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Applying Ethical Principles

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Applying Ethical Principles

Medical professionals provide treatment to their patients on the premise of ethics. What is

morally right or wrong relies on the individual's views and standards. Autonomy, beneficence,

nonmaleficence, and justice are the fundamental principles applied across all healthcare practice

settings (Grace & Uveges, 2022). As nurses, we are frequently faced with ethical conundrums in

our professional environments; using ethical principles helps to solve ethical dilemmas. This

study aims to analyze incident nine, the missing needle protector case study.

Case Summary.

E.L. Straight is the director of clinical services at Hopewell Hospital, where she has

implemented programs to improve the quality of care. However, some physicians, like Dr.

Cutrite, continue to provide acceptable but subpar care. Straight has been considering reducing

Cutrite's privileges due to his declining physical and mental capabilities. On Monday, the

operating room supervisor reported that a plastic needle protector was accidentally left in a

patient's belly. Investigations revealed a discrepancy in needle records, indicating that the

protector was left in Mrs. Jameson during surgery with Cutrite. Straight instructed the supervisor

to bring Mrs. Jameson back to the surgery, but she had already been discharged. Despite the

potential risks, Cutrite warned against any intervention, believing the protector to be harmless.

The chief of surgery agreed, indicating that it might only cause occasional discomfort. Straight

hesitated to confront Cutrite, a politically powerful physician, but was overwhelmed with anxiety

(Capella University, 2020).

Dilemma

The dilemma in this case study revolves around Dr. Cutrite's slipping physical and mental

condition and his potentially harmful actions during surgery. As director of clinical services at
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Hopewell Hospital, E.L. Straight is contemplating recommending a reduction in Cutrite's

privileges. However, Cutrite continues to perform surgeries, and a plastic needle protector from a

disposable syringe was left inside a patient's belly after surgery. The operating room supervisor

reported the issue to Straight, but the patient had already been discharged. Cutrite refuses to

acknowledge the problem and warns the hospital staff not to take any action. Straight is

conflicted about what to do, as he is hesitant to cross swords with Cutrite, who is politically

powerful, but also wants to ensure patient safety.

Ethical Decision-making model

Components.

The ethical decision-making model comprises of moral judgment, ethical behavior, and

moral awareness. Moral awareness requires recognizing an ethical or moral issue (Lee et al.,

2020). In the case of Dr. Cutrite leaving a plastic needle protector in a patient's belly, the ethical

issues involve potential harm to the patient and possible cover-up by Dr. Cutrite and the hospital

staff. Moral judgment involves analyzing the facts and deciding what is right or wrong. Leaving

a needle protector in a patient's body is wrong, and informing the patient is the morally right

thing to do. On the other hand, ethical behavior requires taking action based on the decision

made. The hospital should inform the patient of the incident and ensure proper medical care, as it

is in the patient's best interest. Withholding information would be unethical.

Contributing factors

The ethical problem, in this case, is multifaceted. Dr. Cutrite's declining physical and

mental health resulted in a decrease in the quality of care he provides and an increase in

mistakes. There is also the issue of the surgical pack being mismarked, leading to confusion

about the syringe and the needle cover being overlooked. The operating room supervisor did not
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report the problem immediately, allowing the surgeon to cover it up. The surgeon was also

unwilling to inform the patient, while the chief of surgery failed to act upon being informed, all

of which contributed to the ethical dilemma.

Literature analysis

The ethical dilemma in this case study is the refusal of Hopewell Hospital to inform Mrs.

Jameson about the protector needle left in her belly. Surgical errors like this occur more

frequently than one might imagine. Titus and Rifennbery (2021) report cases of retained surgical

items in healthcare settings ranging from 0.3 to 1.0 in every 1000 abdominal surgical operations.

The consequences of surgical errors are significant, and according to a study by Susmallian et al.,

(2022), the incidence of surgical sponges left inside a patient after surgery is 1 in 5500 cases.

These incidents can cause complications such as pain, infections, and even death. Thus, this

highlights the need for better patient safety practices in hospitals.

