Question

a place against his or her WI tent patient from leaving the hospital or the or application of restraints without proper authorizat imprisonment. Read the following case study. As you read, think about how ing principles might apply to this case. False imp CASE STUDY On November 2, 2000, Lewis Black 15-year-old, entered a teaching hospital for elective s Sur. gery for pectus excavatum, a deformity of the anterior wall of the chest. The surgery was successful. Lewig was prescribed a full adult course of ketorolac (Torado for pain by a young senior resident who wasf the postoperative protocols for that procedure. Onte morning of the third postoperative day, Lewis began to experience severe pain in his upper abdomen, and h abdomen grew hard and distended. A nurse told himit was gas. By afternoon, his temperature was dropping his skin was pale, and he was diaphoretic; his pulse was increasing. Lewis's parents were becoming increasingly alarmed at his rapid decine and asked nurses to call the attending physician. The physician who arrived, however was a resident; despite repeated requests, nurses had not summoned the attenarg physician. Lewis was developing peritonitis and was also bleeding internally. O d IV 30 hours of alarming clinical decline were going unnoticed. Prescribe inadequate. Lewis went more than 24 hours with virtually no urine output a fluids were t and 4 hours

Answer 1

Each professional nurse has to follow code of moral principles in order to deliver safe and quality care towards health promotion of any individual.

1. The legal and ethical duties breached here are non- maleficence, autonomy, accountability, advocacy the patient

Non maleficence- A professional nurse always work towards good to patient and don't engage in any activities which bring harm to patient. Here in Lewis case

• The nurse's didn't inform the attending physician.
• They didn't inform their nursing supervisor about the unavailability of physician.
• Nurses didn't communicate and also they didn't examine the patient well ( SOAP - subjective, objective, assessment, and plan was not carried out , if they maintained the charting well ,Lewis would have been saved)
• The nurses also didn't question the junior resident 's order for Inj.Ketorolac (adult dose) prescribed to a boy aged 15.

Autonomy- The nurses couldn't make their own decisions here. When Lewis was trembling in pain , they didn't inform the attending physician or even examined Lewis. They gave a false statement , that pain was due to gas.

Accountability- The nurses are always accountable for the well-being of patient .

• In Lewis case , they acted lethargic ,simply saying reasons and they spent 2.5 hours looking for blood pressure cuff.
• They are accountable for working of every instrument in their work station.
• When there was no urine output, it their responsibility to report the physician or their supervisor and nurses should go to any level for safety of patient.

Advocacy- The nurses should always be the advocate of the patient in a hospital to ensure safety and quality care to their patient.

• For an advocate communication is very important. Here there was lack of communication
• The nurses gave false answer to patient (false reassurance)
• The nurses didn't practice reasoning.
• They lacked professional knowledge ( because they blindly carried orders for NSAID wrong dosage to a pediatric patient)

These were breached because of lack of professional training, lack of communication, lack of evidence based practice, lack of knowledge about quality assurance.

2. Some factors involved in failure of health care providers are

• Inadequate knowledge and professional training
• Poor communication
• Lack of reasoning
• Lack of courage to question the physician
• Lack of supervision( Instruments were not in working condition)
• Lack of insight

3. According to me , if I am the primary care nurse ,I couldn't provide any rationale for my failure to contact the supervisor. It is my duty , because Im accountable for my patient care. I should have gone to any extent to save my patient .