Author Question: The licensed practical/vocational nurse is caring for a client frequently admitted for constant ... (Read 93 times)

savannahhooper · **on:** Jul 17, 2018

The licensed practical/vocational nurse is caring for a client frequently admitted for constant stabbing pain in her lower back, rated 8 out of 10 on a pain scale. Diagnostic testing reveals no treatable back issues.

The physician prescribes a placebo (a substance that has no therapeutic effect to comfort the client). The physician wants the nurse to administer normal saline in a syringe that will look like the narcotic because he does not believe the client's pain is real. The nurse believes this is an ethical dilemma because is it right or wrong to administer a placebo and lie to the client that it is the narcotic the client requested for her pain. The nurse believes that pain is what the client says it is. Which is the best action for the nurse to take?
A) Administer the placebo, but don't say what it is, and if the client remains in pain within 15 minutes, and then administer the narcotic analgesic as ordered and report the findings to the physician
B) Ignore the physician's order and continue to administer the narcotic analgesic as ordered previously
C) Inform the physician that he has an issue with administering the placebo because he feels it is unethical and ask if it would be best served to refer the client to a chronic pain management clinic
D) Inform the nursing supervisor of the physician's unethical behavior, and ask what to do in the situation

Question 2

The nursing student was so excited about her first day of clinical on the maternity unit at the hospital and wanted to tell her friends on social media about her experience, so she posted information about her client. She posted the following:

Today I cared for one of my neighbors who had a baby girl, so adorable, weighing 6 pounds 5 ounces, and mom has a huge episiotomy-ouch One of the other nursing students saw the post and informed the instructor. The student quickly removed the post and blocked everyone from seeing the site. The nursing instructor confronted the student about the event. Which statement demonstrates personal accountability?
A) I can show you what I posted, and I meant nothing by it and when the other student told me that I should not post anything about clients because people reading the site may figure out who the person is, I quickly removed the post and shut the social site down; I will never post or talk about anything at clinical again.
B) I don't agree that there is anything wrong with posting items when there is no name mentioned or the name of the hospital, and our school has clinical at several area hospitals, and my neighborhood has at least four mothers who delivered that day, but since the other student made a big deal out of it, I removed it and shut down the social site; do you want to see the post?
C) I never posted anything about my clinical because I know there is a rule against such action, and I don't even have a social media site; I don't know what you heard, but I believe someone is jealous and trying to frame me because I am a great nursing student and love my clients and what I do.
D) I am so sorry, and I did not know it was wrong to post anything, but the other student showed me the policy our school has on social media, and I quickly removed the post and shut down the social site, but I believe it is wrong for the other student to go to you instead of just me because I handled the situation, so she needs to learn about accountability.

huda · **Reply #1 on:** Jul 17, 2018

Answer to Question 1

Ans: C
Feedback:
When presented with an ethical dilemma, there is no right or wrong way to approach the matter, and since the nurse is uncomfortable about administering the placebo and lying to his client, he should inform the physician and ask the physician about referring the client to a chronic pain management clinic. Just because the client's diagnostic tests reveal no treatable cause for her back pain does not mean that her back pain is not real. Since she is frequently visiting the hospital for pain management solidifies that the pain management is ineffective, she needs expert help that the pain clinic may offer to provide the client with the fullest potential for a pain free or manageable level of pain. Administering the placebo goes against the nurse's belief that an ethical dilemma exists and that he feels it is wrong to lie to a client and withhold treatment because he believes pain is what the client says it is. Ignoring the order is an incorrect action to take because the newest order supersedes the previous order for narcotic administration. Informing the nursing supervisor that the physician is acting unethically is also incorrect because the nurse recognizes the situation as an ethical dilemma. The nursing supervisor should advise the nurse to call the physician back and discuss the issue and ask about a referral to a chronic pain management clinic.

Answer to Question 2

Ans: A
Feedback:
The nursing student demonstrates personal accountability when, as soon as she found out she had made a mistake, she shut down the site and removed the post, and she admitted what she did to her clinical instructor and stated she had learned from the incident and will safeguard client information in the future. The student should not argue that she did not do anything wrong. This shows the student does not want to take personal accountability for her actions, which is unethical behavior. The nursing student should not lie and cover her tracks to try to prevent suffering possible consequences for her actions. This is also unethical. The student should not try to project the blame unto the student who confronted her about the post, which is also unethical behavior.