Critique Ethical Issues in Current Nursing Practice
Ethical values remain an essential component of nursing practice. Nursing ethics defines provisions that guide nurses in their practice and enable them to navigate the complexities that present within the healthcare setting. Ethical considerations in nursing practice enable the recognition of healthcare dilemmas that present within the practice and inform the appropriate clinical judgment that enhances care outcomes (Milliken & Grace, 2016). This paper seeks to discuss ethical issues that are present during routine patient handling, drawing findings from the presented case scenarios. The case presented depicted a 4-bed emergency department receiving seven patients involved in a mass shooting at a local grocery store. Do you need any help for completing your assignment ? Contact us at eminencepapers.com. We endeavor to provide you with excellent service.
Triage Evaluation and Effects of Providers’ Ethics and Beliefs
32-year-old Pregnant Female
The first patient was a 32-year-old pregnant female at 36 weeks of gestation with abdominal injuries upon being trampled on during the shooting incident. Assessment of the patient revealed that the patient was alert and had the highest level of orientation. The patient had a respiratory rate of 25 breaths per minute, palpable radial pulses, and complained of pain in the abdomen. The patient was triaged as green. The triaging of this patient was inappropriate. The assessment findings on this patient were consistent with the code yellow. According to Bazyar et al., 2019, code yellow is assigned to nonambulatory patients with respiratory breaths of less than 30 breaths per minute, palpable radial pulse, and proper mentation. Other factors, such as pregnancy, could be put into consideration when triaging this patient. This was the case with this patient since additional care was warranted to rule out fetal and maternal injuries that may have been life-threatening. The triaging on this patient may have been inappropriate. Still, there is however no indication that the clinician’s values, beliefs, and ethics may have affected their course of action on this patient.
45-year-old Caucasian Female
The patient presented with a right chest gunshot wound. The patient was unconscious, had a thready radial pulse, and shallowed breathing with a pulse rate of 8 breaths per minute. The patient was triaged as red. Triaging on this patient was appropriate. Red code is indicative of severe injuries but with potential for survival. Red code is assigned to patients who present to the ED unconscious despite having a palpable radial pulse and respiratory rate below 25 beats/minute (Bazyar et al., 2019). This is the case with this patient.
There was significant evidence that personal beliefs, values, and ethics may have affected the provider’s approach while triaging this patient. This patient is the suspected perpetrator of the shooting incident. While treating this patient, the providers were divided in line of personal beliefs, values, and ethics. Reports on the case reveal that an argument ensued upon discovery that the patient was the perpetrator of the shooting incident and that the patient was not offered health services after that discovery. This may have been the attributing factor to her death.
52-year-old Caucasian Female
The patient presented with a right leg gunshot wound. The patient appeared confused, had no palpable radial pulse, and shallow breathing with a respiratory rate of 40 breaths per minute. The patient was triaged as red. This patient was triaged appropriately. The patient had a respiratory rate of above 30 beats per minute, had no palpable radial pulse, and was confused. All these assessment findings are consistent with the agreeable criteria of assigning triage color red, as detailed by Magnusson et al., 2020. The triaging of this patient was satisfactory and showed no evidence of interference with the providers’ ethics and beliefs.
45-year-old African American
The patient presented with no observable physical injuries. However, the patient was hyperventilating with a respiratory rate of 45 breaths per minute, was light-headed, and had a palpable pulse. The patient was triaged as green. The patient was triaged appropriately. The patient presented to the clinic with no physical injuries. His higher respiratory rates could have been due to his past medical history that revealed a history of PTSD. The triaging of this patient was appropriate and with no evidence of interference from the providers’ beliefs and ethics.
6-year-old Hispanic Male Child
The patient presented with an abdominal gunshot wound. The patient was unconscious, had no spontaneous respirations, and had no palpable radial pulse. The patient was triaged as red. This triage was inappropriate. Assessment findings on this patient were consistent with the black triage color code. Black code is assigned to a patient with no spontaneous respirations, has a non-palpable radial pulse, and is unconscious (Magnusson et al., 2020). These patients should be classified as deceased and not presented at the collection point. This was the case with this patient. Despite the inappropriate triage by the providers, no evidence indicates that their values and ethics may have clouded their clinical judgment.
29-year-old Hispanic female
The patient presented with an open left leg fracture. The patient had a palpable radial pulse with a respiratory rate of 40 breaths per minute. The patient was hysterically screaming for her child and was even attempting to climb out of the gurney. The patient was triaged as yellow. This triage was inappropriate. This patient could not walk and had a respiratory rate of 40 breaths per minute. These findings are consistent with the red triage code. According to Bazyar et al., 2019, any patient who is unable to walk and presents with respiratory breaths of more than 30 beats/minute should be assigned code red. Even though the triaging on this patient may have been inappropriate, no evidence indicates that the clinician’s judgment may have been affected by their ethics and beliefs.
Migrant Spanish-speaking Male
The patient presented to the ED with significant lacerations on the head. The patient appeared lethargic, had a palpable radial pulse, and had a respiratory rate of 30 breaths per minute. The patient was triaged as green. This triage was inappropriate. This patient had a respiratory rate of 30 breaths per minute, had a palpable radial pulse, and exhibited proper mentation, as evident in his ability to point to the location of pain in his body. This is consistent with the code yellow. This patient should have been monitored closely, and further examinations were to be done to rule out the possibility of any life-threatening injury that may not have been apparent at the time of initial assessment.
There was significant evidence that personal beliefs, values, and ethics may have affected the provider’s approach while triaging this patient. The providers did not make any attempt to find a translator to aid in assessing the presenting signs of confusion or the symptoms of pain in this individual. This may have led to the delay in the establishment of the real extent of injury that the patient may have suffered. As reported in this case, a CT scan revealed a subdural hematoma several hours after the patient presented to the ED.
