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Critical Thinking Case Study

Introduction

In a rapidly changing healthcare environment, clinical healthcare professionals face difficult choices concerning what is best for their patients. Sometimes these choices become enmeshed in ethical dilemmas, and what the patient chooses may not be in unison with what the family or physician believes should be done. From person to person, our value systems may prove to be different.

Problem in the Case Study

There are a lot more ethical issues that we could be talking about in this case study. This case obviously represents a moral dilemma, because there are two strongly opposing views, based on strong belief systems that direct two different approaches/outcomes. This case represents a fairly common scenario in the current healthcare world. Primary provider and unit medical doctor are not marinating and following proper health care documentation. Another problem is that both primary provider and unit medical doctor are not willing to accept each others orders or suggestions, which can lead to a complete disaster.

Managed care administration may very often play a central role in a team’s decisions without actually being a physical part of the team. This can engender frustration from care providers, patients, and family members alike.

Team composition is blurry. There are several care providers, but it is not clear if there are teams at all. Certainly the provision of care is not coordinated. The patient’s primary care physician is not actively involved throughout the transitions. The health care providers at the hospital, including the hospital’s inpatient nurse do not play an active role.

Even if all the various health professionals involved in this case are regarded as functioning as a single “mega-team”, lack of clear team management still obscures what should be the central role of the patient’s daughter being able to make her own choices about living arrangements. In conflicts of interest, looking out for number one, it means something a little different. It means look out for the primary interest, which must come first and also appear to come first, or you will be in a weak situation.

Appropriate Solution and Rationale

Ethical decision making tackles these and other very pressing issues facing the healthcare profession. In order to chart a problem-solving course, all healthcare professionals involved need specific tools to assist in this endeavor. Understanding the ethical shop talk prepares the healthcare professional for the extraordinary demands of today's high-tech medical environment. Ethical precepts and principles contained within the described ethical systems can help the nursing professional to conceptualize a problem-solving approach to assist in resolving the ethical dilemma.

New consulting approach incorporates a much greater emphasis on the measurement of risk reduction strategies. Primary provider will contact the unit medical doctor within new and existing healthcare insured organizations to initiate risk management consulting services. The initial discussion will focus on the current concerns and areas of risk exposure that the unit medical doctor has identified. Although it will not be routine, if the unit medical doctor would like to have some type of risk assessment, the primary provider can provide this service in order to determine the focus for risk reduction activities. This may be desirable in a number of circumstances. For example, the unit medical doctor may be new to the organization and may benefit from an external, professional assessment. Or, the assessment may be focused on a specific risk area, such as an entity that has been recently acquired by the organization (e.g. ambulatory practice setting, long term care facility) or a credentialing program. A specific clinical risk such as obstetrics or emergency services, or an area which showed significant claim activity in the past, may be targeted.

If an assessment is not necessary or requested, the primary provider will work with the unit medical doctor to focus on specific risks and develop a Service Plan for risk reduction, including methods to obtain objective, measurable results. The consultant will provide a written Service Plan to the risk manager to concisely outline the focus of the service, the risk reduction strategies, measurement methods, and an implementation and measurement timeline. During the course of the Plan, the primary provider will work with the unit medical doctor to support and guide implementation of the risk reduction strategies as well as the capture of measurement data.

Creating measurement processes: Using the criteria, a chart audit format should be devised and an audit tool should be created. The chart audit should be performed before the intervention to provide a baseline and/or after the intervention to measure and monitor the effectiveness. In creating the tool, the parties who will be performing the chart audits are selected. To ensure effectiveness, the parties who are already collecting the data, such as the reviewers or the committees, would most likely be the parties involved. The goal of the process is to incorporate the performance improvement project into the normal risk and quality activities of the facility as seamlessly as possible to avoid creating new work or burdensome additional responsibilities.

Ms. Lydia is obviously the decision maker in this case. The nurse though has an important role in providing education before she makes this decision. It is at this point that the nurse practitioner takes on the educator role. The nurse has the responsibility to educate at this point about the likely consequences of each of these options.

To determine the ethical implication of a decision, the following four points must be considered:

·        No one suffers physical harm from the decision

·        No one suffers serious emotional pain from the decision

·        The decision will not hurt one’s reputation, credibility or relationship

·        The decision will not impede the achievement of any important goal

Like all decisions, ethical decisions too have some consequences. The most important consequence of an ethical decision is that it makes a person, a person of character. Thus ethical decision-making has far reaching consequences, which affects our society directly.

Conclusion

Ethics is the set of rules, which indicates how we treat one another and the way that dictates how one chooses to live his or her life. Ethics is something, which compel us to do the right thing even when it is not in our best interest to do so.

This particular case study has an unsatisfying conclusion and implicitly raises several disturbing questions. Is the perceived erosion in medical record security so real that physicians should consider adjusting their records' contents? Should theoretical security risks enter at all into how physicians chart and maintain patient records? Most important, is there anything physicians can do to safeguard our patients' medical privacy in the electronic age, so as to protect our patients' trust and insure the integrity of the medical record within a technological framework certain to vastly improve the quality of care at a lower cost?