Reference no: EM133843758
You are a staff nurse working on a busy medical-surgical unit. The daughter of a patient, an 80-year-old retired nurse you cared for several days ago, comes to you to complain about a staff nurse taking care of her mother this evening. The patient had requested a stronger analgesic for a headache caused by a cerebral hemorrhage due to a high international normalized ratio related to Coumadin therapy. The physician ordered it at lunch time, and by 3 PM, it had not yet been administered. The daughter, upon arriving to visit her mother, asked that the medication be administered. She again asked a nurse to have it administered at 3:30 PM at the conclusion of the change of shift report and again at 3:45 PM. A nurse came to the room with the oral analgesic (Vicodin, hydrocodone-acetaminophen) but not with the morphine that had been requested by the patient. The patient then asked for the morphine because the Vicodin was ineffective. The nurse said that there was no order for morphine. The patient questioned the nurse because the physician had told her he would write the order. The nurse recommended that the patient take the Vicodin because it might take several hours to reach the physician and get the order processed by the pharmacy. The patient stated that she did not want to take the Vicodin because she would then be reluctant to take the morphine after the order was written because of the potential additive effect. During this time, the daughter, also a nurse, noticed that a morphine order was listed on the PRN screen on the computer used for medication administration and asked the nurse about it. The nurse replied that she did not see it and then went to prepare the morphine and subsequently administered it at 4 PM. At that time, the patient also asked the nurse why she wasn't receiving her 4 PM intravenous piggyback antibiotic. The nurse replied that she had taken the piggyback container out of the refrigerator to let it return to room temperature and that she would return with it. Subsequently, the antibiotic was administered 2 hours late, at 6 PM.
Questions:
1. What tenets of the ANA Code of Ethics for Nurses (2001) can be applied to this situation?
2. What would your initial response be to the patient's daughter? Provide a rationale.
3. The patient had two PRN medications ordered. Is it ever acceptable to tell a patient that nothing is ordered when this is not the case? Why, or why not?
4. Would it be acceptable to provide less than the morphine 2 mg intravenously if the nurse thought the dose was too high? Why or why not?
5. Are there any HIPAA concerns in discussing this situation with the patient's daughter?
6. What additional resources might be available in the institution to address the daughter's concerns about her mother's care?
7. If you speak to the patient and she indicates that she does not wish to pursue the matter, should the issue be dropped? Why or why not?
8. What is the mechanism for handling a patient complaint in your facility?
9. What strategies are in place to ensure that the patient care issue is addressed?
10. What needs to be done to ensure that the nurse's rights are protected?
11. How would you handle it if a patient reports an explanation (or action) provided by a staff member that does not make sense or is at odds with accepted practice and/or policy?
12. What should be included in an apology?
13. Who should make the apology in this situation?