An Ethical Dilemma in the Health Care Setting Bobbi K. Handy HCS/478 November 29, 2010 Barbara Scheibe, RNC, MSN An Ethical Dilemma in the Health Care Setting Ethical dilemmas in the health care setting present themselves almost daily. It is imperative that the health care worker be able to understand when an ethical dilemma presents itself and know how to deal with the dilemma in the best interest of all involved. Many ethical dilemmas that health care workers face are difficult. There is no easy fix and often the result is upsetting.

Occasionally, an ethical committee is needed to offer solutions and direction. The primary ethical issues in the case study presented will be addressed as well as how to use the ethical principles to address the issues. Personal values and the ethical principles will be addressed and applied as well as how the situation may be handled if the patient were in a different health care setting. A professional nursing organization and how it incorporates ethical principles in their practice will be described. This case study describes an eight month old child in the emergency department with bilateral femur fractures.

It presents several ethical issues. The first ethical issue would be the possibility of child abuse by the mother or the day care. Second, the mother waited several hours before seeking care for her child and made no mention of the child’s thighs. The mother reported the child crying constantly for the last several hours, but did not mention looking to see what may have been the cause. The nurse expressed concern that the child may have been injured; however, made no effort to follow up. A case worker, social worker, or proper agency was not consulted.

The physician stated that he felt it was not child abuse so he did not report it. Health care workers are governed by law to report suspected abuse to the proper authorities (Fraser, J. A. , Mathews, B. , & Walsh, K. , 2009). The ethical principles that should be used to address the issues in the case study are autonomy, beneficence, veracity, fidelity, paternalism, and justice (Guido, 2010). The nurse should have used autonomy to protect the patient’s rights by making the decision to report the suspected abuse to the proper authorities, even if the physician did not agree.

Beneficence means to promote good and ensure the patient was treated properly. Veracity is the concept that people should always tell the truth. This ethical principle, if used by the mother would have been beneficial in that the staff could have identified the problem and began treatment earlier. The nurse and the physician should practice fidelity. By not reporting the situation with the child to the proper authorities, the nurse and physician did not keep their promise or commitment as health care workers.

The nurse could have also used paternalism in making the final decision to report the suspected abuse to the proper authorities. Paternalism removes the decision making from the patient or patient’s family. In doing so, justice would have been served ensuring the patient would have been treated fairly and the authorities would have been notified to investigate. Johnson (2002) states that child abuse is the second leading cause of death in children. It is imperative that health care workers can recognize and report suspected child abuse.

The determination of whether the child was abused cannot be made in a brief encounter in the emergency room. Personal values would lead one to think that the suspected abuse needed to be reported immediately for professionals in the field to investigate and make the required determinations on this case. In many states, it is considered breaking the law if a health care worker suspects abuse and does not report it. Educating the physician for future cases of suspected abuse is important. “All states provide immunity to professionals who report suspected child abuse in honesty and good faith” (“Advice, p. . n. ,” 1980, p. 1). Many health care settings fail to report child abuse even when presenting with signs of abuse or neglect. In 1986, approximately 56% of the cases were not reported (“Child abuse reporting,” 1996). Some of the failure to report can be attributed to complacency and some can be attributed to lack of education of the health care workers. The difference in outcome could also be attributed to cultural differences. Some states still allow the use of corporal punishment in the school setting.

Corporal punishment may cause complacency in health care workers when seeing bruising, especially if the parent is attributing the bruises to punishment at school due to unruly behavior of the child. The American Nurses Association (ANA) (2010) website states that they credential lifelong learning to enhance professional nursing excellence through standards, code of ethics, and professional development. The standards are viewed as authoritative statements by which professional nurses are accountable and provide direction. ANA also define accountability to the public.

The Code of Ethics for Nurses is a guide for nursing responsibilities to be performed in a quality and ethical manner. The American Nurses Association also clearly defines the nurse’s rights in the workplace as directed toward mandatory overtime and work fatigue. The highest principle, respect for others, has been placed as their first principle in their Code of Ethics for Nurses (Guido, 2010). This case study presents several ethical issues with just one short visit in the emergency room. A busy day in the emergency room can open up to many cases of ethical concern.

By using the ethical principles to address the issues, some conflicts could be addressed and resolved quickly and efficiently. Even while considering cultural differences, one must understand the main ethical principles and refer to other professional organizations for guidance when unsure how to handle a situation.

References Advice, p. r. n. (1980). Nursing, 10(9), p21-23. Retrieved from http://ehis. ebscohost. com/ ehost/pdfviewer/pdfviewer? vid=23&hid=5&sid=f9c9c297-18cb-4bf0-a486-704d4be444b0%40sessionmgr14. American Nurses Association. 2010). Nursing standards. Retrieved from http://www. nursingworld. org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards. aspx. Child abuse reporting. (1996). Society, 33(4), p40-46. Retrieved from http://ehis. ebscohost. com/ ehost/pdfviewer/pdfviewer? vid=4&hid=5&sid=f9c9c297-18cb-4bf0-a486-704d4be444b0%40sessionmgr14. Fraser, J. A. , Mathews, B. , & Walsh, K. (2009). Factors influencing child abuse and neglect recognition and reporting by nurses: A multivariate analysis. International Journal of


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