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BSN-FP4006_TallarineSamantha_Assessment2-2.docxRUNNING HEAD: MORAL DILEMMA & ETHICS 1
MORAL DILEMMA & ETHICS 2
RUNNING HEAD: MORAL DILEMMA & ETHICS 3
Moral Dilemmas and Ethical Decisions
Samantha M. Tallarine
Capella University
Policy, Law, Ethics, and Regulations
May, 2019
Looking after patients in an emergency room brings forth ethical dilemmas. Owing to the limited time and the condition of the victim in addition to the absence of treatment history, difficulties usually occur. The nurse is faced with minimal time to analyse all the details regarding the patient in question. It is therefore recommended that the nurse should make a quick assessment and take the necessary action which is by the hospital protocol. This chaos that occurs in emergency rooms poses a distinct ethical challenge, which calls for nurses to familiarize themselves with ethical principles as well as concepts.
Health care protocols and policies guiding triage attention in the event of an emergency
“Nursing intuition and subjective decision making are required even with the most advanced triage systems, further leading to variability in triage processes and outcomes. Given the associated risk in the triage environment, as our patient demands evolve, so must our nursing practice to ensure optimum patient outcomes” (Domagala & Vets, 2015). Nurses expect to treat patients and also save lives. While assessing patients and beginning the triage process, nurses must be able to separate patients into emergent, urgent, and non-urgent. In effectively classifying the patients in this way they can assure that the most serious injuries and illnesses are being treated first in order to save lives.
Strategies Used During Triage
According to Aacharya, Gastmans, and Denier there are numerous different strategies that can be implemented when triaging patients. “The most commonly used guidelines for ED triage on the international literature are The Manchester Triage Score, The Canadian Triage and Acuity Scale (CTAS), The Australasian Triage Scale (ATS), and Emergency severity Index. In ESI, there are five-levels of these triage score. In addition national and institutional guidelines are also developed and used in practice” (Aacharya, Gastmans & Denier, 2011). CTAS and ATS break down their triage system into 5 tiers; Resuscitation – Level 1 (0 minute wait), Emergency – Level 2 (10-15 minute wait), Urgent – Level 3 (30 minute wait), Semi-urgent/less urgent – Level 4 (60 minute wait), Nonurgent – Level 5 (120 minute wait). Manchester Triage Score goes as following; Immediate (Red) – Level 1 (0 minutes), Very urgent (Orange) – Level 2 (10 minutes), Urgent (Yellow) – Level 3 (60 minutes), Standard (Green) – Level 4 (120 minutes), Nonurgent (Blue) – Level 5 (240 minutes). All the systems use a 5-tiered system, but differ on the time expected for patients to see the provider.
The Emergency Service Index (ESI) is what is most commonly used in United States hospitals. It is also a 5-tiered system that relies on nurses to triage patients effectively into the appropriate category using both their judgment and diagnostic testing. Level one requires immediate life-saving interventions, level two consists of high-risk patients (i.e. dyspnea, confusion, extreme pain, lethargy, etc.), and the following three tiers are non-emergent cases that can afford to wait for medical treatment. In learning the ESI effectively, nurses can efficiently triage patients and ensure people are receiving the correct level of care.
Medical attention disparities effects on treatment decisions
Unfortunately, it is not uncommon to hear that someone died in a particular hospital as a result of neglect by the clinicians. Treatment disparities occur as a result of institutionalised inequities and not technology, medication or access. Even though the process helps make swift decisions, it serves as an avenue through which impressions and assumptions flow which in effect brings about biased treatment judgments on the part of the practitioner (Griffith, 2018). Nurses are human, and with that comes imperfections. It is very possible that a nurse can have underlying biases that they may not even be conscious of. This can come through when they are treating patients who may be homeless, or have mental illness. This is why there should be more than one nurse that is in charge of doing triage.