Treatment Interventions
Treatment interventions for these patients varied and were determined by their acuity levels as well as their time of arrival at the ED. The 45-year-old Caucasian female believed to be the perpetrator of the incident was the first to be brought to the ED. She was started on aggressive treatment and then halted upon discovering her actions by the healthcare providers. These interventions were futile since this patient did not survive despite being the first patient to be brought to the ED. Interventions with the Hispanic female believed to be the mother of the 6-year-old male child were satisfactory. The course of her treatment followed stabilization of the left fractured leg and wound care. The patient was stable and was admitted to the medical/surgical unit for recovery. The outcome on this patient was excellent and may be attributable to her early arrival at the ED. Her son, the Hispanic male child, however, did not survive. The interventions done on him by the providers, such as wound care, cardiac monitoring, ventilation, and blood transfusions, were all futile.
The pregnant female who presented with abdominal injuries was assessed for fetal injury and discharged 24 hours later upon establishing no fetal or maternal damage. This intervention was satisfactory for the patient. The 45-year-old African American Male was observed by an ED nurse for several hours before being handed over to police. This intervention was satisfactory since the patient had no presentation that may have required intensive treatment. The 52-year-old Caucasian Female, on the other hand, was started on aggressive treatment that included access to the operation room and subsequent stabilization in the ICU. The interventions on this patient were satisfactory and may have been the reason for her survival. The treatment of the migrant Spanish-speaking male patient was unsatisfactory. This patient seemed to have had a rash assessment during triaging due to the language barrier between him and the providers. As a result, vital details that may have aided in the fast identification of an apparent head injury were omitted. The patient fell unconscious several hours later and was in a vegetative state.
The Outcome of the Patients
The outcome of each patient can be correlated to their triage grade. Patients who are triaged green often have better clinical outcomes and are usually discharged earlier than those who are triaged red or yellow (Bartholomew & Young, 2019). This is the case with the 45-year-old African American Male who was discharged and handed over to the police after several hours. The 32-year-old pregnant female was also discharged 24 hours after presenting to the ED. An exception in the outcome of the patients triaged green was the migrant Spanish-speaking Male whose condition deteriorated several hours after presenting at the ED. His poor outcome may be attributed to factors related to providers.
Patients who were triaged red had varied outcomes. The Caucasian female was believed to be the shooter, and the 6-year-old Hispanic male child did not survive. Negative outcomes for this patient may have been correlated with the providers’ personal beliefs and values since they stopped offering services to her upon discovering her actions. On the other hand, the 52-year-old Caucasian female who was triaged as red survived and is now stable. Her survival may be attributable to the swift course of action taken by the providers. The 29-year-old Hispanic female patient triaged as yellow also had better clinical outcomes and is now recovering in the medical/surgical unit.
Corrective Actions
Several corrective actions are necessary to enhance clinical outcomes for patients presenting to the ED. The providers in this scenario should be educated on the significance of ethical care. In this regard, they should be educated on the ethical principles that govern care processes and their significance in ensuring better clinical outcomes. Various ethical provisions may be necessary for these providers. The first provision is the exhibition of respect and compassion for a person’s attributes and inherent dignity (Hunt et al., 2021). This provision postulates that providers should provide care processes to persons who need it irrespective of who they are. Therefore, they should view every patient as a human being and not judge them by their deeds. This provision would have enabled them to care for the patient who was suspected to be the perpetrator of the shooting incident. Another provision is health promotion, doing no harm, and ensuring the safety of the patients (Hunt et al., 2021). Caregivers should always strive to promote the patient’s safety and prevent any harm from befalling them. This consideration will enable them to offer care to all persons presented to the clinic irrespective of their backgrounds and affiliations.
Ethical considerations in care processes are essential to all care providers. The significance of ethical practice in ensuring better care outcomes underpins its necessity in care provision. As depicted in the case scenarios above, personal values, beliefs, and ethical principles may negatively impact care provision. Therefore, providers should be educated on the importance of ethical practice to ensure better clinical outcomes.
References
Bartholomew, S., & Young, A. (2019). Emergency Department Triage Prediction of Clinical Outcomes Using Machine Learning Models. The Journal Of Emergency Medicine, 57(5), 752-753. https://doi.org/10.1016/j.jemermed.2019.11.006
Bazyar, J., Farrokhi, M., & Khankeh, H. (2019). Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach. Open Access Macedonian Journal Of Medical Sciences, 7(3), 482-494. https://doi.org/10.3889/oamjms.2019.119
Hunt, D., Dunn, M., Harrison, G., & Bailey, J. (2021). Ethical considerations in quality improvement: key questions and a practical guide. BMJ Open Quality, 10(3), e001497. https://doi.org/10.1136/bmjoq-2021-001497
Magnusson, C., Herlitz, J., & Axelsson, C. (2020). Patient characteristics, triage utilization, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study. BMC Emergency Medicine, 20(1). https://doi.org/10.1186/s12873-020-0302-x
Milliken, A., & Grace, P. (2016). Nurse ethical awareness: Understanding the nature of everyday practice. Nursing Ethics, 24(5), 517-524. https://doi.org/10.1177/0969733015615172
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Question 
Purpose of Assignment:
Nurses encounter ethical issues in their daily practice and must be able to apply ethical considerations to scenarios and their ethics.
Critique Ethical Issues in Current Nursing Practice
Course Competency:
Critique ethical issues in current nursing practice.
Scenario:
You are the nurse manager of a minor, four-bed emergency department. Your department received seven patients involved in a mass casualty shooting at a local grocery store two days ago. A brief overview of each client is provided below.