Ethical dilemma

[um elias]

last course, i had seen an incident that put in my mind a big question about right and wrong things in the field of nursing practice.

the incident was about administering morphine injection to a patient diagnosed as multiple myeloma and complains of pain all over his abdomen and flank areas.

while the staff nurse m.a was preparing the morphine ampoule, it falls from her hands and broken, i saw the incidence so i informed a senior staff about it and she suggests taking it to the pharmacy and bringing new one, but m.a refused to take it to the pharmacy to avoid the process of reporting including writing accident report.

m.a said" why i have to bother my self, i am sure that he will ask again for morphine, so i will sign in the medication sheet like i gave him and since the patient is having due distalgesic q 6 hrs, i will give him his due distalgesic and after 4 hours if he asks again i can give him morphine injection".

when i heard her i get shocked, i was staring at her and thinking who she will left the patient in pain, the patient was not my assign that day, but i knew him, the distalgesic will not relieve his pain.

because i am student the nurse ask me to take the distalgesic for him to avoid facing him, but i explain for her that this is not professional and violate nursing ethics and i refuse to take the tablets, so she took the tablets for him and when he asked her about the injection she said "morphine injections are not available now, so i will give your due distalgesic now and if they supply morphine, sure i will give you the injection".

can u help me to find literatures about this ethical dilemma and i will be very thankful ..

[um elias]

my instructor knows, that is why i am asking about literatures help

in this issue, because i am gonna write about it ..

thanx

[Woodenpug, BSN]

You probably won't find anything in current literature to support the ethical questions. It should be adequate to find definitions for the various ethical principles and then describe how they were violated. To me these principles were violated:

1. Beneficence. The nurse failed to do good by not adequately treating the pain.

2. Non-malfeasance. The nurse caused harm to the patient by charging the patient for a medication the patient did not receive.

3. Self-determination. The patient was not informed of the error and thereby not able to make an informed decision about his treatment.

4. Advocacy. The nurse and you did not consult a pain management specialist or other M.D. to find adequate pain control for the patient. Refusing to pass the other medication was a weak attempt at advocacy. Advocating for the patient better would have been to address the problem up the chain of command until the patient was adequately medicated or you understood the reasons for not adequately medicating the patient. (It's O.K. we all make ethical errors and this one is understandable, you did well under the circumstances. I have found that instructors like it when we point a finger at ourselves.)

5. Justice. In this case, I think it overlaps with non-malfeasance. You could try the distributive justice angle here as per my earlier post.

That's from the top of my head, I'm sure you can find more. Once again, the supporting literature is any place you have definitions for the ethical principles. In school, I used my Nursing leadership and management text book, by a similar title.