collaborative case analysis – hce 430

8/11/2019 Collaborative Case Analysis HCE 430

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Collaborative Case Analysis HCE 430

Sunday and Monday Step 1:Identify relevant information including additional details from the relevant

literature. From the details, you have gathered, what are the most relevant andimportant in making a decision about the issues?

Below is the relevant information from the case study, The Medication Error:

Clinical indications: The patient is recovering from a car accident in which he suffered some chest

and abdominal trauma as well as a broken leg. The nurse gives the wrong medication to the patient because the chart did

not match the name on the room. She did not check the patients name(patients wristband ID or ask the patient) with the chart.

The patient becomes dizzy and nauseous but does not have an allergicreaction from the incorrect medication that was administered.

The nurse did not document the medication error but does document theregular does of pain medication.

The patient suffers from pain through out the evening because painmedication is not administered as scheduled.

The patient dies of an embolus in the lung, which could have been the resultof unavoidable complications of his car accident injuries.

Patient preferences: Since the patient is uncomfortable, it could be assumed that he wants pain

and nausea medication.

Quality of life: Since the patient suffered from a car accident, suffered from nausea,

dizziness and pain, and died from an embolus, I would assume his quality oflife is very poor or no quality of life at all because of death.

Organization/Legal factors: The hospital (organization) is in jeopardy of being sued by the family. The nurse did not record the medication error, which is against the hospitals

policy.

Professional factors: I just graduated from nursing school and currently at orientation of my new

job. I am following a busy and flustered nurse who gives the wrong medication to

the patient because the chart did not match the patient.


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It could be assumed that the nurse and I will be in jeopardy of losing our jobsbecause of the lawsuit.

Financial factors: The case study does not mention any financial factors other than money

could be involved in the lawsuit.

Social factors: The family wants to sue because of negligence and my name will be involved.

Monday and Tuesday Step 2:Discuss and narrow down the range of possible practical problems to one singleproblem statement. This statement will form the basis for the remainder of youranalysis. Remember, the problem statement should reflect the decision to be madein response to the case. You must agree on one problem statement.

I did not report the nurse who neglected to document the medication error thatmight have resulted in the patients death, though the autopsy said it was due to hisinjuries. Should the nurse and I get in trouble because we did not report themedication error?

Should I report the nurse for not documenting the medication error though thepatients death was most likely due to his injuries? I could lose my job because I did not initially report the medication error.

Tuesday and Wednesday Step 3:Identify the ethical issues inherent in the case. Formulate a range of ethicalquestions that help you analyze those issues. Work to reach consensus on theprimary ethical questions, and no more than three or four secondary ethicalquestions.

If I report the nurse and myself, will it help the situation?

--This question is based on utilitarianism, which is a theory that focuses on the outcomeof the situation instead of the actions it took to get there (Bennett-Woods, 2005). Here,the outcome must promote the most happiness.

If I report the nurse and myself about the medication error, will it serve the greater good?


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This argument is based off of the utilitarianism theory, which is a theory that focuses onthe outcome of the situation instead of the actions it took to get there (Bennett-Woods,2005). Here, the outcome must promote the most happiness.

Argument:

The most happiness would be justified in telling the patients family the truth about his orher health care, including the medication error. This way the family would know thecomplete truth and could start the healing process of losing a loved one. Additionally, byexposing the medication error, the nurse and myself would receive disciplinary actionthat could help prevent a harmful action from happening again, which promotes thegreater good for patients. Sometimes people need disciplinary action to learn from theirmistakes and pay closer attention to detail.

A counter-argument to this would be if the medication error were exposed, then thelawsuit would have further evidence for prosecution. Therefore, exposing the error will

not promote the most happiness because an entire institution will suffer. Furthermore, theautopsy reported that the embolism was caused from the injuries, not the medicationerror. Thus, reporting the error was not the cause of death and will only bring destructionon the nurse, the institution and myself.

What is my duty as a nurse?

--This is based off of Kantian Ethics, which focuses on us being consistant in our moralactions, which does not depend on the outcome (Bennett-Woods, 2005). Additionally,this perspective is based one's moral duties.

Am I inflicting harm on the family by not telling the truth?

--This question is based off of the nonmaleficence priniciple, which states not to inflictharm or evil (Bennett-Woods, 2005).

Reference

Bennett-Woods, D. (2005). Ethics At A Glance. Regis Univeristy. Retrieved February 25,

2014, from http://rhchp.regis.edu/hce/ethicsataglance/ethicsataglance.pdf.

Step 4:Make a list of ethical principles and theories that you will use to ground yourarguments and counter-arguments. Be sure that you have included those conceptsreflected in the ethical questions. What other ethical concepts may help you


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generate a robust set of arguments/counter-arguments? Once you have the list,define each of the principles and theories so that everyone in the group shares acommon understanding of the central tenets of each of these concepts.

