Case Study #4 Ethics

Case Study 4: Sterilizing the Developmentally Delayed Patient

Case Study Assignments (45 points each)

Mary Ellen Thompson, a skilled maternal-child nurse, has recently been employed by a public hospital in a large southwestern city. Because she speaks fluent Spanish, she has been asked to serve as a translator for the scheduled C-section of a 14-year-old, mildly developmentally delayed, Hispanic teenager. The patient undergoes epidural anesthesia without incident and delivers a small but healthy 6 lb. 4 oz. baby girl. While completing the C-section, Mrs. Thompson suddenly realizes that the surgeon is going to perform a tubal ligation. Checking the patient’s chart, Mrs. Thompson does not find any specific consent for the tubal ligation and asks the physician if the procedure was anticipated and whether the patient was informed of its possibility. The physician tells Mrs. Thompson that he believes the procedure is “medically necessary” and that he will record it as such in his operative report.

Several days later, Mrs. Thompson visits the patient and her parents. The parents are concerned about their daughter’s ability to care for her child, but they have made a commitment to shoulder the responsibility for both the mother and the child. In talking to them, Mrs. Thompson realizes that they have no awareness that a tubal ligation was performed on their daughter. They are economically indigent and poorly educated, yet Mrs. Thompson does not think that these circumstances warrant the involuntary sterilization of a mildly developmentally delayed individual without parental consent. What should she do?

If you were Mrs. Thompson, which of the following actions would you consider and why (respond to all that apply)?

1. Speak to the physician and ask him to inform the girl and her mother of what had happened.

2. Speak to nursing staff about taking collective action against the physician.

3. Report to administrators that a surgical procedure was done without adequate consent.

4. Ask not to be assigned to work with that physician again.

5. Explain to the mother what took place.

6. Speak to a public advocacy group about the ethical issue of sterilization without consent.

NM410 Unit 5 Week 10 Assignment: Case Study 4 Rubric

5
Demonstrates the ability to construct a clear and insightful problem statement/thesis statement/topic statement with evidence of all relevant contextual factors.

13.5 pts

4
Demonstrates the ability to construct a problem statement, thesis statement/topic statement with evidence of most relevant contextual factors, and problem statement is adequately detailed.

12 pts

3
Begins to demonstrate the ability to construct a problem statement/thesis statement/topic statement with evidence of most relevant contextual factors, but problem statement is superficial.

10.5 pts

2
Demonstrates a limited ability in identifying a problem statement/thesis statement/topic statement or related contextual factors.

9 pts

1
Demonstrates the ability to explain contextual facts but does not provide a defined statement.

0 pts

0
There is no evidence of a defined statement.

15 pts

15 pts

5
The paper exhibits a excellent command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling.

9 pts

4
The paper exhibits a good command of written English language conventions. The paper has no errors in mechanics, or spelling with minor grammatical errors that impair the flow of communication.

8 pts

3
The paper exhibits a basic command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.

7 pts

2
The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.

6 pts

1
The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.

0 pts

0
The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning.

10 pts

5
The required APA elements are all included with correct formatting, including in-text citations and references.

4.5 pts

4
The required APA elements are all included with minor formatting errors, including in-text citations and references.

4 pts

3
The required APA elements are all included with multiple formatting errors, including in-text citations and references.

3.5 pts

2
The required APA elements are not all included. AND/OR there are major formatting errors, including in-text citations and references.

3 pts

1
Several APA elements are missing. The errors in formatting demonstrate limited understanding of APA guidelines, in-text-citations, and references.

0 pts

0
There is little to no evidence of APA formatting. AND/OR there are no in-text citations AND/OR references.

5 pts

2

STERILIZING THE DEVELOPMENTALLY DELAYED PATIENT CASE STUDY#4

Zizette C. Howard

Department of Nursing Herzing University

NM 410: Ethics in Nursing

Professor Sandie Yeager

April 3, 2022

Following the ethics and standards for health professionals, the relationship between the doctor and patient should be ethical and proper (McDermott-Levy, Leffers, & Mayaka, 2018). Patients have the right to honest and open communication with doctors; doctors should earn the patient’s trust by being honest and sincere. The patient should be free from forced treatment or unwanted therapy that jeopardizes their functionality and consciousness. Therefore, patients have the right to be informed about their past and present health status (Pesut, Greig, Thorne, Burgess, Tishelman., et al. 2020). Comment by Reybitz, Graham: This sentence feels redundant, try not using ethics twice to communicate the same idea. Comment by Reybitz, Graham: Remove Therefore

