Moral Issues Paper

Moral distress is faced by the nurse when they are providing care to the patient and will have to negotiate ethical and moral dilemmas (Chinn & Kramer, 2010, p. 90). I had a patient who was 80-year-old non English speaking Hispanic female and had a discharge order at the change of shift. I worked night shift and our floor had 1:4 nurse: patient ratio. As soon as I got the report, my charge nurse wanted me to discharge this patient first. This is because we were full and she wanted me to get new patient once room was ready. As I went to the patient room, I communicated with her using telephone interpreter service to do her discharge teaching. I realized that she was not aware of the fact that she was going to get discharged. She was told by

the one of the physician the day before that she will be discharged tomorrow not today. Her daughter was out of town and was coming back tomorrow to pick her up. Besides her daughter, she does not have any other family member around. She cannot drive, but she can go home on cab if we provide her with cab voucher.

It was already 8pm, and social worker were not available until the next day. So, I notified my charge nurse and then called the nursing supervisor asking for cab voucher. Apparently, our hospital stopped giving cab vouchers to the patient and she finally agreed to delay her discharge until morning when the social worker or her daughter comes back. I felt sorry for the patient that there was not any proper communication about her discharge. Then, I questioned myself, “Is this right?” and “Is this responsible?” (Chinn & Kramer, 2010, P. 98). I was morally distress because I knew that insurance was not going to pay her cost after being discharged by the physician. Hence, in this case legal requirements created moral distress. Things that need to happen so that the next time nurses will not experience moral distress in a similar situation would be to include the patient in the discharge plan before making any decisions and not making decisions in a hurry just because Emergency Room (ER) is busy. Also, if the patient was told earlier than may be her daughter would have been back by then to pick her up. Furthermore, moral distress can be prevented by not having discharge order at the change of shift

time. I felt that patient right to information and right to being full partner in health care decisions was violated because she was not made aware about her plan of care and there was no collaborative decision. The short term outcome of possible actions was that after communicating with the patient, her voice was heard and was allowed to stay at the hospital. However, long-term outcomes would be her unnecessary medical charges that she would get after getting discharged. In this way, this case was related to outcomes, fairness, authority, liberty, rights and responsibilities, empathy and character of the 8 key questions (James Madison, 2013). This is because consideration was given to short term and long term outcomes, expectation of the physician, charge nurse and supervisor, fair treatment, patient autonomy, patient right, nurses duties and obligations, proper care and response to the patient situation, and action to become ideal self.