Can any policy take precedence over the professional judgment of trained ICU nurses?

 

Unit 9 Assignment: Professional Standards and Institutional Ethics

In each case, answer the questions at the end of the case and give researched references to support your assertions; also, explain what would be the ethical course of action and the legal requirements for action in the case.

Case One

Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of 6 months, she noticed that all patients admitted from the Shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis. There appeared to be patient abuse in the nursing home. Mrs. Lewis investigated discreetly and found no explanation possible except abuse. In accord with the obligations of the law in her state, she reported the matter to the Department of Welfare Bureau of Inspection.

The Welfare Department investigated immediately, found proof of abuse, and threatened to close down Shady Rest if there were any more recurrences. Mrs. Lewis was overjoyed until her hospital administrator, bypassing the director of nursing, called her in and warned her that she would be fired if she reported any other instances of abuse. Shady Rest sent the hospital a lot of business, and good relations had to be maintained.

Mrs. Lewis was even more shocked when she discovered that the administrator was a golf partner of the owner of Shady Rest and was doing an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a lawyer, who threatened the hospital with exposure and with penalties that would follow if one of its employees failed to follow the reporting provisions of the law on abuse in nursing homes.

Did Mrs. Lewis act correctly? What should she have done if she could not have afforded to consult with a lawyer? In what ways can whistle-blowers protect themselves? Must the art of intimidation be part of the toolbox of healthcare professionals in order to protect their patients? Is power an appropriate consideration in healthcare ethics?

Case Two

On a July weekend, Mrs. Allesfertig, nursing supervisor of the whole hospital, discovered that the intensive care unit was seriously understaffed. She pulled two nurses with previous ICU experience off other floors to bring the unit up to strength in view of the extreme level of acute care needed. On the following Monday, Dr. Bestknabe, who has overall responsibility for the ICU unit, closed the unit for further admissions until the staffing had been worked out on a permanent basis.

 

Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU nurses?

 

Please follow the grading rubric fully and have three written pages and reference page in APA style

Assignment Rubric
Utilize this rubric if an Assignment specific rubric is not available. Refer to the Assignment directions for specific content requirements.
Instructors: Enter total available points in cell H2, and values between 0 and 4 in the yellow cells in the Score column. Total available points =
Content Rubric Introductory Emergent Practiced Proficient/Mastered Score Weight Final Score
0 – 1.9 2 – 2.9 3 – 3.9 4
Content Quality Submission does not address most of the assignment requirements and/or indicates no understanding of critical concepts. Includes some of the assignment requirements. Opinions and ideas may indicate misconceptions or little understanding of some critical concepts. Includes all assignment requirements with minor errors/omissions, supports opinions and ideas creatively, clearly, and correctly. Displays understanding of most critical concepts. Includes all assignment requirements, supports opinions and ideas creatively, clearly, and correctly with details and examples where appropriate. Displays complete understanding of critical concepts. 90% 0.00
Resources Does not include any resources (0) or sources utilized are not relevant and credible sources of information(1). Not all sources utilized are relevant and/or credible and/or does not meet the required number of sources. Supports many opinions and ideas with relevant and credible sources of information; meets the required number and types of resources. Supports opinions and ideas with relevant and credible sources of information; meets or exceeds the required number and types of resources. 10% 0.00
Content Score 0
Writing Deduction Rubric Introductory Emergent Practiced Proficient/Mastered Score Weight Final Score
0-1 2 3 4
Grammar & Punctuation The overall meaning of the paper is difficult to understand. Sentence structure, subject verb agreement errors, missing prepositions, and missing punctuation make finding meaning difficult. Several confusing sentences or 1 to 2 confusing paragraphs make understanding parts of the paper difficult, but the overall paper meaning is clear. Many subject verb agreement errors, run-on sentences, etc. cause confusion. A few confusing sentences make it difficult to understand a small portion of the paper. However, the overall meaning of a paragraph and the paper are intact. There may be a few subject verb agreement errors or some missing punctuation. There are one or two confusing sentences, but the overall sentence and paragraph meanings are clear. There are a few minor punctuation errors such as comma splices or run-on sentences. 35% 0.00
Spelling The many misspelled words and incorrect words choices significantly interfere with the readability. Many typos, misspelled words, or the use of incorrect words making understanding difficult in a few places. Some misspelled words or the misuse of words such as confusing then/than. However, intent is still clear. A few misspelled words normally caught by spellcheckers are present but do not significantly interfere with the overall readability of the paper. 35% 0.00
Order of Ideas & Length Requirement Paper has some good information or research, but it does not follow assignment directions and is lacking in overall organization and content. The order of information is confusing in several places and this organization interferes with the meaning or intent of the paper. However, the paper has a generally discernible purpose and follows assignment directions overall. The order of information is confusing in a few places and the lack of organization interferes with the meaning or intent of the paper in a minor way. The overall order of the information is clear and contributes to the meaning of assignment. There is one paragraph or a sentence or two that are out of place or other minor organizational issues. A few sentences may be long and hard to understand. Meets length requirements. 20% 0.00
APA There is some attempt at APA formatting and citing. There are one or more missing parts such as the cover page or references list. Citation information may be missing. Citation mistakes make authorship unclear. This is an attempt use APA formatting and citing. There are both in-text citations and reference listings. Citation information may be missing or incorrect (i.e. Websites listed as in-text or reference citations). There is an attempt to cite all outside sources in at least one place. Authorship is generally clear. There is an overall attempt at APA formatting and citation style. All sources appear to have some form of citation both in the text and on a reference list. There are some formatting and citation errors. Citations generally make authorship clear. There is a strong attempt to cite all sources using APA style. Minor paper formatting errors such as a misplaced running head or margins may occur. Minor in-text citation errors such as a missing page number or a misplaced date may occur. Quotation marks and citations make authorship clear. 10% 0.00
Writing Deduction 0.00
Final Score 0.00
Percentage ERROR:#DIV/0!
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