One of my client had been put on anticoagulants upon her admission to the hospital for prophylaxis. She had a history of hypertension, COPD and pneumonia. She had been okay by the doctor for discharge. I was preparing to go on my break but wanted to take care of my client’s ten o’clock dose of Heparin. I had previously read the physicians discharge orders and saw nothing about discontinuing or sending the client home on an anticoagulant. Hearing that my client could be discharged that afternoon, I felt that maybe she did not need the Heparin anymore or it was over looked. I am not able to find any of the nurses I was working with, I spoke to the charge nurse regarding this matter. She said “she is going home soon and does not need it …show more content…
I decided not to give the shot based on facts that my clients was up moving around, she was doing exercise to improve blood flow and what the charge has said to me. I still had feeling that I was missing important steps. Feeling unsure about not giving the client her injection or having spoken to her about, I followed up about contacting the physician just to clarify the situation. I was not comfortable about the decision I made and felt confused about conflicting information I had been given by the charge nurse. In the end I explain to my client that she had not prescription for anticoagulant to go home with and if she still wanted to take the shot. My clients was a nurse for 35 years, so she had an in-depth understanding of the purpose and action of the anticoagulant she was taking. She explained that she was much more mobile and would like to decline the injection. Although I honored what the client wanted and knowing she likely did not neeed the injeciont I still felt that from my own understanding the right thing to do want to make sure I have physicians order to discontinue the drug. I shared this situation with a fourth year nurse whom this was her client and would be taking over her carefully …show more content…
I understand that they have the experience and knowledge to make decision that students do not, but I feel confused about where the line is sometimes. Another example was with the same clients and it had to do with discontinuing her saline lock. My understanding is that we cannot take out an IV without an order, but the RN in charge of my client said that she felt it was ok and she would do it without the order. I feel the lines are blurry about what we can and can’t do. I don’t want to miss out on an opportunity to learn, but I don’t want to develop habits at this time that is not best practices. I want to develop the best practices as a student and when I am an RN I will then be in a position to make those types of calls. I just don’t feel I have the knowledge or understanding about where I can deviate from the best practices that we are being taught. I recognize that RNs have and will make decision, I just don’t know where and what those are
I cared for a 76-year-old end-staged chronic obstructive pulmonary disorder patient who was admitted for respiratory distress. The doctor requested that my nurse and I get the family together for a family meeting. During the meeting, the doctor communicated to the patient and his family members that the patient will be palliative and no longer be in the ICU. The family members were concerned about the transfer of care to the medicine unit, what to expect from palliative care and other options for care. This scenario did not go well because the patient and family would have benefited from a palliative nurse with expertise, respiratory therapist to discuss other options, pharmacist about medication change if needed, social worker to help guide the family through end of life care for their father. In addition, there was no collaboration with interprofessionals prior to the family
Planning included reaching out to other health organizations, objectives, and goals of health fair were established. The implementation includes getting volunteers, set up for the health fair. The evaluation of the process occurred throughout the implementation and changes were made as needed. The evaluation will be completed by gathering information from health booth to determine the number of participants. Review vendor and participant evaluations about the health fair including how they heard about the health fair, ratings of booths and suggestions for improvements. Record everything to determine changes. Reflection on past experiences and what worked and did not work.
Every nurse will be faced with a decision making dilemma at some point in his or her career. Being familiar with the nursing code of ethics, what is ethically and morally expected in society and how to approach the situations can help make dilemmas less of a nightmare. “The purpose of nursing ethics is to inspire questions and examine what would be the ethically right action in health care situations demanding a choice between at least two undesirable alternatives” (Toren & Wagner, 2010, p. 394). There are many different ways one can approach a situation to reach a resolution, finding a method that works best with the situation at hand is ideal.
In the medical profession, doctors and nurses run into ethical dilemmas every day whether it be a mother who wants to abort her baby or a patient who has decided they want to stop cancer treatment. It is important for the nurse to know where they stand with their own moral code, but to make sure they are not being biased when educating the patient. Nurses are patient advocates, it is in the job description, so although the nurse may not agree with the patient on their decisions, the nurse to needs to advocate for the patient regardless.
Define a critical thinking task that your staff does frequently (Examples: treat high blood sugar, address low blood pressure, pain management, treating fever etc.). Create a concept map or flow chart of the critical thinking process nurses should take to determining the correct intervention. Include how much autonomy a nurse should have to apply personal wisdom to the process. If the critical thinking process was automated list two instances where a nurse may use “wisdom” to override the automated outcome suggested. Note the risks and benefits of using clinical decision making systems.
...care. It is not easy to prevent unjust practice in health care facilities, because each individual deal with each circumstances differently. All we can do is continuously teach nurses that the patient come first and our job is to advocate for client’s right to autonomy, respect, privacy, confidentiality, dignity, and access to appropriate information. Practice in accordance with the Nursing Profession Act and its regulations and bylaws, the Canadian Nurses Association (CNA) Code of Ethics, principles, statements, guidelines or documents. Nurse most also responds to and reports to appropriate person, when there is a situation, which may be adverse for clients or health care providers, including, incompetence, misconduct and incapacity. In conclusion, you should act as and role model for student nurses, colleagues and others, by doing the ethical thing.