CHARLES:

( Ethical Questions

Do I have a duty to tell the truth in this situation? (Veracity, Kantian Theory) What action will promote the good with virtuous intent? (Virtue Ethics) Is the patient being treated respectfully as an autonomous person? (Respect for persons) Does lying to the family rob the patient of dignity/autonomy, even though he has already died?

(Respect for persons, Autonomy) Does not reporting the medication error cause avoidable or intentional harm to the family?

(Nonmaleficence) Does exposing the error serve the greater good? (Utilitarianism)

Once we have agreed upon ethical questions then we can split up the theories/principles within the groupand each person can define a few of them.

Charles

Wednesday through Saturday Steps 5 and 6:Challenge one another in creating arguments and counter-arguments in response toyour practical problem. Work to answer each of your ethical questions as youdiscuss the arguments and counter-arguments. Remember, the arguments shouldreflect one pathway for action, while the counter-arguments reflect all of thereasons why you might not take that path. The counter-arguments should alsologically lead to alternate options for action. Be sure that you are supporting bothsides with credible information from the literature, both that contained in therelevant facts and new information that helps strengthen your arguments on bothsides.

Saturday and Sunday Steps 7 and 8:Make a list of the options for action. These options should flow logically from thearguments and counter-arguments. Based upon you discussion to this point, select


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ONE option for action as agreed upon by the group and justify your respond bystating how that action satisfies each of the ethical questions.You should conclude the discussion with a summary of how the process went foryour group and what you might have done differently in order to improve theprocess. Were you always focused on the patient, or did some members at times lose

sight of the patient in the bed in favor of their own thoughts or positions? How didyou know that you reached consensus on key points.

Grading

Individual Participation:

Demonstrated consistent participation throughout the week Demonstrated initiative in terms of additional research, writing, or other group tasks Demonstrated a good basic understanding of the issues Demonstrated the ability to separate personal positions from professional ones, including the best

interests of the patient and other stakeholders. Demonstrated effective collaboration that helped moved the group forward during the week

(dealing with conflict, summarizing comments, setting goals, meeting deadlines, etc) Demonstrated ability to apply ethical principles and theories in the case analysis. Applied 8-step model effectively Offered respectful, thoughtful, and well-supported critique of others' positions Demonstrated ability to respectfully challenge classmates in the use of a variety of theories and

principles, and on their thoughts and positions about the topic. Offered constructive feedback in the final forum

Group Collaboration:

Maintained open and respectful dialogue Demonstrated professional communication strategies throughout the week Full participation by all members Demonstrated good depth and detail in the discussion Demonstrated ability to stay on track and/or self-correct as needed Demonstrated good use of time Resolved group conflict effectively Achieved consensus

Note: Groups are not expected to construct a written analysis of the case outside of the discussion;rather, the discussion forum itself serves as the output for the exercise and will be gradedaccordingly.

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Share with your classmates what you think was the most significant learning youexperienced during the course. What surprised you the most? What impact will thiscourse have on you both personally and professionally?


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First, here is a little background on my level of education in health care ethicsbefore this class. Though I was in the military as a medic for over eight years, I wasnever trained on the ethical side of medicine. My job was to screen and assesspatients, start IVs, take vital signs, apply casts and splints, stock rooms, ordersupplies, etc. Most of the patient care I did was performed under a nurse or

physician. Therefore, I never had to make any ethical decisions.However, the military did instill th e core values of service before self,integrity first, and excellence in all we do. I believe the core values that wereinstilled into me from basic training helped me to document honestly on patients,even if I made a mistake. It also helped me to pay attention to detail, which isimperative in the nursing field, considering we handle IV medications and triagepatients.

The most significant learning experience would be applying the Eight-StepModel. Before I used this process, I thought ethical problems were solved by whatthe majority of people thought was morally correct. However, a lot more goes intosolving health care issues, such as determining the relevant facts and the practical

problem. Additionally, by considering arguments and counterarguments, principlesand theories can be applied to the problem.

What surprised me the most was how many ethical problems there were inhealth care. I knew about the ethical problems about abortion and the everydayissues that arise between coworkers, such as reporting negligence. However, I didntknow about patient-assisted suicide (PAS) issues. I know this may sound nave ofme, but I didn t know it was illegal almost nationally for physicians to assist inhelping a patient die. Ive never been in a situation where a patient wanted to die orhad over heard discussions at work. I suppose thats a good thing, though I know Iwill come across it as a nurse.

Personally, my expanded knowledge in healthcare ethics will have an impacton the way I view political issues about our health care system. I believe this hasopened my eyes to why there are issues around certain healthcare topics.Additionally, this knowledge will help me professionally as a nurse because I will beable to evaluate situations and make the right choice. Understanding the differenttheories and principles expanded my knowledge of how to make an ethical decision.Perhaps, I could volunteer on an Ethics Committee Board when I earn by BSN. Iwould like to help make a difference in this world, whether it is hands-on-patient-care or on an Ethics Board.

collaborative case analysis – hce 430

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