BIOETHICS IN NURSING PRACTICE SET 1 (Questions) Prepared By Ro!!ie "ia!res# RN 1$ Patient Patient C$G$ %as !rain &an&er &an&er 'it% poor pronosis$ pronosis$ S%e S%e %as !een !een aditted to t%e %ospita* +or o,er t'o ont%s no'$ Her &ondition is deterioratin$ S%e a*ready eets t%e !rain-deat% &riteria$ .%i&% nursin inter,ention is t%e ost appropriate at t%is tie/ a$ 0ae 0ae t%e de&isio de&ision n to 'it%dra' 'it%dra' t%e t%e *i+e *i+e support$ support$ !$ Seda Sedate te t%e t%e &*ie &*ient nt$$ &$ Approa&% Approa&% t%e t%e patient2s patient2s +ai*y +ai*y +or possi! possi!*e *e oran oran donation$ donation$ d$ Ta* to t%e t%e sta3 a!out a!out t%eir t%eir +ee*ins +ee*ins$$ 4$ Nurse .arr .arren en 'ors 'it% a &o**eaue '%o '%o &onsistent*y &onsistent*y +ai*s to use use standard standard pre&autions or 'ear *o,es '%en &arin +or patients$ Nurse .arren &a**s t%e attention o+ t%e &o**eaue !ut t%e &o**eaue insisted t%at standard standard pre&autions pre&autions and t%e use o+ *o,es are not ne&essary unti* t%e patient is no'n to %a,e tested positi,e +or HI5$ .%at is t%e ost appropriate a&tion Nurse .arren 'ou*d tae/ a$ Instru&t Instru&t t%e t%e patients patients to reind reind t%is t%is &o**eaue &o**eaue to 'ear 'ear *o,es$ *o,es$ !$ 6o&uent 6o&uent t%e pro!*e pro!*e in 'riti 'ritin n +or t%e anae anaerr$ &$ 6is&uss 6is&uss t%e t%e issue issue 'it% 'it% ot%er ot%er sta3 e!ers$ e!ers$ d$ Inore t%e pro!*e7 pro!*e7 Nurse Nurse .arr .arren en %as done %is %is 8o! in reindin reindin %is &o**eaue$ 9$ Nurse :enny :enny a&&identa**y a&&identa**y adinisters adinisters t'o &apsu*es &apsu*es o+ p%enytoin (6i*antin) instead o+ one &apsu*e$ T%e patient e;%i!its no ad,erse rea&tions to t%at *arer dose$ .%at is t%e appropriate a&tion Nurse :enny s%ou*d tae/ a$ Ca** t%e %ospita*2 %ospita*2s s *a'yer *a'yer$$ !$ 6o not%in not%in !e&aus !e&ause e t%e patient2s patient2s &onditi &ondition on is sta!*e$ sta!*e$ &$ 6o&uent 6o&uent t%at t%at s%e %as i,en i,en a &apsu*e &apsu*e o+ p%enytoin p%enytoin (6i*an (6i*antin)$ tin)$ d$ A&&op*i A&&op*is% s% a &op*et &op*ete e in&ident in&ident repor report$ t$ <$ Nurse Pau*o Pau*o suspe&ts suspe&ts t%at Nurse Gi*!ert Gi*!ert %as !een !een drinin drinin a*&o%o* !e+ore !e+ore t%eir ni%t s%i+t$ He se**s a*&o%o* on Gi*!ert2s !reat% and notes s*urred spee&%$ .%at is t%e !est &ourse o+ a&tion Nurse Pau*o s%ou*d tae/ a$ Iediate* Iediate*y y noti+y noti+y t%e nursin nursin super,i super,isor sor$$ !$ Co,er up +or Nurse Nurse Gi*!ert Gi*!ert !e&ause !e&ause t%e pro+ess pro+ession ion depends depends on *oya*ty +ro &o**eaues$ &$ Te** Nurse Gi*!ert t%at t%at %e %as one *ast &%an&e# !ut !ut i+ %e drins !e+ore !e+ore anot%er s%i+t# %e 'i** !e reported$ reported$ d$ Ca** t%e t%e se&urity se&urity and %a,e %a,e Nurse Nurse Gi*!ert Gi*!ert arrested arrested !e&aus !e&ause e %e endaners t%e *i,es o+ t%e patients$ =$ 6urin %er %er &o3ee !rea# !rea# Nurse A!!y o,er%eard o,er%eard a roup o+ residents residents passin passin !y t%at a &e*e!rity patient 'it% syp%i*is is aditted at t%e %ospita* *ast ni%t$ Ha,in %eard t%is# Nurse A!!y 'ent to %er +riend Nurse >ate '%o 'as an a,id +an o+ t%e &e*e!rity$ .%at et%i&a* prin&ip*e 'as ,io*ated !y Nurse A!!y/ a$ :usti&e !$ Con? Con?de dent ntia ia*i *ity ty &$ In+o In+orred ed Cons Consen entt
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d$ Bene Bene?& ?&en en&e &e Nurse *or *or is 'aitin +or t%e adission orders +ro t%e adissions adissions departent$ A+ter a +e' inutes t%e runner o+ t%e adissions departent %anded t%e order inside a +o*der$ .%en Nurse *or opened t%e +o*der# s%e 'as surprised to see a &ari&ature o+ t%eir %ated %ospita* dire&tor 'it% deroatory stateents a!out %er inserted toet%er 'it% t%e orders$ .%at is %er ost appropriate nursin a&tion/ a$ Ca** t%e t%e nursin nursin super,is super,isor or and repor reportt t%e in&ident$ in&ident$ !$ Ca** t%e t%e runner runner !a& and as as +or %is nae nae and t%e nae nae o+ t%e person person '%o sent t%e adission orders$ &$ Ca** t%e t%e se&urit se&urity y and %a,e %a,e t%e runne runnerr arreste arrested$ d$ d$ S%red S%red t%e p%oto p%otorap% rap% and and eep eep it to %er se*+ se*+ +or +or +un$ 6r$ 6r$ Bai*ey ordered ordered a !ron&%os&op !ron&%os&opy y +or Patient Patient R$S$ R$S$ '%o %as a &%roni& &ou%$ Nurse Cai**e !rins t%e in+ored &onsent to Patient R$S$ +or %is sinature$ S%e t%en ass Nurse Cai**e to e;p*ain '%y t%e in+ored &onsent is ne&essary$ Nurse Cai**e responds proper*y '%en s%e te**s %i t%at a$ T%e patient arees to t%e pro&edur pro&edure e ordered ordered !y t%e p%ysi&ian# e,en i+ %e does not understand '%at t%e out&oe 'i** !e$ !$ T%e p%ysi&ian p%ysi&ian ust i,e t%e patient and %is sini?&ant ot%ers enou% enou% in+oration to ae %ea*t%-&are 8udents &onsistent 'it% t%eir ,a*ues and oa*s$ &$ T%e +ai*y +ai*y o+ t%e patient patient 'i** 'i** ae de&isi de&ision on aainst aainst t%e t%e patient2s patient2s 'i**$ 'i**$ d$ T%e patient patient re*eases re*eases t%e p%ysi&ian +ro a** a** responsi!i*i responsi!i*ity ty +or t%e pro&edure$ Nurse SuDette SuDette 'ors in a prenata* prenata* &*ini&$ &*ini&$ S%e 'as 'as in+ored in+ored !y %er patient '%o is prenant t%at %er *i,e-in partner (t%e +at%er o+ t%e in+ant) %as %it %er in t%e past$ T%e patient a*so to*d %er t%at %e is s%ort tepered and t%at s%e is 'orried a!out '%at i%t %appen i+ t%e ne' in+ant %as &o*i& and %e ets upset$ S%e !es to Nurse SuDette not to report t%e pro!*e !e&ause s%e is a+raid t%at %e 'i** !eat %er$ Nurse SuDette s%ou*d a$ Re&ord Re&ord t%e in&ident in&ident in t%e nurse2s nurse2s notes !ut !ut do not not report report +or s%e s%e did not a&tua**y 'itness t%e !eatin and s%e s%ou*d eep a proise to ain t%e trust o+ t%e patient$ !$ Re&ord Re&ord t%e in&ident in&ident in t%e nurse2s nurse2s notes !ut !ut do not not report report +or s%e s%e 'i** p*a&e t%e ot%er and t%e in+ant in reater ris o+ %ar$ &$ Re&ord Re&ord t%e in&ident in&ident in t%e nurse2s nurse2s notes and and report report it as reasona!*e reasona!*e suspi&ion o+ &%i*d and 'oan a!use$ d$ 6i,ert t%e ot%er2s attention attention and and tea&% %er to !reast+eed %er !a!y !a!y to redu&e t%e possi!i*ity o+ &o*i&$ Nurse Ryan Ryan is assined to pro,ide pro,ide postoperati,e postoperati,e &are +or Patient Patient $"$ $"$ '%o %as dia!etes e**itus$ 6urin t%e assessent inter,ie'# t%e patient reports t%at %e is ipotent and is u&% &on&erned a!out its e3e&ts on %is arriae$ In p*annin +or %is &are# t%e ost appropriate nursin inter,ention 'ou*d !e a$ En&ourae t%e patient to as Fuestions Fuestions a!out a!out persona* persona* se;ua*ity se;ua*ity$$ !$ Pro,ide Pro,ide tie +or pri,a&y# t%e t%e patient needs to e;aine %is t%ou%ts$ t%ou%ts$ &$ Pro,id Pro,ide e support support +or t%e spouse spouse or sini? sini?&ant &ant ot%er ot%er$$
