Aha! That’s Ethical knowledge
Before taking this course I had experienced many “aha” moments but never knew that an actual definition existed for this experience or that this was a concept developed by Dolores Krieger, RN. Clearly, nursing is a profession that requires ethical knowledge to guide our practice as stated in Chinn & Kramer (2008) but it was not until after reading the chapter on ethical knowledge and reflecting back on a day at work, that almost caused me moral distress, that I was able to understand the chapter and my “aha” moment much clearer. In this paper, I will describe how an experience at work required ethical knowledge.
A Day in Labor and Delivery
The day started as any other normal work day. I reported to work promptly at 7 am in my clean crisp uniform with my name tag clearly visible. I accepted my assignment from my head nurse and went to receive my report from the night nurse. As I walked into my patient’s room, I noticed that whole team, the attending, the resident, the anesthesiologist and the night nurse were all present. I made my way into the room, greeted everyone with a good morning and introduced myself to my patient. I received report from the nurse and thought to myself, ok this seems like a straight L&D case. The patient, F.D. was a 33 year old female G 5 P4004 at 39 weeks in labor. She came into the hospital at 4 am complaining of contractions and that her water bag had broken. She was admitted at 4:30am at 5 centimeters and now at 7 am she was 8 centimeters. She seemed to be progressing well and laboring all on her own. The team leaves the room and the attending states that rounds will be in 10 minutes. I continue to do my work, assess the patient, evaluate the fetal heart rate, read the H&P and nurse’s notes and write my receiving note. Before going to rounds, I prepare my room for delivery because as a competent nurse I anticipate that F.D. will deliver in about 1-2 hours based on her obstetrical history. At rounds I am taking by shock to find out that the attending doctor starts with report on my patient by saying this patient will be set up for Cesarean section if she does not deliver in an hour. I ask the attending what is the indication for the section and he simply states I will check her in an hour and if she has made no changes you will set her up and be ready to go for a Cesarean section. After rounds which took about 45 minutes, I go back to my room to review my patients chart and fetal heart rate strips but could not find any indication for the cesarean section. I was getting mad because there was already a saying going around the hospital that this attending likes to do Cesarean sections for no reasons because he is trying to better his surgery skills and I did not want my patient to endure a Cesarean section to fulfill this attending desire. 20 minutes later I noticed that there were decelerations in the fetal heart rate that are connected with head compressions and descent. I called for the attending to come evaluate, he examines the patient and states that she has an anterior lip (which is like saying the patient is 9.5 centimeters and you have to be 10 centimeters in order to deliver). He orders me to set the patient up for cesarean section. I ask him why and he tells me because she is having decelerations, I inform him that the decelerations are consistent with head compression and descent and that maybe she could push the baby out since she has already had 4 vaginal deliveries but he continues to tell his residents to consent her. As the resident is explaining the risks, benefits and alternatives of the cesarean section the attending grabs the consent from the resident and tells her we don’t have time to explain all of that to her. The attending then tells F.D. that she has to sign the consent for the surgery because she needs the surgery now because her baby could die. F.D refuses to sign the consent stating that she has to...
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