and empower all stakeholders to treat all relationships with respect and dignity. The healthcare industry should encourage a Kantian workplace environment and culture in general, but specifically when it relates to medical error reporting which can save future lives and prevent death from human errors
For anyone who has ever worked in healthcare, or simply for someone who has watched a popular hit television show such as Grey’s Anatomy, General Hospital, House or ER know that there can be times when a doctor or health care provider is placed in extremely difficult situations. Often times, those situations are something that we watch from the sidelines and hope for the best in the patient’s interest. However, what happens when you place yourself inside the doctors, nurses, or any other of the medical provider’s shoes? What if you were placed in charge of a patient who had an ethically challenging situation? What you would you do then? That is precisely what Lisa Belkin accomplishes in her book “First Do No Harm”. Belkin takes the reader on
I have been aware of medical errors for some time now. While in nursing school I have heard many stories from classmates and instructors of instances where people they knew, or loved ones had been either harmed or died because of a medical error. I have had experiences with medical errors. When I was in the hospital for the birth of my first child, the nurse that came to change out my IV bag did not check the
He said, “Studies of specific types of error, too, have found that repeat offenders are not the problem. The fact is that virtually everyone who cares for hospital patients will make serious mistakes, and even commit acts of negligence, every year. For this reason, doctors are seldom outraged when the press reports yet another medical horror story. They usually have a different reaction: This could be me. The important question isn’t how to keep bad physicians from harming patients; it’s how to keep good physicians from harming patients” (658). Like Gawande asked—how do you keep good physicians from harming patients? Even the best of doctors and surgeons manage to make mistakes that led to being sued or even worst—they get to experience the death of their
Nurses practice in a complex environment. Providing the best patient care centers around moral, legal, and ethical values (Laureate Education, 2012). Ethical, moral, and legal principles must guide a nurse’s professional practice. The purpose of this paper is to discuss the conceptual frameworks, describe a dilemma in the workplace, analyze the moral, ethical, and legal implications, and finally, discuss the leadership affect of my particular leadership style on this dilemma.
Nurses everywhere face problems and challenges in practice. Most of the challenges occur due to a struggle with the use of ethical principles in patient care. Ethical principles are “basic and obvious moral truths that guide deliberation and action,” (Burkhardt, Nathaniel, 2014). Ethical principles that are used in nursing practice include autonomy, beneficence, non-maleficence, veracity, confidentiality, justice, and fidelity. These challenges not only affect them, but the quality of care they provide as well. According to the article, some of the most frequently occurring and most stressful ethical issues were protecting patient rights, autonomy and informed consent to treatment, staffing problems, advanced care planning, and surrogate decision making (Ulrich et. al, 2013). The ethical issue of inadequate staffing conflicts with the principle of non-maleficence.
This paper explores the legal, ethical and moral issues of three healthcare colleagues by applying the D-E-C-I-D-E model as a foundation of decision making as found in Thompson, Melia, and Boyd (2006). Issues explored will be those of the actions of registered nurse (RN) John, his fiancé and also registered nurse (RN) Jane and the Director of Nursing (DON) Ms Day. Specific areas for discussion include the five moral frameworks, autonomy, beneficence, Non – maleficence, justice and veracity in relation with each person involved as supported by Arnold and Boggs (2013) and McPherson (2011). An identification and review of the breached code of ethics and the breached code of conduct in reference with the Nursing, Council, and Federation (2008) will be addressed. Lastly a brief discussion on how the three schools of thought deontology, teleology and virtue had effects on each colleague (McPherson, 2011) .