Failure of the medical team to identify discrepancies and act promptly indicates a lack of

accountability and negligence among the team. This case study brings up questions about the

facility's patient safety practices and patient-centered care. It is important to ensure that hospitals

prioritize patient safety, and surgical errors should be taken seriously to avoid life-threatening

consequences. A study by Hafezi et al. (2022) found that improving patient safety culture in

healthcare organizations is linked to a reduction in medical errors. Therefore, healthcare facilities

should focus on improving their patient safety culture to prevent surgical errors, and healthcare

professionals should prioritize their patient’s safety and well-being over personal and political

gains.

Communication
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The communication approaches present in this case study are not effective, as there is a

lack of transparency and accountability. Dr. Cutrite appears to be withholding information and

discouraging others from taking action, which puts patient safety at risk. The facility should

implement measures to prevent potential abuse of power and retaliation, such as anonymous

reporting systems and regular training on ethical behavior. This situation highlights the need for

continued efforts to manage risk and improve quality, as even one mistake can have serious

consequences for patients. It also underscores the importance of taking a proactive approach to

risk management, rather than waiting for a problem to arise. The facility should prioritize open

communication, ethical behavior, and a patient-centered approach to care.

Effectiveness of Approach Used in Case Study

Straight demonstrates moral awareness by recognizing the ethical issue of the needle

protector left in the patient's belly. She makes a moral judgment by deciding that informing the

patient is the right thing to do, but she fails to act on her decision due to political pressure. This

ineffective approach does not align with ethical behavior, which requires taking action based on

the decision made. Instead, it results in a cover-up of the mistake and puts the patient's health at

risk. E.L. Straight's ethical behavior is influenced by the principle of non-maleficence. Although

she recognizes the moral issue and concludes that informing the patient is an ethical decision, her

failure to act on it disregards her responsibility to act in the best interest of the patient and risks

causing harm.

Proposed solution

The suggestion is for Straight to inform Mrs. Jameson of a potential issue that may

necessitate her return to the hospital. This would enable the hospital to verify whether the needle

cap is indeed lodged in her abdomen and remove it. This proposal is expected to facilitate a
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cooperative partnership by encouraging interaction between Straight and Cutrite. Nevertheless,

Cutrite will probably reject this plan, and it may not achieve the objective of creating

interdisciplinary relationships.

Conclusion

Healthcare professionals rely on ethical principles to address moral dilemmas, such as

E.L. Straight's decision on whether to disregard the needle cap in the patient's abdomen, as

instructed by Dr. Cutrite, or perform surgery to remove it. The solution suggested entails

contacting the patient and conducting a surgical intervention.

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References

Capella University (2020). NHS-FP4000 Exemplar Sample Ethical Case Study Incident 9: The

Missing Needle Protector. Capella Website

https://media.capella.edu/CourseMedia/nhs4000element18655/wrapper.asp

Grace, P. J., & Uveges, M. K. (2022). Nursing ethics and professional responsibility in advanced

practice. Jones & Bartlett Learning.

Hafezi, A., Babaii, A., Aghaie, B., & Abbasinia, M. (2022). The relationship between patient

safety culture and patient safety competency with adverse events: A multicenter cross-

sectional study. BMC Nursing, 21, 292. https://doi.org/10.1186/s12912-022-01076-w

Lee, S., Robinson, E. M., Grace, P. J., Zollfrank, A., & Jurchak, M. (2020). Developing a moral

compass: Themes from the Clinical Ethics Residency for Nurses’ final

essays. Nursing Ethics, 27(1), 28–39. https://doi.org/10.1177/0969733019833125

Susmallian, S., Barnea, R., Azaria, B., & Szyper-Kravitz, M. (2022). Addressing the important

error of missing surgical items in an operated patient. Israel Journal of Health Policy

Research, 11(1), 19. https://doi.org/10.1186/s13584-022-00530-z

Titus, D., & Rifenbery, J. (2021). Use a pacemaker magnet to remove a broken suture needle

during laparoscopic cholecystectomy. Journal of Surgical Case

Reports, 2021(10). https://doi.org/10.1093/jscr/rjab444