Ethical Dilemma

Introduction:

In this situation, the topic of the ethical dilemma is about a registered practical nurse that is unable to administer morphine intravenously to one of her patients because she is not licensed. The purpose of this ethical dilemma is to explain an event, which took place in the past, and to inform many nurses of what ethical dilemma may happen when you are working all alone.

2. In this case study there are two individuals who are involved, Mrs. Smith the patient and Sara the registered practical nurse. Mrs. Smith is a 78 year old lady diagnosed with Brain Cancer six months ago and refused treatment. Later Mrs. Smith begins to experience severe pain and requests for treatment that is unavailable for her temporarily. Sara the nurse is unable to perform recommended treatment due to her scope of practice not allowing her.

3. In this situation, the nurse must call for assistance to solve the situation on behalf of Mrs. Smith to prevent any further complications.

4. In this case study we clearly understand that Sara the nurse values her patients needs, and is following the right policy and procedures by seeking out for help from the agency. The nurse is valuing the clients right for treatment to prevent severe pain.

5. Moral and Ethical Principles:

Nonmaleficence: Sara's duty is to make sure that nobody would get hurt and by Sara calling another nurse who is qualified to give the narcotic or calling the Director of Care would prevent the situation of harm to her patient, if Sara didn't have this option then Mrs. Smith might have suffered, gotten hurt if Sara administered the narcotic because she is not licensed. In addition, making a phone call would allow another nurse who is on call to come in and administer the Morphine and this would prevent Mrs. Smith from more severe pain that she is experiencing. Therefore, now that Sara took this action it would prevent this situation from reoccurring in the future.

Justice: Mrs. Smith has the right to receive fair treatment, which means that her pain should be treated right away and not later. It wouldn't be fair that other clients can receive their treatment but Mrs. Smith cant because what she needs is a nurse who in charge, which is Sara who is not qualified to care for her needs. In addition, the Director of Care is entitled to follow the ethical principles based on her client's care including Mrs. Smith.

Autonomy: Sara has the right to do what she thinks is best for her safety including the patient, so by Sara making a phone call to someone that would be her best choice. Sara should know better not to even think about administering the narcotic because that may result in her license being suspended or even being fired.

6. Sara the nurse must follow her agency policies, which means she is unable to perform intravenous therapy because it is not within her scope of practice, and she has no education with this therapy.

7. In this case, Sara the nurse must research and find out information about how to treat oncology patients who are suffering from pain when treatment is not available.

Case:

Mrs. Smith, a 78-year-old elderly resident of a nursing home, was diagnosed with brain cancer six months ago. Mrs. Smith was given the options for treatment, including chemotherapy and radiation. The day before her appointment to the cancer clinic, she told the nurse to cancel her chemotherapy and radiation, stating that she lived a good life, refusing care, and is ready to die. She does not want to suffer, and does not want the treatment to prolong her life. Sara, a Licensed Practical Nurse, has just begun working in this new nursing home. During her night shift, she finds Mrs. Smith is in pain of 10/10 and is in need of pain medication. Sara checks the chart for Mrs. Smith, and finds that there are orders to be given via "I.V" for pain. Medication orders are for Morphine Sulfate sliding scale. Later, Mrs. Smith began screaming, begs Sara for her help and awakens everyone in the nursing home.

Sara is the only nurse on the night shift and is responsible for forty patients. However, she knows she is not licensed to administer narcotics, but has seen her supervisor in the past that is a Registered Nurse, give the Morphine I.V., thinks she may be able to do it. Mrs. Smith needs immediate attention to relieve her suffering pain.

What should Sara do? She could lose her job and license for performing treatments outside her legal authority.

What would you do?

Dilemma: Should Sara the Licensed Practical Nurse who is not licensed to administer narcotics give the morphine I.V. to Mrs. Smith.

Reaction: I would not administer the Morphine; however, I would make a phone call to the registered nurse who is qualified to give the narcotic or I would call the director of care, or whoever is in charge of the company to come in and administer the Morphine IV or have them find someone, community agency to come in the nursing home as soon as possible to treat Mrs. Smith's pain.

Background Data: Mrs. Smith an 78 year old female who has brain cancer is not receiving any treatment because she refused to do so, however, Sara who is a Licensed Practical Nurse is working a night shift all by her self and unaccompanied. Sara finds Mrs. Smith in extreme pain and wants Sara to give her the pain medication, which is on sliding scale. Sara is not licensed to administer narcotics but Sara thinks she can do it because she has watched the other nurse give the Morphine to Mrs. Smith.

Values:

1. Choice- Sara has a choice whether she wants to give narcotics (Morphine) to Mrs. Smith or whether she doesn't want to give the narcotic.

2. Choice- Mrs. Smith has a choice whether she would want to receive the narcotic from Sara who is not qualified to give the narcotic.

1. Accountability- Sara is accountable for her own actions regarding if she wants to administer the Morphine to Mrs. Smith. Sara will be responsible for her own actions and her performance if she goes beyond her scope of practice.

2. Accountability-The Director of Care will be accountable for leaving Sara the Practical Nurse to work all by herself in a very dangerous situation. Also, the Director of Care should know better by having a back up plan so that Sara will not be responsible for any wrong actions that she performs to herself and all of her clients including Mrs. Smith.

1.Safe, Competent