February 7, 2012
Barbara Scheibe, RNC, MSN
Ethics Game Simulation Reflective Journal
This journal contains my reflections of the Ethics Game simulation assignment. The purpose of this assignment is to help me understand how to make ethical decisions using a decision model.
Ethical Issue #1-Presented during my shift
We have a 16 year old pregnant patient (RB), in her tenth hour of labor. Her parents are present and have been with her the entire time. They have chosen to limit medication and assistance available citing personal reasons. Her primary nurse is (YN) is concerned that given her current status, the situation could become critical for the patient and her unborn child. The fetus is not in distress at this moment but there are indications that this is gradually changing as time goes on. Close observation of the fetus and mother continues with the care team unsure if her parents are understand the perils of their daughter’s situation as the baby and the mother move toward irreversible medical danger if the appropriate interventions are not made in a timely manner.
Ethical Issue #2-Presented during my shift
AT was admitted to the ICU and has been unconscious all day with no definitive diagnosis made for him. AT was brought to the ER by his domestic partner YM who stayed with him in the ER till his transfer to the ICU. Once AT was admitted to the ICU, YM was prevented from visiting him by CB, the shift supervisor for the day shift despite hospital policy which clearly states that domestic partners are to be treated as married couples.
Decision making process
From the readings for this week, I saw there are several steps involved when attempting to resolve any ethical dilemma. First I needed to define the dilemma in both scenarios within the simulation. “Questions need to be raised about the meaning of the situation to all the participants and how the behavior of the nurse and the decision of the manager will affect them all” (Toren & Wagner, 2010)(p. 395). I need to be attentive, taking in the facts and gathering all the information about the situation that I can. I need to be intelligent, and identify the real issue and identify the primary stakeholders in the case. I need to be reasonable; understand my duties, look for the greater good, see the fairness, and remember my role. Finally I need to be responsible in that I need to develop a situation that has balance and meets the needs of all the stakeholders and communicate that decision to everyone involved. Applying these steps to issue #1
I gathered all the information I needed from the patient’s chart, went over her care plan, the medical plan and received verbal reports from RB’s nurse. I looked at her care overall and note that she had not received any medications nor was she seen by a physician that was on duty at the time as he/she was attending to an emergency elsewhere. My priority is to decide how assure that the best care is given to RB and her child. The stakeholders in this situation are as follows: *RB-the patient
*LB-RB’s unborn child
*YN (RN)-nurse caring for RB
Using the rights and responsibility lens I could identify my duties as leader in Issue #1. They include: *Duty to support the staff in doing their job
*Duty to not interfere with staff doing their job
*Duty to provide the best care possible
My responsibility was to find the option that best reflects my core values in this particular situation. I felt I should ask the nurse to do a thorough check to verify that the situation has not reached the point where we would have to compromise the rights of the patient and her parents.
Applying these steps to issue #2
Again here I needed to identify the problem. This issue included two problems, allowing access to a domestic partner, and ensuring a hospital policy was being followed. I...