d$ Suest re+erra* re+erra* to se; &ounse*or or appropriate appropriate pro+essiona*$ pro+essiona*$ 1$Nurse "orraine is &arin +or 0an Ti!ur&io# a %oe*ess patient '%o %as a&ti,e tu!er&u*osis$ tu!er&u*osis$ T%e patient is a*ost ready +or dis&%are$ Ho'e,er# Nurse "orraine is &on&erned o+ 0an Ti!ur&io2s a!i*ity to +o**o' t%e edi&a* treatent reien$ .%i&% inter,ention inter,ention 'i** !est ensure ensure t%at t%e &*ient &op*ies 'it% treatent/ a$ Pro,id Pro,ide e %i%*y indi,idu indi,idua*iD a*iDed ed patient patient edu&ation edu&ation$$ !$ Re+er 0an Ti!ur&i Ti!ur&io o to a so&ia* so&ia* 'orer 'orer +or dis&%are dis&%are p*annin$ &$ Ha,in Ha,in t%e &*ient &*ient attend attend a +ora +ora** edu&atio edu&ation n session$ session$ d$ Care+u**y *oo +or a e!er o+ 0an Ti!ur&io2s Ti!ur&io2s +ai*y +ai*y and as +or assistan&e$ 11$Patient B$6$"$ is aditted to t%e edi&a* unit 'it% a dianosis o+ %epatitis B$ Hospita*s are andated !y a&&reditin !odies to deonstrate respe&t +or t%e patient2s &on?dentia*ity$ .%i&% o+ t%e +o**o'in is a &oon ,io*ation to patient &on?dentia*ity/ &on?dentia*ity/ a$ >eepin >eepin t%e edi&a* edi&a* re&ords re&ords in t%e ,ie' and &are &are o+ %ea*t%&are %ea*t%&are pro,iders dire&t*y in,o*,ed 'it% t%e patient$ !$ P*a&in a sin sin on t%e patient2s patient2s door statin statin Iso*ation Iso*ation +or Hepatitis B B +or ot%ers2 sa+ety$ &$ Nurse ain ain sure sure t%at t%e t%e patient2s patient2s &%art is se&ured se&ured at t%e ra& in t%e nurses2 station d$ Pro,idin Pro,idin t%e patient patient a &opy &opy o+ %ospita* %ospita* po*i&ies po*i&ies and pro&edur pro&edures es t%at address patient &on?dentia*ity &on?dentia*ity at ea&% unit$ 14$Patient R$Q$ '%o 'as rus%ed to t%e eeren&y roo t'o %ours ao is no' de&*ared !rain dead$ Nurse Ra3y %as !een 'it% t%e patient sin&e adission$ No'# %e ust ta* to t%e +ai*y a!out oran donation$ .%i&% o+ t%e +o**o'in s%ou*d !e done !y Nurse Ra3y/ a$ Tae ae t%e +ai* +ai*y y to t%e t%e &%ape*$ &%ape*$ !$ 6is&u 6is&uss ss *i+e *i+e suppor supportt systes systes$$ &$ .%en dis&uss dis&ussin in oran oran donation# donation# in&*ud in&*ude e as any +ai*y e!ers e!ers as possi!*e$ d$ C*ari+y t%e +ai*y2s +ai*y2s understandin understandin and per&eption per&eption a!out a!out !rain !rain deat%$ 19$Nurse Gise**e is &arin +or a 'oan '%o is prenant and is terina**y i** 'it% inopera!*e &an&er$ T%e 'oan %as not !een in+ored a!out %er status !y t%e p%ysi&ian$ T%e 'oan states to Nurse Gise**e I no' I a terri!*y si&$ I t%in you no' '%at it is$ I 'ant you to te** e ri%t no'$ .%i&% o+ t%e +o**o'in is t%e appropriate t%in +or Nurse Gise**e to do/ a$ Gi,e a detai*ed detai*ed e;p*an e;p*anatio ation n on t%e disease disease o+ t%e patien patient$ t$ T%e patient patient needs to no'$ !$ 6eny no'*ed no'*ede e a!out a!out t%e patient2s patient2s &ondit &ondition ion and do not not i,e t%e patient any +urt%er in+oration$ in+oration$ &$ 0ae 0ae t%e patient2s patient2s &%art &%art a,ai*a! a,ai*a!*e *e to %er !e&ause !e&ause a+ter a+ter a**# s%e s%e is entit*ed to see it$ d$ 6is&uss 6is&uss t%e t%e situatio situation n 'it% t%e p%ysi& p%ysi&ian$ ian$ 1<$ "es*ie is a 4 year-o*d patient 'it% *o'er astrointestina* astrointestina* tra&t !*eedin$ S%e is a :e%o,a%2s .itness$ T%e p%ysi&ian ordered 4 units o+ pa&ed RBC RBC to !e
adinistered o,er 4 %ours ea&%$ Upon no'in t%is# "es*ie stron*y re+used and te**s Nurse >i s%e 'on2t %a,e it$ .%i&% o+ t%e +o**o'in is t%e ost appropriate response o+ Nurse >i/ a$ 0a2a t%e p%ysi&ian2s p%ysi&ian2s order order o,errides o,errides your your de&ision$ de&ision$ .e .e %a,e to to do t%is$ !$ 0a2a# 0a2a# are you &raDy/ &raDy/ Jou2* Jou2*** die i+ you 'on2t 'on2t %a,e t%is t%is &$ >i approa&% approa&%es es %er super,is super,isor or and 'is%es 'is%es to &%ane &%ane patient patient assinent d$ 0a2a I understand understand your &on&ern# &on&ern# I2** in+or in+or your p%ysi&ian a!out t%is$ t%is$ 1=$In an eeren&y &ase# '%erein '%erein t%e p%ysi&ian &onsents i+ t%e patient is un&ons&ious# '%i&% o+ t%e +o**o'in is t%e !e*ie+ t%at is up%e*d '%i&% states t%at anot%er person no's '%at is !est +or anot%er indi,idua*/ a$ Autonoy !$ reedo &$ Pater aterna na*i *is s d$ Con&ern 1@$Cynt%ia %as !een t%e patient assined to Nurse :e3 +or one 'ee no'$ S%e re,ea*s to Nurse :e3 t%at s%e is p*annin to &oit sui&ide and ased %i to eep t%is as a se&ret$ .%i&% o+ t%e +o**o'in stateents &an uide you in ain a de&ision in response to Cynt%ia2s p*ead/ a$ In+oratio In+oration n ay !e re,ea*ed re,ea*ed 'it% t%e periss perission ion o+ t%e patient$ patient$ !$ It is iproper iproper to re,ea* re,ea* t%is type o+ in+oration in+oration !e&ause it 'i** destroy destroy t%e trust '%i&% is iportant in any nurse-patient re*ations%ip &$ Con?dentia Con?dentia*ity *ity s%ou* s%ou*d d ne,er ne,er !e ,io*at ,io*ated ed at a** a** ties$ ties$ d$ Con?dentia* in+oration in+oration ay !e re,ea*ed re,ea*ed in serious %ar is deeed to %appen
