Health science students often experience immense trouble in trying to apply their understanding of medical ethics to the particular needs of medical problems. There may be challenges because either health professionals lack methods to apply their ethical knowledge and understanding to the ethical implications of the concerns of patients, or just because they neglect a rational framework for ethical aspects of medical cases (Johnstone 2019). Failure to tackle ethical problems systematically in clinical settings can generate what appear to be unsolvable disputes, but open dialogue and a structured method to clinical ethical reasoning often can lead to easy solutions.
In the case study, the undergraduate student nurse (SN) at the university has learned the importance of correctly handling sharps (needles and cannulas). Literature was also presented to the students where it was specified that the needles used must not be cut, bent, broken, or recapped by hand before disposal due to increased risk of injury while handling needles. Recapture, deliberately bend, break, detach from disposable syringes, or another manual handling of needles is expressly prohibited. A Registered Nurse (RN) has been partnered on the placement with the student nurse (SN). The RN told the SN to give an insulin injection to a patient. SN gave an injection to the patient and remembered instantly that she did not bring a kidney dish to the bedside. This situation caused me a bit of fear as she did not know about the needle disposable container nearest to clear. The RN sees SN holding the needle loosely and instructing it to re-cap. Recognizing that recapping needles increases the risk of a needle-stick infection that can potentially spread severe blood-borne diseases, SN immediately declined. The RN once again told her to re-cap the needle but once again SN holds the ground. The RN then yells to SN to re-cap the needle. Anxious and frustrated, the SN tries to put the cap on the needle, but shake it so much that it unintentionally punctured her left thumb.
In this situation, I felt the nursing student is not at fault as she is applying the information and knowledge, she has gained in her university about nursing care. In nursing, it is always required that the nurse should follow the research approach and evidence-based application during the practice. The SN finds it difficult to apply their understanding of medical ethics to the basic criteria of real clinical problems. In the medical practice, the Health practitioners also make challenging clinical decisions in which no simple solution appears to be correct or wrong, but they are often able to proceed through a process that arrives at a conclusion that is accepted (Lantos 2018). In other words, while the right answer may not exist, there are ways of thinking that are stronger, more comprehensive and inclusive than others. The SN is facing ethical legal dilemmas in the given scenario, as she is willing to follow the correct procedure by not recapping the needle but being pressurized by the RN to do so. The pressure from senior colleagues sometimes leads to a situation of panic and the duty is not performed efficiently. Faced with tough moral decisions it is no different. Healthcare practitioners should learn to thoroughly examine the ethical aspects of their work to address ethical issues, even though a variety of specific and often contradictory moral viewpoints need to be taken into consideration (Pozgar 2019). The situation was difficult for the SN because she felt that the RN lack methods to apply their knowledge base to the ethical dimensions of the concerns problem, also the RN lack a rational framework for ethical aspects of clinical cases. The situation would have been better if the RN would have discussed the importance of not recapping the needles and they both would have come out with the best solution. Failure to tackle such kind of issues systematically in clinical settings can generate what seem to be intractable disputes, but open dialogue and a methodical process to clinical ethical reasoning can often quickly lead to resolution (Lee & Yoon 2017).
The National Health and Medical Research Council (NHMRC) issued recommendations in October 2010, outlining the essential aspects of infection control practices, such as the management of sharp objects products (Barr 2017). These recommendations support healthcare personnel and facilities in a risk-management system in establishing procedures and processes for infection prevention. These recommendations: Sharps must not be transferred straight from hand to hand and carrying should be minimized. Upon use, needles should not be recapped, twisted, or damaged. The RN when asked the nursing student to recap the needle after use, made me feel that how the real-time nursing care procedures differ from the studied and literature-based information. Realistically, clinical ethics would not provide solutions to all the moral issues which occur in health care (Rushton 2018). Different individuals in any institution will have different moral perspectives reflecting on their own experiences in life and beliefs. Profit and nonmaleficence concepts also require both emotional and intellectual involvement. Only if they reflect the particular circumstances of the patient's situation can clinical decision-making and patient management be successful. This necessitates the implementation of reliable and effective communication skills, and the ability to function well in teams (Armstrong 2017). These skills are not necessarily considered to be legal, but are at the heart of good professional ethics. There will always be some level of disagreement between ethical standards, laws, or rights, and definition (defining their purpose and scope) and balance (providing reasons or justification) will be needed in each instance (Beauchamp and Childress 2009). How the ethical values, ideals or rights are determined will not depend on a priori moral framework, but on the strength of reasoning, the clinical sense, and the moral viewpoint of the judging agent.
Law provides a context systemic to the ethical argument. The ethical response clashes with what is legal in the specific case but this is unusual. The legal standards most frequently operate in tandem with the ethical principles, or they promote the kind of ethical decision-making mentioned above. The nurses are expected to collect all relevant information sensitively and systematically, so that any decision can be evaluated closely with the ethical decision making (Standing 2020). The SN should have taken realistic decisions in the case, should have conveyed and reported the decision, and attempts should be made to facilitate relevant stakeholders in coping with the decision or choices effectively and in making a plan. The SN will also understand that there would not be a single right choice and that the patient or the health-care team must be offered a variety of ethically feasible alternatives. The provider can include negotiation, agreement, mediation, and scheduled analysis in these circumstances (Guo 2020). As careful members of the health-care team, they should find a variety of acts that represent a variety of diverse moral viewpoints ('wide reflective balance'). Within the context of the particular event, each of these viewpoints-their advantages, deficiencies, explanations, and implications-must be acknowledged. In this case also instead of panicking the SN should have conveyed the reason behind not capping the needles with evidence-based information and should have tried to convince the RN. As both SN and RN are part of the medical team the decision should have been discussed with all concerned and reported clearly in the notes -specifying who was involved in making the decision and why the decision was made.
Health-care decision-making requires collaboration, involving individuals from many different technical and non-professional backgrounds. Often, disputes are inevitable (Sinclair et al. 2019). Garcia indicates that there are many sources of spiritual discord where consensus cannot be achieved. There are nevertheless a variety of techniques that can overcome gaps in moral outlook (Garcia et al. 2017). Beauchamp proposes the following strategies for dealing with discrepancies: specification, adoption of a code or regulation, obtaining details, providing consistency in description, using instances and counterpoints, and review of arguments. Besides, several legal disputes are resolved by scrupulously paying attention to keeping communication lines open between the parties involved in the dispute. Taking all these things into account if a similar situation arises in the clinical practice of the SN she can always use the communication strategy with the team members and an evidence-based approach in explaining her point of view in the situation (Gupta et al. 2017).
In the healthcare decision making, the involvement of different team members can bring about disagreements in the clinical issues. In such a situation it is important to take use of a rational framework for all ethical and legal aspects of medical cases. Failure to convey the viewpoint to the team members systematically in clinical settings can generate disputes among the team. a structured method to clinical ethical reasoning and effective communication is the only solution to come out of such problems.
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