1.

CASE: A patient refuses to go on procedure so called phlebotomy because of the fact

that he doesn’t want his blood to be discarded. Phlebotomy is to treat angina pectoris and
the high blood pressure of the patient. Bleeding lessens blood viscosity, and this is
thought to increase blood flow through the narrowed coronary arteries. The doctor
chooses the procedure to be done because despite of the medications rendered to the
patient still there are no improvement in his condition.

Though the patient refuses to undergo the procedure, still the procedure had pondered
because the doctor as well as the nurse and the medical technologist had come up on the
decision to tell the patient that they will not anymore perform phlebotomy instead he
would have a bloodletting procedure. Autonomy and freedom of the patient so had been
manipulated and disregarded.

Ethical Principle: Autonomy

We nurses allow our patient to maintain character, values, and uniqueness, regardless of
the nurse's own values. The nurse helps the patient to understand the nature, extent, and
possible outcome of treatment so the patient can make health care decisions based on
information provided in an easily understood manner. The nurse has the responsibility to
continue to provide information to the patient and to evaluate the patient's understanding
of that information in order to satisfy the moral obligation of maintaining the patient's
autonomy.

The patient is 61 year old; he is in his sound mind. Yes, it is true that phlebotomy would
do good for the patient and the intention of the procedure is for the benefit of the patient.
The patient refuses the procedure.

I think the doctor and the nurse should have given the patient an ample time to decide and
continuously encouraging him, explaining the bad effect if he will not undergo
phlebotomy. I think they lied to the patient because the doctor is not a resident on the
hospital and just attending his private patients there and he have to maximize his time
whenever he attends to the patient.
1. CASE : breach of confidentiality /privacy

This is not new to us nurses especially to us staff nurses, in my work place nurses and
nursing attendants often talk about lives of their patients even though there are students
around and even watchers listening.

Ethical Principle: Confidentiality/privacy

This moral obligation endorses the theory of self-ownership and privacy; i.e., the patient
has the right to expect that the nurse will guard against the unwarranted or unethical
release of information about the patient. This principle protects the patient from harm that
may be caused by breach of confidentiality or privacy.

It maybe difficult for me to stop the trend that has been crawling around the nursing
profession. As a volunteer staff nurse it is difficult for me to just tell my superiors to stop
talking about lives of patient but instead it would be more convenient to me to tell my co-
volunteer the wrongdoings of our superior and not to imitate them and to start a new
trend respecting the patient’s right to confidentiality/privacy

2. I am assigned at the Emergency room; one of my duties is to triage patients. We are

waiting for the doctor to come, and ask us who did the triaging,
"Who triaged this patient?" She called out across the room to anyone who would pay her
attention. Everyone ignored her except me. I ask him what is the name of the patient, and
I was the one who triage the patient. She asks me why the patient is in the category 3 and
it seems the patient is to be in category 4 or 5.

I told her she is 93 years old. She's from a rest home, and it was a big deal getting here.
They had to get an ambulance to get her here, and then have to arrange one to take her
back. She's got a care giver sitting with her as well. I'd thought I'd sneak her in first. It
just doesn't seem right to let a 93-yr-old lady wait for three or four hours, I explained.
Then she told me that I should have not triage according to age, and I told her that it
would take only ten minutes to assess her and have medical orders and I will do the rest.
She grabbed the file of the patient. I felt hope, but instead she put it in category 5, then
grabbed files in category three and start on calling the patients. I was so disappointed but
I get the file o the patient and put it under the files of category 3, the doctor gave a glance
on me. We nurses should be assertive, even though we did not attend medical school, we
have educational foundations on how to assess the patients.

2. The doctor does things like place excessive orders, in a fashion that makes
my life more difficult (ordering meds 5-10 minutes apart meaning that i make
multiple trips to the med room instead of just one or two). He has a bad
attitude towards me and seems to do things to make me upset. I haven't said
anything to anyone thus far (being a new nurse and fearing that it could
mean the end of my job or making my life miserable there) but I can't stand
by and let this happen. I do not have the guts to interfere with the doings of
the doctor so I talked to my superior about my situation and told me that she
would assist me whenever the doctor does his rounds and to further observed
the attitude of the doctor towards me.