Ethical Dilemma

[lilfayfay]

Does this sound like an ethical dilemma? I'm not sure what grade my teacher gave me but I did my calculations on my overall grade in Blackboard and it seems like she gave me a 2/40 for the assignment. The ethical dilemma was the last assignment to be graded. Throughout this Thanksgiving weekend my grade dropped from a 75% to a 73.12% to a 71.93%. I need a 73% to pass and clinicals is over. I don't get it, my teacher told me on the last day of clinicals that I passed but I had 1 more assignment to turn in which was the ethical dilemma, worth 5% of my grade and worth 40 points. Do you guys think this might be a typo? If she only gave me 2/40 points on the assignment, shouldn't she have just given me a 0% for the assignment? Is the 2 points just writing down my name? I'm so sad, angry, and confused. I feel like all of my hard work throughout this semester was all in vain. Anyways, here's my ethical dilemma.

1. Identify the clinical setting the situation occurred in. Describe the situation and ethical conflict in detail. You will not receive full credit if you do not describe the complete clinical setting/situation along with the ethical conflict. (4 points)

The clinical setting was in the Labor and Delivery Unit at X Hospital. The patient was diagnosed with Gestational Hypertension and was given Hemabate and Cytotec to control her postpartum hemorrhage. The patient was feeling nauseous, had vomited, and had constant, heavy diarrhea due to the Hemabate and Cytotec. Methergine was not given to control her postpartum hemorrhage because the patient had gestational hypertension and Methergine could have the potential of increasing her blood pressure even more, leading to a stroke. If the patient did not receive Methergine, then she would lose electrolytes and water from the vomiting and the heavy diarrhea caused by the Hemabate and Cytotec. The loss of electrolytes would affect her heart by causing dysrhythmias, and the loss of water could affect her kidneys from dehydration. The nurse gave the patient medications to control her vomiting but none were given to help control her diarrhea. When I came back from lunch and went inside the patient's room, the patient was sitting in a huge pool of diarrhea and the room smelled horrible.

2. Select the top 3 Principles/Rules of Healthcare Ethics involved and describe them in detail utilizing references. (16 points)

The top 3 Principles/Rules of Healthcare Ethics involved are Autonomy, Beneficence, and Nonmaleficence (American Nurses Association, n.d.). Autonomy is allowing the patient to choose the treatment of his or her choice (American Nurses Association, n.d.). Before the patient started pushing, the patient should have been informed of the potential of a postpartum hemorrhage, and the medications available to control the postpartum hemorrhage such as methergine, cytotec, and hemabate, along with the contraindications, side effects, and possible outcomes. After the patient's education, the patient should be allowed to decide which medications to use in her treatment. Beneficence is to promote wellness in our patients (American Nurses Association, n.d.). The nurse should have gave the patient medications to help control her vomiting and diarrhea. Nonmaleficence is to avoid hurting the patient (American Nurses Association, n.d.). The nurse should have monitored and consistently cleaned and changed the patient due to her heavy, constant diarrhea to prevent skin breakdown.

3. Select the top 3 AWHONN Standard X. Ethics involved in this issue and describe them and how they specifically relate to your ethical conflict (in detail). You must utilize references. (16 points)

The top 3 AWHONN Standard X Ethics involved in this issue are promoting patient advocacy and helping them learn the skills to maintain their advocacy, compassionately delivery patient care to promote their dignity, and safety, and protecting patients from unethical healthcare decisions and practices (Association of Women's Health, Obstetric, and Neonatal Nurses, 2009). Promoting patient advocacy and helping patients learn the skills to maintain their advocacy as well as compassionately delivering patient care to promote their dignity, and safety (Association of Women's Health, Obstetric, and Neonatal Nurses, 2009) relate to my ethical conflict because when I came back from lunch, my patient was sitting in a large pool of diarrhea and the room smelled horrible. The nurse should have consistently monitored the patient helped changed her chucks, and made sure the patient had her call light in reach so the patient could call for assistance whenever possible if she had another episode of diarrhea. Protecting patients from unethical healthcare decisions and practices relates to my ethical conflict because the doctors and nurses chose the treatment option for the patient instead of letting the patient choose what treatment option was best for her. Before the patient started pushing, the nurse should inform the patient of the potential for a postpartum hemorrhage, the medications available to control the postpartum hemorrhage such as methergine, cytotec, and hemabate, and their contraindications, side effects, and possible outcomes.