Health care policies directed towards the care of uninsured patients
Health care across different nations provides little priced safety nets, which include free clinics, community health centers, as well as public hospitals. Here, the uninsured patients receive medical attention at a low price irrespective of their differences. Whether the uninsured patients are low-income earners or high-income earners, they are always aware of the existence of low cost and high price medical centers respectively.
There are also policies that exist to allow any patient to receive medical attention in the event of an emergency. There is no valid reason to discriminate an individual based on their financial condition during a crisis (Christakis, 2014). The responsibility for uninsured patients is also widely recognized through offering high-class major safety nets, which include educational health centers and free clinics. It can, therefore, be concluded that in the event an uninsured person falls sick, there are many places to receive medical attention.
Moral and ethical challenges faced by nurses when enacting hospital protocols and policies.
In every country of the world, nurses have encountered ethical difficulties in the pursuit of patient’s health care. It is also by the nursing profession that they should uphold principles, moral virtues and duties which have become increasingly sophisticated in the face of immense pressures and moral choices incurred in the line of duty (Jones, 2016). The demand for nurses to meet the multifaceted requirements for the patients creates a very complex nursing environment. The nurses must ensure that the rights of the patients are upheld irrespective of the multidimensional differences.
Unethical practices in emergency rooms and other areas should be avoided at any cost to maintain the image of the firm. It is also a moral obligation to ensure that end of life concerns are well taken care of, alongside preserving the confidentiality of the patients towards health care. These honest and ethical obligations result in more stress among nurses. There is also a conflict of interest that arises if an uninsured patient comes along. Although nurses have the obligation to treat each patient fairly regardless of race, sex or income, they may receive pressure from the organization to treat insured patients first, regardless of acuity.
Strategies for managing the care of the uninsured and indigent population
The number of uninsured patients has been on the rise for a few decades as a result of the premiums paid for life insurance, which is far beyond the budgets or natural population. Their governments through the public health sector can support the non-working, uninsured patients.
The funds to finance medical activities are raised from taxes, and this results in high fees amongst the employed as well as the business sector. General tax revenues which may include income tax, import duties and sales tax can be preferred. The medically uninsurable population comprises of a small group of the general population. Their health care demands can be met through incentives or taxes or both (Kolodner, 2014). The uninsured working group can be mandated to take insurance policies since they can afford them. The employers should ensure that their employees pay a regular amount towards their insurance policy.
In conclusion, it is therefore clear that many steps are involved in triage nursing. There already exists health care policies and protocols that have to be adhered to in case of an emergency. The general nursing environment is also a major factor that affect the treatment decisions made by nurses. Conflicts of interest and maintaining confidence of patients are some of the ethical challenges faced by nurses. However , the uninsured patients can be taken care of through numerous strategies which can be adopted by the various states.
Resources
Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency department triage: An ethical analysis. BMC Emergency Medicine, 11, 16. doi:http://dx.doi.org.library.capella.edu/10.1186/1471-227X-11-16
Asch DA, Jedrziewski K, Christakis NA. Response rates to mail surveys published in medical journals. Journal of Clinical Epidemiology. 2014;50(10):1129–1136.
Burns JP, Mitchell C, Griffith JL, Troug RD. End-of-life care in the pediatric intensive care unit: Attitudes and practices of pediatric critical care physicians and nurses. Critical Care Medicine. 2015;29(3):658–664.
Butz A, Redman BK, Fry ST, Kolodner K. Ethical conflicts experienced by certified pediatric nurse practitioners in ambulatory settings. Journal of Pediatric Health Care. 2014;12(4):183–190.
Domagala, S. E., & Vets, J. (2015). Emergency nursing triage: Keeping it safe: JEN JEN. Journal of Emergency Nursing, 41(4), 313-316. doi:http://dx.doi.org.library.capella.edu/10.1016/j.jen.2015.01.022
Grady C, Soeken KL, Danis M, O'Donnell P, Taylor C, Farrar A, Ulrich CM. Does ethics education influence moral action of practicing nurses and social workers. American Journal of Bioethics. 2018; 8(4):4–11.
