Patient Safety And Ethical Dilemmas

A) There are several issues in the case of Mr. J that need to be examined. Using nurse sensitive indicators “reflect patient outcomes that are determined to be nursingsensitive because they depend on the quality or quantity of nursing care” (American Sentinel University, 2011). Mr. J. was not receiving acceptable care, because his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. This skin condition is the first stage of a developing pressure ulcer. a. Nurses should be aware that a patient with limited mobility is at risk for skin breakdown, and pressure ulcers.

The negligence of this incident had a negative impact on the patient’s family members. Approximately 25% of cases involving medical negligence involve poor nursing care. Another negative aspect was patient’s family follow up was poor resulting in lack of importance highlighted on the pressure wounds. Ashley (2003) states nurses can be sued for malpractice, this means he or she is being sued for “negligence”. Furthermore, the nursing health professionals can lose its credibility among a community as they failed to provide a holistic care for the patient. However, a positive outcome was nurses were able to reflect among this evidence based practice to assist in better quality in patient

One of the main ethical issues that faces health care is the security of patient information. This information is protected by laws and regulations such as HIPPA, but there are still concerns Scott, et al, 2005). Among those concerns is the new concept of electronic patient records and information. These records are designed to help hospitals and doctors get patient information more quickly, so that patients can receive treatment as soon as possible. Unfortunately, anything kept and transmitted on a computer has the potential to be hacked, so that is a serious concern for patients. Not all patients want their medical records to be available electronically, but they may not have too many options (Romano & Stafford, 2010). Opting out may not be an option for them, and if they do have that option it could reduce the speed and quality of treatment that these patients would receive. Do they want to risk that, just so they can feel as though their medical information is better protected?

For the most part, hospitals are places where one comes for healing and it is place where our clients should feel safe and away from harm. Nurses have an important role as a patient advocate and are to provide all clients with safe, compassionate, and quality care at all times. Nonetheless, the hospital can also be a dangerous place for inpatients. It is a foreign environment to clients and there may be alterations in their medical condition in regards to their physical and/or mental status. With this said, there is a need to improve upon how we care for our clients, especially those who are at most risk for various incidents.

The mix up could have happened due to carelessness of incorrect records or some other reason. A plan will be devised to make necessary changes to avoid such mistake. In case of Mr. J, the possible cause of the mix up could be a lack of communication among nursing and dietary staff. A policy for eliminating communication barrier will be devised so that the dietary concerns of patients a communicated to dietary staff. After this the daughter of Mr. J will be communicated about the incident and the cause of the food mix up. An apology will be made and she will also be told about the steps which the hospital is taking to make sure that this does not happen again. This insurance is to make the family believe that the hospital is sensitive about every concern of the patient. If necessary the Rabbi of Mr. J will be called to give his opinion on the matter. After satisfying the patient and family, a report of the incident will be given to hospital administrator. The report shall include an explanation of the event and the necessary changes which have been made to make sure such mistake is not repeated.

Identifying patients is key in preventing medication errors and relates to provision 3 in the code of ethics, “The nurse promotes, advocates for, and protects the

Patient satisfaction is a big nursing-sensitive indicator that has a lot of room for improvement within this patient scenario. Patient satisfaction can also refer to patient’s family satisfaction in most cases because they are both the customer. The certified nursing assistant taking care of Mr. J could have approached the daughters concerns in a more appropriate and professional manner. She could have begun by validating the daughters concerns followed by notifying the RN, who in turn could have implemented certain interventions to prevent further harm. Honesty and better communication could have resulted in improved patient satisfaction in the last part of this scenario. If the staff would have been honest with Mr. J’s daughter by communicating the mistake and given her an action plan as to what they are going to do in order to never allow this to happen again, she may not have complained to the hospital administration. Nursing can improve patient safety and outcomes by better understanding and incorporating nursing-sensitive indicators such as restraint prevalence,

Hospital data on the use of restraint can also be analyzed to improve patient outcomes and satisfaction. This information could be scrutinized to determine if restraints were truly warranted in that particular situation, or if another method could have or should have been utilized first. Documentation should also be examined to determine if the patient was adequately cared for during this time period. In my hospital, the patient must be released from the restraints at least every two hours, and must be toileted at that time. The nurse must also do range of motion exercises with the extremities affected by the restraints. The skin and circulation should be assessed at this time. Every hour, the nurse is required to check the pulses in the extremity affected by the restraint. The nurse’s documentation should reflect that all of these assessments were performed and the appropriate precautions were taken.

