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(Topic 4) DQ1: A recent ethical issue I have faced in my nursing practice was due to a surgeon not following policy and procedure. Surgery can be a stressful environment, especially when you are working with a surgeon who doesn’t value policy and procedure. In fact, these types of surgeons can influence good nurses to cut corners to be validated. This specific case happened when the surgical patient was brought to the room without signing the surgical consent. The surgeon was rushing the staff and circulating room nurse and said that he would sign the consent in the room. The patient was scheduled for a hysterectomy with bilateral Oophorectomy, the consent did not have the Oophorectomy listed on the procedure. Many times, ethically challenging situations that nurses encounter in everyday practice are usually situations in which they know an appropriate course of action to take but do not do so. Sometimes, nurses may have difficulty in recognizing the right course of action (Kim et al., 2021). During the time out, after the patient had been put to sleep, the nurse realized that the surgeon and the patient sill had not signed the consent. This is where the ethical dilemma came into play, the nurse asked if the surgeon would take the consent out to the family and get it signed by them and sign it himself, but he refused.
As nurse we have a code of ethics that we need to abide by and one of those ethics are Nonmaleficence. Medical errors are among the major challenges that threaten patients’ health worldwide (Mohammad et, al. 2019). Nonmaleficence means, “do no harm”. Abiding by the code of ethics for nursing drove the circulating room nurse and the surgical team to do the right thing. The surgeon dropped from the sterile field and went out and talked to the family. Thankfully he did because he had forgotten that the patient had decided at the last minute that she wanted to keep her ovaries. This surgeon would have taken out her ovaries based on the surgical schedule. It is imperative that the surgical team always follow policy and protect the patient. The operating room nurse is the advocate for the sleeping patient at all times.
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DQ 2- Topic 4 see above !!! was base on an ethical dilemma that was experienced in my professional practice, I chose to tell the story about how a choice was made to ensure that no harm came to a patient. The principle of nonmaleficence directs healthcare professionals to “do no harm” to patients (Pallipedia, n.d.). This assignment ask the student to provide a decision tree which will provide the reader a visual module on how the ethical decision was made to “do no harm”. Within the article by Edgar et al 2002, he discussed that by establishing that two core values are in conflict constitutes an ethical dilemma. The first priority is to define core values, and identify which, if any, are in conflict. This awareness is the first checkpoint in the dilemma resolution process. After recognizing an ethical dilemma does exist, the practitioner can then apply the remaining nine checkpoints for ethical decision making (Edgar, 2002). The core values that were in conflict within this authors story were , following policy and ensuring that the patient was safe and the right procedure was done. There are 9 checkpoints in the decision tree that are based on the Checkpoints for Ethical Decision Making,” in the article “Resolving Ethical Dilemmas: Applying the Institute for Global Ethics’ Ethical Fitness’ Model to Occupational and Environmental Health Practice Issues,”1. Determine the moral issue. 2. Determine the actor. 3. Get the facts. 4. Determine if the moral issue is right versus wrong. 5. Test for right versus right by assigning one of the four dilemma paradigms. 6. Apply resolution principles: Ends based. Rules based, or Care based. 7. Identify if a trilemma third option exists. 8. Make the decision. 9. Reflect on the decision. By addressing each one of these points, the readers will be able to identify if the dilemma was ethical in nature. After going through all of the 9 checkpoints, the reader will see that the problem that was discussed in DQ1 was truly an ethical dilemma.
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The scenario described in the content raises an ethical dilemma where following protocol and ensuring patient safety were core values in conflict. The nurse had to make a critical decision to intervene and advocate for the patient’s safety. This ethical dilemma highlights the importance of healthcare professionals following policy and procedure and practicing nurse ethics, specifically nonmaleficence. This essay will provide an ethical decision-making tree to present the reader with a visual module of how the ethical decision was made to “do no harm.”
Ethical Decision-Making Tree:
The decision tree presented follows the “Checkpoints for Ethical Decision Making” model, which is suitable for occupational and environmental health practice issues (Edgar, 2002). The first checkpoint is determining the moral issue, which in this case was the patient’s safety and following policy and procedure. Then, the actor involved in this decision-making process was identified, which was the circulating nurse. The facts were gathered, and the moral issue was determined to be right versus wrong since the patient’s safety was at risk.
The next step was to test for the right versus right dilemma paradigm, which involved assigning one of the four paradigms. Based on the scenario, the care-based paradigm was identified as the patient’s safety was the primary concern. The resolution principles were then applied, and the nurse chose the care-based approach to prioritize the patient’s safety over policy and procedure.
The ethical decision-making tree then identified if a trilemma third option existed, which was not feasible in this case. The final steps involved making the decision and reflecting on it. The nurse intervened to ensure that the surgeon and patient signed the consent for surgery, ensuring that the patient’s wishes were honored and the right procedure was completed. The nurse’s decision was ethical and aligned with the nursing code of ethics, emphasizing nonmaleficence.
The scenario described in the content highlights an ethical dilemma faced by the nurse where the patient’s safety and policy and procedure were in conflict. The ethical decision-making tree presented to evaluate the dilemma ensures a methodical and structured approach to address ethical issues. It is crucial for healthcare professionals to follow ethical practices and abide by the nursing code of ethics to prioritize patient safety above all other core values.
Edgar, L., Remmers, H., & Rosenthal, M. (2002). Resolving ethical dilemmas: applying the Institute for global ethics’ ethical fitness’ model to occupational and environmental health practice issues. International journal of occupational and environmental health, 8(2), 139-146.
Pallipedia, n.d. Nonmaleficence. Retrieved October 13, 2021, from https://pallipedia.org/non-maleficence/