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You have just come from your 6-month performance evaluation as a new charge nurse. While your supervisor stated that he was very pleased in general with how you are performing in this new role, one area that he suggested you work on was to learn to be calmer in hectic clinical situations. He suggested that your anxiety could be transmitted to coworkers and subordinates who look to you to be their role model. He feels that you are especially anxious when staffing is short and that at times you vent your frustrations to your staff, which only adds to the general anxiety level on the unit. ASSIGNMENT:  Create a specifi c plan of 6 to 10 things you can do to bolster your emotional intelligence in terms of self-regulation during stressful times.

 

 
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For the last few days, you have been taking care of Mr. Cole, a 28-year-old patient with end-stage cystic fibrosis. You have developed a caring relationship with Mr. Cole and his wife. They are both aware of the prognosis of his disease and realize that he has only a short time left to live. When Dr. Jones made rounds with you this morning, she told the Coles that Mr. Cole could be discharged today if his condition remains stable. They were both excited about the news because they had been urging the doctor to let him go home to enjoy his remaining time surrounded by things he loves. When you bring in Mr. Cole’s discharge orders to his room in order to review his medications and other treatments, you find Mrs. Cole assisting Mr. Cole as he coughs up bright red blood. When you confront them, they both beg you not to tell the doctor or chart the incident because this is the first time this has happened. They believe that it is their right to go home and let Mr. Cole die surrounded by his family. They said that they know that they can leave against their physician’s wishes and go home AMA (against medical advice), but if they do, their insurance will not pay for home care. ASSIGNMENT:  What is your duty in this case? What are Mr. Cole’s rights? Is it ever justified to withhold information from the physician? Will you chart the incident, and will you report it to anyone? Solve this case, justifying your decision by using ethical principles.

 

 
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You are a perinatal unit coordinator at a large teaching hospital. In addition to your management responsibilities, you have been asked to fi ll in as a member of the hospital promotion committee, which reviews petitions from clinicians for a step-level promotion on the clinical specialist ladder. You believe that you could learn a great deal on this committee and could be an objective and contributing member. The committee has been convened to select the annual winner of the Outstanding Clinical Specialist Award. In reviewing the applicant fi les, you find that one fi le from a perinatal clinical specialist contains many overstatements and several misrepresentations. You know for a fact that this clinician did not accomplish all that she has listed, because she is a friend and close colleague. She did not, however, know that you would be a member of this committee and thus would be aware of this deception. When the entire committee met, several members commented on this clinician’s impressive fi le. Although you were able to dissuade them covertly from further considering her nomination, you are left with many uneasy feelings and some anger and sadness. You recognize that she did not receive the nomination and thus there is little real danger regarding the deceptions in the fi le being used inappropriately at this time. However, you will not be on this committee next year, and if she were to submit an erroneous fi le again, she could be highly considered for the award. You also recognize that even with the best of intentions and the most therapeutic of communication techniques, confronting your friend with her deception will cause her to lose face and will probably result in an unsalvageable friendship. Even if you do confront her, there is little you can do to stop her from doing the same in future nomination processes other than formally reporting her conduct. ASSIGNMENT:  Determine what you will do. Do the potential costs outweigh the potential benefits? Be realistic about your actions.

 

 
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You are the evening shift charge nurse of the recovery room. You have just admitted a 32-year-old woman who 2 hours ago was thrown from a Jeep in which she was a passenger. She was rushed to the emergency department and subsequently to surgery, where cranial burr holes were completed and an intracranial monitor was placed. No further cranial exploration was attempted because the patient sustained extensive and massive neurologic damage. She will probably not survive your shift. The plan is to hold her in the recovery room for 1 hour and, if she is still alive, transfer her to the intensive care unit. Shortly after receiving the patient in the recovery room, you are approached by the evening house supervisor, who says that the patient’s sister is pleading to be allowed into the recovery room. Normally, visitors are never allowed in the recovery room but occasionally exceptions are made. Tonight, the recovery room is empty except for this patient. You decide to bend the rules and allow the young woman’s sister into the recovery room. The visiting sister is near collapse; it is obvious that she had been the driver of the Jeep. As the visitor continues to speak to the comatose patient, her behavior and words make you begin to wonder if she is indeed the sister. Within 15 minutes, the house supervisor returns and states, “I have made a terrible mistake. The patient’s family just arrived, and they say that the visitor we just allowed into the recovery room is not a member of the family but is the patient’s lover. They are very angry and demand that this woman not be allowed to see the patient.” You approach the visitor and confront her in a kindly manner regarding the information that you have just received. She looks at you with tears streaming down her face and says, “Yes, it is true. Mary and I have been together for 6 years. Her family disowned her because of it, but we were everything to each other. She has been my life, and I have been hers. Please, please let me stay. I will never see her again. I know the family will not allow me to attend the funeral. I need to say my goodbyes. Please let me stay. It is not fair that they have the legal right to be family when I have been the one to love and care for Mary.” ASSIGNMENT:  You must decide what to do. Recognize that your own value system will play a part in your decision. List several alternatives that are available to you. Identify which ethical frameworks or principles most affected your decision making.

 

 
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