Posted: March 21st, 2022

Clinical judgment and ethics part 2

Clinical judgment and ethics part 2
Please provide feedback to two of your colleagues. It is critical that we as health care providers work in a culture of safety. We need to encourage each other to create a health care environment that promotes safe, quality care.
Today more than ever are we reminded of what a medical error can incite within the healthcare field and in individuals’ lives with the recent circumstances of the RaDonda Vaught trial. The case study involving Dr. Jones, Nurse Smith, and Joe highlights the circumstances that led to an unfortunate and preventable patient outcome.
The patient Joe came into the clinic complaining of right ankle pain after falling while taking care of his chickens in the chicken coup. His complaints consisted of cuts and bruises on both legs and a swollen right ankle. Dr. Jones and Nurse Smith had instructed him to purchase an air cast for his right ankle as well as some ibuprofen. However, there was never a documented assessment of his left leg, follow-up appointment, or further instructions if his condition worsens. The two healthcare professionals only attended to and focused on the right leg, despite complaints of cuts and bruises on both legs. If they had assessed both, they would have seen the cut on the left leg prior to it becoming infected and leading him into septic shock. A full assessment needed to be completed to ensure all factors/complaints were addressed.
The circumstances of the patient’s injury should have also been considered. The patient was a known diabetic and stated that he had fallen into the chicken coop with cuts afterward. Diabetes can reduce the ability of the skin to heal itself and small cuts such as those on the feet can develop into diabetic foot ulcers which are vulnerable to infection and other serious complications such as lower limb amputations, disability, and death (Reynolds, 2020). This factor in itself puts Joe at a higher risk for infection and the setting of the accident being a chicken coop is an additional factor that greatly increases the risk for infection even more. The doctor could have prescribed Joe an antibiotic that may have prevented the infection from developing into septic shock leading to Joe’s unfortunate death. These factors along with a complete body assessment should have been considered and completed to prevent this from occurring.
I believe that Dr. Jones and Nurse Smith do have an ethical obligation to admit an error. As healthcare professionals, we are first and foremost trained to do no harm- essentially meaning to do what is best for the patient and to avoid harm. An error can be harmful to the patient, however covering it up and not reporting it to the provider and/or the patient can be even more harmful. Two ethical principles guide this- autonomy and nonmaleficence. “The principle of respect for autonomy directs the doctor to disclose errors to patients since it gives patients an insight into what is going on” (Edwin, 2009, p. 38). Patients have the right to be involved in their care and informing them of errors facilitates this principle. The ethical principle of nonmaleficence directs healthcare providers not to harm patients. “The doctor or health institution that fails to disclose an error consequently causes a ‘double jeopardy’ by delivering substandard care as well as failing to inform the aggrieved party, thereby depriving the part of a just recompense” (Edwin, 2009, p. 38).
The ANA Code of Ethics also holds nurses to an ethical obligation including admitting and accepting responsibility for an error. There are two provisions that uphold this obligation which are provisions 5 and 6. Provision 5 states “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth” (American Nurses Association, 2015). Provision 6 states “The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action” (American Nurses Association, 2015). Being a part of the nursing profession, it is expected that one holds themselves to these standards and admits when errors occur as they did in this case.
While admitting and accepting responsibility for an error in the medical field is daunting, there are possible benefits that can arise from doing so. New policies and procedures can arise from reflecting on how and why an error occurred. A plan of care is typically developed to help prevent the same error from occurring again. Having the healthcare provider and their team reflect on why the error occurred can also help to make changes in their own daily practices to reduce the likelihood of an error. “Accepting the contributions of team members, reducing barriers to reporting errors, and promoting a work environment where all individuals work together will have the most significant effect on improving patient and staff safety” (Rodziewicz, Houseman, & Hipskind, 2022, p. 66).
Patient safety and the reduction of harm is one of the most important and focused on aspects in the healthcare field today. This case study highlighted what can happen when things are missed and not acted upon, which can ultimately lead to ill-fated patient outcomes. It is more important than ever that as healthcare professionals we ensure we are doing the best practice for our patients and the most that we can to prevent harm. Admitting and accepting responsibility for our mistakes is terrifying, given the verdict of the RaDonda Vaught trial, but we must uphold ourselves to be ethical and do what is best for our patients.

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