1$$ 1 Nurs Nurse e Gia Gian n& &ar are+ e+u* u**y *y asse assess sses es %is %is 9 9 y ye ear-o ar-o*d *d pati patien ent$ t$ He ent ent*y *y assesses t%e patient so to pre,ent in8urin or %urtin t%e patient$ T%is pra&ti&e +o**o's '%i&% o+ t%e +o**o'in prin&ip*es/ a$ Bene Bene?& ?&en en&e &e !$ Non- Non-a* a*e? e?&e &en& n&e e &$ Con? Con?de dent ntia ia*i *ity ty d$ 6ou! 6ou!*e *e E3e& E3e&tt 1$Nurse 0a!e**e 'ors in a %ea*t% &enter$ &enter$ S%e i,es a patient p*a&e!o dru +or a patient$ .%i&% o+ t%e +o**o'in prin&ip*es is !ein ,io*ated !y 0a!e**e/ a$ 6ou! 6ou!*e *e e3e& e3e&tt !$ Autonoy &$ 5era&ity d$ Con? Con?de dent ntia ia*i *ity ty 1$0ary :ane is a 4 year-o*d year-o*d patient '%o is s&%edu*ed +or e;p*oratory e;p*oratory *aparotoy toorro' at in t%e ornin$ 6urin t%e ornin o+ t%e surery# '%i&% o+ t%e +o**o'in s%ou*d t%e nurse do/ 1$ Assess Assess t%e patien patient2s t2s readi readiness ness +or +or t%e sur surery ery 4$ Gi,e 'ritte 'ritten n and ora* ora* preoper preoperati,e ati,e tea&% tea&%ins ins 9$ As t%e patient2s patient2s re*ati,es re*ati,es to sin sin t%e &onsent &onsent i+ t%e patient is as*eep$ as*eep$ <$ O!tain O!tain and a&&op* a&&op*is% is% t%e preope preoperati rati,e ,e &%e&*ist &%e&*ist
a$ 1#4#9 !$ 1#4#< &$ 1#9#< d$ A** A** o+ o+ t%e t%e a!o, a!o,e e 4$Nurse 0innie up%o*ds t%e prin&ip*e o+ so&ia* 8usti&e at a** ties$ .%i&% o+ t%e +o**o'in pre&epts uide Nurse 0innie in doin t%is/ a$ Up%o*d uni,ersa* a&&ess to %ea*t%&are %ea*t%&are and %ea*t%&ar %ea*t%&are e +a&i*ities +a&i*ities !$ Co**a!ora Co**a!orate te eK&ient*y eK&ient*y 'it% 'it% t%e e!ers e!ers o+ t%e %ea*t% %ea*t% tea tea &$ 6e+end 6e+end +or +or t%e t%e patie patient2 nt2s s ri%t ri%ts s d$ 6o no no %ar %ar to to t%e t%e patie patient$ nt$ 41$Nurse Pau* no's t%at a 'e**-in+ored &onsent does not in&*ude &oer&ion$ .%i&% o+ t%e +o**o'in stateents depi&ts &oer&ion or anipu*ation/ 1$ Jour Jour +ai*y +ai*y needs you 'it% 'it% t%e$ t%e$ 4$ I2** I2** i,e i,e you you tie tie to to de&ide de&ide$ $ 9$ Jour Jour 'i+e 'i** die 'it%out t%is t%is surery surery$ $ <$ Jou2, Jou2,e e 'aited 'aited so *on *on +or a donor donor$ $ a$ 1 and 9 !$ 1#4#9 &$ 4#9#< d$ 1#9#< 44$E,a 'as rus%ed to t%e %ospita* a+ter !ein +ound *yin un&ons&ious un&ons&ious in t%e !ea&%$ E,iden&es s%o' t%at s%e 'as raped$ Treatent o+ rape ,i&tis is one o+ t%e ost et%i&a**y &%a**ened !e&ause it in,o*,es se;ua*ity and *i+e$ E,a ay opt to undero a pro&edure t%at &ou*d pre,ent &on&eption !ut ay a*so !e a!orti+a&ient i+ +erti*iDation %as a*ready o&&urred$ .%i&% o+ t%e +o**o'in is ,io*ated !y t%is/ a$ Ben Bene?& e?&en& en&e !$ NonNon-a a*e *e?& ?&en en&e &e &$ Hua Huan n 6in 6init ity y d$ 5era& era&it ity y 49$0rs$ Patri&ia 6e Castro is !rou%t to t%e operatin roo +or %er s&%edu*ed &aesarean se&tion !e&ause t%e !a!y is in !ree&% position$ Nurse "aura s%ou*d ree!er t%at '%i&% o+ t%e +o**o'in is t%e ost iportant inter,ention !e+ore 0rs$ 6e Castro re&ei,es anest%esia/ a$ Proper Proper sin sin prepar preparation ation o+ o+ t%e operati operati,e ,e area area !$ Insertio Insertion n o+ t%e ind'e**i ind'e**in n &at%e &at%eter ter &$ O!tain O!tain an in+or in+ored ed &onsen &onsentt +ro +ro 0rs$ 6e 6e Castro Castro d$ Start Start and and intra intra,eno ,enous us (I5) *ine 4<$ As%*ey# 1 years o*d# is s&%edu*ed +or tonsi**e&toy at in t%e ornin$ Nurse Ge*o is t%e operatin roo nurse '%o 'i** !rin As%*ey in t%e operatin roo$ As%*ey ass Ge*o is s%e &an pray ?rst !e+ore t%ey *ea,e t%e roo$ .%i&% o+ t%e +o**o'in is t%e appropriate response o+ Nurse Ge*o/ a$ I2 sorry As%*ey As%*ey 'e i%t !e !e *ate +or your surery$ .e .e are stri&t*y stri&t*y +o**o'in t%e tie$ !$ It2s a*ri%t$ a*ri%t$ .i** I stay %ere %ere and pray pray 'it% you or 'i** I o out +or +or a '%i*e/ &$ :ust :ust pray !y yourse yourse*+ *+ on our 'ay 'ay to t%e opera operatin tin roo$ roo$
d$ Jou Jou s%ou*d %a,e %a,e prayed ear*ier ear*ier$$ T%ere are are a *ot o+ patient s&%edu*ed +or operation today$ 4=$Proper dis&*osure dis&*osure o+ a** needed in+oration to t%e patient a!out %is &ondition and treatent a*ternati,es is e!edded in '%i&% o+ t%e +o**o'in prin&ip*e/ a$ 6ou! 6ou!*e *e E3e& E3e&tt !$ Tota* ota*it ity y &$ Autonoy d$ Pri,a&y 4@$An un&ons&ious 4 year o*d a*e patient is rus%ed in t%e eeren&y roo a+ter a ,e%i&u*ar a&&ident$ He %as a &*osed %ead in8ury$ .%i&% o+ t%e +o**o'in *ea* do&uents 'i** ost *ie*y !e used to ae a edi&a* de&ision +or t%e patient/ a$ Spe&ia Spe&ia** Po' Po'er er o+ Attor Attorney ney !$ Ho*o Ho*or rap ap%i %i& & .i* .i*** &$ Ad Ad,a ,an& n&e e 6ir 6ire& e&ti ti,e ,e d$ 6ura! 6ura!*e *e Po'e Po'err o+ Atto Attorn rney ey 4$Nurse Rupert no's t%at an in+ored &onsent is iportant !e&ause it prote&ts !ot% t%e patient and t%e %ospita* +or potentia* *a'suit$ .%i&% o+ t%e +o**o'in are e;&eptions to in+ored &onsent/ 1$ Copu*sor Copu*sory y treaten treatentt is andated andated !y !y a &ourt &ourt order order 4$ I+ patient patient re*in re*inFuis Fuis%es %es t%e t%e ri%t ri%t to &onsen &onsentt 9$ Eer Eere en& n&y y &as &ases es <$ T%e patient patient is an ean& ean&ipat ipated ed inor inor a$ 1 and 9 !$ 1#4#9 &$ 4#9#< d$ 1#9#< 4$.%i&% o+ t%e +o**o'in patients are &apa!*e o+ i,in an in+ored &onsent 1$ 0arrie 0arried d ean& ean&ipa ipated ted ino inorr 4$ B*in B*ind d adu* adu*tt 9$ A ani&ani&-dep depre ress ssi,e i,e patie patient nt <$ 4= year year o*d o*d ute ute pati patient ent a$ 1#4#9 !$ 1#4#< &$ 1 on*y d$ None None o+ t%e t%e a!o a!o,e ,e$$ 4$.%i&% o+ t%e +o**o'in situations e;%i!its t%e app*i&ation o+ t%e prin&ip*e o+ 8usti&e/ 1$ Asin Asin t%e poor peop*e peop*e to !e&oe su!8e&t su!8e&ts s in resear&% resear&% +or drus drus 4$ Pro,id Pro,idin in Fua*ity Fua*ity %ea*t% %ea*t% &are &are eFua**y eFua**y to a** patients patients 9$ 6e*i,ery o+ t%e iniu %ea*t% &are &are to a** a&&ordin a&&ordin to indi,idua* indi,idua* needs <$ Proper*y Proper*y dis&*osin dis&*osin o+ in+oration in+oration reardin reardin t%e pro&edure pro&edure and aintainin anonyity o+ resear&% su!8e&ts on a!ortion a$ !$ &$ d$
1#4#9 1#4#< 4#9#< A** A** o+ o+ t%e t%e a!o, a!o,e$ e$
