Introduction
Work in the health care sector is inseparably connected with interaction with patients, which means that conflict situations increase significantly. Different worldviews, national-ethnic and cultural differences, and specific human behavior often become initiators of practical communication problems. This is especially true in the context of working as an emergency care team member when health hazards and severe stress for all parties are likely to result in a critical incident. This research paper explores one of the real-life scenarios the author encountered in her professional career as an ER nurse. In more detail, the conflict described involved the family’s desire for the hospitalized patient to be aware of the exact diagnosis even when diagnostic testing had not been performed.
Critical Incident Description
A call was received from the emergency dispatcher for emergency medical services for a patient with suspicious symptoms. Upon arrival at the scene, an initial diagnosis of the patient’s health was performed. More specifically, the middle-aged man was in a pre-stroke condition: he lost consciousness, his facial expression was inactive, and his temperature was reduced. In addition, the man could not speak clearly and was constantly swallowing saliva. Although the initial symptoms were similar to a stroke, the patient’s severe aggressiveness and skeletal muscle spasms cast doubt on the diagnosis. In addition, the man refused water and was aggressive when the author wiped the patient’s forehead with a wet wipe. Such signs prevented an accurate diagnosis on the spot; therefore, it was decided to take the man to the nearest cardiac care facility urgently.
However, this decision was not satisfactory to the patient’s elderly wife, who had called the ambulance. The woman wanted to get information about the diagnosis immediately rather than wait for her husband’s hospitalization and diagnostic tests. At one point in the conflict, the woman was even ready to refuse medical help, believing our team to be incompetent and irresponsible. All attempts to resolve the critical situation and urge the woman to postpone the dispute due to the serious threat to her husband’s life were unsuccessful. The author then decided to move the man in an emergency without his wife’s consent. In turn, the woman threatened to sue us over the incident, although she later recanted her decision because her husband was doing better clinically.
Ethical Analysis of the Incident
The above clinical scenario reflects a real-life case closely related to the resolution of a complex ethical dilemma. On the one hand, the functional role of the emergency nurse is to provide first-rate medical care to keep the patient healthy (Roche et al., 2017). On the other hand, since the man was in a pre-conscious state and could barely be characterized as capable at the time, the decision to hospitalize should have been made by his wife, but our team refused to listen to her (Kernisan, 2017). It is likely that if the man’s health had not improved, the woman would not have changed her mind about filing a lawsuit against us, and eventually, our entire team would have been sued.
It is not difficult to analyze the concepts of leadership used in this incident. Of primary importance is recognizing that the author took a risky initiative when she decided to hospitalize a temporarily incapacitated patient against his wife’s request. This is an example of an autocratic leadership style in which the nurse made a unanimous decision without regard for the interests of other parties (Rahbi et al., 2017). At this point, the author was driven by a desire to provide genuine emergency care to a patient on the brink of death. In this light, both the team members and the patient’s wife acted as obedient subordinates, while the patient acted as the objects of the chief executive’s actions, or in other words, the author. In the context of ethical perspectives, it is correct to note that the author was guided by Immanuel Kant’s deontological theory, which postulated that the presence of moral intent could trump the desire to achieve the right results (Barrow & Khandhar, 2017). In other words, the author, as an ambulance crew nurse, sought to fulfill her functional role and help a sick patient survive rather than act in a legally coherent manner. Moreover, the wife’s behavior at that moment was difficult to predict, and it is impossible to unequivocally determine whether her desire to leave her husband unaided was conscious or emotionally motivated. In turn, the independent resolution of this dilemma, while leading to positive results, was not fully justified in terms of professional ethics. Had the outcome for the patient’s life been different, his wife would have had every reason to sue, and the author would have been punished by law for abuse of power (Kernisan, 2017). At the same time, this would have affected the ambulance service’s reputation and potentially undermined public trust in ER teams and the educational center from which the author graduated.
In this regard, it seems appropriate to dissect the way in which the incident described was handled. Rather than demonstrating an authoritarian leadership model, the author should have used Orlando’s leadership theory in more depth, with the patient’s wife acting as the interlocutor (May 2017). In particular, the woman’s emotional distress was indicative of her cry for help, and therefore, instead of confronting her, she should have detailed the professional intentions of the team and tried to reassure her. A discussion of the patient’s needs would also have been an important step that would have resolved the current issues in a meaningful way. It should have been made clear that leaving the husband at home now will almost certainly result in his death. Moreover, it should have been said that the author is unsure of the diagnosis because of the confounding symptoms, so diagnostic tests are critically needed. Ultimately, this close interaction between the author and the patient’s wife would have saved considerable time and prevented stress on both sides at such a critical time.
Conclusion
In conclusion, it should be emphasized that the ER nurse’s work is inextricably linked to the resolution of conflict situations. Therefore, to prevent their negative impact on both parties, the author should do more communication work with patients or family members. In this incident, the problem was resolved positively, and it is possible to say that the author was lucky. However, in the future, one should not rely only on luck, so one should be trained to resolve ethical dilemmas effectively in the clinical setting.
References
Barrow, J. M., & Khandhar, P. B. (2017). Deontology. NCBI. Web.
Kernisan, L. (2017). 10 things to know about HIPAA & access to a relative’s health information. Better Health While Aging. Web.
May, B. A. (2017). Orlando’s nursing process theory in nursing practice. Nurse Key. Web.
Rahbi, D. A., Khalid, K., & Khan, M. (2017). The effects of leadership styles on team motivation. Academy of Strategic Management Journal, 16(3), 1-14.
Roche, T. E., Gardner, G., & Jack, L. (2017). The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study. BMC Health Services Research, 17(1), 1-14.
Roussel, L., Swansburg, R. C., & Swansburg, R. J. (Eds.). (2006). Management and leadership for nurse administrators. Jones & Bartlett Learning.