The physician should ethically inform the girl and her mother about the tubal ligation procedure he conducted. The patient needs to understand her medical status if anything happens without her know-how. The disclosure of information will help the patient and her mother to be prepared mentally for the future, just if she wishes to have a baby (McDermott-Levy, Leffers, & Mayaka, 2018). This disclosure will also prevent the physician from imposing any legal action. The patient and her mother can then best acknowledge the mistake made by the physician (Pesut et al., 2020). Comment by Reybitz, Graham: ‘knowledge’ or ‘consent’ might be better. Comment by Reybitz, Graham: This section is oddly phrased, and I think you should go back over what you mean to say here. Comment by Reybitz, Graham: Would it not be the patient that sues the hospital? Comment by Reybitz, Graham: This statement does not follow. You need a few extra lines to build into this hypothetical botched surgery.

A nursing practitioner needs to act as an advocate for the patient. Whenever challenges like poor treatment and high medical bills or costs encounter patients, it’s ethical for the nurse to advocate for better treatment options, affordable medical payment options, and legal options, ensuring that patients have access to quality care and affordable healthcare (McDermott-Levy, Leffers, & Mayaka, 2018). Comment by Reybitz, Graham: A two-sentence paragraph feels like it needs more, maybe expand or merge this. How do nurses look for said options? What is the process of making these options available? Why do I only ever hear horror stories about hospital bills? That kind of thing.

The nurse should practice the ethical values and principles, including justice, non-maleficence, autonomy, and honesty, which promotes better care for patients. Therefore, as the nurse, I will take up the responsibility to advocate for the girl’s health status by informing the public advocacy about the unethical or misconduct duty performed to the patient without her consent. It is my role to defend the needs of the patient and put care first before anything else. Through patient advocacy, there will be a decrease in medical errors and patient needs consideration. Moral distress needs to be identified and addressed to public advocacy organizations, preferably after acting, assessing, affirming, and asking (McDermott-Levy, Leffers, & Mayaka, 2018). Comment by Reybitz, Graham: Why are you suddenly talking about yourself? Comment by Reybitz, Graham: About the malfeasance? Some of these summary statements could be stretched to two for more details to fill out the paper.

Report to administrators that a surgical procedure was done without adequate consent. It is the right of a nurse to make a report of any medical misconduct even if the misconduct will or will not harm the patient. Reporting of medical errors is known to improve patient satisfaction and well-being (Pesut et al., 2020). It benefits the health professionals and patients by developing better solutions to solve the problems and evaluation of the causes, aiding in reducing the risks of medical errors. Comment by Reybitz, Graham: This transition is jarring, as I am now lost as to what it is you want to convey. You seem to have a hypothetical situation where a woman wants to have her tubes tied, but you keep swapping between talking in the third and first person. It would be helpful to probably pick a personhood (maybe first) and write from that perspective Comment by Reybitz, Graham: This sentence is what I mean. First sentence seems to be in first person, this one seems to be in third. It makes the whole paper confusing to parse.

Therefore, as a nurse, I’ll report to the administrator about the procedure done to the patient without the patient’s consent. It’s done to find a better solution and prevent future occurrence of the problem to other patients. Comment by Reybitz, Graham: Nice sentiment, but without some kind of concrete examples/details, it ends up feeling like a hypothetical handwave.

Conclusion and Recommendation

I recommend that physicians and other healthcare providers to embrace the ethical values and principles in practice to avoid harm done on the patients and promote patient satisfaction. (Pesut et al., 2020). Proper healthcare is an all-inclusive task that involved both utilization of medical skills and knowledge as well as adherence to and practice of ethical standards associated. In conclusion, medical errors can occur intentionally or accidentally, although it’s our goal as medical providers to ensure we don’t perfom any misconduct that would harm the health of the patient. Intentional misconduct should be approached in the sensible ways that would ensure safety of the patient (Pesut et al., 2020). Comment by Reybitz, Graham: You need more details overall in this paper. There are many nice ideas and sentiments, but nothing really concrete. The vagueness of the paper drags it down.

References

McDermott-Levy, R., Leffers, J., & Mayaka, J. J. N. o. (2018). Ethical principles and guidelines of global health nursing practice. 66(5), 473-481.

Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., et al. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. 27(1), 152-167.

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