Assignment: Venipuncture Drug Administration
Do your Standards of Practice specifically list venipuncture drug administration and IV medication? What is a health care professional in your position allowed to do?
This is a discussion question, at least 300 words and one reference
When this review separated the setting into a gen- eral hospital versus operating room area, studies done in a general hospital setting identified other frequent ethical issues: dealing with an irresponsible or unethi- cal or incompetent or impaired colleague (Berger, Sev- erson, & Chvatal, 1991; Cook, Hoas, & Joyner, 2000), end-of-life care (Killen, 2002; Scanlon, 1990, 1994), and pain management (Omery et al., 1995; Scanlon, 1994). Nurses in hospitals reported that they experienced fre- quent ethical problems related to patient confidential- ity or privacy issues as well as staffing patterns issues.
T A
B L
E 2
. F re
qu en
t E
th ic
al I
ss u
es
A rt
ic le
s Se
tt in
g E
n d-
of -L
if e
T re
at m
en t
D ec
is io
n s
P at
ie n
t C
ar e
Is su
es H
u m
an R
ig h
ts I
ss u
es
B er
ge r
et a
l. (1
99 1)
A h
os pi
ta l
(U )
P ro
lo n
gi n
g lif
e w
it h
h
er oi
c m
ea su
re sa
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in
ap pr
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at e
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on o
f re
so u
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, d ea
lin g
w it
h
si tu
at io
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w h
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pa ti
en ts
a re
d is
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ed i
n ap
pr o-
pr ia
te ly
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lin g
w it
h c
ol le
ag u
es ’ i
rr es
po n
si bl
e ac
ti vi
ty C
oo k
et a
l. (2
00 0)
H os
pi ta
ls (
R )
St af
fi n
g pa
tt er
n s,
p at
ie n
t fa
m ily
r eq
u es
ti n
g m
or e
ag gr
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ve t
re at
m en
t op
ti on
s, a
pa ti
en t
h as
u n
cl ar
i- fi
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on fu
si n
g or
n o-
co de
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a re
di
sc u
ss in
g pa
ti en
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el y,
d ea
lin g
w it
h
an i
n co
m pe
te n
t co
lle ag
u e
F ry
a n
d D
am ro
sc h
( 19
94 )
R N
s in
M ar
y- la
n d
Q u
al it
y of
p at
ie n
t lif
e St
af fi
n g
pa tt
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s, n
u rs
e– ph
ys ic
ia n
r el
at io
n sh
ip s
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vi di
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at p
la ce
s th
e n
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ka
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ki n
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a l.
(2 00
6) O
R i
n a
rm y
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n s,
c on
fl ic
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n t
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ph ys
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ti on
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a P
ro vi
di n
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re w
it h
r is
k to
s el
f, p
ro te
ct in
g pa
ti en
t ri
gh ts
a n
d h
u m
an d
ig n
it y
K ill
en e
t al
. (1
99 6)
O R
St af
fi n
g pa
tt er
n s,
n u
rs e–
ph ys
ic ia
n r
el at
io n
sh ip
P ro
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w it
h r
is k
to
se lf
,a i
n fo
rm ed
c on
se n
t,
pa ti
en t
ad vo
ca cy
K ill
en (
20 02
) O
R E
n d-
of -li
fe c
ar e,
ab
or ti
on i
ss u
es
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al it
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c ar
e,
tr u
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bu se
o f
ch ild
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al it