According to Poorolajal, medical errors occur when health care providers choose inappropriate methods of care or improperly execute an appropriate method of care (Poorolajal, et al. para 5 -10), which could potentially lead to loss of life and severe or permanent trauma to the victim. Valiani et al. argues, “Committing an error is part of the human nature” (540). Valiani et al. insist that no health care practitioner is immune to committing an error event if they demonstrate mastery of their skills (540). However, error in health care systems is dependent on many causes and factors. Management of such factors is essential to reducing the occurrence of errors in a health care system. Therefore, what strategies can medical practitioners implement to reduce medical errors? Medical practitioners can implement strategies such as communication, verification, and eliminating extended work shifts. These strategies are most effective because they help medical providers fulfill their full potential in doing their job in the most effective
The frameworks are (a) utilitarian, (b) rights-based reasoning, (c) duty-based reasoning, and (d) intuitionist. The utilitarian framework infers that decisions should be for the greater good. In other words, the decision made should take into consideration the needs of a group versus that of an individual. Conversely, rights-based reasoning is more concerned with one person's rights. Duty-based reasoning focuses on the rights of the people and a caregiver’s duty to maintain these rights. Lastly, the intuitionist framework is based on the decision maker's feelings and instincts about a situation. It is the individual’s intuition that drives the decision. In addition to frameworks, there are ethical principles. The nursing profession is based on a group of ethical principles. As nurses, we strive to promote good (beneficence) and to do no harm (non-maleficence). Nurses support patient autonomy and self-determination. Society expects that nurses will be trustworthy, respectful and act with integrity (fidelity and veracity). Nurses have an obligation to tell the truth and treat patients fairly and equally; and, deal with them with respect and dignity (justice). These ethical principles, in addition to the ethical frameworks, help us, as leaders, to make the right decisions at the right time in all situations. The situations may be patient or staff-centered; ultimately, all healthcare
In saying 1.5 million Americans have witnessed hospital errors in the care of the medical center or even 40,000-100,000 deaths is a ridiculous amount of faults. Errors should be minimized, especially when dealing with people’s lives. The number of deaths is so high hospitals should take notice and really pinpoint where their facility is miscalculating and create in-service training to all employees and not just the ones that are making the errors but all employees. This will decrease the chances of errors made in the hospital. With continuous training every month there can be a huge change in the number of mistakes. The fact that these inaccuracies are even causing deaths really highlight the importance of the need for a change. Families
The article “Whistleblowing: The Patient or the Paycheck?” was written by Tracy Hill, BSN, RN (2010) to discuss the ethical issue of whistleblowing in healthcare, in particular, how it pertains to nursing. The following paper summarizes the article which addressed the ethics, barriers and consequences, and support and for whistleblowing. Hill (2010) explained whistleblowing as taking action to uncover negligence or malpractice and in the instance of nursing this would occur within a healthcare organization. Hill (2010) goes on to emphasize that nurses hold the ethical responsibility to be advocates for patients by practicing principles such as virtue, Kantian duty, utilitarianism as well as beneficence. However, while nurses hold an ethical duty to act in the best interest of and protect patients from harm, whistleblowing
However, we are looking at a case study where patients safety has been compromised, professionalism has been voided, lack of communication, nurses aren’t liable for their work, the duty of care has been breached and lot more issues can be discovered. Which will be incorporated in this paper. Looking at the patient Christopher Hammett
...can be minimized when nurses-patients’ rights are prioritized, moral integrity and trust is upheld, limiting the adverse effect of ethical climate and moral distress among nurses.
After reading the case study related to this assignment and other related articles and talking to co-workers, I realized there are many around us that ethical principle were somehow violated on them. Despite most nurses’ best efforts to make ethical decisions; they might not be able to make the right decision. As it was mentioned in the case study, nurses might feel their job will be jeopardized if they go against higher authorities’ will. If they lose their job, they cannot be useful for themselves or for other patients. This problem takes me back to the title of section three of doing the right thing, “if we know what is right, can we do it?... in properly ordered soul, reason will be on control and passion will be under control”(n.d.). It
In healthcare ethical theories on the issue look at how we interpret harm in a clinical setting. Doctors are expected to improve and promote the health of patients using their skills and knowledge. Patients in turn put their trust in doctors and make decisions based on that trust. Doctors, nursing personnel and allied healthcare have a duty to the patients which is guided by the mission and vision of the organization. For example, under the patient’s rights to access, no patient shall be refused treatment.
The health care is extremely important to society because without health care it would not be possible for individuals to remain healthy. The health care administers care, treats, and diagnoses millions of individual’s everyday from newborn to fatal illness patients. The health care consists of hospitals, outpatient care, doctors, employees, and nurses. Within the health care there are always changes occurring because of advance technology and without advance technology the health care would not be as successful as it is today. Technology has played a big role in the health care and will continue in the coming years with new methods and procedures of diagnosis and treatment to help safe lives of the American people. However, with plenty of advance technology the health care still manages to make an excessive amount of medical errors. Health care organizations face many issues and these issues have a negative impact on the health care system. There are different ways medical errors can occur within the health care. Medical errors are mistakes that are made by health care providers with no intention of harming patients. These errors rang from communication error, surgical error, manufacture error, diagnostic error, and wrong medication error. There are hundreds of thousands of patients that die every year due to medical error. With medical errors on the rise it has caused the United States to be the third leading cause of death. (Allen.M, 2013) Throughout the United States there are many issues the he...