Capella 4000 Assessment 3 Applying Ethical Principles
Case Study Overview: The Missing Needle Protector
This ethical case of a missing needle protector is about E. L. Straight, who is working as a director of clinical services at Hopewell University. E.L. Straight has been involved in improving the quality of care outcomes for the hospital. He has noted that Dr. Cutritee, a well-trained surgeon at the hospital, has been demonstrating a lapse in quality with adverse events, citing both physical and mental decline. Before E. L. Straight could take any action, a new adverse event took place in the hospital. An operating supervisor highlighted the missing plastic needle protector that could have been left in the patient’s abdomen during surgery.
The operating supervisor stated that they could not be sure where the syringe cap was and interviewed the scrub nurses regarding the cap, who also recalled not seeing the cap. E.L. Straight wanted to reopen the patient and discussed with his team that they would ask the patient as it is necessary for a checkup for her stats and incision; however, he was told that the patient had been discharged. Upon inquiring about the supervision regarding Dr. Cutritee’s verdict, the supervisor told him that he would not consider calling the patient back or reopening him as, according to Cutritee, there would be only mild discomfort for the hazard.
Meanwhile, Straight called the chief of surgery and asked the situation as a hypothetical question. The chief of surgery also reported the same and left the discussion with an open-ended statement: “One never knows.” Regardless of the incident, Straight avoided asking further questions from Cutritee due to his political inclination; however, he has been restless since.
Assessment of the Facts
The current ethical case study concludes that it is an ethical dilemma for E. L. Straight to choose between reporting the incompetent behavior of the colleague, beneficence to the patient, autonomy for the patient to know his post-surgical complications, nonmaleficence, and justice. Medical malpractice is very common within healthcare settings, where nurses or doctors accidentally overlook surgical procedures or equipment protocols. Some of the facts from the case study are surgical malpractice, avoidance of reporting collegial incompetent behavior, and scrub nurses’ inability to account for surgical equipment right after the surgery.
As mentioned in the case study, there was a potential lack of patient benefit when the surgical mishap took place, and the operating surgeon realized the mistake two days after the discharge. Literature has highlighted that delayed reporting of surgical harm significantly poses a threat to patient welfare, leading to more serious consequences such as rehospitalization, surgical site infection, and constant discomfort for the patient (Ansari et al., 2019). The chosen article supports the analysis as the research also signifies that delayed reporting can increase the risk of post-surgery complications. This contradicts the ethical principle of beneficence, which obligates physicians to act in the best interests of the patient.
Avoidance of Reporting Collegial Incompetency
Another important fact is the moral awareness of reporting or highlighting collegial incompetence. In this case study, from the scrub nurse to the director, all fail to highlight and acknowledge Cutrite’s mistake and instance of not calling the patient back for assessment. Thus, multiple poor decisions took place, such as the scrub nurses not accounting for the syringe cap, Dr. Cutritee needing to be more adamant about not informing the patient, and E.L. not outright informing the chief of surgery about the potential harm.
In accordance with this, literature has also cited that around 50–90% of medical errors go unreported by nurses due to different factors such as seniority, power dynamics, and their inability to call out malpractice behaviors (Woo & Avery, 2021). This resource backs the analysis by providing evidence regarding the reasons for minimal reporting of errors which can lead to ethical dilemmas. This resource explicitly supports the importance of timely reporting and taking action to reduce the incidence of malpractice and improve the quality of care.
Effectiveness of the Communication Approaches in the Case Study
Interprofessional communication was used in this study as the operating supervisor discussed the malpractice case with the director, who then investigated with the surgeon, scrub nurse, and chief of surgery to weigh the options and make informed decisions. Two-way communication between interprofessional teams allows them to discuss risks, legal implications, benefits, and alternative treatment approaches and improve collaboration across settings (Sheehan et al., 2021). Effective communication on reporting and investigating the missed cap was important because it aligns the physician and nurse with care practices and improves care quality. However, this communication strategy could have been more effective in regards to not involving the patient and highlighting the case two days after the patient’s discharge.
Another communication approach in the case study was direct communication between the director and operating supervisor, where the supervisor, as soon as he identified the malpractice, directly informed the director regarding it. This approach could have been more effective in identifying and reporting the issue, as the operating supervisor bypassed the hierarchy and directly reported to the director instead of going to the chief of surgery. The organization’s goal of interprofessional collaboration and attention to patient care may be different from the direct communication style that emphasizes individualism, self-reliance, and independence (Vaseghi et al., 2022). The director’s other communication strategy was conflict avoidance because he purposefully withheld information from the patient and failed to hold Dr. Cutrite accountable.
Capella 4000 Assessment 3
Even when the director learned about the doctor’s stance, he tended to avoid comforting him and left the case unanswered. Such approaches have a significant effect on the quality of care and may increase the number of malpractices in hospitals. Some of the approaches that research recommends be used frequently are effective collaboration, timely reporting of malpractice, and legal responsibility for malpractice for physicians and nurses (DuBois et al., 2018), while direct communications, delayed reporting, and conflict avoidance should be avoided to reduce ineffective decision-making.
