Emergency Care for Severe Acute Appendicitis - Case Study Example

Written Case Study B Assignment Name: Course: Instructor: August 28, 2014 Case study B presents a situation where Mr. J, is supposedly admitted to a rural hospital on an emergency case of severe acute appendicitis. On arrival, he receives an appendectomy operation in the same hospital. Thereafter, Mr. J develops post-operative complications where he suffers elevated heart rate, temperature together with increased respiratory rate. There were also complains related to abdominal pain. As a result, the medical doctor orders several tests conducted on him and that he receives further relief for the elevated pain. However, there are some core problems and issues that arise in the process of the post-operative tests, diagnosis and nursing care. The cases of negligence arise among the nurses, the RN’s and the medical doctor which further raises several legal and ethical implications. The essay will form a discussion and relevant justification of the main problems and issues and how they relate to law, ethical theory and nursing together with the relevant codes of ethics and frameworks. There are several core problems arising from Mr. J’s post-operative care. First, there was a delay in the post-operative blood results due to the eminent technical problems identified in the case study. The delaying of the blood tests was another core problem despite the patient complaining of an elevated abdominal pain, increased rates of breathing and temperature. Secondly, after the blood results were lately discharged, the nurse on duty failed to contact the medical doctor and further issue him/her with the test results. In contempt, the nurse filled the pathology report of the patient without possibly being sure of the implications of the test results (Cowen, & Moorhead, 2011). In this respect, the main issue that arises as a result of the three identified core problems is negligence (Cowen, & Moorhead, 2011). Negligence occurs in many aspects evidenced in Mr. J’s case. First, upon realization of technical difficulties preventing the blood tests of the patient, the medical doctor could have ordered the tests to be transferred to another facility with immediate effect. Secondly, the nurse on duty upon receiving the blood test results showed negligence in two ways. First, she failed to contact the medical doctor and inform him/her on the nature of the results. Secondly, she ignorantly filled the pathology results on Mr. J’s personal history and never even failed to inform the other nurses on the same. The third case of negligence occurs when the nurse fails to give a full update on the patient’s condition to the RN on duty that weekend (Guido, 2006). The fourth case of negligence occurs with the medical doctor since he failed to follow-up on the pathology results of the patient till the morning of Monday. In all, all the medical staff at the rural facility fall guilty of negligence (Guido, 2006). These issues relate to law and ethical theories in a number of ways. First the legal issues raised in this case all relate to negligence (Badzek, Henaghan, Turner & Monsen, 2013). The major categories of negligence include but not limited to the failure to follow necessary standards of patient care, the failure of effective communication, the failure of correct and responsible documentation, the failure of monitoring and assessing the patient’s condition and the failure to act accordingly as the patient’s advocate (Badzek et al., 2013). The first legal issue relates to the failure of following prescribed nursing care standards. The nursing standards imply that hospital policies should and have the responsibility of protecting a patient from substandard nursing and medical care (Badzek et al., 2013). Acceptable care in this case would refer to those levels of care that are legally acceptable and that ensures that no harm befalls on the patients. The appendectomy operation performed on Mr. J raises concerns of substandard nursing and medical care since later laparotomy procedures indicate substantial leaks that later led to the death of the patient. The latter raises a legal issue on the provision f substandard care to the patient (Badzek et al., 2013). The second legal issue is the failure to monitor and assess the patient’s post-operative condition. The changes in the status of health in a post-operative patient could be sudden or gradual. Nurses are the first practitioners to see this aspect through constant monitoring and assessment through checking of vital signs. In Mr. J’s case, the nurses and the RNs failed to constantly monitor the patient during the weekend and thus leading to the deterioration of his condition (Badzek et al., 2013). The third legal issue is the failure of effective communication. Upon monitoring and assessment of the patient’s condition through checking the vital signs, the nurse is supposed to offer timely reporting to the physician or the medical doctor (Griffith & Tengnah, 2008). According to the case study, the nurses failed to give timely reports on the pathological reports to the medical doctor despite the apparent deterioration of the vital signs and the imminent risks associated with post-operative nursing. The fourth legal issue relates to the failure to document (Griffith & Tengnah, 2008). The nurse failed to document the pathological report properly and since it was not her role she ignored it. The RN’s failed to document the reports on assessment of the patient during the weekend. The medical practitioners also failed to act as the patient’s advocate despite being in full knowledge of the legal and ethical code of conduct for the nursing practice (Rejeh, Ahmadi, Mohammadi, Kazemnejad, & Anoosheh, 2009). The issues underlying the problem can also be analyzed solely basing on ethical theories. Ethical theory relies on the ethical principles of beneficence, least harm, respect for the autonomy and justice (Pera, & Van, 2005). Each emphasizes on the different aspects characteristic of ethical dilemmas and thus