If known, describe the actual outcome. If known, then points will be deducted for choosing this ethical dilemma. (4 points)

Before my nurse and I handed the patient to the postpartum nurse, the patient still felt nauseous and had diarrhea. However, she was able to get up to the bathroom and urinate with our assistance.

[Sour Lemon]

An ethical dilemma that revolves around diarrhea is questionable. I hope the 2 is not accurate, but I fear that it might be.

[Shanimal]

Before you get yourself too worked up you should discuss the discrepancy with your instructor. Nursing faculty are human too and can make data entry mistakes. I've caught a couple assignment grading mistakes over the course of my college career and after (nicely) inquiring about it, the mistakes were quickly corrected. Easy fix.

[Ruas61, BSN, RN]

Good grief. My mind is boggled at the education system in nursing once again. I hope it is a typo.

[seaofclouds21, BSN, RN]

I would definitely talk to your instructor about the grade to be sure it is accurate. That being said, I have trouble finding the ethical dilemma in your post. Instead, I have many other questions, like was there a reason they didn't want to give medications to control the diarrhea (allergies, risk of passing through breast milk to child, etc) and how long had the patient been sitting in her diarrhea when you found her? If how you worded things here is how you wrote your paper, you never clearly stated what the dilemma was. Are you claiming the ethical dilemma was that the patient did not get to choose her treatment, the lack of diarrhea control, because the patient wasn't cleaned up in a timely manner, or something else?

[Castiela]

What you've described in the for your assignment isn't really an ethical dilemma which is possibly why you failed the assignment. An ethical dilemma is when you are trying to make treatment decisions which do not have a clear right or wrong answer - do you incubate a patient with stage 4 cancer who is having respiratory distress but the cancer is incurable so you're only prolonging their life and decreasing their quality of life? What if the patient and the family insists on it etc.

The situation you are describing is more related to the nursing process and critical thinking. In the scenario you described, the nurse chose to withhold a medication because it would cause more harm to the patient. She withheld something which caused the patient some discomfort but prevented negative adverse effects. As nurses, we do this all the time. I'll hold narcotics despite the patient or the family requesting them if they are drowsy and their rr is 10. I might try some Tylenol and I will continue to reassess the patient. As nurses, are expected to use our critical thinking in making decisions about medications and care provided instead of blindly following orders. it isn't a one time decision either. Once you decide to withhold a medication, you are continually reassessing the patient to see if the patients status changes so they can receive their medication, or you follow up with the doc and request a change in the care plan.

Finally, I don't know if you pared down your response to post it online but what you responded with for each question but from what you write, you did not write enough to justify the amount of points per question. I'm sorry that you failed this assignment but I feel it was rightly so

[lilfayfay]

I had normal patients, I couldn't really think of anything else as obvious as your example besides this one. This ethical dilemma assignment was based on my L&D/PP/NICU rotation.

[Castiela]

I would talk to your instructor and explain that. I know when I was a student, if I didn't have direct experience with an essay question required either the instructor would have me "borrow" one from a classmate or create one to write about. Maybe your instructor would let you do a second attempt at the assignment?

When I first read your paper, it seemed like you didn't have a grasp of what an ethical dilemma was. Maybe your instructor had the same thoughts? It rarely hurts to talk to you instructor about it

[lilfayfay]

My grade was originally a 75.45% before the assignment and was changed to a 73.12 after she graded it so I think originally she put down 11.5/40 which is a 28.75%. But then 2 days later my grade changed from a 73.12% to a 71.93% so that means she changed her mind and gave me 2 points, a 2/40 which is a 5% for the assignment. I'm just hoping it's a typo and maybe she meant to put a 12/40 or 20/40 or just accidentally erased my grade and put down a 2 on there when she submitted it again because my grade for my ethical dilemma isn't showing up on Blackboard anymore and that was the last assignment that needed to be graded on Blackboard. Do you really think 2 points was justified? If so, she should've just given me 0 points out of 40 points for the assignment then. I also didn't receive an email from my my clinical instructor or my instructor that's the head of the L&D clinical rotation in calling my attention to this, maybe because it's the Thanksgiving weekend and didn't have the heart to tell me?

