Week 3-4 Assignment: Ethical Dilemma Case Study : Select one of the three scenarios below. Present the scenario and discuss why it is an ethical dilemma. Apply an ethical decision-making model (see the supplemental Week 2 resources) to the dilemma (the Nelson, 2005 is recommended). Be sure to include your decision after applying the ethical decision-making model which at a minimum requires discussion of the following elements:

• Dilemma introduction and discussion regarding why this is a dilemma (right versus right with the ethical principles in conflict)
• Stakeholder identification and perspectives
• Options for resolution (including discussion of the ethical basis for each option)
• Option selected with rationale
• Plan for implementation and consideration of evaluation methods
• Discussion of the potential impact of moral distress on decision-makers

The paper must be submitted in APA format (see template posted in the course assignment area) and must be written in third person. Paper length 1200-1500 words. A minimum of five valid resources cited and referenced in APA format is required.

Scenario #1: To tell or not to tell “Bad Blood”: You are the CEO of a hospital and just arrived to work on Monday morning. Janice, a well-respected and skilled nurse is also a family friend arrives in your office. Janice practices in ICU. Janice appears visibly shaken and stressed. She shared the events of her weekend shifts. She tells you that shortly before she arrived for her 7:00 am Saturday morning shift, a consulting physician left an order for the volume expander Hespan (not derived from blood products) to be given to one of the physician’s patients that was very ill with hypovolemic shock. She further explained that she had then inadvertently administered a different volume expander (Albumin, derived from blood products) commonly used in the ICU. Janice charted this in the medical record and went on to fulfill a multitude of duties in the ICU. Unfortunately, none of the therapies, treatments or interventions helped the woman. Her condition continued to decline. At the end of her shift, Janice talked with the attending physician. The physician told her she was going to meet with the family of the patient shortly to tell them that there was little more that she could offer to cure this patient. The physician wanted to alert the family that the patient may die in the very near future. With this distressing news Janice ended her shift in the ICU.

When she came to work the next morning, Janice learned that the woman had died the night before. She also overheard a comment from one of the other nurses the woman that had died the night before and her family were members of the local Jehovah’s Witnesses Church community. Janice had cared for patients who were Jehovah’s Witnesses many times and knew of their opposition to the administration of blood products (recognizing there are some exceptions and individual decisions regarding this treatment). Janice reviewed the chart at the nurses’ station and saw the order, which clearly stated “No blood products”, yet Janice had administered a volume expander that included a blood product.

As far as she knew, the family, the attending physician, nor any of the other nurses knew of Janice’s mistake in giving the incorrect volume expander medication. Janice’s error DID NOT contribute to the patient’s death. However, she explains to you that she has never made a mistake like this before and feels tremendous sense of anxiety and guilt over her failure to abide by the patient’s and family’s wishes. She knew that she had to tell someone about what had happened and she thought it was best to talk with you.

Scenario #2: Community Hospital facing an Emergency Department Closure: “Imagine that” – You are the CEO of a 100-bed locally owned community hospital. The CFO proposes, that as a cost-saving measure, you close the Hospital’s Emergency Department from 10:00pm until 6:00am. The CFO explains that the hospital is in danger of “losing a lot of money if you do not find ways to control costs.” These losses could mean that the facility would be forced to close. The Emergency Department is very expensive to operate on a 24/7 basis. However, a significant percentage of your hospital admissions come through the ER. The CFO has also done a study on the “volume” of patients that use the ER between those hours and it is very small compared to the hours that you will keep the ER open. People in the community will not be left without access to Emergency medical services when the ER is closed as there is an Emergency Department at the County Hospital which is only 50 minutes away.

Scenario #3: Prioritization of Scare Resources post Hurricane Katrina: You are a healthcare team member working in an inpatient setting during the Hurricane Katrina disaster. Regardless of attempts, you have no communication with the rest of the world. At this time, you have no power, running water or sewage plumbing and the temperature on the floors that have not flooded is hovering around 100 degrees Fahrenheit. The healthcare team is exhausted and all supplies including water, food, and medical supplies are running low. Family members and friends as well as homeless community members and their pets have taken refuge in the hospital during this disaster. You are assigned to a team to determine how to prioritize the remaining resources (food, water, and medical supplies/medications) with recognition there is not an ability to evacuate patients. (Approach this dilemma and decision-making as if you are in real-time after Katrina had struck and in the disastrous healthcare situation. How will you prioritize the use of resources including who transfers out first?).