Nursing Case Studies: Ethical Dilemmas and Medication Assessments

This assignment presents two short case studies reflecting on nursing practice during clinical placement. The first case study focuses on an episode of care involving pain management after medication administration, highlighting the student's inexperience, lack of guidance, and an ethical dilemma concerning patient suffering. The second case study explores an ethical dilemma faced when disclosing a patient's deteriorating health condition to their family, emphasizing the importance of ethical principles like fidelity and non-maleficence. Both case studies include references and reflect on the challenges and complexities of nursing care, emphasizing the need for knowledge, communication, and ethical decision-making in patient care.

RUNNING HEAD: SHORT CASE STUDIES
SHORT CASE STUDY
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RUNNING HEAD: SHORT CASE STUDIES
Topic 2: An episode of care where you complete an appropriate assessment following a
medication you administered
In the current scope of reflection vignette, I will discuss my experience in patient care
during my clinical placement (Saunders, Dunn, Merrill, Sullivan, Weisner, Braden, Psaty & Von
Korff, 2010). I was given the responsibility to handle two aged patients along with a Registered
Nurse. Bothe the aged patient was experiencing extreme pain and was given relief with pain
medication. One of the aged patients had experienced fall whereas the other patient had been
operated on. The patient had been provided medication post evaluation and risk assessment of
their condition; however the pain failed to subside. Both the patients wanted immediate relief
and I being an inexperienced nurse was not able to understand how to provide them immediate
relief. The RN was absent for some time as she had gone to finish her dinner and I did not have
adequate knowledge regarding procedure to manage pain. I feel that I should have read the
standards for practices related to pain management handling risks in such extreme pain (Herr,
Coyne, McCaffery, Manworren & Merkel, 2011). When the RN returned she behaved with me
rather rudely and did not guide me on ways to provide adequate care to the patients.
While handling the patients, I felt rather helpless and tried to provide them with adequate
mental support. I feel there was extreme stress prevailing as I was unable to handle and take care
of my regular duties. Due to my inexperience and lack of proper guidance from RN or
communication from other nurses in the department, I was not able to take proper care of the
patients (Hickman, Nelson, Perrin, Moss, Hammes & Tolle, 2010). From this experience I feel
that every nurse need to have adequate knowledge in pain management as specified in the
National Safety and Quality Health Service (NSQHS) Standards. The guidance for practice for
nurses to have a proper understanding related to the health systems and the individual. I
understood from this experience that nurses need to work hand in hand with clinicians and other
staffs and there should be proper communication regarding the same. This would allow nurses
who are appointed in duty to deliver appropriate care to patients and relieve their pain. Especially
in cases of pain in aged care, there needs to be adequate care provided which includes
psychological as well as physical care. In absence of such care, there might be greater risks at
which the patient might be exposed to.
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RUNNING HEAD: SHORT CASE STUDIES
Reference List
Herr, K., Coyne, P. J., McCaffery, M., Manworren, R., & Merkel, S. (2011). Pain assessment in
the patient unable to self-report: position statement with clinical practice
recommendations. Pain Management Nursing, 12(4), 230-250.
Hickman, S. E., Nelson, C. A., Perrin, N. A., Moss, A. H., Hammes, B. J., & Tolle, S. W. (2010).
A comparison of methods to communicate treatment preferences in nursing facilities:
traditional practices versus the physician orders for life‐sustaining treatment
program. Journal of the American Geriatrics Society, 58(7), 1241-1248.
Saunders, K. W., Dunn, K.M., Merrill, J.O., Sullivan, M., Weisner, C., Braden, J.B., Psaty, B.M.
and Von Korff, M (2010). Relationship of opioid use and dosage levels to fractures in
older chronic pain patients. Journal of general internal medicine, 25(4), 310-315.
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RUNNING HEAD: SHORT CASE STUDIES
Topic 6: A situation where you perceived an ethical dilemma, either affecting yourself or a
patient under your care
Nursing care can be very complex at times, especially when it requires interacting with
patient parties (Koocher & Keith-Spiegel, 2008). During my clinical placement, I was once given
the responsibility of a patient, who was facing morbidity and end of life care in a case of
carcinoma. Though the patient was in a critical stage, the aged patient of 75 years of age was
allowed visitors from his family every day. I had to disclose to his family regarding his
deteriorating health condition to his aged wife and only daughter. Other nurses and staffs in the
ward were apprehensive to disclose information to the patient related to his condition. Every
staff and nurse was however, very concerned regarding his deteriorating health condition. At this
stage I faced ethical dilemma of whether or not to disclose the truth to the patient or be
deceptive. Often many families request that the patient be not told regarding the situation faced
by the patient regarding his medical condition. Though the patient has every right to know
regarding his medical condition, it imposes immense challenges on the nurse in telling the
patient regarding his medical condition (Wu, Huang, Stokes & Pronovost, 2009). I feel that every
nurse has an obligation towards the patient to disclose information according to ethical principles
of fidelity and non-maleficence.
Evaluating the various health complications and the condition of the patient’s health, I
decided that I will disclose the truth. I felt that it is important that nurses acts ethically according
to principles and be faithful to the patient as well as to colleagues. Non-disclosure of information
at this stage could have led to depriving the family during key times at the last moment. I
gathered all my mental strengths to disclose entire facts to the patient (Gallagher, Bell, Smith,
Mello & McDonald, 2009). As I feel that while working with patients, there would be many
occasion where there would be need to deal with nursing ethics during difficult situations. From
my experience and learning during my course, I gathered that nurses in varied departments face
varied ethical issues where they have to reconcile own values along with professional obligations
in nursing. In case any nurse is unable to reconcile such differences, there might arise a
challenge. In the view of such challenges, I decided to disclose all relevant information regarding
the patient condition to him. Though it was very difficult for me yet I took all the reports and
provided them with a brief of his condition. After disclosing of information, I also felt relieved.
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RUNNING HEAD: SHORT CASE STUDIES
Reference List
Gallagher, T. H., Bell, S. K., Smith, K. M., Mello, M. M., & McDonald, T. B. (2009). Disclosing
harmful medical errors to patients: tackling three tough cases. Chest, 136(3), 897-903.
Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health
professions: Standards and cases. Oxford University Press.
Wu, A. W., Huang, I. C., Stokes, S., & Pronovost, P. J. (2009). Disclosing medical errors to
patients: it’s not what you say, it’s what they hear. Journal of General Internal
Medicine, 24(9), 1012.
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