Ethical dilemmas are common in all workplaces globally, and the hospital setting is no exception. Healthcare experts always meet ethical dilemmas whenever they are at work and have been trained to reduce or eliminate them whenever possible. Many ethical principles guide all healthcare professionals who are supposed to use them whenever they face a dilemma. Medical errors, for instance, can arise when nurses omit crucial prescription details, including medicine, dose/strength, drug type, timing, and validity. These errors happen because of unexpected experiences, unclear communications, nurse or doctor interruptions, and failure to observe patient history. The four principles of healthcare ethics were developed to aid professionals in navigating patient care because the healthcare industry is such a dynamic environment. These values include justice, beneficence, non-maleficence, and autonomy. These principles work together to strengthen all healthcare workers and guarantee that patients are receiving high-quality, moral care and each of these principles has a specific goal. According to the American Nurses Association (ANA), a culture of safety is one in which healthcare professionals at all organizational levels are dedicated to guiding principles and practices that prioritize safety over competing objectives (ANA, 2016)
Case study
Susan, a 76-year-old widow with a right hip fracture, underwent an ORIF on October 6, 22, at Houston Hospital. Important admission signals included BP 132/76, HR 82, and RR 18, and her medical history revealed recurrent exacerbations of congestive heart failure. She was moved to the intensive care unit with a prescription for Lasix and other drugs. Her nursing home prescription list before the hospital included Lasix. The transfer resulted in fresh, revised prescription orders being placed on a new Medication Administration Record (MAR), while the old Medication Administration Record (MAR) was not removed. When the first nurse reviewed the order, she incorrectly interpreted the new Lasix order on the MAR as an unintentional duplicate in the record and yellowed out the line. She was interrupted by the phone and told the second nurse to continue the procedure. The second nurse verified that the old MAR was still present, removed it, and informed the first nurse that her role was complete. The yellow line for Lasix caught the attention of the third nurse dispensing the prescription, but it was too late because she had been dispensing it for three days. On October 9th, 22, she took it out and returned them to the pharmacy. The patient gained 3 pounds since being in, and the next morning at 3 a.m., the patient was having difficulty breathing with an RR of 28, a BP of 190/110, a +4 pitting edema, and an HR of 120. The second nurse informed the doctor about the error immediately after she noticed it. When her lungs were examined, they were found to be moist with crackles. The patient experienced a sudden cardiac arrest, but luckily, she was revived but was not told what had happened.
Communication Effectiveness
Communication and attentiveness play a big role in communication between Patient-Doctor, Nurse-Nurse, and Nurse-Doctor because it ensures that no information or data is missing. In our case, it was amid Nurse-Nurse communication. Listening is also important as it assures the other party that whatever you are all doing agrees. The first nurse was busy with the phone and could not listen to the second nurse after she accomplished the duty she had assigned her. The two most frequent causes of medication administration mistakes among nurses are incompetence and interruptions, and research has demonstrated that these mistakes continue to result in preventable fatalities (Wheeler et al., 2017). The third nurse never clarified whatever she had received from the second nurse to check if it was correct. Before administering the drug, she should have clarified the yellow line drawn on Lasix to comprehend its meaning.
Application of Ethical Principles to Resolve the Ethical Dilemma
According to (Bonney, 2014), there are four ethical principles which include disclosure and the right to knowledge, the right to self-determination and autonomy, integrity, beneficence, and non-maleficence, and are all ethical concerns relating to medical mistakes.
Veracity
The provision of thorough, accurate, and objective information by healthcare professionals in a way that aids patients in understanding is required under the veracity principle. Providing accurate information about medical mistakes promotes trust. The doctors and nurses never disclosed the medical error to Susan.
Autonomy and Right to Self Determination
The right to self-determination and autonomy concepts recognize patients’ freedom to make decisions and perform acts according to their values and desired outcomes. Healthcare professionals have an ethical duty to update patients on their treatment plan, including any instances of medical error. The doctor would not have been able to decide on the appropriate course of therapy if the second nurse had not told others about the mistake.
Disclosure and Right to Knowledge
Healthcare professionals have an ethical duty to give patients the knowledge they need to make wise decisions. The Patient’s Bill of Rights mandates that any medical error be fully disclosed (Ghazal et al., 2014). Unfortunately, in Susan’s case, nurses and doctors never disclosed to Susan what had happened. Only the second nurse disclosed a medical error to the doctor to decrease harm.
Beneficence and Non-maleficence
Healthcare professionals are directed to act in patients’ best interests and prevent harm by the principles of beneficence and non-maleficence. When weighing the patient’s potential risks and benefits, it could put healthcare professionals in a moral conflict (Kalra et al., 2013). Doctors and nurses must take essential steps to reduce the harm caused by an error. The doctor dealt with cardiac arrest immediately and saved Susan from dying. The second nurse also did her best to inform the doctor of medical error; she never feared suffering, punishment, or unnecessary worry.
Conclusion
In their daily work, healthcare professionals frequently run into ethical dilemmas that force them to make choices based on their moral convictions and values. These moral guidelines are universally acknowledged in the medical industry. Medical professionals and health care administrators frequently employ these concepts when presented with difficult patient-related issues to guide their judgments. Health care workers can use the four principles of health care ethics to evaluate and resolve ethical dilemmas, particularly concerning medical errors.
Reference
American Nurses Association (ANA), (2016) American Nurses Association calls for a culture of safety in all health care settings. Retrieved from http://www.nursingworld.org/Call-for-Culture-of-Safety.html
Bonney, W. (2014). Medical errors: Moral and ethical considerations. Journal of Hospital Administration, 3(2), 80-88. doi:10.5430/Jha.v3n2p80
Ghazal, L., Saleem, Z., & Ariani, G. (2014). A medical error: To disclose or not to disclose. Journal of Clinical Research & Bioethics, 5(2). doi:10.4172/2155-9627.1000174
Kalra, J., Kalra, N., &Baniak, N. (2013). Medical error, disclosure, and patient safety: A global view of quality care. Clinical Biochemistry, 46, 1161-1169. doi: 10.1016/j.clinbiochem.2013.03.025.
Wheeler, J. S., Duncan, R., & Hohmeier, K, (2017), Medication Errors and Trainees: Advice for Learners and Organizations. Annals of Pharmacotherapy, 51(12), 1138-1141. doi:10.1177/1060028017725092
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