Leadership, Ethics, and the Law

A brief explanation of the issues and considerations at work in the Incident in the ER scenarios. Explain the lesson(s) you see illustrated in this comparison and the principle(s) that you would identify to guide legal and ethical decision making in healthcare settings. From a leadership perspective, explain your recommendations for nurse executives on safeguards to avoid “incidents” like that portrayed in Part 1 and responses to ensure the outcome in Part 2. Support your post with Learning Resources or current literature.

Incident in the ER – Scene 1 Program Transcript

MALE SPEAKER: Last night, an 83-year-old patient arrived at the hospital emergency room with his daughter. The patient had diabetes and was suffering from respiratory distress. What happened next raised questions about whether or not the ER staff behavior legally and ethically when determining the patient’s autonomy.

The next day, the hospital’s director of emergency services met with me, the director of risk management, to debrief me about the incident. She asked for the meeting because she knows that mistakes were made.

So tell me what happened.

FEMALE SPEAKER: Well, last night, around 6:00, a Mr. Hector Jimenez was brought to the emergency room by his daughter Maria. Mr. Jimenez Is 83 and a diabetic. When he arrived at the emergency room, he was suffering from respiratory distress. He was then examined by the physician on duty, who found that he had gangrene in his right foot up to his ankle. His daughter also stated that he had been diagnosed with Alzheimer’s.

MALE SPEAKER: Was a preliminary assessment done?

FEMALE SPEAKER: Yes, and according to the ER staff’s assessment, it was consistent with mild dementia. However, one of our nurses noted that part of the confusion may have been brought on by his respiratory distress and that the atmosphere of the ER could’ve also attributed to his disorientation.

MALE SPEAKER: Who was assigned to take care of him?

FEMALE SPEAKER: Let’s see, that would be Dr. Jason and Nurse Hattie. And because of the severity of the gangrene in his right foot, Dr. Jason recommended performing a below the knee amputation, but the patient refused at that point.

MALE SPEAKER: Take your time. What happened next?

FEMALE SPEAKER: Let’s see, a social worker, Carol Grimes, was called into interview Mr. Jimenez and his daughter. Mr. Jimenez told the social worker and the doctor that he had lived long enough and that he wanted to die with his body intact. Of course, the daughter disagreed with that, and she wanted the amputation performed immediately. She also said that she wanted her father to be taken home as soon as possible and threatened to sue the hospital if we didn’t cooperate with her.

MALE SPEAKER: Must’ve been quite a scene.

Incident in the ER – Scene 1

© 2015-2019 Walden University 2

FEMALE SPEAKER: Yes, it was. The amputation was performed, and I’m just waiting to hear back from the surgical team now as to the outcome and to the patient’s current health status.

MALE SPEAKER: Anything else to report about what happened?

FEMALE SPEAKER: A couple of things– in the nurse’s medical report the nurse reported that the patient was diagnosed with mild dementia. She also notes in there that the patient might be more lucid if he was moved to a ward where he could receive treatment for his respiratory condition. But at that time, Dr. Jason went ahead and called the on-call surgical team, and the surgery was completed at 2:00 AM.

Something else– the social worker, she also reported that the daughter might be afraid of an elder neglect investigation if her father died. In her opinion the daughter failed to provide proper care for her father and should be reported for suspected elder abuse or medical neglect. While the father suffered advanced gangrene in his right foot, the daughter did not seek care for the open wound but instead saw care for the respiratory problem.

MALE SPEAKER: So what do you think about what happened?

FEMALE SPEAKER: Well, I think we have good, competent people working in the ER. No one wants a lawsuit, but I think mistakes were made, and I need your help in identifying them. I’m feeling really overwhelmed right now, and I’m worried that maybe we amputated the leg too soon without consideration for the patient’s mental status.

This scene contained information about numerous errors that were made by the emergency room medical team when dealing with the patient and his daughter. Now it’s your turn to get involved. Assume that you’re the director of risk management. Tell the director of emergency services what specific policy errors you spotted in her oral report.

Incident in the ER – Scene 1 Additional Content Attribution MUSIC: Creative Support Services Los Angeles, CA Dimension Sound Effects Library Newnan, GA

Incident in the ER – Scene 1

© 2015-2019 Walden University 3

Narrator Tracks Music Library Stevens Point, WI Signature Music, Inc Chesterton, IN Studio Cutz Music Library Carrollton, TX

Incident in the ER – Scene 2 Program Transcript

MALE SPEAKER: Now let’s revisit the same scene. Only this time, the director of emergency services is able to report to me that the hospital’s medical team made all the right moves and handled the emergency room visit of Mr. Jimenez and his daughter without any policy errors.

Our meeting precedes just as it did the first time, until she reports that Mr. Jimenez refused to be operated on, and his daughter demanded that the amputation be performed at once, or she would sue the hospital.

That must have been quite a scene.


MALE SPEAKER: Then what happened?

FEMALE SPEAKER: Well, the nurse wisely intervened. She made a note in the report that the patient was disoriented due to his respiratory condition and that he only suffered from mild dementia. She informed Dr. Jason that the patient would be more lucid if he were transferred to award where he could receive proper care for as respiratory problem. Dr. Jason agreed and said that the wound was not an emergency.

The patient was then transferred to the ward, and he received antibiotics for the wound as well as for the respiratory condition. Dr. Jason has also arranged to consult with the infectious disease doctor in the morning to determine the level of urgency in the care of the wound.

MALE SPEAKER: Good move.

FEMALE SPEAKER: I agree. Even though the daughter was threatening to sue the hospital, the nurse saw the need to first determine the mental capacity of Mr. Jimenez.

MALE SPEAKER: So what’s next?

FEMALE SPEAKER: Well, that’s what I want to confirm with you so that we have complete transparency.

MALE SPEAKER: What do you have in mind?

FEMALE SPEAKER: My recommendation, following hospital policy, is that the doctor will talk to Mr. Jimenez and determine his mental capacity. He’ll use the Mini-Mental instrument to determine a treatment plan. Bottom line, we want to



Incident in the ER – Scene 2

© 2015-2019 Walden University 2

make sure that Mr. Jimenez understands the treatment plan, its risks, its alternatives, as well as its consequences.


FEMALE SPEAKER: Next, I intend to talk with the family. I’d like to talk to the daughter regarding her role, if any, about her father’s competency, and her alleged medical neglect or abuse as the custodian of his care. I’ve scheduled an emergency ethics committee consult, as well, for today. I would like a plan from the social worker, as well, to investigate whether we should report the daughter to the state for possible elder abuse or medical neglect. Her findings should be made f to the hospital as well.

MALE SPEAKER: Well, it sounds like you have covered all the bases. I think your staff has done a great job.

FEMALE SPEAKER: They have. It was a tough situation for any ER team to have to face, but they made all the correct ethical decisions. They kept the patient in focus. I’m proud of them.

MALE SPEAKER: You should be. Well done.



Incident in the ER – Scene 2 Additional Content Attribution MUSIC: Creative Support Services Los Angeles, CA Dimension Sound Effects Library Newnan, GA Narrator Tracks Music Library Stevens Point, WI Signature Music, Inc Chesterton, IN Studio Cutz Music Library Carrollton, TX



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