9$Nurse >ristine re&ei,es an order +ro 6r$ 5e*as&o to i,e %er patient# Say CruD t'o ta!*ets CiproLo;a&in (Cipro!ay) +or urinary tra&t in+e&tion$ Nurse >ristine no's t%at Say %as no urinary tra&t in+e&tion and t%at t%e dru s%ou*d !e i,en to anot%er patient '%o %as urinary tra&t in+e&tion$ .%i&% o+ t%e +o**o'in s%ou*d Nurse >ristine do/ a$ Gi,e t%e t%e dru !e&ause !e&ause it is t%e orde orderr o+ t%e t%e do&tor do&tor !$ Gi,e t%e t%e dru to t%e t%e patient patient 'it% 'it% urinary urinary tra&t tra&t in+e&ti in+e&tion on &$ Ca** t%e t%e attendin attendin p%ysi& p%ysi&ian ian and &*ari+ &*ari+y y t%e order order$$ d$ .rite .rite a report report i,e i,e it to t%e %ospita* %ospita* *a'yer *a'yer$$ 91$6r$ Paredes ordered a edi&ation to !e i,en intraus&u*ar*y on t%e *e+t de*toid o+ 0rs$ To*edo$ Nurse Per&y no's t%at 0rs$ No*as&o is post *e+t 0R0$ .%i&% o+ t%e +o**o'in s%ou*d Nurse Per&y do/ a$ Gi,e t%e t%e edi&at edi&ation ion on on t%e ri%t ri%t de*toid de*toid$$ !$ Gi,e t%e edi&at edi&ation ion on t%e ri%t ri%t de*toid de*toid and and do&uent do&uent it on t%e t%e patient2s &%art$ &$ o**o' o**o' t%e t%e order order$$ It is not &ontr &ontraind aindi&at i&ated$ ed$ d$ In+or 6r$ 6r$ Paredes Paredes t%at 0rs$ To*edo is post ri%t ri%t 0R0 and &*ari+y t%e t%e order$ 94$0s$ Tan8uat&o is s&%edu*ed +or pro&tosioidos&opy$ S%e needs to sin an in+ored &onsent !e+ore t%e pro&edure$ .%i&% o+ t%e +o**o'in is true a!out in+ored &onsent/ 1$ T%e patient %as no a!i*ity to re+use t%e pro&edur pro&edure e a+ter t%e t%e &onsent is is sined$ 4$ An in+ored in+ored &onsent s%ou*d e;&*ude e;&*ude an e;p*anation e;p*anation o+ a*ternati,e a*ternati,e treatents and pro&edures 9$ .%en a patient re+uses re+uses to i,e &onsent# &onsent# t%e %us!and or any sini?&ant sini?&ant ot%er &an sin$ <$ T%e do&tor do&tor 'i** 'i** de&ide de&ide '%at '%at is !est +or +or t%e patien patient$ t$ a$ 1#4#9 !$ 1#4#< &$ 4#9#< d$ None None o+ t%e t%e a!o a!o,e ,e 99$Be+ore !ein %ired as sta3 nurses# Fua*i?ed app*i&ants are su!8e&ted to andatory HI5 testin$ T%is pra&ti&e o+ %ospita*s s%o's '%i&% o+ t%e +o**o'in et%i&a* prin&ip*es/ a$ Bene Bene?& ?&en en&e &e !$ NonNon-a a*e *e?& ?&en en&e &e &$ Tota*i ta*itty d$ 6ou! 6ou!*e *e E3e& E3e&tt 9<$Nurse "ea %as !een ased to 'itness an in+ored &onsent +or surery$ Nurse "ea understands t%at '%at s%e is 'itnessin is t%at t%e a$ In+or In+ored ed &ons &onsent ent too too p*a&e p*a&e$$ !$ Patient Patient 'as 'as +u**y +u**y in+ored in+ored a!out a!out t%e pro&ed pro&edur ure e &$ Patient atient sin sins s t%e &on &onsen sentt +or +or d$ ai*y &onse &onsented nted to to t%e pro& pro&edur edure$ e$ 9=$Nurse 0y*ene 'ors on t%e postpartu unit and is i,in edi&ations at a$ S%e enters t%e roo o+ a patient# &a**s t%e patient !y nae# &%e&s t%e
nae !and +or a&&ura&y and adinisters an ora* ,itain$ A+ter A+ter t%e patient s'a**o's t%e pi**# s%e states t%at anot%er nurse %as a*so i,en %er t%is sae pi** an %our ao$ 0y*ene &%e&s t%e edi&ation re&ord and ?nds t%at anot%er nurse %as sined o3 on t%e dru entry$ entry$ T%e ost appropriate a&tion !y t%e nurse is to a$ 6o not%in# not%in# !e&aus !e&ause e t%e patient patient 'as not %are %ared d !y t%e se&ond se&ond ,itain$ !$ Report Report t%e ?rst nurse to to t%e nurse nurse anaer +or not in+orin t%e edi&ation nurse t%at a dru %ad !een i,en$ &$ Su!it Su!it an in&ident in&ident report report des&ri! des&ri!in in t%e &ir&us &ir&ustan& tan&es es o+ t%e edi&ation error$ d$ Noti+y Noti+y t%e patient patient2s 2s p%ysi&ia p%ysi&ian n and as as +or ad,i&e$ ad,i&e$ 9@$Nurse ran&is 'ors in a %ospi&e$ .%i&% o+ t%e +o**o'in is a &%ara&teristi& o+ %ospi&e &are/ a$ 0ost o+ o+ t%e patient patients s %a,e @ ont%s ont%s or *ess *ess to *i,e$ *i,e$ !$ Care Care &eases &eases '%en '%en t%e patien patientt dies$ dies$ &$ "i&ensed "i&ensed perso personne* nne* pro,ide pro,ide a** a** o+ t%e t%e &are &are and &o+ort &o+ort d$ Ser,i&e Ser,i&e is is a,ai*a! a,ai*a!*e *e at at spe&i?ed spe&i?ed ties ties 9$:ason Ba**esteros# RN# 0BA is a nurse anaer in St$ Isidore 0edi&a* Center$ Carin +or patient 'it% non-edi&a* pro!*es# pro!*es# %e &a**s +or t%e ser,i&e o+ a so&ia* 'orer in order to address soe o+ t%ese pro!*es o+ soe patients$ .%i&% o+ t%e +o**o'in patients in :ason2s *ist reFuires assistan&e ?rst/ a$ Gertrudes Gertrudes Sa*,a&io Sa*,a&ion# n# @1 years o*d# o*d# post stroe stroe## *i,es a*one$ a*one$ !$ 6ani*o 0asanay# 0asanay# =< years o*d# 'it% 'it% a %istory %istory o+ o+ re&ent re&ent yo&ardia* yo&ardia* in+ar&tion (0I)# in a idst o+ a di,or&e &$ Arteio Arteio Roero Roero## 4 years o*d# 'it% 'it% %eart +ai*ur +ai*ure# e# no insuran&e insuran&e &o,erae$ d$ 0ayui Jasuan# Jasuan# 4 years o*d# %oe*ess and ne'*y dianosed 'it% dia!etes e**itus 9$Nurse Ce*ine is re,ie'in t%e edi&ations in t%e p%ysi&ian2s order and notes a edi&ation 'it% a dose t%at is t'o ties reater t%an t%e usua* dose$ .%i&% o+ t%e +o**o'in is t%e ost appropriate appropriate nursin a&tion o+ Nurse Ce*ine/ a$ Understa Understand nd t%at t%ere t%ere ay !e spe&ia* &i &ir& r&usta ustan&es n&es in '%i&% '%i&% additiona* edi&ation is needed and i,e t%e edi&ation as ordered$ !$ 6is&uss t%e t%e Fuestion a!out t%e dru 'it% 'it% t%e p%ysi&ian p%ysi&ian '%o '%o ordered ordered it and re&ord t%e resu*ts o+ t%e dis&ussion$ &$ C%e& 'it% t%e nurses nurses +ro +ro t%e pre,ious pre,ious s%i+t to see i+ t%e edi&ation 'as i,en as ordered$ d$ As t%e patient patient i+ %e or s%e %as %as !een re&ei,in t%e dose o+ edi&ation as ordered$ 9$Nurse Ga!rie* re&ei,ed %is patient assinents +or t%e s%i+t$ .%i&% o+ t%e +o**o'in patients is Ga!rie*s priority in an a&ute &are situation/ a$ 6e*ia '%o is is ne'*y ne'*y aditted aditted 'it% &%est &%est pain pain !$ Hope '%o is &op*ainin &op*ainin o+ pain +o**o'in surery surery +or %ip pinnin$ pinnin$ &$ "u*u 'it% dia!e dia!etes tes '%o '%o %as a *u&o *u&ose se readin readin o+ 1$ 1$ d$ 0ary '%o is t%re t%ree e (9) days postop postoperat erati,e i,e 'it% *e+t *e+t &a*+ &a*+ pain$
