Case Analysis

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Case analysis

Case 2

Define the ethical problem

The ethical tension arises due to the fact that the nurse Julie can either respect the culture of Hassan’s family and remain quiet or explains them the harm of such practices. This reflects an ethical dilemma because the nurse can choose any one action. There is a competition between two goods. It is an ethical issue because speaking about the harms of traditional Somali practices could hurt the sentiments of the Somali family that is against the ethical principle of cultural competency.

Relevant facts

The facts reveals that Hassan’s family is facing communication issues due to their cultural difference. When the nurse tries to ask his mother about the burns she face difficulty n expressing her views. Ethical principle of Cultural Competency stresses on understanding the cultural values of the patient. This reflects conducting assessment of cultural competence. The facts also depicts that the family is lacking knowledge about the negative consequences of such practices.

Perspective of players

The actions will have direct impact on the patient and also the career of the doctors and nurses who have attended him. The selected course of action will also impact the nurse because she has directly encountered the patient. The perspectives of Julie depicts that she had to comply with the ethics of cultural competency that means respecting the cultural values of the patients belonging to different backgrounds. Her ethical obligation also reflects her responsibility of information the patient and his family about the consequences of engaging in harmful traditional practices of warding off evil. The choice of the first perspective has impacted the decision of Julie because she finally decides to remain quiet for respecting the values of Somalia family. Julie can alter the outcomes such as by sharing the knowledge with the family and minimizing the risks of such events in the future.

Obligations of the clinical and guiding principles

The clinicians must comply with the ethics by addressing personal autonomy of the patient. The processional must integrate cultural competence in the ethical decision-making. This reflects informing the family about the medical treatment and possible outcomes. Healthcare staff adheres with patients’ rights of autonomy that means informing them about the diagnosis, treatment and probable outcomes. Ethical obligations also suggest the moral duty of nurse to fulfill patient’s rights.

This requires obtaining informed consent from the patients before adopting a treatment plan CITATION Vik10 \l 1033 (Entwistle, Carter, Cribb, & McCaffery, 2010). The doctors and staff obtain signed consent from the patients before starting the surgery. The policy reflects that the staff must respect the patient's autonomy and provide the opportunity of making independent choices. The staff is responsible for providing the cost-benefit analysis that leads to an informed decision. Personal autonomy reflects that other people does not influence the patient’s family.

Possible course of action

Action 1: The first possible action is to remain quiet and avoid talking on the harmful traditional Somalia practices that might offend the family.

Action 2: The second possible action is to explain the harmful impacts of such practices by adopting culturally competent means. This emphasize on speaking in a way that could be understood by the mother of Hassan.

Consequences of various action choices

The first action could provide timely relief to the patient’s family such as by respecting their culture and remaining quiet. This action will not hurt their dignity or pride and will make them feel good. However this action will pose future risks of revealing more harms due to continuous encounter of Hassan with such traditional activities.

The second course of action could offer long-term benefits to the family because the nurse will adopt a culturally competent way of communicating with the patient’s family. Ethical obligations states that Julie must adopt a polite tone and talk in a way that will allow patients family to understand the harmful impacts of such practices. This action is also linked to the ethical principle of autonomy because it involve providing complete knowledge to the patient and his family.

Actions

The decision of Julie to remain quiet even after learning the reason behind the burns is unethical. The ethical principle of cultural competency focuses on respecting the cultural and personal values of the patient but it does not mean to stay quiet in threatening situations. Julie has an ethical responsibility of informing the family about the repercussions of receiving such traditional treatments. She has a legal responsibility to fulfill the needs of the patient, which in the present scenario is to guide the family about the critical condition of Hassan and what practices they must avoid for maximizing his welfare. Incorporation of cultural competence leads to the best ethical decision that acts in the favor of the patient. Remaining quiet is negligence of duty because Julie will not take the responsibility of acting as a counselor. Julie can fulfill her ethical responsibility by adopting a caring attitude and explaining the consequences of the traditional Somali practices in a positive way.