She should have not made the assumption that there were no doctors available until 2100 hours. Instead, she should have sought clarifications on whether the Emergency Department (ED) doctor was prevailed on examining the patient. She should’ve escalated concerns to the Clinical Nurse Manager (CNM). She also should’ve not made the assumption that the administration of antibiotic would improve the patient’s condition and “recover” her from the “red zone”. Finally, she should have documented her observations and implement a care
I chose to go into nursing because I had taken a sports medicine class in high school I enjoyed, and I thought I would be guaranteed a job graduating that had something to do with medicine. I can remember being so excited to learn how about illnesses and medications, and all the difference procedures done in the hospital. At the time I thought a nurse’s job was to do what the physicians said, and I expected set guidelines that would tell me what I was and wasn’t allowed to do. I had no idea that I was entering onto a career path involving so much complexity, and that the skills I had dreamed of learning were such a small part of nursing in comparison to the emotional, decision making, and critical thinking skills that a nursing career requires. Ethics in nursing was not something that had ever crossed my mind when I chose to take this path, however now ethics is something that I think about every day I am practicing, whether in clinical or theory courses. Ethical theories often come from the idea that because we are human we have the obligation to care about other’s best interests (Kozier et al., 2010), however in nursing ethical practice is not just a personal choice but a professional responsibility.
When I was working as a bedside nurse in the Emergency Department, in one of my duties I was not satisfied with the treatment plan made by a resident doctor for XYZ patient. He entered intravenous KCL (potassium chloride) for the patient. The purpose of that medication and its dose for that patient was not clear to me. I assessed patient history and came to know that a middle aged patient came with the complaint of loose bowel movements, vomiting, and generalized weakness. His GCS (Glasgow comma scale) was 15/15, looked pale but was vitally stable. I exactly do not remember about his previous disease, social or family history but I do remember that he was there with his son. According to the care plan, I inserted intravenous cannula, took blood
An ethical dilemma is defined as a mental state when the nurse has to make a choice between the options and choices that he or she has at her disposal. The choice is a crucial task as the opting of the step will subsequently determine the health status of the concerned patient, hence it requires a great deal of wisdom along with proper medical and health training before any such step is opted as it is a matter of life and death. Strong emphasis should therefore be on the acquisition of proper knowledge and skills so that nurses do posses the autonomy to interact with patients regarding ethical issues involved in health care affairs and address them efficiently. It is normally argued that nurses are not provided sufficient authority to consult and address their patients on a more communicative or interactive level as a result of which they are often trapped in predicaments where their treatments of action and their personal beliefs create a conflict with the health interests of the patient. (Timby, 2008)
Deontology is an ethical theory concerned with duties and rights. The founder of deontological ethics was a German philosopher named Immanuel Kant. Kant’s deontological perspective implies people are sensitive to moral duties that require or prohibit certain behaviors, irrespective of the consequences (Tanner, Medin, & Iliev, 2008). The main focus of deontology is duty: deontology is derived from the Greek word deon, meaning duty. A duty is morally mandated action, for instance, the duty never to lie and always to keep your word. Based on Kant, even when individuals do not want to act on duty they are ethically obligated to do so (Rich, 2008).
One must evaluate all parties involved. It can be argued that do to the lack of documentation or communication of the physician this was an act of negligence. A jury can decide that lack of documentation is sufficient evidence in finding a physician guilty of negligence (Pozgar, 2009). When we look at the role of the defendant which was the pharmacist not the physician his duty goes above just filling prescriptions, the duty of a pharmacist is to monitor the patient’s medication. In order for him to have achieved this properly he should have made sure he contacted the physician for further information even if the physician failed to communicate with him. Because of his actions the plaintiff is holding the pharmacist accountable for his treatment and that is not where all of the blame should be consumed. The argument that can be made for the pharmacist is that the pharmacist acted within his scope of practice and left everything to the physician. This situation can easily be construed as, if the physician needed further medications or if there were any adverse reaction then he would have contacted the pharmacist. Once again the prosecutor may argue that the pharmacist had a duty to follow up on any treatment that he provided to a patient. These arguments would be the most persuasive. These are the key elements in determining the case being argued. For example the pharmacist not following up with the patient’s physician may be
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.
On my first day of week three clinical at 0830, client W and I were on our way to the dinning room and client B asked me to put his jacket on, so I told client W that I would meet him in the dinning room. After I helped Client B, I was on my way to the dinning room and nurse A told me that client W was experiencing difficulty breathing and we needed to give him his 0900 inhalers earlier. He was having audible wheezing and rapid respiratory rate. Therefore, we had to give client W his inhalers, SalbutaMOL Sulfate, which is a bronchodilator to allow the alveoli in the lung to open so th...
The nurse confirmed patient identification, asked subjective questions focusing on chief complaints, performed a focused assessment, obtained medication list, baseline vitals, and assessed the patient’s past medical history. She asked the patient questions such as previous hospitalization/surgery, metal implants, allergies, health history, sleep apnea, and alcohol/tobacco use. The nurse told the patient the doctor would be with her shortly. The nurse reported to the doctor regarding the patient and obtained orders for treatment from the doctor. The nurse then started an IV line and hung an IV solution bag of normal saline because the patient was experiencing abdominal pain. The nurse also administered pain medications and the patient was ready to be discharged. The nurse gave discharge instructions and made sure that the patient had a ride