Case study-Applying ethical principles- The missing Needle protector

Case study-Applying ethical principles- The missing Needle protector

 

The missing Needle Protector

 

 

1. L. Straight is director of clinical services at Hopewell Hospital. As in many hospitals, a few physicians provide care that is acceptable, but not of very high quality; they tend to make more mistakes than the others and have a higher incidence of patients going “sour.” Since Straight took the position 2 years ago, new programs have been developed and things seem to be getting better in terms of quality.

 

Dr. Cutrite has practiced at Hopewell for longer than anyone can remember. Although once a brilliant general surgeon, he has slipped physically and mentally over the years, and Straight is contemplating taking steps to recommend a reduction in his privileges. However, the process is not complete, and Cutrite continues to perform a full range of procedures.

 

The operating room supervisor appeared at Straight’s office one Monday afternoon. “We’ve got a problem,” she said, somewhat nonchalantly, but with a hint of disgust. “ I’m almost sure we left a plastic needle protector from a disposable syringe in a patient’s belly, a Mrs. Jameson. You know, the protectors with the red–pink color. They’d be almost impossible to see if they were in a wound.”

 

“Where did it come from?” asked Straight.

 

“I’m not absolutely sure,” answered the supervisor. “All I know is that the syringe was among items in a used surgical pack when we did the count.” She went on to describe the safeguards of counts and records. The discrepancy was noted when records were reconciled at the end of the week. A surgical pack was shown as having a syringe, that was not supposed to be there. When the scrub nurse working with Cutrite was questioned, she remembered that he had used a syringe, but, when it was included in the count at the conclusion of surgery, she didn’t think about the protective sheath, which must have been on it.

 

“Let’s get Mrs. Jameson back into surgery.” said Straight. “We’ll tell her it’s necessary to check her incision and deep sutures. She’ll never know we’re really looking for the needle cover.”

 

“Too late,” responded the supervisor, “she went home day before yesterday.”

 

Oh, oh, thought Straight. Now what to do? “Have you talked to Dr. Cutrite?”

 

The supervisor nodded affirmatively. “He won’t consider telling Mrs. Jameson there might be a problem and calling her back to the hospital,” she said. “And he warned us not to do anything either,” she added. “Dr. Cutrite claims it cannot possibly hurt her. Except for a little discomfort, she’ll never know it’s there.”

 

Straight called the chief of surgery and asked s hypothetical question about the consequences of leaving a small plastic cap in a patient’s belly. The chief knew something was amiss but didn’t pursue it. He simply replied there would likely be occasional discomfort, but probably no life–threatening consequences from leaving it in. “Although,” he added, “one never knows.”

 

Straight liked working at Hopewell Hospital and didn’t relish crossing swords with Cutrite, who, although declining clinically, was politically very powerful. Straight had refrained from fingernail biting for years, but that old habit was suddenly overwhelming.

 

 

 

 

 

Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.

Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

1. Access the Ethical Case Studiesmedia piece to review the case studies you will be using for this assessment.
   • Select the case most closely related to your area of interest and use it to complete the assessment.
     • Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
   • Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APAsection of the Writing Center for guidance.
2. Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
   • Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.
   • Identify who is involved or affected by the ethical problem or issue.
   • Access the Ethical Decision-Making Modelmedia piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.
     • Apply the three components outlined in the Ethical Decision-Making Model media.
   • Analyze the factors that contributed to the ethical problem or issue identified in the case study.
     • Describe the factors that contributed to the problem or issue and explain how they contributed.

3. Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
   • In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The NHS-FPX4000: Developing a Health Care Perspective Library Guidewill help you locate appropriate references.
     • Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.
     • Review the Think Critically About Source Quality
       • Assess the credibility of the information source.
       • Assess the relevance of the information source.

4. Discuss the effectiveness of the communication approaches present in a case study.
   • Describe how the health care professional in the case study communicated with others.
   • Assess instances where the professional communicated effectively or ineffectively.
   • Explain which communication approaches should be used and which ones should be avoided.
   • Describe the consequences of using effective and non-effective communication approaches.
5. Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
   • Describe the actions taken in response to the ethical dilemma or issue presented in the case study.
   • Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
   • Discuss the key lessons this case provides for health care professionals.
6. Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
   • Describe the proposed solution.
   • Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
   • Discuss how likely it is the proposed solution will foster professional collaboration.
7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
   • Apply the principles of effective composition.
   • Determine the proper application of the rules of grammar and mechanics.
8. Write using APA style for in-text citations, quotes, and references.
   • Determine the proper application of APA formatting requirements and scholarly writing standards.
   • Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

• Assessment 1 Example [PDF].