There are many resources than can be used in this scenario to alleviate the ethical dilemma presented near the end of the scenario. The patient is Jewish and therefore has a strict diet of Kosher foods. The diet order was originally placed correctly, but the patient was served only partially correct as he did not receive a Kosher meal, but the other aspects of his diet were followed. Diet orders should be checked before bringing patients their food and again with the patient at the bedside. However, the staff never should have tried to “cover it up” and do not understand the implications of the patient eating non-Kosher foods. There are many resources than can

In this scenario the hospital in order to advance the quality of care, could have shared the information about the incident with the nursing personnel. The hospital could provide the best quality of care to the patients and achieve the patients’ satisfaction, by sharing the data. Advancing the quality of care would have positive effect on both patient satisfaction and nursing care. Knowledge of nursing care empowers the nursing staff in such cases. In this scenario the knowledge of pressure ulcers, restraints and patient care is significant. On the other hand the nursing care in this scenario could have been better and the family/patient could have been cared better if the nursing staff had gotten the best patient care knowledge.

J’s scenario is pressure ulcer. From analyzing Mr. J’s case one can see the correlation between the use of restraints and pressure ulcers. Obtaining data listed on the Braden Scale such as moisture, mobility, activity, and nutrition are important when assessing for pressure ulcer risks. Once the collected data indicates the patient is high risk then the established pressure ulcer protocol needs to be followed. Nurses will need to minimize friction, support bony surfaces, manage moisture, and maintain adequate nutrition to advance quality patient care. The other nursing-sensitive indicator in this case is restraints. As I have mentioned earlier the use of restraints in Mr. J’s case seems appropriate as he pose great fall risk which may further complicate his current health condition. However, it is important to perform a complete assessment on the parameters for restraint such as cognitive functioning, history of dementia, physical impairment, and drug interactions to determine the need for restraints. When restraint is clinically indicated, and the benefits outweigh the risks then protocol for restraints has to be followed. Once the patient is restrained, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints will need assistance to change position every two hours. B) To improve quality patient care throughout the hospital, the quality improvement department should scrutinize, and keep track of the

When the primary nurse reported Mr. J had received and eaten a non-kosher entree to the nursing supervisor, she instructed the nurse to keep it quiet. Reporting errors to the patient and apologizing for errors is an evidence based practice for improving patient satisfaction and maintaining trust. Although Mr. J may not have retained the information due to his dementia, his daughter should have been informed of the error. Keeping the error quiet is unethical nursing practice. Mr. J’s daughter needs to know she can trust the staff to care for her father and respect his patient rights and wishes. This is of particular concern when a family member lives eight hours away and may have limited opportunity to visit. Also, the nurse’s comments to Mr. J’s daughter were unprofessional. Reports from the hospital administrator of other Jewish patients’ feeling their dietary requests were not taken seriously, sends the message that actions have not been taken to correct inexcusable practices and behavior. Patients who have poor experiences most often have poor outcomes. Actions must be taken to review system failure causes such as errors, compromised care, safety infractions, and poor outcomes. Without prompt resolutions, the patients will choose alternative resources for their health care needs ultimately resulting in

Healthcare professionals will be faced with ethical dilemmas throughout their career, particularly in the hospital environment. Having an education regarding professional healthcare ethics will provide some direction in how to best address these dilemmas at a time when either the patient or their family is in need of making decisions for themselves or their family member. It can be difficult for healthcare professionals to weigh professional protocol against their own personal beliefs and ethical understandings when determining critical care for their patient.

The role of ethics in organizational behavior is the underlying factor to the success and longevity of any organization. A set of rules and guidelines focusing on promoting safety, trust, and responsible practice within the workplace must be established internally. Organizations develop code of ethics that center upon the promotion of good. Ethics are vital in developing trusting relationships between employees and administration within.

Everyday, healthcare professionals are faced with ethical dilemmas in their workplace. These ethical dilemmas need to be addressed in order to provide the best care for the patient. Healthcare professionals have to weigh their own personal beliefs, professional beliefs, ethical understandings, and several other factors to decide what the best care for their patient might be. This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brains hemispheres which has left her unconscious. She only has some brain stem reflexes and requires a ventilator for support. She is unable to communicate how she wishes to proceed with her healthcare. Mrs. Smith’s children, Sara and Frank have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life, as Sara would like to do, or stop all treatments and care, as Frank feels his mother would want. In the healthcare field, there are situations similar to this case that happen daily where moral and ethical judgment is necessary to guide the decision that would be best for the patient. The purpose of this paper is to explore and discuss, compare and contrast the personal and professional values, ethical principles, and legal issues regarding Mrs. Smith’s quality of life and further plan of care.