<$Nurse .i**ia &ares +or a patient 'it% Hepatitis B$ T%e patient &a**s %i and says Coe %ere$ T%ere T%ere is soet%in I 'ant to te** you !ut you %a,e to eep it a se&ret$ T%e ost appropriate rep*y o+ .i**ia 'ou*d !e a$ Sure# you &an te** e$ Our &ode o+ et%i&s pre,ents e +ro +ro te**in anyone$ !$ .%y not$ not$ Jou Jou &an te** te** e anyt%in# anyt%in# you no' no'$ $ &$ I a respons responsi!*e i!*e +or +or t%e %ea*t% %ea*t% o+ ot%er ot%er peop*e peop*e as 'e**$ I2 I2 sorry sorry !ut I &an2t eep anyone2s se&rets$ d$ I 'i** not not te** anyone anyone '%o does does not need need to no'$ no'$ But i+ it is iportant iportant to your %ea*t% or to soeone e*se2s %ea*t%# I ay %a,e to te** anot%er person$ <1$A nurse is ora**y opposed to a!ortion at any tie durin prenan&y$ .%i&% stateent !est des&ri!es t%e nurse2s responsi!i*ity re*ated to t%is !e*ie+/ a$ T%e nurse nurse ust ae t%is position position no'n no'n !e+ore !e+ore !ein !ein ep*oyed ep*oyed at an an aen&y t%at pro,ides a!ortions$ !$ T%e nurse nurse ay de&*ine de&*ine to parti&ipate in a!ortions# a!ortions# !ut !ut ust &are +or 'oen a+ter t%e pro&edure$ &$ T%e nurse nurse &annot &annot a&&ept a&&ept ep*oyent ep*oyent in any any aen&y aen&y t%at ay pro,id pro,ide e a!ortion ser,i&es$ d$ T%e nurse nurse ust pro,ide t%e sae &are +or +or 'oen underoin underoin a!ortion a!ortion pro&edures as +or any ot%er 'oan$ <4$S%ort*y arri,in +or t%e e,enin s%i+t# t%e triae nurse e,a*uates se,era* patients '%o %a,e &oe into t%e eeren&y departent$ departent$ .%i&% o+ t%e +o**o'in patients s%ou*d re&ei,e %i%est priority/ a$ :e3# a !aset!a* !aset!a*** p*ayer# *ipin and &op*ainin &op*ainin o+ o+ pain and s'e**in s'e**in on %is ri%t an*e$ !$ 0artin# a idd*e-aed idd*e-aed an# an# diap%oreti& diap%oreti& and &op*ainin &op*ainin o+ se,ere se,ere &%est pain radiatin to %is 8a'$ &$ Ce*este# 'it% 'it% %er =-year-o*d =-year-o*d son# '%o %as !een &op*ainin &op*ainin o+ nausea nausea and %as ,oited on&e sin&e noon$ d$ Pa&ita# Pa&ita# an e*der*y e*der*y '%o is &op*ainin &op*ainin o+ a *oss o+ appetite appetite and +atiue +or t%e past 'ee$ <9$Nurse O*i,ia 8oins a tea '%o 'i** respond in a &a*aity area$ To pre,ent ass %ysteria durin a disaster# Nurse O*i,ia 'ou*d &are ?rst +or '%i&% o+ t%e +o**o'in patients$ a$ 0ano*o 0ano*o '%o '%o is a dru dru add addi&t i&t !$ Jo**y o**y '%o is depr depress essed$ ed$ &$ Perry erry '%o '%o is is eup% eup%or ori& i& d$ Sis Sisa a '%o '%o is pani& pani&in in <<$Nurse Nedy &ares +or a patient '%o 'is%es to donate %is *i,er to %is !rot%er$ .%at s%ou*d !e in&*uded in Nedy2s response '%en t%e patient ass +or +a&tua* in+oration a!out !e&oin an oran donor/ a$ A donor donor &an !e o+ any any ae$ ae$ !$ 5er!a* er!a* &onsent &onsent 'ou*d 'ou*d !e enou%$ enou%$ &$ ai*y e!er e!ers s ust ust a*so i,e t%eir t%eir &ons &onsent$ ent$ d$ T%ere are are soe &ontraindi&ations &ontraindi&ations +or !ein an oran donor donor$$
<=$It is iportant to &onsider t%e &u*tura* and re*iious !e*ie+s o+ patient in pro,idin %ea*t%&are$ .%at is t%e !est reason to in&*ude +a,orite or &u*tura**y reFuired +ood in t%e diets o+ patients +ro &u*tures ot%er t%an t%e doinant one/ a$ To pre,ent pre,ent t%e patient patient +ro +ro !e&oin !e&oin aitated$ aitated$ !$ To pre, pre,ent ent a*nutri a*nutrition tion &$ To &on,ey &on,ey a&&eptan&e a&&eptan&e o+ t%e patient2s patient2s !e*ie+s and identity identity d$ To ensure ensure t%e patient2s &ooperation &ooperation 'it% 'it% s&ienti?&a**y s&ienti?&a**y !ased treatent treatent <@$0r$ Ra8i, Sin% is a <-year-o*d Hindu 'it% a se,ere ne&rotiDin u*&er o+ t%e *o'er *e+t *e re+uses to undero surery !e&ause o+ re*iious !e*ie+s reardin rein&arnation$ T%e p%ysi&ian 'ants to s&%edu*e a !e*o' nee aputation o+ t%e *e+t *e$ .%at is t%e ro*e o+ t%e nurse in t%is situation/ a$ En&oura En&ourae e t%e patient patient to %a,e %a,e t%e sure surery ry$$ !$ 6is&uss 6is&uss t%e t%e re*iious re*iious !e*ie+s !e*ie+s 'it% 'it% t%e p%ysi& p%ysi&ian$ ian$ &$ Ca** Ca** a +ai +ai*y *y ee eeti tin n$$ d$ In+or In+or t%e patient patient o+ t%e t%e ot%er option options s a,ai*a!*e a,ai*a!*e$$ <$Nurse Apri* is a sta3 at t%e Ne'!orn unit$ On a parti&u*ar s%i+t# s%i+t# t'o o+ t%e reu*ar*y reu*ar*y assined sta3 e!ers are on si& *ea,e and no ne' sta3 is a,ai*a!*e +or assistan&e$ S%e is 'it% a &%are nurse and no ot%er !edside nurse$ .%i&% o+ t%e +o**o'in s%ou*d Nurse Apri* do/ a$ Brin Brin t%e in+ants in+ants out to t%eir t%eir ot%ers ot%ers to tae tae &are &are o+ t%e# t%is is is andated !y t%e *a' any'ay$ !$ Pro,ide Pro,ide Fua*ity nursin nursin &are &are on*y to t%ose patients reu*ar*y reu*ar*y assined assined to %er$ &$ Coordinate Coordinate 'it% t%e &%are &%are nurse nurse and prioritiDe prioritiDe patient &are &are so t%at a** patients re&ei,e reasona!*y sa+e Fua*ity &are$ d$ Re+use Re+use t%e nursin assinent !e&ause t%e in&reased in&reased nu!er nu!er o+ patients aes it unsa+e not 8ust to t%e patients !ut to t%e nurse as 'e**$ <$0r$ 5entura is in t%e ?na* staes o+ *un &an&er$ He te**s Nurse :udy# I 'is% I &ou*d 8ust !e a**o'ed to die$ I2 tired o+ ?%tin t%is i**ness$ I2,e *i,ed a ood *i+e$ I &ontinue y &%eot%erapy and radiation treatent on*y !e&ause o+ y +ai*y 'ants e to$ .%at is Nurse :udy2s !est response/ response/ a$ .ou*d .ou*d you *ie *ie to ta* to a psy&%o*oist psy&%o*oist a!out your your t%ou%ts and +ee*ins/ !$ .ou*d .ou*d you *ie *ie to ta* to your inister a!out a!out t%e sini?&an&e sini?&an&e o+ o+ deat%/ &$ .ou*d .ou*d you *ie to eet 'it% your your +ai*y and your your p%ysi&ian p%ysi&ian a!out t%is atter/ d$ I no' you are tired tired o+ ?%tin t%is t%is i**ness# i**ness# !ut deat% deat% 'i** &oe in due due tie$ <$One o+ t%e patients is dissatis?ed 'it% %is %ospita*iDation$ %ospita*iDation$ He de&ides to *ea,e aainst edi&a* ad,i&e and re+uses to sin t%e paper'or$ .%i&% o+ t%e +o**o'in is t%e nurse2s ne;t &ourse o+ a&tion/ a$ 6etain 6etain %i unti* unti* %e sins sins t%e paper' paper'or$ or$ !$ 6etain 6etain %i unti* unti* %is p%ysi&ia p%ysi&ian n arri,es arri,es$$ &$ Ca** Ca** t%e se&u se&urit rity y +or ass assis istan tan&e &e
