Reference no: EM133662423

Assignment

Several nurses in a nursing team rotate through the same schedule in a busy Intensive Care Unit (ICU) of a major hospital. One of the nurses, Kathy, has recently been under extreme personal stress owing to the breakup of a relationship and the death of a close family member. Over the past four to five weeks, her colleagues have noticed occasions on which Kathy has arrived for the night shift smelling of alcohol. When the other nurses have raised their concerns with her, Kathy has explained that she had a glass or two of wine over dinner with some friends. As the weeks go by, these incidents increase in frequency. At times, Kathy's speech is slurred. The other nurses on the team hesitate to report these incidents to the nurse manager, as they do not wish to add to Kathy's stress. They hope that as she deals with her personal problems, this issue will resolve itself. To protect Kathy and to minimize the risks to her patients, the nurse in charge gives her easy assignments and sends her on a break whenever the night supervisor visits the unit.

In this ICU, nurses are expected to have and to use specialized skills and to perform certain delegated medical acts. As well, under the hospital's nursing standards policy, each nurse is subject to an annual review of knowledge and skills. Kathy is three months overdue for her annual review. The unit educator has scheduled it three times, but on each occasion, Kathy has cancelled, citing illness or heavy workload. It is unclear when her review can be rescheduled, since, as a result of budget cuts, the number of educators has been reduced.

One night, when Kathy again arrives smelling of alcohol, she is assigned a patient who is experiencing cardiac arrhythmias. During her shift, Kathy notes an arrhythmia on the patient's monitor, which she identifies as runs of ventricular tachycardia. In this unit, nurses have been delegated the act of administering lidocaine, a drug that treats such an arrhythmia. Kathy prepares and administers the intravenous bolus of lidocaine. A few minutes later, the patient has a respiratory and cardiac arrest. Fortunately, he is easily resuscitated.

Upon review of the patient's status, it is noted that he had, in fact, experienced supraventricular tachycardia, for which lidocaine is not indicated. Furthermore, one of the other nurses noticed that the empty drug ampoule contained pancuronium, not lidocaine. These drugs are contained in similar-sized ampoules, and the labeling is the same colour. Pancuronium causes paralysis and is used during general anesthesia or, sometimes, for patients who are being mechanically ventilated in an ICU. Clearly, the drug led to the patient's cardiac arrest.

Original Post:

Using your knowledge of ethical theories, use one of the ethical theories (ex. deontology, utilitarianism, bioethics, care ethics, relational ethics, feminist ethics, etc.) to explore this ethical issue. How does this ethical theory inform your understanding and selection of ethical actions to resolve the issue?

Consider at least one of the following questions below in your original post:

A. Do the nurses on the unit have an obligation to blow the whistle on Kathy?

B. What are Kathy's responsibilities for reviewing her knowledge and skills? What are the hospital's responsibilities, including those of the nurse educator? What responsibilities does the second nurse have to report that the incorrect drug was given?

C. Does the hospital have any obligation to disclose the occurrence to the family of the patient or to the patient himself?

D. Are Kathy, the hospital and/or the nursing team at risk of any legal, civil or criminal actions against them?

E. How do regulatory bodies such as the CNO, ensure safe and ethical care in this situation? How are the concepts of negligence and malpractice relevant to this scenario?