Case Study – Nursing Ethics principle of Justice

ED ETHICAL LOG Criteria: Select and analyze an ethical clinical incident of interest. Format the log as follows:

Part 1 – description of event (3 points).

Part 2 – thought processes during incident. Recall: What were you thinking? What did you think afterwards? (3 points).

Part 3 – supportive evidence citing the ANA Code of Ethics for Nursing. Include the moral principle involved in the situation, i.e. justice, autonomy, beneficence, nonmaleficence, fidelity, or veracity in your analysis. How was the code breached or maintained in the particular situation you are describing? (4 points).

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Part 4 – evaluation of your thought process after the event. Is your thought process supported by the ANA Code of Ethics for Nursing? Your thought process may not have been accurate, which is OK, as long as this is documented in the entry with identification of corrected thought processes. Make recommendations for future practice (4 points).

References and citations should be in APA format with reference listed at end of text (1 point). The logs are confidential.

A woman brought in to resuscitation was weak and had slurred speech. It was suspected that she had a seizure and in post-ictal state. She was brought in for CT scan. There was another patient already on the CT scan table but she was told she will be excused because the resus patient takes priority According to justice in the nursing code all patient should be given equal right. As long as they both require to get the same service

The ethical Principle of Justice

The emergency department (ED) was full all day. Patients were waiting up to seven hours to be seen. Room five was reserved as of 1600 hours and a sterile clean was done. The nurse walked to the front of the hospital at 1630 to meet a patient. She sat with a patient and her mother to inquire how the patient was doing and for the patient to explain the reason she was at the ED. The patient explained she had her menstrual cycle for the past two weeks and her hemoglobin level was now at six so she needed blood transfusion. The nurse then got up and told the patient to come with her. The patient was taken into the ED bypassing all the other persons that were present and had been waiting for an extended time. Case Study – Nursing Ethics principle of Justice

During the process I was saying to myself that it must be a unique patient that warranted the nurse to leave her post to get this patient. I was thinking how unfair it is to others that was sitting there for hours and not receiving any care. After leaving the patient in the room, the nurse explained to me that this patient was a former tech at the hospital. The patient was typing her reports and letters were missing from some of the words. The patient was later diagnosed with brain cancer. The patient has had surgery and is receiving chemotherapy to ensure that all the cancer is gone. The patient is now immunocompromised, therefore, the patient must be away from people who are sick and should be in a sterile environment as much as possible. After getting an understanding of the background surrounding the treatment of the patient, I would have done the same thing.

The ethical principle involved in the situation is Justice. The American Nurses Association (ANA) Code of Ethics, 2016, provision one states that the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every patient, unrestricted by considerations of social or economic status, personal attributes or the nature of the health problem. Based on this provision the nurse breached the ANA code as well as the Justice principle. Under provision one guideline, the nurse should have taken the patients that were there first and remove the personal connection the nurse had with the immunocompromised patient. However, provision four states that the nurse has authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to promote health and to provide optimal care (ANA, 2016). This provision allows the nurse to use judgment in the situation provided to promote and provide optimal care to the patient that was immunocompromised as the nurse is accountable for individual nursing practice.

Of all the patients involved in the scenario, the immunocomrpromised patient appears to be in the greatest harm. The nurse made a decision that was crucial to protect the well-being of the patient that was more ill. The principle of justice requires that we act in ways that treat people equitably and fairly (Vryonides, Papastavrou, Charalambous, Andreou, and Merkouris, 2015). Actions that discriminate against individuals or a class of people arbitrarily or without a justifiable basis would violate this basic principle, however, the nurse can justify the actions taken in this case.

The emergency department presents ethical issues that are not commonly found throughout the healthcare system (House et al., 2015). It is difficult to apply moral and ethical principles in a straightforward manner as a result. Situations and circumstances that present themselves can affect how the application of the ethical principles are interpreted (Vryonides, et al., 2015). Had the immunocompromised patient not be personally known to the nurse would the situation appears to be an ethical breach or would the situation just be looked at as nursing judgment being applied.

For future practice, common sense nursing must be applied at all times. The patient that is in the greatest need should receive care first regardless of the time they have been waiting. The triage system that is being used to treat patients in terms of highest priority must be used to ensure the least harm is being done to patients.

References

American Nurses Association Code of Ethics for Nurses (2016). The 9 Provisions. Retrieved

from https://anacalif.memberclicks.net/assets/Events/RNDay/2016%20code %20of%20 ethics%20for%20nurses%20-%209%20provisions.pdf

House, J. B., Theyyunni, N., Barnosky, A. R., Fuhrel-Forbis, A., Seeyave, D. M., Ambs, D., & …

Santen, S. A. (2015). Understanding Ethical Dilemmas in the Emergency Department: Views from Medical Students’ Essays. Journal Of Emergency Medicine (0736-4679), 48(4), 492-498. doi:10.1016/j.jemermed.2014.09.058

Vryonides, S., Papastavrou, E., Charalambous, A., Andreou, P., & Merkouris, A. (2015). The

ethical dimension of nursing care rationing. Nursing Ethics, 22(8), 881-900. doi:10.1177/0969733014551377

Case Study – Nursing Ethics principle of Justice