d$ "et "et %i %i *ea *ea,e ,e$$ =$0r$ C*i3ord :ones# 4 years o*d 'it% prostate &an&er and u*tip*e etastases# is in respiratory distress and is aditted to a edi&a* unit +ro a si**ed nursin +a&i*ity$ His ad,an&e dire&ti,e states t%at %e doesn2t 'ant to !e p*a&es on a ,enti*ator or re&ei,e &ardiopu*onary resus&itation (CPR)$ Based on t%e patient2s ad,an&e dire&ti,e# '%i&% o+ t%e +o**o'in nursin inter,ention s%ou*d t%e nursin &are p*an in&*ude/ a$ C%e& 0r 0r$ :ones2 :ones2 status status on&e on&e per per s%i+t$ s%i+t$ !$ Pro,ide Pro,ide out% and sin &are &are on*y i+ 0r$ 0r$ :ones2 +ai*y +ai*y reFuests reFuests it$ &$ Turn t%e t%e patient patient on*y on*y i+ %e2s %e2s un&o+or un&o+orta!*e ta!*e$$ d$ Pro,id Pro,ide e eotiona* eotiona* support support and pain pain re*ie+ re*ie+$$ =1$0rs$ 6a,id !e&ae serious*y i** a+ter a nurse a,e %er t%e 'ron edi&ation$ .%en 0rs$ 6a,id re&o,ered# s%e ?*ed a *a'suit$ .%o is ost *ie*y to !e %e*d *ia!*e/ 1$ T%e attend attendin in p%ysi& p%ysi&ian ian 4$ T%e T%e %os %ospi pita ta** 9$ T%e nurse nurse '%o adinis adinister tered ed t%e 'ron 'ron edi&at edi&ation ion <$ T%e T%e &%a &%ap* p*ai ain n a$ 1#4#9 !$ 1 and 4 &$ 4 and 9 d$ 1 and 9 =4$A patient 'it% end-stae *i,er &an&er te**s t%e nurse %e doesn2t 'ant e;traordinary easures used to pro*on %is *i+e$ He ass '%at %e ust do to ae t%ese 'is%es no'n and *ea**y !indin$ Ho' s%ou*d t%e nurse respond to t%e patient/ a$ 6is&uss 6is&uss do&uent do&uentin in %is 'is%e 'is%es s in an ad,an&e ad,an&e dire&ti dire&ti,e$ ,e$ !$ Te** t%e patient t%at it is a *ea* *ea* Fuestion and is !eyond !eyond t%e s&ope o+ nursin pra&ti&e &$ Pro,id Pro,ide e a &opy &opy o+ t%e t%e patient patient2s 2s !i** !i** o+ ri%ts ri%ts d$ Gi,e in+ora in+oration tion on a&ti, a&ti,e e eut%ana eut%anasia sia =9$0a; Perido# Perido# a 41 year-o*d year-o*d &a** &enter aent# is aditted to t%e psy&%iatri& unit !e&ause o+ se,ere depression$ e' days a+ter %is adission# t%e ep*oyer o+ 0a; &a**s t%e nursin station inFuirin a!out t%e patient2s proress$ proress$ T%e nurse doesn2t no' i+ t%e patient %as i,en &onsent to a**o' t%e sta3 to i,e in+oration out to &a**ers on t%e p%one$ T%e !est response o+ t%e nurse on t%e *ine is a$ I2 sorry sorry %e is is not %ere$ %ere$ I2** I2** 8ust 8ust te** %i %i to &a** you you !a&$ !a&$ !$ I2 sorry sorry I &an not not &on?r &on?r '%et%er your your ep*oyee is a patient patient %ere$ %ere$ &$ I2 sorry sorry sir$ sir$ I a not in t%e position position to dis&uss %er proress proress$ $ d$ or a '%i*e a2a# a2a# %is attendin attendin p%ysi&ian p%ysi&ian is 6r$ 6r$ 0a**en and and %is nu!er is M@949=94=@$ M@949=94=@$ =<$0s$ "u*u Jat&o 'is%es to !e dis&%ared +ro t%e %ea*t% &are +a&i*ity aainst edi&a* ad,i&e$ .%at s%ou*d t%e nurse do/ a$ Ca** t%e t%e se&urit se&urity y to %e*p %e*p detain detain 0s$ Jat&o !$ Noti+y Noti+y t%e p%ysi& p%ysi&ian ian o+ 0s$ Jat&o$ at&o$ &$ Tae easures easures to to pre,ent pre,ent t%e 0s$ Jat&o +ro +ro *ea,in
d$ ReFues ReFuestt 0s$ Jat&o Jat&o to sin sin a 6A0A 6A0A +or$ +or$ ==$Nurse Ra&%e**e 'ors in t%e pediatri& unit o+ a tertiary %ospita*$ As s%e oes !a& to t%e nurses2 station# s%e %ears t'o +ai*y e!ers aruin in a &%i*d2s roo$ T%ey start to %it ea&% ot%er and t%e &%i*d is &ryin$ .%i&% o+ t%e +o**o'in s%ou*d Nurse Ra&%e**e do/ a$ Ca** t%e se&urity se&urity to &oe &oe and and inter, inter,ene$ ene$ !$ Reo,e eo,e t%e &%i* &%i*d d +ro +ro t%e roo roo &$ As one one o+ t%e t%e +ai*y +ai*y e!ers e!ers to *ea,e *ea,e t%e t%e roo roo d$ Try to reason reason 'it% 'it% !ot% !ot% +ai*y +ai*y e!ers$ e!ers$ =@$Nurse :eroe needed assistan&e assistan&e in trans+errin trans+errin "o*a Care*a '%o is &on+used# to !ed$ Nurse :eroe *ea,es "o*a Care*a to ?nd soeone to assist %i 'it% t%e trans+er$ .%i*e Nurse :eroe is one# "o*a Care*a +a**s and %urts %erse*+$ Nurse :eroe is at +au*t !e&ause %e %asn2t a$ Restra Restrained ined "o*a "o*a Care*a Care*a !e+ore !e+ore *ea,in *ea,in %er a*one a*one !$ Proper*y Proper*y instru&ted instru&ted "o*a Care*a Care*a a!out t%e t%e sa+ety sa+ety easures$ easures$ &$ Arrane Arraned d +or &onti &ontinua* nua* &ar &are e o+ "o*a "o*a Care*a$ Care*a$ d$ Proper Proper*y *y do&uente do&uented d t%at %e %as *e+t *e+t "o*a "o*a Care*a$ Care*a$ =$A nurse in an a!u*atory &are &*ini& is per+orin an adission assessent +or a patient s&%edu*ed +or a &atara&t reo,a* 'it% an intrao&u*ar *ens ip*ant$ .%i&% o+ t%e +o**o'in Fuestions 'ou*d !e t%e *east iportant +or t%e nurse to as on an initia* assessent/ assessent/ a$ 6o you you %a,e +reF +reFuent uent episo episodes des o+ %eada&%e/ %eada&%e/ !$ 6o you you %a,e %a,e any diK&u diK&u*ty *ty in !reat%i !reat%in/ n/ &$ 6o you you e,er e;pe e;perie rien& n&e e &%est &%est pain/ pain/ d$ 6o you %a,e %a,e a &*ose &*ose re*ati re*ations% ons%ip ip 'it% 'it% your +ai*y/ +ai*y/ =$0rs$ Tanya 0anDano is dianosed 'it% &an&er and is to*d t%at surery +o**o'ed !y &%eot%erapy 'i** !e ne&essary$ S%e te**s Nurse Cat%y# I %a,e read a *ot a!out &op*eentary t%erapies$ 6o you t%in I s%ou*d try it/ Cat%y responds !y ain '%i&% ost appropriate stateent/ a$ No# !e&ause !e&ause it 'i** intera intera&t &t 'it% t%e &%eot% &%eot%erap erapy y$ !$ Jou Jou need to to as your your p%ysi&ia p%ysi&ian n a!out a!out it$ &$ I 'ou*d 'ou*d try anyt%in anyt%in t%at I &ou*d &ou*d i+ I %ad %ad &an&er &an&er$ $ d$ T%ere are any any di3erent di3erent +ors +ors o+ &op*eentary t%erapies$ "et2s ta* ta* a!out t%ese t%erapies$ =$Nurse Aanda %ears a patient &a**in +or %e*p$ S%e %urries do'n t%e &orridor &orridor and enters t%e patient2s roo '%ere s%e +ound t%e patient +a&e do'n on t%e Loor$ Nurse Aanda per+ors a t%orou% assessent and assists t%e patient !a& to !ed$ T%e nurse noti?es 6r$ O*a*ia# t%e attendin p%ysi&ian o+ t%e in&ident and &op*etes and in&ident report$ .%i&% o+ t%e +o**o'in 'ou*d Aanda do&uent in t%e in&ident report/ a$ Patient Patient $R$ $R$ s*ipped s*ipped +ro +ro %is !ed$ !ed$ !$ Patient :$G$ 'oe 'oe up +ro +ro s*eep terror terror and and a&&identa**y a&&identa**y 8uped +ro %is %is !ed$ &$ Patient Patient N$:$ 'as 'as +ound +ound on t%e t%e Loor Loor +a&e +a&e do'n do'n d$ Patient 0$"$ o,ed t%ree t%ree (9) in&%es in&%es +ro +ro t%e *ast seen position position and 8uped ?,e (=) in&%es in&%es +ro +ro t%e !ed sur+a&e$ sur+a&e$