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ri va
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In fo
rm ed
c on
se n
t, a
H IV
/ A
ID S
ca re
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s af
et y
K in
g an
d M
is ko
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(1 99
6) O
R St
af fi
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s, a
al lo
ca ti
on o
f re
so u
rc es
, pa
ti en
ts ’ a
u to
n om
y/ ad
vo ca
cy In
fo rm
ed c
on se
n t,
o cc
u –
pa ti
on al
r is
k, p
at ie
n t
se lf
– de
te rm
in at
io n
a ct
O m
er y
et a
l. (1
99 5)
A h
os pi
ta l
(U )
P ai
n r
el ie
f/ m
an ag
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ta D
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it h
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lt p
at ie
n ts
, p at
ie n
t– ph
ys ic
ia n
– n
u rs
e re
la ti
on sh
ip , c
ar e
of n
on co
m pl
ia n
t pa
ti en
t,
co st
o f
ca re
t o
th e
pa ti
en t
Sc an
lo n
( 19
90 )
H os
pi ta
ls (
U )
D o
n ot
r es
u sc
it at
ea
de at
h a
n d
dy in
g. P
ro fe
ss io
n al
p ra
ct ic
e is
su es
, A ID
S, a
llo ca
ti on
o f
re so
u rc
es P
at ie
n ts
’ r ig
h ts
, A ID
S
Sc an
lo n
( 19
94 )
H os
pi ta
ls i
n
50 s
ta te
s E
n d-
of -li
fe c
ar e,
pa
in m
an ag
em en
t C
os t
of c
on ta
in m
en t
is su
e, a
co n
fi de
n ti
al it
y,
in co
m pe
te n
t, u
n et
h ic
al , o
r ill
eg al
p ra
ct ic
es o
f co
lle ag
u es
Sc h
ro et
er (
19 99
) O
R
Im pa
ir ed
p ro
vi de
r/ po
te n
ti al
f or
u n
sa fe
p ra
ct ic
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re pr
es en
ta ti
on b
y ca
re p
ro vi
de r,
p ro
vi de
r ju
dg m
en t/
co m
pe te
n cy
C on
se n
t/ ad
vo ca
cy ,a
di
sr es
pe ct
f or
p at
ie n
t
N ot
e. U
= u
rb an
a re
a; R
= r
u ra
l ar
ea ; R
N =
r eg
is te
re d
n u
rs es
; O R
= o
pe ra
ti n
g ro
om .
a M os
t fr
eq u
en t
it em
i n
t h
e ar
ti cl
e.
72 • Journal of Nursing Law • Vol. 13, No. 3
TABLE 3. Rankings of Frequent Ethical Issues and Disturbing Ethical Issues
Frequent Ethical Issues in All Reviews (N)
Frequent Ethical Issues in Hospital Setting (N)
Frequent Ethical Issues in Operating Room (N)
Disturbing Ethical Issues (N)
Staffing patterns that limit patient access to nursing care
(6) Patient confiden- tiality or privacy
(4) Protecting patient rights and human dignity
(4) Prolong dying process with inappropriate measures
(4)
Protecting patient rights and human dignity
(5) Staffing patterns that limit patient access to nursing care
(3) Informed consent to treatment
(4) Child or spousal or elderly or patient abuse or neglect
(3)
Providing care with possible risk to RNs’ health
(5) Allocation of resources (human, finan- cial, equipment)
(3) Providing care with possible risk to RNs’ health
(3) Staffing patterns that limit patient access to nursing carea
(2)
Conflict in nurse or doctor rela- tionship (or other professional rela- tionship)
(4) Irresponsible or unethical or incompetent or impaired col- league
(3) Staffing patterns that limit patient access to nursing care
(3) Acting against your own personal or reli- gious views
(2)
Allocation of resources (human, finan- cial, equipment)
(4) Conflict in nurse or doctor rela- tionship (or other professional rela- tionship)
(2) Conflict in nurse or doctor relationship (or other profes- sional relationship)
(2) Irresponsible or uneth- ical or incompetent or impaired colleaguea
(2)
Informed consent to treatment
(4) Providing care with possible risk to RNs’ health
(2) Providing care with possible risk to RNs’ healtha
(2)
Irresponsible or unethical or incompetent or impaired col- league
(4) End-of-life deci- sion
(2) Treatment or nontreat- ment despite patient or family wishes
(2)
Patient confiden- tiality or privacy
(4) Pain manage- ment
(2)
aFrequent ethical issues included in the disturbing ethical issues.
