Question

Case 85: Inappropriate Touching in the Operating Room

You are giving anesthesia for a patient undergoing ankle surgery. The patient adeep and her vital signs are good. You look up and see that the podiatrie foot surgeon is at the wrong end of the table and appears to be fondling the breast of the patient.

You cant believe your eyes and ask, "What are you doing?"

The surgeon stops touching the patient and looks up with a surprised expression. The nurse and the podiatric resident who are present in the OR are widecyed. The surgeon stops the inappropriate behavior. The surgery then proceeds without any further problems.

At the end of the case after the podiatrist has left the room you ask the nune and resident if they also observed the same behavior. The nurse confirms your observation and states she will only report the incident if you report it too. You and the OR nurse meet with the head nurse of the operating room as well as the Chief of Surgery and recount the story. Both administrators request the observa- tions be put in writing as an incident report which you and the OR nurse do.

When the surgeon is confronted with this digression from acceptable profes- sional behaviors he has no reasonable or plausible excuse for his behavior.

USE INFORMATION FROM CASE TO DO A WRITE UP (PLEASE INCLUDE DETAILED EXPLANATION AND COMPLETE ALL 6 STEPS)

1 - Write a background statement

2- What are the major problems and secondary issues?

3- Your Role

4- Organizational Strengths and Weaknesses

5- Alternatives and Recommended Solution

6- Evaluation

THEIR IS AN EXAMPLE BELOW OF HOW THIS SHOULD LOOK!!!!

Case Write-Up

Background Statement

A Wiccan patient who visited a nondenominational community hospital was discussing her religious beliefs with her primary care nurse, Penny Baker, when suddenly another nurse, Ruth Goose, walked into the conversation and rudely stated, “Thou shalt not suffer a witch amongst you.” The Wiccan nurse felt offended and complained that she was discriminated in the hospital because of her religious beliefs.

Major Problems and Secondary Issues

The major problem is that the two nurses, Penny Baker and Ruth Goose, made the patient feel unwelcomed in the nondenominational community hospital because of her Wiccan religious beliefs. The secondary issues that the nondenominational community hospital may face is that the Wiccan patient is threatening to go to the media. This means that there may be news coverage that your hospital engages in religious discrimination. This may make people, especially Wiccans, look down on your medical services.

Your Role

In this case, I am the Vice President of Nursing Services. As stated in the text, it writes, “You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient, who is a Wiccan.” The advantages of this role are that I can sit down with Penny and Ruth to let them know that religious discrimination is not to be tolerated while we are caring for the patients. The disadvantages of this role are that I must decide how I am going to discuss this matter with Penny and Ruth because they’re passionate about being against the Wiccan patient. I need to let Penny and Ruth know that our patient’s care matters above everything else, not what religion they practice.

Organizational Strengths and Weaknesses

As the Vice President of Nursing Services, my strengths are that I can hold a training on racial, ethnic, and religious diversity. This training can supplement nurses with the information they need to work in a diverse environment. Nurses need to know that they must treat their patients justly despite their identity. The weaknesses I may face are that the two nurses are very religious themselves. They may not listen to what I have to say about religious discrimination because the two nurses try to justify their act by saying, “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?”

Alternatives and Recommended Solution

As a solution for this problem, I will make sure to provide all the nurses working in the hospital with diversity training. It is important that I sit down with the nurses and make it clear that discrimination will not be tolerated while they are working in our hospital. I can also offer every patient visiting the hospital with a survey. The patient can fill out the survey to let us know how they felt about their stay. Nurses who’ve been accused of any sort of discrimination, will have to speak with management. We would keep these incidences of discrimination in a file, and it the dilemma does not change, I would have to begin writing up the nurses. Discrimination would not be tolerated while the patient is in the hospital trying to recover from a medical condition. I would also recommend Penny and Ruth write an official letter of apology to the Wiccan patient before she decides to go to the media. Writing the official letter of apology would be my first recommended solution to Penny and Ruth, so that the patient does not feel unwelcomed to our hospital’s services in the future.

Evaluation

If there are enough surveys to prove that our medical treatment is getting better and there are less patients coming from the patients about discrimination, then I would know that the instances of discrimination have stopped. The goal is to aid in the medical recovery of patients. Patients must also feel welcomed to our hospital services despite their identity. By getting fewer, or even better, no discrimination complaints, I would know that my diversity trainings and meetings have worked.

Answer 1

CASE WRITE UP
1.Background Statement:
During podiatric surgery, the surgeon performed an inappropriate behaviour by fondling the breast of a sedated patient which he stopped on questioning by OR crew. This event was raised as an incident report by myself and OR nurse after discussing with head nurse and Chief of surgery.

2.Major Problems and Secondary Issues:
The major problem is that the surgeon misbehaved with his patient while she was sedated. When this event is raised as an incident report, Surgeon cannot defend his act since it is against the Codes of conduct and Ethics of health care. The secondary issues are that this news will reach the media and will attract huge public attention and this will cause disgrace for the hospital.This incident will cause terrible mental trauma for the patient.

3.Your Role:
As specified in the description, I am the anaesthetic who witnessed the incident along with the nurse and the resident. I have given an incident report along with the OR nurse regarding the surgeon’s misbehaviour towards the patient. The advantage of the role is that I am the direct witness of the incident so that I understand the depth and ethical violations of this incident. I can convey the exact details of what happened and can protect the interests of my patient. The disadvantage of my role is that I must decide how I am going to discuss this incident with my superiors and the patient. The patient may feel heart broken about what happened to her in the OR. I need to raise this issue and make the surgeon aware that his act is against the ethics of medical profession.

4.Organizational Strengths and Weaknesses:
As an anaesthetic, my strengths are that I can train my OR nurses and residents regarding medical ethics and codes of conduct. This training will help them to avoid non-ethical practices as well as prevent and report non ethical practices of others. The weaknesses I may face are that the patient herself is not aware of this incident as she was sedated, so when she comes to know about this incident she may feel insecure and helpless. Also, the surgeon may not accept his mistake and may give unnecessary excuses for his behaviour.

5.Alternatives and Recommended Solutions:
As a solution for this problem, I will make sure that all the staffs working in the hospital undergo training in medical ethics. Also a close monitoring of patients admitted to the OR through continuous video monitoring and supervision by ethical committee members. Those who behave unethically will have to produce an explanation in front of the management, has to undergo an internal enquiry and has to face illegal issues associated with the incident. So I would recommend the surgeon to confess his mistake to the patient and write an official letter of apology before she decides to go to the media. This may help the patient to recover from the emotional trauma caused by this incident.

6.Evaluation:
If there are fewer reports of unethical practices from the OR, I can understand that my interventions and ethics training has worked out. The goal is to make sure that every patient admitted to the OR has a safe and secure environment, so that they can feel free inside the hospital. Also, I can get feedbacks regarding ethical practices of OR staff, surgeons and residents from patients. If the majority of the patients report a satisfactory behaviour of OR crew then I can feed confident about my actions.