leading to identification of ethically correct decisions in relation to specific ethical theories. Mr. J’s case study can be analyzed using the ethical theories applicable in healthcare which includes consequentialism, deontology, virtue ethics and principlism. These ethical theories are analyzed based on the case study below. Deontological theory emphasizes on the rights and duties and plays a main emphasis on the respect for individuals being an end in themselves wholly. Acting from duty through the intentions of the individual is viewed as ethical and the contrary as unethical (Pera, & Van, 2005). It is clear that the negligence postulated by the medical practitioners in Mr. J’s case acted as a contradiction to acting on duty and obligations. In relation to the virtue ethics, moral character and virtues possessed by individuals determine their actions. When an individual acts according to virtues and good moral character, then, their actions are deemed ethical (Holt & Convey, 2012). In reference to Mr. J’s case study, the medical practitioners did not act on virtues and thus unethical. The principlism ethical theory places emphasis on crucial ethical principles of beneficence, autonomy, justice and non-malificence. The theory incorporates the most important elements of ethical theories that are perfectly compatible with a wide array of religious, individual and societal beliefs (Doane, Storch & Pauly, 2009). The theory demands that healthcare professionals place added value to particular principles and find a balance in decision-making and rationality. In this application, the nurses could have utilized such balance to identify the serious post-operative complications using the ethical principles stressed by this theory. Due to the failure to observe any of these virtues, the nurses, medical officer and the RNs acted unethical in Mr. J’s case (Doane et al., 2009). The code of ethics for nurses identifies the fundamental values and standards of ethics through which the nursing professional are supposed to be committed to in their conduct. It also guides the ethical practice and decision making while highlighting ethical values and human rights standards that the society expects the nursing professionals to uphold. The code of ethics for nursing also relates the aspect of human rights where the nurses have the moral responsibility of safeguarding the equal worth and inherent dignity of every person (Nursing and Midwifery Board of Australia, 2008). In this case, the nurses breached several nursing codes of conduct which are discussed below. First, the code of ethics for nurses stipulates that nurses should uphold value in the provision of quality nursing care to the patients. In Mr. J’s case, the nurses failed to issue quality nursing care through constant neglect of monitoring, assessment, reporting and effective patient management. The neglect contravened the above mentioned code of conduct. The code of ethics also provides that nurses value ethical management of information. In relation to the case study, the nurse did not manage the pathological reports of the patients as required since she neglected issuing them to the medical officer and also falsified the patient’s history form. These codes of conduct appear to have been breached deliberately by the nurses and thus contributing to the death of the patient (Australian Nursing and Midwifery Council., & Nurses Board of South Australia, 2008). In conclusion, Mr. J’s case is one that raises many legal and ethical issues in the nursing practice regarding post-operative patients. The major problems arising include that of constant neglect and negligence. This leads to several legal issues which include the failure to follow necessary standards of patient care, the failure of effective communication, the failure of correct and responsible documentation, the failure of monitoring and assessing the patient’s condition and the failure to act accordingly as the patient’s advocate. Ethical issues arising from the ethical theories conclusively find that the nursing practice in the rural facility to be unethical. The nurses also breached the code of ethics for nursing on two separate counts. All these revelations lead to the summation that Mr. J’s death occurred due to illegal and unethical conduct of the healthcare/nursing professionals. References Australian Nursing and Midwifery Council, & Nurses Board of South Australia. (2008).Codes of professional conduct & ethics for nurses & midwives in Australia 2008. South Australia: Nurses Board of South Australia. Accessed August 28, 2014 Badzek, L., Henaghan, M., Turner, M., & Monsen, R. (2013). Ethical, Legal, and Social Issues in the Translation of Genomics into Health Care. Journal of Nursing Scholarship, 45(1), 15-24. Accessed August 28, 2014 Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, Mo: Mosby Elsevier. Accessed August 28, 2014 Doane, G., Storch, J., & Pauly, B. (2009). Ethical nursing practice: inquiry-in-action. Nursing Inquiry, 16(3), 232-240. Accessed August 28, 2014 Guido, G. W. (2006). Legal and ethical issues in nursing. Upper Saddle River, N. J: Pearson/Prentice Hall. Accessed August 28, 2014 Griffith, R., & Tengnah, C. (2008). Law and professional issues in nursing. Exeter: Learning Matters. Accessed August 28, 2014 Holt, J., & Convey, H. (2012). Ethical practice in nursing care. Nursing Standard, 27(13), 51-56. Accessed August 28, 2014 Nursing and Midwifery Board of Australia, (2008). Code of Ethics for Nurses in Australia. Accessed August 28, 2014 Pera, S. A., & Van, T. S. (2005). Ethics in health care. Lansdowne, South Africa: Juta. Accessed August 28, 2014 Rejeh, N., Ahmadi, F., Mohammadi, E., Kazemnejad, A., & Anoosheh, M. (2009). Nurses’ experiences and perceptions of influencing barriers to postoperative pain management. Scandinavian Journal of Caring Sciences, 23(2), 274-281. Accessed August 28, 2014 Ulrich, C. M., Taylor, C., Soeken, K., O'Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced Nursing, 66(11), 2510-2519. Accessed August 28, 2014 Read More