Question

You are working as a nurse on a cancer floor in a large urban hospital. You come into work and learn that you will be working with several new patients during your shift change briefing meeting. One of those patients, Jane, has been admitted to the hospital due to issues related to a cancer diagnosis. She was given medication to address a cancerous tumor along with Propofol to sedate her for the procedure.  

During the shift change meeting, you learn that Jane had lost touch with reality after her procedure and the prior shift nurses made sure everyone knew that Jane was a real pain to deal with because she was non-cooperative and was acting irrationally. She was pulling out her IVs and trying to leave the hospital. Unfortunately, she was a bit like Houdini and could even slip out of the restraints. She also shouted at people that were not in her room and “folded her laundry” in mid-air. Jane also insisted that she was in tremendous pain.

One of the confounding issues is that Jane has a family member who recently showed up to direct Jane’s care, but she does not want any medical treatment for Jane because the family member is convinced that it is the medication that is creating the situation of Jane losing touch with reality. As you interact with Jane and her loved one, you begin to suspect that there was more to this situation than was being reported by the previous nursing shift. You then go to Jane’s complete medical history and find that there is a diagnosis of schizophrenia when Jane was admitted to the hospital for mental health issues almost 20 years prior.

You ask Jane and her loved one about the ways that Jane is handling her schizophrenia, and they explain that she doesn’t take any medication for it, but manages it using LSD and holistic treatments. Jane insists that she has not had any mental health episodes for almost 20 years because of the holistic treatments. Jane and her loved one are insisting that she not be given more medication because it just makes her mental state more confused and her behavior worse. She is obviously in pain, and you want to be able to help alleviate some of her suffering, while you work to stabilize her mental state.  

You realize that the prior nursing shift had just ignored Jane because she was just too difficult to deal with on a very busy floor. Given that Jane has not received any medication for the last 12 hours, you find that there are some problems with her quality of care due to her challenging behavior.  

Describe and explain the ethical issues that you identified in Jane’s situation. Provide evidence from the scenario and from your course materials this week as support of your claims.

• List and explain at least three ethical issues related to the care that Jane has received.
• What steps would you take to correct the issue of Jane’s medications?
• What steps would you take to address the quality of care provided?

Answer 1

Describe and explain the ethical issues that you identified in Jane’s situation

The Ethical issues with Jane are 1. Lack of compassion by the on duty nurses to understand Jane's pain/problem, 2. Incomplete medical history knowledge on Jane and 3. No treatment/ medication given to jane for 12 hours. In case of Jane due to schizophrenia she is not in conncection to the rational behavious but that is not the case with the on duty nursing staff. Instead of understanfng situation, Jane was labelled stubborn and uncooperative and left without proper treatment. The ethical patient treatment was not given to Jane and making an effort to study her case was missing in this patient case.

List and explain at least three ethical issues related to the care that Jane has received.

1. Ignorance of responsibility: In case of Jane, the nursing staff ignored their professional and thical responsibility to care for jane despite her behaviour amd left her with the presumption of non-cooperation without knowing the root cause of the behaviour

2. Non stadard medical care: According to standard medical care, a pain relieving drig/medication is supposed to be given to Jane but instead due to her bheavious eh was left wiith on-stadard care due to non-cooperation and ignorance by the nursing staff

3. Professional accountability: The nurses as professional as supposed to have a proper background checks of the patient's medical history (Schizophrenia in case of Jane) and medication required. This would have helped the nursing staff to better understand her behavioural reasons and methods to deal with Jane and provide her with the appropriate treatment.

What steps would you take to correct the issue of Jane’s medications?

Had the doctor of healthcare staff known the Jane's medical history with schizophrenia and non-compliance to medical treatment the the use of Propofol for sedation could be avoided. As Propofol was used with currrent medical condition (schizophrenia), it could have triggered the confusion and other related effects observed in case of Jane. So now that we know Jane has schizophrenia, we can initiate her treatment on schizophrenia and avoid using sedatives and other medication that have contraindication with schizophrenia

What steps would you take to address the quality of care provided?

The issue of quality care can be tackled by implemeting a mandatory patient medical check and recoring it in the patient file to help healthcare provider with better and complete undrestanding of the full extent and all the current and prior medical conditions that the patient has. Secondly, we can train the nurses and staff for ethical roles and responsiblity to treat the patient non-cooperative and associated behaviours with more sensitivity and compassion. We can also have mental illness awaress and specialised professional and ethical treatment semiars to help impove knowledge, sensitivity and understaning in healthcare providers.