Question A

QSEN Reflective Practice: Cultivating QSEN Competencies CHALLENGE TO ETHICAL AND LEGAL SKILLS

While in a clinical rotation in my junior year, I was assigned the dreaded Jack Camp (I still remember his name). He was a middle-aged single man receiving care for a compound fracture of his left lower extremity being treated with an external fixator. He had a bad case of diabetes, and an even worse sweet tooth. Before I even met him, the nurses on the floor were saying things like “good luck,” which made this junior nursing student extra paranoid (although I was grateful for the warning). The patient was known for voicing loud complaints about his room, the food, and the hospital routine. He also was using his call light very frequently. The nurses called him names and discussed their dislike of him in the nurses’ station, which was in the center of the unit. As the day progressed, I found out that all this patient wanted was some attention, because he was used to running things in his business. I actually found him entertaining. Thinking Outside the Box: Possible Courses of Action Ignore the comments of the other nurses on the floor, hoping that no one else hears them. Report the nurses to my clinical instructor, possibly causing tension on the floor. Politely tell the nurses to keep it down and refrain from talking about the patient, risking my own comfort level; after all, I am only a visiting student—what do I know? Evaluating a Good Outcome: How Do I Define Success? Act as a patient advocate despite my limited power, which means correcting unethical behaviors as cordially as possible. Have the courage to go to the next level if the nurses’ behavior is not corrected. Inform the patient politely to modify his behavior. Personal Learning: Here’s to the Future! My response was to ignore the nurses’ comments and hope no one else heard them either. I was not courageous enough to be the patient advocate that we had been taught to be. I knew my response should have been to ask them to keep it down, which would allow them to maintain their personal opinions while at the same time keeping the comments from jeopardizing patient confidentiality. From this experience, I learned that you have to be a leader, speak up, and take the risk. Part of that means being able to go against the group, risking being ostracized. In doing so, others may follow your lead, but if they choose not to follow, at least you know you advocated for your patient. Since this experience, I have not been in a situation that has challenged my personal ethics, but I have the self-confidence to believe that I can be the leader that I spoke so passionately about.

Then, answer the following questions:

1) How do you think you would respond in a similar situation? Why?

2) How do you think the nursing staff would have reacted had the nursing student approached them regarding their comments about Mr. Camp?

3) How could the nursing student initiate improved communication between Mr. Camp and the nurses working on his unit?

Question B

Nursing Advocacy in Action

Patient Scenario Everybody loves Sarah. Mature for her 9 years, Sarah has advanced leukemia, and her only medical hope now is to transfer to a hospital 3,000 miles from home that has the bone marrow that she needs. There are, however, several problems. Sarah’s family is homeless and visits rarely. She makes excuses for them—saying how hard it is to be on the street and always trying to find shelter—but she couldn’t hide her disappointment when no one visited on Christmas and her birthday. You have met the parents and were struck by their immaturity. Sarah’s health care provider is working passionately to get Sarah to the transplant center; the latest hurdle is ensuring that they will accept her given the fact that the family has no insurance or finances. Many of Sarah’s professional caregivers aren’t sure that the bone marrow transplant is a good idea. It is doubtful the funds would be found to send any of her family with her, and the possibility exists that, if unsuccessful, she could die at the transplant center surrounded by strangers. You mention these concerns to Sarah’s doctor, who replies, “But this is her only hope for cure!” Implications for Nursing Advocacy How will you respond if you are Sarah’s nurse? Talk with your classmates and experienced nurses about the questions that follow. If you elect to advocate for Sarah, what practical steps can you take to ensure better health outcomes? What is it reasonable to expect of a student nurse, a graduate nurse, and an experienced nurse in this situation? What advocacy skills are needed to effectively respond to this challenge?

Answer these questions

1) If you elect to advocate for Sarah, what practical steps can you take to ensure better health outcomes?

2) What is reasonable to expect of a graduate nurse in this situation?

3) What advocacy skills are needed to effectively respond to this challenge?

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