The ethical decision-making model consists of three components: a) moral awareness, b) moral judgment, and c) ethical behavior (Capella University, 2023). The action in the case study is to recognize that leaving a needle protector inside a patient’s body is an ethical dilemma; the incident was earlier unreported, and the patient was consciously not informed regarding the surgical malpractice, which is moral awareness. After identifying the issue, the director’s strategy to find a solution and decide to perform the surgery again without the patient’s consent in order to avoid any malpractice lawsuits is morally right. However, the solution (ethical behavior) is yet to be decided because of delayed reporting and the doctor’s negligent behavior.
Physicians should treat their patients with dignity and care, which includes meeting their basic needs for autonomy and moral agency (Gabay et al., 2019). The consequence of using the ethical approach would be the improved quality of care that the director aimed to achieve. Having a on-time reporting system would help the organization to take timely action to rectify the situation; however, consequence of unethical approach is interprofessional conflict, as bypassing the reporting hierarchy, and refusing to inform the patient fall under the category of unethical behavior. Similarly, The patient and the community as a whole will suffer as a result of ineffective measures like ignoring ethical principles and failing to make well-informed decisions.
Ethical-based Solution for the Case Study
The major ethical principles that are obligatory for professionals to follow in their decision-making are autonomy, beneficence, nonmaleficence, and justice. The first solution, in this case, is to follow the principle of autonomy. Studies have identified that a patient’s autonomy should be respected by providing them with accurate information and allowing them to make informed decisions (Liang et al., 2022). The right course of action for this was a timely assessment of the possible missing surgical instruments, reporting the situation to the patient, and letting them decide whether they wanted to redo the surgery, as research has highlighted that having a transparent and timely reporting system help in reducing serious consequences (Susmallian et al., 2022).
Another solution was cultivating a culture of reporting collegial incompetence and taking action against it. In this case, Dr. Cutrite has established a bad reputation for malpractice and should be held accountable for others to learn the lesson. It serves the principles of justice for the patient and communal benefit. Another solution is based on maintaining the ethical boundaries of nonmaleficence and goodwill for the patient. E.L. Straight should inform the chief of surgery regarding the event and should call the patient for another surgery to remove the cap after informing the patient regarding the incident.
Malpractice issues are very common across hospitals; therefore, it is important to devise strategies that effectively raise awareness regarding reporting and accountability among the professionals to ensure the quality of care for the patients. Thus, the organization should incorporate an ethically evident reporting system that can productively respond to the clients’ concerns. However, further research is needed for effective evidence-based strategies for this ethical dilemma.
Ansari, S., Hassan, M., Barry, H. D., Bhatti, T. A., Hussain, S. Z. M., Jabeen, S., & Fareed, S. (2019). Risk factors associated with surgical site infections: A retrospective report from a developing country. Cureus, 11(6), e4801. https://doi.org/10.7759/cureus.4801
Capella University (2023). Ethical Decision-Making Model. Capella Library Online.
DuBois, J. M., Anderson, E. E., Chibnall, J. T., Diakov, L., Doukas, D. J., Holmboe, E. S., Koenig, H. M., Krause, J. H., McMillan, G., Mendelsohn, M., Mozersky, J., Norcross, W. A., & Whelan, A. J. (2018). Preventing egregious ethical violations in medical practice: Evidence-informed recommendations from a multidisciplinary working group. Journal of Medical Regulation, 104(4), 23–31. https://doi.org/10.30770/2572-1852-104.4.23
Gabay, G., & Bokek-Cohen, Y. (2019). Infringement of the right to surgical informed consent: Negligent disclosure and its impact on patient trust in surgeons at public general hospitals – the voice of the patient. BMC Medical Ethics, 20, 77. https://doi.org/10.1186/s12910-019-0407-5
Liang, Z., Xu, M., Liu, G., Zhou, Y., & Howard, P. (2022). Patient-centred care and patient autonomy: Doctors’ views in Chinese hospitals. BMC Medical Ethics, 23(1), 38. https://doi.org/10.1186/s12910-022-00777-w
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Sheehan, J., Laver, K., Bhopti, A., Rahja, M., Usherwood, T., Clemson, L., & Lannin, N. A. (2021). Methods and effectiveness of communication between hospital allied health and primary care practitioners: A systematic narrative review. Journal of Multidisciplinary Healthcare, 14, 493–511. https://doi.org/10.2147/JMDH.S295549
Susmallian, S., Barnea, R., Azaria, B., & Szyper-Kravitz, M. (2022). Addressing the important error of missing surgical items in an operated patient. Israel Journal of Health Policy Research, 11(1), 19. https://doi.org/10.1186/s13584-022-00530-z
Vaseghi, F., Yarmohammadian, M. H., & Raeisi, A. (2022). Interprofessional collaboration competencies in the health system: A systematic review. Iranian Journal of Nursing and Midwifery Research, 27(6), 496–504. https://doi.org/10.4103/ijnmr.ijnmr_476_21
Woo, M. W. J., & Avery, M. J. (2021). Nurses’ experiences in voluntary error reporting: An integrative literature review. International Journal of Nursing Sciences, 8(4), 453–469. https://doi.org/10.1016/j.ijnss.2021.07.004