Case 3

Define the ethical problem

The ethical tension reflects the decision of giving prescribed drugs or not. This depicts if the staff has violated ethical obligations or not during the treatment of the patient. Ethical tension reflects choosing between giving the dose or avoiding it. The purpose is to choose the course of action that will lead to the maximization of patient welfare. highlights the laws and regulations that the nursing staff will follow at the clinic. The purpose is to ensure that they follow the guidelines during interacting with workplace or clients. This will eliminate the scope of illegal or corrupt practices. The compliance plan also minimizes the issues of non-compliance. It provides a roadmap that identifies the fundamental scenarios that healthcare professionals will encounter in clinical settings. A compliance plan involves a written plan including all components that address the legal and ethical concerns.

Relevant facts

Facts reveal that the physical examination was normal that gave a go sign to the doctors for performing treatment. The family of the patient doubted that he had taken drug. The signs were also revealed in the tests that depicts the need for Aside from the abnormal vital signs, the patient's physical examination was normal by the time he reached the hospital, including normal neurologic function and normal mentation. He denied any suicidal ideations. A urine toxicology screen was performed and was positive for both cocaine and opiates.

The patient's blood pressure was 124/80, his pulse was 104, and his respirations were 12 and shallow. His Glasgow Coma Score was 3. These facts reported after examination indicates that the patient was in the critical condition when he made to the hospital. The examination further revealed that on triage in the hospital, the patient's vital signs were: temperature 97.4, pulse 111, respirations 24, and blood pressure 117/88. Patieent denied that he previously had medical issues. When the shift was changed in the emergency the nurse noted some other problems such as decrease in breath sounds in both lungs. Patient’s wife also nottiiced that he exhibited normal signs. However after five hours patient died. The evaluation of conditions and scenario depicts that the narcotic overdose has been the cause of patient’s death. The autopsy also revealed that the cocaine intoxication had resulted in death.

Perspective of players

The actions will have direct impact on the patient and also the career of the doctors and nurses who have attended him. The staff can alter the outcomes by choosing the right course of action. From the perspective of nurse and physician it was important to adopt the best strategy that could save the life of the patient. The current case lays more responsibility on the patient because needle puncture was found in his left arm that confirms the doubts of his family that he had taken drugs. The perspective of the staff depicts choosing the best action that could minimize harm and prevent lesser evil.

Obligations of the clinical and guiding principles

The healthcare staff including the nurses and doctors has a responsibility of complying with the ethical principles. The healthcare professional must follow the description of the drug for avoiding the wrong prescription. Proper time is given to the patient that will eliminate the possibilities of medication error. The ethical behaviour policy defines the code of conduct that is mandatory for healthcare professionals. It includes an explanation of the unacceptable code of conduct such as misbehavior or discrimination against patients. The inability of the professionals to comply with the code results in strict disciplinary actions. At the time of decision-making, the professionals must incorporate law and fulfil their commitment. The professions will ensure that they are doing the right thing and following the standards or principle mentioned in the guideline. They will perform their responsibility by abiding the laws of policy and procedures.

The obligations also states that staff is provided training to use the manual for following the standards and principles of compliance. They are provided information about unethical acts and behaviors. The training will use presentations and lectures for familiarizing staff with the ethics and Code of Conduct. They are provided instructions about adopting the right behavior towards patients.

Possible course of action

Action 1: The possible course of action that the clinicians could have taken was to perform tests and wash the stomach of patient after confirming presence of cocaine components in blood.

Action 2: The doctor could have adopted the possible action of taking signed consent from the family of the patient before adopting any procedures.

Action 3: Personal autonomy could have been respected by telling the possible course of actions and their outcomes. This reflects giving complete information to the patients.

Consequences of various action choices

The first action could have two possible outcomes because timely action of washing the stomach could have saved the patient. However the chances of death are equally likely. The second course of action would have allowed the doctors to respect the privacy of the patient that could have allowed them to avoid legal or ethical implications. By choosing the third course of action the doctors would have complied with the ethical obligations of medical practices.

Actions

The doctors and the nurses have an ethical role to choose the best course of action that would help saving the life of patient. The common ethical concerns raised in the scenario are personal autonomy, patient’s rights and sense of professional duty. The emergency staff has the responsibility of addressing the patient on time, without any delay. The doctors best action is to fulfill patients rights to autonomy before undergoing any treatment.