@$As Nurse S%ei*a a&&urate*y and *ei!*y in t%e patient2s &%art# s%e up%o*ds '%i&% o+ t%e +o**o'in et%i&a* prin&ip*e/ a$ Ben Bene?& e?&en& en&e !$ 6ou! 6ou!*e *e E3e& E3e&tt &$ Tota*i ta*itty d$ 5era& era&it ity y @1$As Nurse G*enn taes !ene?&ent a&tions '%en %e per+ors ora* and sin &are to t%e patient and pro,ide eotiona* support to t%ose an;ious or do'ned patients# %e s%o's an app*i&ation o+ '%i&% o+ t%e +o**o'in/ a$ Ben Bene?& e?&en& en&e !$ NonNon-a a*e *e?& ?&en en&e &e &$ Tota*i ta*itty d$ 6ou! 6ou!*e *e E3e& E3e&tt @4$It is ep%asiDed t%at &autiousness durin edi&ation adinistration adinistration is iportant to a,oid errors '%i&% resu*ts to ad,erse rea&tions o+ t%e edi&ation$ "a& o+ &autiousness in dru adinistration adinistration ,io*ates '%i&% o+ t%e +o**o'in ideas/ a$ I 'i** 'i** !e +ait% +ait%+u* +u* to to t%e patient2s patient2s &are$ &are$ !$ I 'i** 'i** !e %ones %onestt in y y patient patient &are &are$ $ &$ I 'i** 'i** a,oid a,oid doin doin ood ood to to t%e t%e patient$ patient$ d$ I 'i** 'i** a,oid a,oid anyt%in anyt%in %ar+u* %ar+u* to to t%e patien patient$ t$ @9$.%en Nurse >enny reports to t%e proper aut%ority t%at 6r$ >u is pra&ti&in dru a!use# %e is up%o*din '%i&% o+ t%e +o**o'in/ a$ 6ou! 6ou!*e *e E3e& E3e&tt !$ NonNon-a a*e *e?& ?&en en&e &e &$ Tota*i ta*itty d$ Pri,a&y @<$As t%e nurse +a&e et%i&a* di*eas# t%e prin&ip*e o+ !ene?&en&e s%ou*d !e ree!ered ree!ered +or it eans a$ 6o no no %a %ar !$ 6o ood &$ Be trut trut%+ %+u u* d$ Be dis& dis&rreet eet @=$.%i&% o+ t%e +o**o'in pro+essiona*s pro+essiona*s &an de&*are de&*are t%e deat% o+ a potentia* oran donor/ a$ Transp ransp*an *antt Sur Sureon eon !$ T%e T%e +a +ai* i*y y *a' *a'ye yerr &$ Atte Attend ndin in P%ysi P%ysi&i &ian an d$ 0edi 0edi&o &o-* -*e ea* a* @@$.%i&% o+ t%e +o**o'in are t%e Fua*ities o+ a +u**y ature and responsi!*e &ons&ien&e/ 1$ ree 4$ Certain 9$ Ca**ous <$ C*ear a$ 1#4#9 !$ 1#4#< &$ 1#9#<
d$ A** A** o+ o+ t%e t%e a!o, a!o,e e @$T%e nurse &an auent %is or %er et%i&a* pra&ti&e !y doin t%e +o**o'in# e;&ept a$ :oin in et%i&s et%i&s &oittee &oittee and t%eir t%eir +orus +orus !$ E*u&idat E*u&idate e t%eir t%eir o'n sets sets o+ ,a*ues ,a*ues in *i+e *i+e &$ Be +ai*ia +ai*iarr 'it% 'it% t%e t%e 0edi&a 0edi&a** Code Code o+ Et%i&s Et%i&s d$ Consider Considerin in t%e ,a*ues ,a*ues in *i+e *i+e o+ ot%er ot%er e!ers e!ers o+ t%e %ea*t% %ea*t% tea @$T%e Ho*y S&riptures pro,ides !asis +or Huan 6inity t%rou% '%i&% o+ t%e +o**o'in/ a$ Easter !$ Pent ente&o e&ost &$ Sa*, Sa*,at atio ion n Hist Histor ory y d$ An Annu nun& n&ia iati tion on @$.%i&% o+ t%e +o**o'in are t%e &onditions t%at s%ou*d !e present +or t%e app*i&ation o+ t%e Prin&ip*e o+ Tota*ity/ 1$ T%at su&% su&% e!er# !y its deterio deteriorati ration on in +un&tion# +un&tion# ay &ause &ause daae daae to t%e '%o*e oranis or at *east pose a serious t%reat to it$ 4$ T%at it is pro,en pro,en t%at t%e patient patient i%t !e e;posed e;posed to ra,e edi&a* edi&a* riss 9$ T%at t%ere t%ere is no ot%er ot%er 'ay t%an t%an tain t%e indi&ated indi&ated a&tion aainst it o+ o!tainin t%e desired ood resu*t$ <$ T%at t%e t%e daae daae !ein a,oided a,oided to t%e '%o*e '%o*e !e propor proportion tiona* a* to t%at '%i&% is &aused !y t%e uti*ation o+ t%e part$ a$ 1#4#9 !$ 1#4#< &$ 1#9#< d$ A** A** o+ o+ t%e t%e a!o, a!o,e e $I+ t%e surery did not pus% t%rou% as stated in t%e &onsent# '%i&% o+ t%e +o**o'in s%ou*d !e done/ a$ O!tain O!tain anot%e anot%err &onsen &onsentt +or +or anot%er anot%er day !$ Put a *ine a&ro a&ross ss t%e date and and tie o+ t%e sined sined &onsen &onsentt o+ t%e postponed surery# surery# ri%t t%e ne' date and tie and aK; your sinature &$ Report Report t%e t%e sureon sureon to t%e %osp %ospita* ita* *ea* *ea* &ouns &ounse* e* d$ Use t%e sae sae &onsent &onsent +or$ +or$ It *asts unti* unti* t%e pro&ed pro&edur ure e is done$ 1$0rs$ 6e*ado re+uses to tae %er edi&ations and &onsue %er +ood$ S%e +ee*s t%at s%e %as no ore reason to *i,e sin&e %er %us!and died *ast year$ T%is situation situation is a dire&t dire&t ,io*ation to '%i&% '%i&% prin&ip*e/ prin&ip*e/ a$ Tota* ota*it ity y !$ Ste'a Ste'ard rds%i s%ip p and Creat Creati,i i,ity ty &$ Pri,a&y d$ In+o In+orred ed Cons Consen entt 4$Nurse Saant%a &ares +or a a*e &e*e!rity '%o is aditted +or %eorr%oide&toy toorro' at a$ .%en s%e 'as ased !y t%e sta3 nurses +ro t%e nei%!orin 'ard '%at t%e a&tor 'as in +or and s%e re+uses to spi** out t%e in+oration# Nurse Saant%a is app*yin '%i&% o+ t%e +o**o'in et%i&a* prin&ip*es/
a$ Ste'a Ste'ard rds%i s%ip p and Cre Creati ati,it ,ity y !$ In+o In+orred ed Cons Consen entt &$ Ben Bene?& e?&en& en&e d$ NonNon-a a*e *e?& ?&en en&e &e 9$0r$ 9$0r$ Saonte 'as re&ent*y dianosed to %a,e a!doina* aorti& aneurys (AAA) and is re&oended +or adission and surery$ He re+uses to !e aditted to a ?rst-&*ass %ospita* and opts to !e aditted in a tertiary %ospita* due to ?nan&ia* &onstraints$ &onstraints$ .%i&% o+ t%e +o**o'in prin&ip*es s%ou*d uide Nurse Henry in ain a response/ a$ :usti&e !$ Tota* ota*it ity y &$ Autonoy d$ Ben Bene?& e?&en& en&e <$ Nurse 5a*erie 5a*erie is 'orin in a suri&a* unit and is assined to post-operati,e patients$ One o+ t%e responsi!i*ities i,en to %er is to &o**e&t post-operati,e se&retions eit%er +ro t%e suri&a* site or +ro t%e drainae &o**e&tion$ I+ one o+ t%e patients re+uses and Nurse 5a*erie sti** &ontinues 'it% t%e pro&edure# s%e is *ia!*e 'it% '%i&% o+ t%e +o**o'in/ a$ Battery !$ Assau*t &$ Ne Ne*ie ien&e n&e d$ A! A!an ando don nen entt =$Upon returnin to t%e Nurses2 station# Nurse Bi**y noti&es t%at a personne* +ro t%e dietary departent is *ooin t%rou% t%e &%art o+ a patient 'it% %epatitis B$ .%i&% o+ t%e +o**o'in nursin a&tion 'ou*d !e t%e ost appropriate/ a$ In+or In+or t%e super super,iso ,isorr a!out a!out t%e t%e in&ident in&ident$$ !$ S%out at t%e personne* personne* te**in te**in %i t%at %e is !ein inappropriate inappropriate &$ Approa&% Approa&% t%e t%e personne* personne* and te** te** %i t%at t%at it is not a**o'ed a**o'ed +or +or t%ose t%ose '%o are not dire&t*y in,o*,ed in t%e patient &are to !ro'se t%rou% t%e patient2s re&ord$ d$ 6o not%in not%in !e&ause !e&ause t%e person is part o+ t%e interdis&ip*inary interdis&ip*inary tea &arin +or t%e patient$ @$ Nurse :os%ua is a ne'*y %ired sta3 nurse in t%e suri&a* 'in o+ a %ospita* in Conne&ti&ut$ One o+ %is Aeri&an &o-sta3 approa&%ed %i and said “We white nurses have more superior intellect that you Asian Nurses.” .%i&% Nurses.” .%i&% o+ t%e +o**o'in is t%e ost appropriate response o+ Nurse :os%ua/ a$ “Yes, I agree.” So t%at t%ere 'ou*d !e no &ootion$ !$ Honestly, Honestly, I think you are a pathetic racist. But i that!s what you think, there is nothing I can "o. It!s your opinion.” &$ “I #elieve that we Asian nurses are ar #etter than you white nurses. Accept the act that that your country country nee"s us #ecause #ecause we are are skille" an" smart.” d$ “I really "on!t think that intellectual capacity capacity an" perormance is relate" to race or color.” $.%i&% o+ t%e +o**o'in is t%e u*tiate destiny o+ %uan !eins/ a$ Utopia
