The selected case study for analysis is “Incident 9: The Missing Needle Protector.” The case study is about a patient safety issue. The case study focuses on a surgery that Dr. Cutrie conducted and it is suspected that a needle protector remained in situ following the surgery. A recount performed after a week revealed that the plastic needle protector was missing, leading to suspicion that it might have been left in the patient’s abdomen. The only solution at the moment of discovery was to take the patient to the theater for a reassessment and determination of whether the plastic needle was left or not. In doing this, the administration of the hospital in collaboration with the management team was to lie to the patient that they wanted to check the incision and deep suture. However, the patient has already been discharged home. The supervisor already talked with the surgeon, Dr. Cutrite, who said that nothing could be done. Dr. Cutrite affirmed that the plastic syringe protector could not possibly hurt the patient except for some discomfort. The surgeon also affirmed that the patient would not know about the left object. The chief of surgery held similar assertions, as he did not want to confront Dr. Cutrite. Therefore, this experience and issues surrounding it raises significant ethical concerns and principles that should be considered in healthcare practice.
As noted above, the case study involves the Hopewell Hospital, Dr. Cutrite (surgeon), E. L. Straight (director of clinical services), the operating room supervisor, Mrs. Jameson (the patient), scrub nurse, and chief of surgery. In applying the ethical decision-making model, nurses must consider the three steps of analyzing ethical situations that include moral awareness, moral judgment, and ethical behavior. Moral awareness entails the identification of the fact that a situation has a moral issue. Moral awareness arises from the individual experience of the feeling that something is wrong. Moral awareness also begins when a person discovers that a violation of ethical principles has occurred in practice. Moral awareness can be seen in the case study from the actions of the operating room supervisor. The supervisor discovered the missing plastic syringe and reported the issue because he felt that failing to act could threaten the health of the patient. The supervisor therefore took the responsibility of informing the director of clinical services about the safety issue. The actions by other actors in the case study that include the scrub nurse, surgeon and chief of surgery also demonstrate moral awareness. These actors were all aware of the risk of the plastic syringe being left in situ. However, they failed to take action to ensure it is addressed.
Moral judgment is the second step in ethical decision-making. Moral judgment refers to the process where an individual decides whether to take action or not in relation to standards of rightness or goodness. The perceived outcomes of a decision influence whether an individual will take an action or not. Moral judgment can be seen in the actions taken by the key actors in the case study. The operating room supervisor utilized moral judgment in decision to report the safety issue to the director of the clinical services. It can be seen from the supervisor’s action that his aim was to promote rightness and goodness of the patient. The surgeon, scrub nurse, and chief of surgery however chose to take no action despite being aware of the safety issue. Their inaction could be attributed to their perceived consequences of the error on their professional practice. For instance, it can be seen from the case study that the inaction from these personnel could be attributed to the legal consequences of their fault in patient care. Ethical behavior focuses on the selection of the most fair and appropriate decision to address the issue in the case study. The operating room supervisor demonstrated ethical behavior in responding to the safety issue. The decision to report the issue demonstrates integrity, honesty, and fairness in the protection and promotion of patient health and safety in the organization. The other healthcare providers that include the chief surgeon, surgeon and the scrub nurse did not demonstrate ethical behaviors due to their inaction (Ulutasdemir, 2018). Therefore, a direct correlation exists between the three steps of ethical decision-making.
A number of factors contributed to the issues in the case study. One of them is the lack of patient safety policies in the hospital. Patient safety policies such as recounting equipment at the end of the procedures could have led to the identification of the problem. The second factor is the existence of poor communication between the management and the staffs. The director of clinical services is aware about the declining quality of care that Dr. Cutrite offers. Ho
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