ethics of health care administration

Case Study Essay Option #1 – To tell, or not to tell, “Bad Blood”

Imagine that you are the CEO of a hospital and…It is Monday morning and you just arrived at the hospital. “Janice” an experienced, well-respected, very conscientious nurse, and family ‘friend’ that works in the ICU enters your office. (It is unusual to have anyone ask to meet with you on an urgent basis) “Janice” enters your office. You immediately notice that she is obviously stressed as she begins to tell you about an event that had happened over the weekend with a gravely ill patient under her care in the ICU.

She tells you that shortly before she arrived for her 7:00 am Saturday morning shift, a consulting physician left an order for the volume expander Hespan (not derived from blood products) to be given to one of the physician’s patients that was very ill. She further explained that she had then inadvertently administered a different volume expander commonly used in the ICU. (and one that is derived from blood products) to this patient. Janice charted this in the medical record and went on to fulfill a multitude of duties in the ICU. After 2 hours he was called back to help care for the patient that she had seen when she first arrived for her shift and that she had given the volume expander Hespan. Unfortunately, none of the therapies, treatments or interventions helped the woman. Her condition continued to decline. At the end of her shift, Janice talked with the attending physician. The physician told her she was going to meet with the family of the patient shortly to tell them that there was little more that she could offer to cure this patient. The physician wanted to alert the family that the patient may die in the very near future. With this distressing news Janice ended her shift in the ICU.

When she came to work the next morning, Janice learned that the woman had died the night before. She also overheard a comment from one of the other nurses the woman that had died the night before and her family were members of the local Jehovah’s Witnesses Church community. Janice had cared for patients who were Jehovah’s Witnesses many times and knew of their opposition to the administration of blood products. Janice reviewed the chart at the nurses’ station and saw the order, which clearly stated “No blood products”, yet Janice had administered a volume expander that included blood products.

As far as she knew, the family, the attending physician, nor any of the other nurses knew of Janice’s mistake in giving the incorrect volume expander medication. Janice’s error DID NOT contribute to the patient’s death. However, she explains to you that she has never made a mistake like this before and feels tremendous sense of anxiety and guilt over her failure to abide by the patient’s and family’s wishes. She knew that she had to tell someone about what had happened, and she thought it was best to talk with you. What are your options? What would you do? Support your decision with the applicable ethical principle(s) and theory.

. Please consider the “ethical decision-making guidelines” listed below :

Ethical Decision-making Guide:

• Awareness of ethical issues
• Knowledge of ethical principles, virtues and theories
• Decision-making guidelines

Note: the book needed is : Morrison, E. (2015), Ethics in Health Administration

 

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