[lilfayfay]

I texted both the head of my L&D clinical rotation and my clinical instructor, and only the head instructor of my L&D clinical rotation responded back by saying that she'll take a look at it Sunday night since she's out of town for the break. My main clinical instructor hasn't responded back to me yet.

[Rose_Queen, BSN, MSN, RN]

I texted both the head of my L&D clinical rotation and my clinical instructor, and only the head instructor of my L&D clinical rotation responded back by saying that she'll take a look at it Sunday night since she's out of town for the break. My main clinical instructor hasn't responded back to me yet.

Well, it is a holiday and your situation isn't an emergency. Personally, I would have waited until classes were back in session and spoken to the instructor face to face.

[macawake, MSN]

OP, is this how you turned in your assignment? Or is it an abridged version?

I'm not a native English speaker so I might be missing some of the finer points/misreading this, but these are my 2 cents for whatever they're worth.

One piece of advice that I would like to share with you for future assignments is this: when I was in school, the last thing I did before I turned in an assignment was to check and double-check that I had actually answered the questions that were asked.

Does this sound like an ethical dilemma? I'm not sure what grade my teacher gave me but I did my calculations on my overall grade in Blackboard and it seems like she gave me a 2/40 for the assignment. The ethical dilemma was the last assignment to be graded.

I'm sorry, but it's not really possible for us to know if the 2/40 is the grade your teacher intended or if it's some type of typo. We can only guess.

1. Identify the clinical setting the situation occurred in. Describe the situation and ethical conflict in detail. You will not receive full credit if you do not describe the complete clinical setting/situation along with the ethical conflict. (4 points)

After I read your reply I wasn't even sure exactly what the ethical conflict was. Read your own answer and see if you think that you've clearly described/identified the nature of the conflict (and the clinical setting/situation).

If how you worded things here is how you wrote your paper, you never clearly stated what the dilemma was. Are you claiming the ethical dilemma was that the patient did not get to choose her treatment, the lack of diarrhea control, because the patient wasn't cleaned up in a timely manner, or something else?

OP, this is what I was asking myself as well after reading your answer to 1). I think you need to be more precise when you attempt to describe the conflict you've identified.

2. Select the top 3 Principles/Rules of Healthcare Ethics involved and describe them in detail utilizing references. (16 points)

This part of the assignment asks you to select three principle rules of ethics and describe them in detail. The way I interpret this is that this wasn't the place to discuss the various meds your patient was given or symtoms she had or really anything about the patient. This asks specifically about ethical principles. The actual principles, not how they relate to your patient. It's a patient-neutral question, not patient-specific. You can get sixteen points for this question so when it asks you to describe the ethical rules and describe them in detail, I think more detail was required.

If you remove the information about the various drugs and what information the patient received or didn't receive (which is repeated in your answer to number 3) anyway), all that basically remanins is a bare-bones definition of autonomy, beneficence and non-maleficence.

3. Select the top 3 AWHONN Standard X. Ethics involved in this issue and describe them and how they specifically relate to your ethical conflict (in detail). You must utilize references. (16 points)

This is where I believe you should have tied the two concepts together. Your specific patient/identified situation-specific ethical conflict and the chosen top three ethical standards. Again, you can get sixteen points for this question. That implies that they were looking for much detail ánd discussion. And clarity.

Still, the third question is where I think that you got closest to actually answering the question asked. Even though I'm still not sure what the ethical conflict was, here I see you linking the three chosen ethics standards with the patient in your case.

As I started off by saying I might be misinterreting your assignment, but this was my take on it.

Well, it is a holiday and your situation isn't an emergency. Personally, I would have waited until classes were back in session and spoken to the instructor face to face.

I think that's good advice.

I understand that you might feel anxious and want answers as soon as possible for peace of mind, but I agree with Rose_Queen, this is better handled face-to-face.

Take care and good luck!