Question

A 21-year-old woman presented to the emergency department of an urban hospital with a history of systemic lupus. Her complaint was dehydration, dizziness, and feeling faint. The woman also had a recent history of being dehydrated, complicated by renal involvement from lupus and having to receive bolus fluids. She was on multiple medications, including steroids and methotrexate. An intravenous (IV) line was started, and blood was drawn for labs. The emergency department physician returned to report that the lab values were within normal limits, yet the young woman felt no better. She stated that she still felt dehydrated, her blood pressure felt low, and she normally received more IV fluids and a steroid injection when she felt this way. The physician indicated that he felt no need for this treatment, but when the patient insisted on more fluids, he agreed to continue them for a while and to give her an injection of steroids. The patient asked, “Do you want to give me anti-nausea medication first?” The physician stated that there was no indication. The patient told him that she was always nauseated following steroids and had sometimes vomited if no antiemetic were administered first. The physician argued but finally grew tired and walked away. The steroid injection was given, and nausea ensued. When the patient got home a few hours later, the patient called her rheumatologist and urologist (neither had been available when the illness occurred because of the late hour). They repeated her labs the next day, only to find that she was severely dehydrated, and many values, including renal panel, were outside normal limits.

Case Questions What are the critical issues in this case description? Consider the six aims (STEEEP) to better ensure quality care. How might they apply to this patient? Is this patient-centered care? Why or why not? If you were the nurse assigned to this patient in emergency department, what could you have done?

Answer 1

The critical issue, in this case, is that the doctor is not listening to the complaints of the patient. This is one of the ethical issues that the doctor is not taking care of the patient. It is a kind of negligence. Always while taking care of the patient by the health worker, the most priority should be given to fulfill the needs of the patient. In this situation, the doctor is not giving priority to the need of the patient and not communicating and explaining properly to the patient. During this time, the patient can raise a voice against the doctor for not taking proper care. To prevent these issues the health care providers should care base on the priority need of the patient and proper therapeutic relationship, communication should be maintained between the patient and the health care workers.

STEEP means safe, timely, effective, efficient, equitable, and patient-centered care.

Safe: This will helps to avoid harm to the patient while taking care of the patient. Whatever intervention or actions used should be prevented from harm to the patient.

Timely: While delivering care to the patient, it should be done immediately and reduce waiting for the intervention to prevent any complication.

Effective: The facilities or the interventions should be provided base on the benefit of the patient. It should be effective after practicing the intervention for the patient.

Efficient: The hospital should be well equipped. so that all the resources available can be used for the treatment or caring of the patient. But always avoid unnecessarily wasted resources by using the appropriate resources available.

Equitable: The care of the patient should be provided in an equal manner. Every patient has equal chances to get the equal care. The health worker should not discriminate while taking care of the patient base of the culture, religion, gender, income, etc.

Patient-centered care: The care is providing a base on the need of the patient.

In this situation, the care provided by the doctor is not patient-centered care because the doctor is not listening to the complaint or needs of the patient. The patient complain of nausea after taking the steroid but the doctor is not listening means that the care is not given base on the need of the patient.

If the patient comes to the emergency department, the first thing to do is the treatment of dehydration as the patient is having severely dehydrated. Start administering Iv fluid to hydrate the body. Assess the condition of the patient. Performed physical assessment. Monitored the vital sign. Provide the psychological support to the patient. Explained the treatment process and lab values to the patient.