Additional Requirements

Your assessment should also meet the following requirements:

• Length: 3–5 typed, double-spaced pages, not including the title page and reference page.
• Font and font size: Times New Roman, 12 point.
• APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance.
• Written communication: Use correct spelling, grammar, and punctuation.
• References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
• APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.

• • Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
• Competency 3: Apply ethical principles and academic standards to the study of health care.

• • Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
  • Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
  • Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
• Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella’s writing standards.

• • Discuss the effectiveness of the communication approaches present in a case study.
  • Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
  • Write following APA style for in-text citations, quotes, and references.

 

 

 

 

 

Applying Ethical Principles Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.	Does not summarize the facts in a case study or use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.	Inadequately summarizes the facts in a case study or incompletely uses the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.	Summarizes the facts in a case study and uses the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.	Summarizes the facts in a case study and uses the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it. Supports the reasoning with examples from scholarly readings.
Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.	Does not apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.	Identifies academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence but does not apply them to support an analysis of the case.	Applies academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.	Applies academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case, and explains how the chosen articles support the analysis.
Discuss the effectiveness of the communication approaches present in a case study.	Does not discuss the effectiveness of the communication approaches present in a case study.	Describes the communication approaches present in a case study but does not discuss their effectiveness.	Discusses the effectiveness of the communication approaches present in a case study.	Discusses the effectiveness of the communication approaches present in a case study, explaining which approaches should be used more and which should be avoided.
Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.	Does not discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.	Describes the approach used by a professional to deal with problems or issues involving ethical practice in a case study but does not discuss its effectiveness.	Discusses the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.	Discusses the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study, and describes consequences of using effective and non-effective approaches.
Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.	Does not apply ethical principles to a possible solution to an ethical problem or issue described in a case study.	Identifies ethical principles involved in a possible solution to an ethical problem or issue described in a case study but does not apply them.	Applies ethical principles to a possible solution to an ethical problem or issue described in a case study.	Applies ethical principles to a possible solution to an ethical problem or issue described in a case study, and explains how the proposed solution is based in ethical principles.
Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.	Does not write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.	Writes clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics with some errors and lapses.	Writes clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.	Writes clearly and logically, using evidence to support a central idea, with correct use of spelling, grammar, punctuation, and mechanics and ensures the paper contains supporting examples for the main points.
Write following APA style for in-text citations, quotes, and references.	Does not write following APA style for in-text citations, quotes, and references.	Writes following APA style for in-text citations, quotes, and references with some errors and lapses.	Writes following APA style for in-text citations, quotes, and references.	Writes following APA style for in-text citations, quotes, and references without errors, and uses current reference sources.

 

 

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Solution

 

Introduction

Healthcare providers often encounter ethical dilemmas in their practice settings due to the increasing complexity of the healthcare system and patient needs. Some of the issues that contribute to ethical issues include poor communication skills among healthcare providers and the increasing integration of new medical technology inpatient care, which has increased the risk of errors. Besides, the lack of clear ethical guidelines regarding integrating technology in medical care is a contributing factor. One factor that makes it difficult for a provider to address ethical dilemmas is the presence of parties that make it difficult for whistleblowers to make sound decisions in fear of workplace incivility (McDermott-Levy, Leffers & Mayaka, 2018). The solution to ethical issues in healthcare is guided by the ethical principles that guide medical practice. For example, in the current case where a needle protector is accidentally left in a patient’s belly during surgery due to physicians’ error, efficient communication and ethical principles could help address the issue.

Summary of the Case

A missing needle protector case illustrates an ethical issue at Hopewell Hospital. Straight, the hospital’s clinical director, has noted that Dr. Cutrite, who has practiced in the facility for the longest as a general surgeon with excellent services, is recently experiencing a mental and physical decline that affects his efficiency. Straight is contemplating reducing his privileges to reduce the risk of errors, but the process has not been initiated yet. It has come to Straight’s attention that Cutrite has accidentally left a plastic needle protector in the belly of a patient he recently operated on. Dr. Cutrite says the needle protector is harmless to the patient; therefore, he has refused to inform the patient of the error. However, the case has raised the question of medical fitness of D, Cutrite. Although Straight demonstrates moral awareness by demonstrating the risks possessed by Cutrite and the appropriate decisions he should take, he is reluctant as he considers Cutrite politically powerful, which could threaten his position at the hospital.

Ethical Issues

There are several ethical issues present in the current case. First, Straight has intentionally put the patient’s life at risk by allowing Dr. Cutrite full practice privileges despite being aware of his significant mental and physical decline. Secondly, Dr. Cutrite has failed to be truthful to the patient by disclosing the medical error, even though it might not be life-threatening. Thirdly, Straight fears the consequences of reducing the work privileges of Dr. Cutrite due to his political influence, which is an indicator of the presence of workplace activity and a deficiency in ethical policies to address the issue at work.

