Question

Ethics and Values

You are caring for a 17-year-old female patient with sickle cell disease who has been admitted for treatment of sickle cell crisis. Sickle cell disease is a genetic abnormality that affects hemoglobin in the red blood cells. In a sickle cell crisis weakened red blood cells clump together and impede blood flow, causing extreme pain. To prevent stroke and manage the pain of the crisis, your patient needs aggressive fluid and comfort management. At the change-of-shift report, you learn that, even though she is receiving pain medication around the clock, she continues to report acute pain at a level of 10 on a scale of 0 to 10. She complains about almost everything: her roommate, the food, even the intravenous line that delivers the fluids and pain medications. Her home is far from the hospital, and her family and friends are not able to visit. During shift report the nurse from the past shift describes the patient as manipulative. On the basis of her concern about a risk for addiction, she has declined to increase the dose of pain medication. 1. Describe this case in terms of the ethical principles that it raises. Refer to the nursing code of ethics to compose your response. 2. How could a values clarification exercise promote an ethical response to this case? 3. In trying to better understand sickle cell disease, you join a chat room online where people with sickle cell disease discuss their problems. Hoping to protect patient privacy, you use only your first name and the patient's first name. You mention the name of the hospital where you work. On the basis of your reading of the ANA White Paper on Social Media, describe benefits and risks of participating in social media in this situation.

Legal Implications in Nursing Practice

You are working the first shift on the hematology-oncology unit and receive report on your assigned team of three patients. You have a nursing assistive personnel (NAP) assigned to help you with routine care. You make quick rounds on your patients to ensure that there are no immediate needs before you begin checking medications. Patient No. 1 is scheduled for surgery later in the morning for a biopsy and needs the surgical consent signed. Patient No. 2 is receiving blood products for a human immunodeficiency virus (HIV) complication and needs frequent vital sign monitoring. You find patient No. 3, an 83-year-old confused man, lying on the floor. He states that he needed to go to the restroom and no one was there to help. 1. The nurse prepares the surgical consent form for patient No. 1. Which key points does he or she need to ensure that the patient received before witnessing informed consent? 2. The son of patient No. 2 calls to talk to the nurse caring for his father. The son asks questions about the reason for the blood administration. Which guidelines does the nurse follow in responding to the son's questions about the father's condition? Which federal statutes are involved in this scenario? 3. One week after discharge from the hospital, the hospital received a written complaint from the family of patient No. 3 about the incident related to the fall and the intent to take legal action. a. What must patient No. 3 establish to prove negligence against the nurse? b. Describe situations in which restraints may be applied legally to prevent falls.

Communication

Mr. Simpson is a 78-year-old patient whose wife died last year. He has been living alone. He has limited cooking skills; thus he eats out a lot. Since his wife died, his blood sugar has been poorly controlled. To help Mr. Simpson gain better blood sugar control, the dietitian came to see him. After she left, Mr. Simpson was angry and stated his desire to leave the hospital right now. He stated, “That diet person came to see me, and she doesn't know anything.” 1. How would you approach Mr. Simpson? Which communication techniques would you use and which would you avoid? 2. You talk with the dietitian and learn that she gave the patient information about his diet and recipes that he could try. As you talk further with Mr. Simpson, you learn that the physician told him he might not be able to live alone anymore. You realize that he doesn't know how to cook. Knowing this, how would you respond to him? 3. After talking with Mr. Simpson, you determine that he is able to care for himself at home but will need some assistance. He is willing to consider various options for meal preparation. You call the physician to discuss this. Your hospital has established SBAR (Situation-Background-Assessment-Recommendation) as a standard communication tool. How do you effectively communicate your concerns and the patient's need to the physician using SBAR?

Answer 1

Ethics and values

1. The nurse is responsible for her duties and responsibilities in the care of the assigned patient. Ethical conflict, in this case, arises between beneficence and nonmaleficence. Beneficence is doing good for the patient. Nonmaleficence is not to harm the patient. The nurse has to plan to reduce the pain of the patient, at the same time pain medication should not be harmed to the patient. According to the Nursing code of ethics, the nurse has to protect and safeguard the health of the patients and the nurse has to provide maximum care for the patient. So the nurse has to reassess the patient and intervention to keep the fidelity of the patient. In addition to the pain medication, the nurse has to provide psychological management of pain such as music therapy, talk therapy for effective well-being of the patient.

2. Values clarification is essential in the case of ethical dilemmas. Value clarification is the assessment of the clinical situation through values and facts. The nurse should perceive pain in the patient's point of view. The nurse has to concern the patient's values, beliefs, opinions, tolerance to pain before taking clinical judgment. The nurse has to respect individual values and opinions.

3. Active participation of people in social media provides emotional support and relaxation to the patient. On the other side, it affects patient rights and privacy of health information. The partial name identifying sometimes gives clues to other patients. The nurse has to maintain a therapeutic relationship in online chat rooms and equal participation to every patient. The nurse has to maintain the integrity and dignity in social media. The nurse has to follow workplace policies and Social media guidance in an online chat to minimize issues.