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 and
important 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 allergic
reaction from the incorrect medication that was administered.
The nurse did not document the medication error but does document the
regular does of pain medication.
The patient suffers from pain through out the evening because pain
medication is not administered as scheduled.
The patient dies of an embolus in the lung, which could have been the result
of 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 of
life 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.
It could be assumed that the nurse and I will be in jeopardy of losing our jobs
because 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 single
problem statement. This statement will form the basis for the remainder of your
analysis. Remember, the problem statement should reflect the decision to be made
in response to the case. You must agree on one problem statement.

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

Should I report the nurse for not documenting the medication error though the
patients 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 ethical
questions that help you analyze those issues. Work to reach consensus on the
primary ethical questions, and no more than three or four secondary ethical
questions.

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 outcome
of 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?
This argument is based off of the utilitarianism theory, which is a theory that focuses on
the 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 or
her health care, including the medication error. This way the family would know the
complete truth and could start the healing process of losing a loved one. Additionally, by
exposing the medication error, the nurse and myself would receive disciplinary action
that could help prevent a harmful action from happening again, which promotes the
greater good for patients. Sometimes people need disciplinary action to learn from their
mistakes and pay closer attention to detail.
A counter-argument to this would be if the medication error were exposed, then the
lawsuit would have further evidence for prosecution. Therefore, exposing the error will
not promote the most happiness because an entire institution will suffer. Furthermore, the
autopsy reported that the embolism was caused from the injuries, not the medication
error. Thus, reporting the error was not the cause of death and will only bring destruction
on 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 moral
actions, 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 inflict
harm 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 your
arguments and counter-arguments. Be sure that you have included those concepts
reflected in the ethical questions. What other ethical concepts may help you
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 a
common 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 group
and 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 to
your practical problem. Work to answer each of your ethical questions as you
discuss the arguments and counter-arguments. Remember, the arguments should
reflect one pathway for action, while the counter-arguments reflect all of the
reasons why you might not take that path. The counter-arguments should also
logically lead to alternate options for action. Be sure that you are supporting both
sides with credible information from the literature, both that contained in the
relevant facts and new information that helps strengthen your arguments on both
sides.




Saturday and Sunday
Steps 7 and 8:
Make a list of the options for action. These options should flow logically from the
arguments and counter-arguments. Based upon you discussion to this point, select
ONE option for action as agreed upon by the group and justify your respond by
stating how that action satisfies each of the ethical questions.
You should conclude the discussion with a summary of how the process went for
your group and what you might have done differently in order to improve the
process. 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 did
you 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 graded
accordingly.
.
Share with your classmates what you think was the most significant learning you
experienced during the course. What surprised you the most? What impact will this
course have on you both personally and professionally?

First, here is a little background on my level of education in health care ethics
before this class. Though I was in the military as a medic for over eight years, I was
never trained on the ethical side of medicine. My job was to screen and assess
patients, start IVs, take vital signs, apply casts and splints, stock rooms, order
supplies, 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 the core values of service before self,
integrity first, and excellence in all we do. I believe the core values that were
instilled 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 is
imperative in the nursing field, considering we handle IV medications and triage
patients.
The most significant learning experience would be applying the Eight-Step
Model. Before I used this process, I thought ethical problems were solved by what
the majority of people thought was morally correct. However, a lot more goes into
solving health care issues, such as determining the relevant facts and the practical
problem. Additionally, by considering arguments and counterarguments, principles
and theories can be applied to the problem.
What surprised me the most was how many ethical problems there were in
health care. I knew about the ethical problems about abortion and the everyday
issues that arise between coworkers, such as reporting negligence. However, I didnt
know about patient-assisted suicide (PAS) issues. I know this may sound nave of
me, but I didnt know it was illegal almost nationally for physicians to assist in
helping a patient die. Ive never been in a situation where a patient wanted to die or
had over heard discussions at work. I suppose thats a good thing, though I know I
will come across it as a nurse.
Personally, my expanded knowledge in healthcare ethics will have an impact
on the way I view political issues about our health care system. I believe this has
opened my eyes to why there are issues around certain healthcare topics.
Additionally, this knowledge will help me professionally as a nurse because I will be
able to evaluate situations and make the right choice. Understanding the different
theories 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. I
would like to help make a difference in this world, whether it is hands-on-patient-
care or on an Ethics Board.