Factors Contributing to the Issue

The ethical issue in the case of needle protectors is a product of several factors. First, the issue was caused by a medical error caused by Dr. Cutrite due to his declining mental and physical abilities. The error also resulted from Straight’s negligence since he was aware of Dr. Cutrite declining competencies, yet he allowed him full practice privilege, thus deliberately endangering patients’ lives. Secondly, the moral judgment of the operating room supervisor led to the discovery of the case. The operating supervisor figured out that if the needle was missing at the end of the operation, there was a high chance it was left inside the patient; thus, he thought it wise to inform the director of clinical services. Thirdly, Right’s moral awareness, and common sense contributed. He found it right to sermon the patient for a check-up to confirm the incidence even if it was harmless to the patient. Conversely, Dr. Cutrite’s response was unethical. He thought it was unnecessary to inform the patient of the occurrence. The patient has a right to know everything regarding their treatment decision.

Communication Approaches

Effective interdisciplinary and interpersonal communication within a healthcare setting is essential in handling issues effectively and preventing them from escalating t ethical dilemmas (Kyaw et al., 2019). In the current case, there were instances of effective and ineffective communication. First, the operating room supervisor noted a missing needle protector and communicated her findings to the director of clinical services. This communication resulted in discovering a medical error that could have gone unnoticed. Secondly, Mr. Straight portrayed effective communication. After learning about the incident, he decided to communicate with the patient. However, he was informed the patient was discharged and suffered by calling the patient back for evaluation to confirm the incidence. Straight then contacted the chief of surgery to enquires about the potential risks of the error to the patient. This communication approach made him discover the consequences of Dr. Cutrite’s actions. On the contrary, Dr. Cutrite demonstrated ineffective communication. His decision to refrain from informing the patient of the error impaired the patient’s right to information and autonomy in decision-making regarding her treatment approach. The ineffective communication created an ethical issue.

The approaches used by professionals to deal with the issue

The issue of needle protectors reflects ethical and quality deficiencies in a healthcare setting. The approaches used by many professionals to address the issue are guided by the medical practitioner’s code of conduct and quality improvement guidelines for healthcare facilities, all aimed at promoting patient health and protecting the patients from harm. Based on these guidelines, addressing the issue mainly ensures healthcare providers offer quality services and protect the patients from intentional harm (Rainer, Schneider & Lorenz, 2018). For instance, in the current case, the ethical issue arose from the hospital director of clinical services’ ignorance of the quality of services rendered by the physicians. Therefore, the issue could be addressed by focusing on the quality or performance of the facility’s healthcare workers. The approach entails monitoring the employee’s competencies, performance, quality of services, and privileges based on competency. Other facilities address the issue by implementing ethical protocols to address such instances and providing training n communication skills to the medical workers.

Applying Ethical Principals

Ethical principles provide the framework for tackling ethical dilemmas that may arise during clinical practice. Several ethical principles apply to the case. The ethical principle of beneficence, nonmaleficence, and autonomy are applicable in the case of the needle protector (McDermott-Levy, Leffers & Mayaka, 2018). The principle of beneficence mandates the healthcare provider to act for the patient’s benefit, defend the right of the patent, prevent harm, and remove conditions that may cause harm to the patient. Non-maleficence mandates providers to avoid intentionally cause harm to the patient and depriving others of the goods of life. Autonomy gives the patient the right to decision-making regarding their clinical care (Rainer, Schneider & Lorenz, 2018). Therefore, Straight should contact the patient for follow-up care to confirm the incidence and give the patient the power to decide whether to remove the needle protector or not and whether to file a lawsuit or not. Withholding the information is intentionally causing harm to the patient as the discomfort could deprive her of a quality life. Besides, allowing impaired practitioners full privilege in intentionally putting patients at risk of medical errors. In that regard, Straight should reduce Dr. Cutrite privileges to protect the patient.

Conclusion

As the complexity of the healthcare system and technology integration in healthcare increases, the risk of ethical issues increases. Healthcare facilities can help facilitate the continuous quality performance of practitioners through monitoring and implementing ethical policies and procedures to deal with unethical providers. This will help get rid of underperforming providers that put patients at risk.

 

 

References

Kyaw, B. M., Posadzki, P., Paddock, S., Car, J., Campbell, J., & Car, L. T. (2019). Effectiveness of digital education on communication skills among medical students: systematic review and meta-analysis by the digital health education collaboration. Journal of medical Internet research, 21(8), e12967. https://www.jmir.org/2019/8/e12967/

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481. https://doi.org/10.1016/j.outlook.2018.06.013

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461. https://doi.org/10.1111/jocn.14542