Case Study:

Ms. Bell, aged 65 years, is under the care of RN Jane. Ms. Bell had a total hip replacement yesterday. She told Jane that her pain was intolerable, groaning loudly and saying, "Ohhh, I hurt worse than I have ever hurt before in my life, please help me, please, please, I can’t stand it anymore! Please give me something for pain now." When Jane assessed her level of pain, Ms. Bell described it as the highest level, 10 on a 10-point pain scale. Her blood pressure and pulse were slightly elevated compared to her last documented vital signs.

Jane checked Ms. Bell’s orders and found something unusual. The surgeon ordered her IV pain medication every 6 hours instead of the typical 3-hour frequency for patients with 1-day postoperative hip replacements. Ms. Bell would have to wait 3 more hours for her next IV pain medication. Jane returned to Ms. Bell’s room to explain the current pain order and inform her she would call the surgeon.

By then, Ms. Bell was crying out with pain and moving her head from side to side. Jane felt empathy and concern for her. She briefly tried to comfort Ms. Bell with words and acts of kindness but needed to quickly return to the unit to call the surgeon for a new order. When he answered, she began informing him of her assessment and the 6-hour interval order, but he abruptly interrupted her, stating, "I meant to order that medication every 6 hours. She does not need more frequent pain medication because of some past problems with prescription pain medications. Please do not call me unless you have critical information that needs my attention."

Jane was shocked, and many conflicting thoughts rushed through her mind. Why did he not want Ms. Bell to have more frequent pain medication, like other postoperative patients in his care? Was it really about her past use of prescription medications? Ms. Bell had a total hip replacement less than 24 hours ago and was in excruciating pain! Jane asked herself what she should do. After some reflection, she notified the nursing supervisor, who reviewed the case and decided to call the surgeon. The supervisor stated the surgeon seemed somewhat approachable and ordered a 1-time dose of IV pain medication to relieve her immediate pain. By that time, another hour had passed, so Jane administered the medication as quickly as she could to relieve Ms. Bell’s pain.

Question:

In the relationship between Jane and the surgeon, what ethical issues are present? To answer, explore the history and research on the nurse–physician relationship in the chapter. What bioethical principles did the surgeon violate with Jane and his patient, Ms. Bell?

In the relationship between Jane and the surgeon, several ethical issues are going on. The surgeon violated the bioethical principles of beneficence and patient autonomy. By ordering the IV pain medication every 6 hours instead of the typical 3-hour frequency, the surgeon compromised Ms. Bell's pain management and failed to prioritize her well-being. Furthermore, the surgeon's disrespectful and dismissive attitude towards Jane violated the principles of respect and professionalism in the nurse-physician relationship.

The surgeon abruptly and loudly interrupted Jane while she was trying to explain her assessment of Ms. Bell's pain and the 6-hour interval order. This demonstrates a lack of communication and respect between the two healthcare professionals. Jane felt empathy and concern for Ms. Bell's excruciating pain and tried to comfort her before contacting the surgeon. However, the surgeon's order for less frequent pain medication goes against typical postoperative protocols and may not adequately address Ms. Bell's pain. This raises concerns about the surgeon's patient advocacy and the prioritization of Ms. Bell's well-being.

StefaniJoanne StefaniJoanne · Answer 2 · 2024-10-13T22:34:17-04:00

Final answer:

Ethical issues between RN Jane and the surgeon include violations of the bioethical principles of beneficence, nonmaleficence, and autonomy in the management of Ms. Bell's postoperative pain, which highlight complexities in the nurse-physician relationship.

Explanation:

Ethical Issues in the Nurse-Physician Relationship

The nurse-physician relationship is an important aspect in the healthcare environment where collaboration and communication are paramount. In the case study provided, registered nurse (RN) Jane faces an ethical dilemma involving Ms. Bell's pain management post total hip replacement surgery. The ethical issues at play revolve around the principles of beneficence, non maleficence, and autonomy. These principles are fundamental to medical ethics, commonly referred to as bio ethical principles.

Violation of Bio ethical Principles :

The surgeon's decision to prescribe IV pain medication every 6 hours, against the typical 3-hour frequency, suggests a potential violation of the principle of beneficence, which dictates that healthcare providers should act in the patient's best interest. By not adequately addressing the patient's severe pain, the surgeon may also be violating the principle of nonmaleficence, which requires healthcare providers to refrain from causing harm. Finally, the principle of autonomy, which involves respecting the patient's right to make informed decisions about their own care, may be at stake given the lack of communication and consideration for Ms. Bell's current state.

Jane's professional response, which includes empathetic care and advocating for the patient by contacting the surgeon and then the nursing supervisor, exhibits a strong adherence to these ethical principles. However, the surgeon's dismissive response raises questions about his adherence to the ethical aspects of the healthcare profession. This discord exemplifies the complexities in the nurse-physician relationship, where power dynamics and differing views on patient care can lead to ethical conflicts.