In contrast, this review found that perioperative nurses experienced more frequent ethical issues related to protecting patient rights and human dignity issues and informed consent than other issues (see Table 3).
Five of the reviewed articles reported disturbing eth- ical issues separately from the frequent ethical issues faced by nurses. Although these ethical issues would not frequently happen in their practice areas, nurses reported to be disturbed a great deal or quite a bit when these occurred. As shown in Table 3, the disturb- ing issues related to patient care issues and end-of-life issues. The disturbing ethical issues were (a) prolonging the dying process with inappropriate measures ( n = 4), (b) child, spousal, elderly, or patient abuse or neglect ( n = 3); (c) staffing patterns that limit patient access to nursing care (Berger et al., 1991; Jenkins, Elliott, &
Harris, 2006); (d) acting against your own personal or religious views (Berger et al., 1991; Cook et al., 2000); (e) irresponsible, unethical, incompetent, or impaired colleague (Jenkins et al., 2006; Killen, Fry, & Damro- sch, 1996); (f) providing care with possible risk to RNs’ health (e.g., TB, HIV, violence) (Fry & Damrosch, 1994; Killen et al., 1996); and (g) treatment or nontreatment despite patient or family wishes (Berger et al., 1991; Cook et al., 2000) (see Table 4).
The most of disturbing issues were not frequent ethical issues experienced by nurses. Disturbing issues often related to end-of-life issues: prolonging the dying process with inappropriate measures, acting against your own personal or religious views, and treatment or nontreatment despite patient or family wishes. Nurses reported being disturbed when patient abuse or neglect
Park • Ethical Issues in Nursing Practice • 73
TABLE 4. The Most Disturbing Ethical Issues
Articles Setting End-of-Life Treatment Decisions Patient Care Issues
Human Rights Issues
Berger et al. (1991) A hospital (U) Treatment despite patients’ objectives, prolonging life with heroic measures, acting against personal principles
Inadequate staffing patterns,a incidents of patients’ abuse
Cook et al. (2000) Hospitals (R) Acting against personal principles,a prolonging life with heroic measures
Patient family requesting more aggressive treat- ment options, cost- containment issues that threaten quality if care, treatment or nontreatment despite patient or family wishes
Fry and Damrosch (1994)
RNs in Maryland Prolonging life with extraordinary measures,a quality of patient life
Cost-containment issues that threaten quality of care, child/spousal / elderly/patient abuse or neglect
Providing care with risk to selfa
Jenkins et al. (2006)
OR in army Dealing with incom- petent or impaired colleagues,a conflicts in the nurse–physician relationship, staffing patterns, unsafe equipment and /or environment hazards
Killen et al. (1996) OR Prolonging life with extraordinary means,a treatment over family objectives
Irresponsible/incom- petent colleagues, patients and families who are uninformed or misinformed about treatment plans, prognosis, child/other abuse
Providing care with risk to self
Note. U = urban area; R = rural area; RN = registered nurses; OR = operating room. aMost frequent item in the article.
of patient care issues occurred. Furthermore, the review found that the staffing pattern and incompetent, impaired colleagues issues and providing care with pos- sible risk to RNs’ health were disturbing issues as well as frequent issues that were faced by nurses.
Approaches/Resources
This study also reviewed the approaches and resources that nurses have taken to solving ethical issues. Four
articles reported that most nurses used their own per- sonal values to solve ethical issues (Berger et al., 1991; Cook et al., 2000; Killen et al., 1996; Schroeter, 1999) (see Table 5). In addition, most nurses discussed ethical problems with nursing peers (Berger et al., 1991; Cook et al., 2000; Jenkins et al., 2006; Killen et al., 1996; Scanlon & Fleming, 1990). One study reported that 68% of respondents reported talking to a higher administra- tive authority (e.g., managers, supervisors, or directors)
T A