!$ Preser Preser,atio ,ation n o+ *i+e at a** a** &ost &ost &$ Be in in union union 'it% 'it% t%e t%e Creat Creator or d$ Attain Attain t%e se*+-a&tu se*+-a&tua*iDa a*iDation tion stae stae a&&ordin a&&ordin to 0as*o' 0as*o' $.%i&% o+ t%e +o**o'in isare ,io*ations aainst t%e Prin&ip*e o+ Ste'ards%ip/ 1$ Ha!itua* Ha!itua* indu& indu&ed ed a!ortio a!ortion n o+ se; se; 'orers 'orers 4$ Be*o' nee nee aputat aputation ion (B>A) (B>A) o+ a anre anrenous nous *e *e 9$ Unaut% Unaut%ori oriDed Ded de+ore de+oresta statio tion n <$ is%in is%in 'it% 'it% t%e use use o+ TNT TNT and e;p*osi, e;p*osi,es es a$ 1#4#9 !$ 1#4#< &$ 1#9#< d$ A** A** o+ o+ t%e t%e a!o, a!o,e e $Nurse >e**y is &arin +or a &oatose patient$ One a+ternoon a+ternoon t%e patient &oded and no re*ati,es 'ere around$ T%e patient does not %a,e any ad,an&e dire&ti,e$ .%i&% o+ t%e +o**o'in pro+essiona*s 'i** de&ide in !e%a*+/ a$ Patie atient nt2s 2s "a'y "a'yer er !$ Nurs Nursin in Super Super,i ,iso sorr &$ Hosp Hospit ita* a* C%ap C%ap*a *ain in d$ Atten Attendin din P%ysi& P%ysi&ian ian $6r$ 5era CruD reFuested Nurse Cai**e to a&&opany %i to se&ure a 'ritten &onsent +ro %er patient '%o is +or pe*,i& *aparotoy toorro' a+ternoon$ .%i&% o+ t%e +o**o'in reFuireent s%ou*d !e present so t%at 'ritten &onsent &an !e &onsidered ,a*id and *ea*/ 1$ T%e patient patient s%ou*d not !e under t%e t%e inLuen&e inLuen&e o+ a*&o%o* a*&o%o* or or drus 4$ T%e &onsent &onsent is se&ur se&ured ed 'it% dures duress s and &oer&ion &oer&ion$$ 9$ T%e patien patientt is in t%e t%e *ea* *ea* ae ae o+ 1$ <$ T%e patient patient %as re&ei,e re&ei,ed d pre-opera pre-operati,e ti,e edi&ati edi&ations$ ons$ a$ 1#4#9 !$ 1#4#< &$ 1 and 9 d$ A** A** o+ o+ t%e t%e a!o, a!o,e e 1$Nurse Portia re&ei,ed a &a** +ro t%e operatin roo and +ro t%e sureon t%at t%e %ypop%yse&toy s&%edu*ed +or t%e patient toorro' toorro' at 1 a is o,ed t%e ne;t day at t%e sae tie$ .%i&% o+ t%e +o**o'in s%ou*d Nurse Portia do/ a$ Put a *ine *ine a&ross a&ross t%e date date 'ritten in t%e &onsent &onsent and rep*a&e it 'it% t%e t%e ne' date$ !$ Se&ure Se&ure a ne' 'ritten 'ritten &onse &onsent nt +ro +ro t%e patient patient$$ &$ A&t as a patient patient ad,o&a ad,o&ate te and air &op*ai &op*aint nt aainst aainst t%e do&tor do&tor$$ d$ 6o not%in not%in !e&ause !e&ause t%e &onsent is is ood up to se,enty-t'o (4) %ours$ %ours$ 4$0rs$ 5ere* de 6ios is t%ree (9) days post odi?ed radi&a* aste&toy (0R0) o+ t%e ri%t !reast$ Nurse G*en a&&urate*y and *ei!*y do&uents %is &are i,en to 0rs$ 5ere* de 6ios$ .%i&% o+ t%e +o**o'in is !ein o!ser,ed !y Nurse G*enn/ a$ Con? Con?de dent ntia ia*i *ity ty !$ Pri,a&y &$ :usti&e d$ 5era& era&it ity y
9$One o+ t%e patients assined to Nurse ara% is a terina**y i** patient '%o e;perien&es se,ere pain$ Nurse ara% no's t%at i+ s%e i,es t%e patient ana*esi&s# it ay s%orten t%e *i+e o+ t%e patient$ .%i&% o+ t%e +o**o'in prin&ip*es app*y to t%is situation/ a$ :usti&e !$ 6ou! 6ou!*e *e E3e& E3e&tt &$ Tota*i ta*itty d$ Autonoy <$Nurse Re!e&&a sa' 6r$ Ho sniKn ari8uana in t%e on-&a** roo o+ p%ysi&ians$ Nurse Re!e&&a iediate*y reported t%is to t%e nursin super,isor$ T%is a&tion o+ Nurse Re!e&&a s%o's app*i&ation o+ '%i&% o+ t%e +o**o'in prin&ip*es/ a$ Ben Bene?& e?&en& en&e !$ NonNon-a a*e *e?& ?&en en&e &e &$ Pri,a&y d$ 6ou! 6ou!*e *e E3e& E3e&tt =$ Pra&ti&in Pra&ti&in !asi& %and'as%in and asepti& te&%niFue in doin pro&edures pro&edures to patients s%o's e;%i!its '%i&% o+ t%e +o**o'in/ a$ Ben Bene?& e?&en& en&e !$ Con? Con?de dent ntia ia*i *ity ty &$ 6ou! 6ou!**e E3 E3e&t e&t d$ NonNon-a a*e *e?& ?&en en&e &e @$.%en Nurse "u*u arri,ed +or t%e e,enin s%i+t# %er super,isor in+ored %er t%at s%e 'i** !e pu**ed +ro t%e 'ard and 'i** !e assined to t%e understa3ed eeren&y roo$ Nurse "u*u %as no e;perien&e !ut t%e spe&ia* area rotation !a& in t%e nursin s&%oo*$ .%i&% o+ t%e +o**o'in is t%e !est a&tion Nurse "u*u 'ou*d do/ a$ Po*ite*y Po*ite*y re+us re+use e to re*ie,e re*ie,e in t%e eere eeren&y n&y roo$ roo$ !$ 0ae 0ae an in&ident in&ident repor reportt and i,e i,e it to t%e C%ie+ C%ie+ Nurse$ Nurse$ &$ Report Report to t%e t%e eeren&y eeren&y roo roo and identi+ identi+y y t%e tass tass s%e &an sa+e*y sa+e*y per+or$ d$ Report Report to t%e eeren&y roo roo and per+or per+or t%e t%e tass t%at t%at s%e sa' sa' t%e nurses do !a& in %er rotation in nursin s&%oo*$ $0s$ 0ati*de Coronado# a 1 year o*d aiden is rus%ed to t%e eeren&y roo roo due to e*!o' +ra&ture$ As Nurse Ro!ert assesses 0s$ Coronado# %e notes o*d and ne' !ruises on %er ars and !a&$ .%en ased %o' s%e a&Fuired t%ose# 0s$ Coronado to*d Nurse Ro!ert t%at %er nep%e' %its %er '%ene,er s%e 'ets %er &*ot%es due to in&ontinen&e$ But t%en s%e &ried and to*d %er t%at s%e %as no +ai*y and no!ody taes &are o+ %er ot%er t%at %er nep%e'$ .%i&% o+ t%e +o**o'in is t%e ost appropriate response o+ Nurse Ro!ert/ a$ I2** instru&t instru&t you 'it% 'it% sip*e 'ays on %o' %o' to &ontro* &ontro* your your urinary urinary ure so t%at you 'on2t 'et your &*ot%es$ !$ I2** try to *oo *oo +or soe soe ot%er re*ati re*ati,es ,es so t%at t%at you &an *ea,e *ea,e your nep%e'$ &$ I 'ou*d 'ou*d *ie *ie to ta* ta* to your your $
