NCM 108: HEALTH CARE ETHICS

Case Application - Documentation & Allocation of Resources

A. Case Application - Documentation
Pat Smith, RN provides discharge instructions for a client with a Halo fixation
who is leaving the hospital to go home. Pat educates the client on pain
medication, self-care (including pin site care) and informs him of the signs and
symptoms of infection. Pat also schedules a follow-up appointment and gives
the client a discharge instruction sheet. During the follow-up appointment in
the out-patient clinic, Kim Jones, RN determines the pin sites are infected. The
client says he was not aware that he was supposed to clean the Halo fixation
pins. Kim reviews the electronic medical record and sees the discharge
documentation of Pat Smith as follows:
3PM: Vital signs revealed T = 36"C, PR = 80, RR = 20 and BP 120/90 mm/Hg.
3:30PM: Discharge instructions given together with his wife and was clearly understood.
Discharged per wheelchair in an improved condition. The patient was brought to the emergency
room and dressing of the pin sites were done and was given a complete dose of antibiotics for
free. Pat's attention was called by the Nurse Supervisor regarding her discharge notes.

Answer the following questions briefly and concisely:

1. What have you noted about the documentation of Pat Smith, which led to the condition
of the patient?
- The patient status is only briefly disclosed in Nurse Pat's documentation for
discharge. It can be described as a generalized observation, similar to monitoring
vital signs or giving instructions without providing specifics. Additionally, a brief
mention was made of nursing interventions, particularly the administration of
antibiotics. The following information is not clear, orderly, pertinent, or related to
nursing process, which will compromise indicated data like the dosage of the
drug administered and the outline of the prescribed health education.

2. What would be our lessons here as nurses in relation to documentation. What could
have been done by Pat Smith to avoid such case to happen?
- Providing essential shared information on health status and advancement is the
main purpose of documentation in patient care. The nurses' direct caregiving
responsibilities with the patient imply a significant level of involvement in
summarizing the data collected. It is crucial to practice critical thinking to enable
the process of clinical data collection, interpretation, and analysis in the context
of Nurse Pat's record.

3. Will the hospital & Pat be accountable to what happened to the patient? Why? Why
not?
- In order to provide patients with rehabilitative therapy, discharge documentation
is essential information. It views direct patient safety as being achieved through

Email: cn@usa.edu.ph | Tel. No.: 0999-997-1485 | Fax No.: (033) 337-4403

 clinical prevention that has been observed, taught, and advised by healthcare
professionals (Hill & Filer, 2015). This value represents moral issues that might
conflict with patient protection in light of their right to health education. Nurse
Pat has subtly left out this crucial information, which is binding as legal proof for
ongoing care. As a result, it is inevitable that the nurse in charge of the case
scenario will be accountable for the information contained in the documentation.
Members of the medical team who were involved in providing collaborative care,
such as the attending and admitting physician, nurses, medical technologists, and
other providers who handled and gave or administered at any point, may be held
accountable.

B. Case Application: Allocation of Resources

Answer the following questions briefly and concise - at least 3 to 8 sentences.

1. A certain victim of "hit and run" is rushed to a private hospital emergency room for
urgent and immediate medical intervention where only one resident, along with one ER
nurse is on duty. The said victim arrives together with the arrival of a patient who is
highly febrile. Whose right to immediate medical intervention is deemed greater? Why?
- A patient who has a high fever has internal injuries that make them more likely
to contract predisposing infections and put them at risk for temporary harm to
the body's systems (Karcioglu & Topacoglu, 2018). Putting the patient in a
life-threatening situation as contrasted to other victims who might have physical
harm or external damage that is manageable but still need priority care. The
bioethical concept for greater right decides which health condition needs to be
managed with rapid treatment, which clarifies the significance of giving the very
febrile patient priority.

2. In catastrophic situations or disaster like an earthquakes where there is limited medical

practitioners & equipment, who will be given medical intervention first by the medical
team? Why?
- The elderly and those in poor physical condition are the most at risk during a
disaster, according to the National Center for Disaster Preparedness of Columbia
Climate School (2020). Due to limitations on their physical mobility and/or
cognitive abilities, they are recognized as the age group that is most vulnerable
to harm. Whereby it causes them to be less resilient either due to a child's
developmental nature or their health (elderly). Adults are seen as the population
most capable of coping with low-hazard risk environments and frequently serve
as the front-line public health workers for disaster response and recovery in local
communities.

Email: cn@usa.edu.ph | Tel. No.: 0999-997-1485 | Fax No.: (033) 337-4403

 3. Compare the micro-allocation (Case#1) and macro-allocation (Case #1) of resources in
terms giving medical intervention on the cases mentioned above, what have you
observed?
- The right distribution of health care resources is defined on a certain patient or
age group that described their severity of disease (Segal, 2017). The idea behind
distributive justice is that certain services should be given priority in places that
are in need, such the emergency room where accident victims were taken (Capp
et al., 2001). Patients with traumatic diseases typically have higher needs,
necessitating broad access to health resources through micro- and
macro-allocation, in which it acts as a systematic way for equal access to the
delivery of medical care, whether it be the medical staff or the therapy
(Scheunemann & White, 2011). While macro-allocation involves the availability
of public health financing for both victims, micro-allocation entails the direct
bedside treatment that results in a limiting decision in allocating the patient as
an individual, in this example the second victim, to receive the limited medical
attention care with the very feverish patient. The unique relative access present,
the single resident, shall take into consideration the allocation of curative
resources devoted to having overall preventative care that is effective in
satisfying the demands of patient healthcare needs (WHO, 2020).

REFERENCES:
● Public health priorities in emergencies. (n.d.). World Health Organization - Regional
Office for the Eastern Mediterranean.
https://www.emro.who.int/eha/information-resources/public-health-priorities-in-emerg
encies.html
● Hill, J. (2015, June 1). Safety and Ethical Considerations in Discharging Patients to
Suboptimal Living Situations. Journal of Ethics | American Medical Association.
https://journalofethics.ama-assn.org/article/safety-and-ethical-considerations-dischargi
ng-patients-suboptimal-living-situations/2015-06
● Karcıoglu, O., Topacoglu, H., & Korkut, S. (n.d.). Approach to the Febrile Patient in the
Emergency Setting; Is there anything New? SCHOLARENA.
http://article.scholarena.co/Approach-to-the-Febrile-Patient-in-the-Emergency-Setting-I
s-there-anything-New.pdf
● Vulnerable Populations. (2020, November 10). National Center for Disaster Preparedness
| NCDP. https://ncdp.columbia.edu/research/vulnerable-populations/
● Prioritizing Patients: How algorithms can promote just resource allocation. (2017,
September 1). Bioethics.
https://bioethics.hms.harvard.edu/journal/AI-resource-allocation
● Capp, S. (2001). Exploring distributive justice in health care. CSIRO PUBLISHING.
https://www.publish.csiro.au/ah/AH010040
● Scheunemann, L. P., MD, MPH & White, D. B., MD (n.d.). The Ethics and Reality of
Rationing in Medicine. CHEST Journal.
https://secure.jbs.elsevierhealth.com/action/cookieAbsent

Email: cn@usa.edu.ph | Tel. No.: 0999-997-1485 | Fax No.: (033) 337-4403