Term Paper: Medical/Nursing Education Nurses

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[. . .] The nurse is experiencing feelings of guilt over her chart omission but she does not want to take the risk of jeopardizing her nursing career through disciplinary action. Furthermore, the patient's bruising is likely to heal in time and it appears that no further internal damage to the arm veins has occurred. Therefore, this particular incident is likely to have no effect on the patient's overall recovery from abdominal surgery. However, the nurses' decision is likely to affect her future decisions and actions regarding patient care. She is likely to be more careful and attentive her responsibilities directly related to patient care and will need to develop a priority system of managing her workload. The nurse is not likely to be questioned regarding her chart notes as the patient does have a history of mental instability and his agitation likely provoked his action. If questioned regarding the incident, the nurse must prepare a valid explanation for the turn of events as family members may question the visible arm bruising and may want to be informed of the events surrounding the incident. Therefore, in order to remain aligned with her personal ethical framework, the nurse must develop a valid explanation for the events and may consider being truthful regarding the omission as she will be able to provide evidence regarding the chest pain patient and subsequent death.

The decision in question is strongly affected by the following two principles of the Code for Nurses:

The nurse assumes responsibility and accountability for individual nursing judgments and actions

The nurse participates in the profession's effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing

The nurse must consider these ethical principles in reevaluating her decision to hide information from the patient's chart. She is morally responsible for her own actions and is accountable to fellow staff members, the healthcare organization as a whole, the patient, and his family to appropriately communicate all relevant information related to the bruising event. On one hand, there is likely to be no permanent damage from the incident that will require further attention. Therefore, although the patient was ignored for a period of time, the long-term effects will be nonexistent. On the other hand, the nurse had a responsibility to care for her patient in a timely fashion, regardless of the circumstances, and should have delegated the responsibility to another nurse who was able to provide a solution that would have resulted in no physical harm. Unfortunately, such incidents are often met with serious time constraints and rash decisions are made because demands are excessive. Nursing ethics are a difficult practice to maintain when nurses are overworked and extreme stress is encountered in daily work activities. According to Smith and Godfrey (309), "Ethical nursing is more than just analytical skill, and perhaps even the addition of intuitive prowess does not capture the whole experience. Rather, ethical nursing is embedded in the wholeness of each person as he or she becomes the good nurse doing the right thing." The practice of nursing ethics is often compromised, and a nurse must attempt to perform all actions in an ethical manner at all times. Sometimes, this is extremely difficult to accomplish when the nurse is faced with decisions that require equal attention.

Decision and Selection of Course of Action

In the situation described in this discussion, the nurse experienced excessive guilt for her omission of pertinent information on the patient chart. When the patient was released two days later, the nurse expressed her guilt to the nurse manager on the unit through a private meeting. The nurse manager is the party responsible for reporting incidences where poor ethical judgment is exercised and is also responsible for reporting situations where disciplinary and even legal action may be required. The nurse manager was not very pleased that the nurse made such a rash decision, but she appreciated her honesty regarding the situation. Although the nurse manager knew of the patient death, the nurse explained her side of the situation in detail and also described her feelings of guilt regarding the neglect directed towards the IV patient. She illustrated her frustration towards the lack of control over matters and the excessive strain placed on nurses that are reflected in times of patient neglect. She also explained that she made the decision because as she is a good nurse and has always practiced ethical judgment, she felt that if she reported the incident as it actually took place, she would be evaluated in a more negative manner during her next performance review and did not want to take that risk. The nurse manager listened to her side of the story and although she was typically required to make a suggestion for disciplinary action under these circumstances, she exercised her own ethical judgment and decided to let the incident go. She explained that the reason for her decision was due to the fact that the nurse had a perfect record up to this point and has always performed to the best of her ability and has always exercised under the pretense of a rigorous ethical framework. The nurse manager also cited that the patient would not suffer any long-term damage from the bruising and that as a result of the patients' mental instability, he may have taken matters into his own hands whether or not the nurse took immediate action in providing a solution to his IV problem. Furthermore, although the family had noticed the bruising, it was not that unusual as they were aware of the patient's medical and mental history. Therefore, the nurse was relieved to know that the nurse manager would not consider taking disciplinary action in this instance. Furthermore, the nurse recognized the need to improve her time management skills in order to better accommodate her patient load on any given shift in the future.

The decision made in regards to the incident is morally justified as it did not affect the long-term well being of the affected patient, nor did the family question the quality of treatment delivered while the patient was admitted to the unit. The family and other health professionals did not recognize a problem with the circumstances surrounding the bruising, as this symptom is common in persons that require IVs. Furthermore, since an emergency on the unit required the immediate attention of the responsible nurse, it was in her best interest to attend to the immediate matter at hand since it quickly turned into a fatal incident. Perhaps a quick communication with another nurse regarding the IV patient would have avoided the physical symptoms that the IV patient experienced, but the nurse exercised her ethical judgment as she saw fit considering the urgency of the chest pain situation. The importance of the decision rests on the fact that the nurse manager in charge recognizes the value and importance of the nurse in question to the overall success of the unit. The nurse is a valuable asset to the staff, and as a result, a minor error in ethical judgment was not recognized as a significant threat to the nurse's future practice as a nurse providing quality patient care in a fast-paced, transitional environment.

Reflection on Decision

The decision made by the nurse manager not to pursue disciplinary action was based upon a number of significant factors that have already been presented. The failure of the nurse to document her failure to reenter the patient's room was not considered to be a significant finding in regards to patient neglect, as the nurse was merely attending to another patient involved in a fatal situation. This decision was morally justified and the nurse was made aware that judgments regarding patient care must be made so that they provide the best possible outcomes for the patient in question. The nurse manager recognized that the nurse was obviously affected by the urgency of the needs of the other patient, so she chose to handle the matter in the best possible way that she could considering the time constraints involved. Although the nurse should have reported the exact time that she discovered the patient had removed his IV, she still acted in the best interests of the patient since she eventually revisited the patient and formulated a solution to the problem. It is a proven fact that "Managed care and the nursing shortage are creating problems for the health care industry that have no immediate solution. Thus, the ethical issues within the health care system that are causing moral distress for nurses will not be eliminated in the near future. As a result, nurses need to recognize signs of moral distress and address this problem in a proactive manner. There is a need to work collaboratively with nurse administrators and other health professionals to create and maintain an ethical work environment in which all are treated with respect and where differences of opinion are valued" (Erlen 80). The situation that the nurse… [END OF PREVIEW]

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APA Format

Medical/Nursing Education Nurses.  (2003, February 24).  Retrieved March 19, 2019, from https://www.essaytown.com/subjects/paper/medical-nursing-education-nurses-required/4463937

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"Medical/Nursing Education Nurses."  24 February 2003.  Web.  19 March 2019. <https://www.essaytown.com/subjects/paper/medical-nursing-education-nurses-required/4463937>.

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"Medical/Nursing Education Nurses."  Essaytown.com.  February 24, 2003.  Accessed March 19, 2019.
https://www.essaytown.com/subjects/paper/medical-nursing-education-nurses-required/4463937.