Running Head: HEALTHCARE ASSOCIATED INFECTIONS 1

Healthcare Associated Infections and Ethical Distress

Mychal Mendoza

March 19, 2017

HEALTHCARE ASSOCIATED INFECTIONS AND ETHICAL DISTRESS 2

Healthcare Associated Infections and Ethical Distress

Healthcare associated infection is a problem that is relevant in today’s healthcare

setting; it is a problem that can be easily prevented with simple measures, yet it still

happens. Healthcare associated infections can happen through a number ways, such as

ignoring contact precautions or not maintaining a sterile field in medical procedures. The

incidence of healthcare associated infections can have multiple negative outcomes

affecting hospital costs, the length of stay at the hospital, and patient mortality rates.

There was a research conducted on the relationship between healthcare associated

infections and transcatheter aortic valve (TAVI) procedures; according to the results of

the research, healthcare associated infections after a TAVI procedure increased patient

mortality and extended length of stay (Tirado-Conte et al., 2016). Another study that was

conducted on hospital length of stay and costs stated that healthcare associated infections

were attributed to causing the longest length of stay and having the highest costs

(Hoogervorst-Schilp, Langelaan, Spreeuwenberg, de Bruijne, & Wagner, 2015).

Healthcare associated infections do not give rise to medical concerns alone; they can also

give rise to ethical issues such insufficient quality of care or lack of concern for patients.

These ethical issues not only create negative patient outcomes, but it also gives a negative

image of the profession of nursing (to the patient, other nurses and other professions) and

undermines the ANA’s Nursing Code of Ethics (which serves to guide nurses to make

ethically guided decisions in order to provide better care and patient outcomes).

Background

I was in clinical when I stumbled across this ethical issue; I was accompanying a

nurse on the unit, helping provide medications and assessments. Everyone on the unit

HEALTHCARE ASSOCIATED INFECTIONS AND ETHICAL DISTRESS 3

was informed of a patient that was on contact precautions for possible C. diff due to an

incident weeks beforehand; at that time, the patient’s lab results had not arrived yet, so it

was not clear if the patient was infected or not. The nurse I was with had to give

scheduled medications to the patient. However, the nurse did not follow the contact

precautions provided (with her reason being that the patient had not had a problem with

C. diff for weeks) and went inside the room to give the meds. During this situation, I

responded by saying nothing and watched as the nurse walked in the room without

gowning up. An alternative response to the situation would have been to ask the nurse

about gowning.

This situation had caused moral distress because there was a right course of action

that was not being taken; the right course of action was to ask the nurse to gown up as per

contact precautions as it was designed to prevent the spread of infection. However, that

course of action was not being taken because I had internalized the idea that the nurse has

had more experience than I myself had, so she probably knew what she was doing.

Methods

In order to analyze the situation I have come across, I will be utilizing the 8 key

questions from the Madison Collaborative. The 8 key questions are fairness, outcomes,

responsibilities, character, liberty, empathy, authority, and rights (James Madison

University), and are asked when faced with a difficult decision; “fairness” refers to giving

everyone equal treatment; “outcomes” refers to thinking about all possible outcomes with

an action; “responsibilities” refers to the duties that one has to uphold and who to uphold

it to; “character” refers to a person’s qualities that make them who they are and how

those qualities can affect people; “liberty” is a person’s freedom that is manifested in a

HEALTHCARE ASSOCIATED INFECTIONS AND ETHICAL DISTRESS 4

number of ways (freedom of speech, freedom or religion, etc.); “empathy” refers to being

in another’s shoes and understanding how they are affected by decisions being made;

“authority” refers to doing what those who are in charge would expect; finally, “rights”

refers to a person’s rights and how they should be respected.

When asking about fairness, I could have most definitely encouraged the nurse to

put on scrubs due to the fact that it would be fair to keep oneself clean in order to keep all

patients in the hospital safe and healthy. When asking about outcomes, asking to gown up

would have achieved the long-term outcome of keeping the unit free of C. diff and

preventing any problems arising from infecting other patients. When asking about

responsibilities, the obligation of the nurse to uphold nonmaleficence applies because the

nurse has a duty to protect her patients from harm, yet not asking to gown up can create a

risk for harm. A nurse also has a duty to provide quality care for the patient to achieve

positive patient outcome, but not asking to gown up also affects this. When asking about

character, my own personal feelings towards this situation promotes gowning up as I

wish to be more careful with the actions I take as a nurse, yet the opposite happened with

inaction. Liberty doesn't apply to this because the patient’s freedom, personal autonomy,

and consent were not at risk with the nurse’s actions. When asking about empathy, if I

cared deeply for those involved, I would most definitely want to make sure to ask nurse

to gown up so that others on the unit may not be infected. When asking about authority,

the hospital authority would most definitely expect adherence to the contact precautions

in order to prevent any complications from arising. Another authority would be the

American Nurses Association, which provides the ANA Nursing Code of Ethics that

guides ethical action for nurses for better care and patient outcomes. When asking about

HEALTHCARE ASSOCIATED INFECTIONS AND ETHICAL DISTRESS 5

rights, the patients have a right to health; according the ANA Nursing Code of Ethics,

Provision 8.1 states “Health is a Universal Right” (American Nurses Association, 2015).

This means that the patient has a right to all the resources that will promote health, which

includes “the prevention and control of locally endemic diseases and vectors” (American

Nurses Association, 2015), which relevant to this ethical situation.

Conclusion

After analyzing this ethical situation, I learned that facing an ethical decision is

much harder in practice than on paper. With the one presented, it was very hard to make

an action, especially when being a student nurse and internalizing the idea that my nurse

is more experienced and knowledgeable. I also learned how the 8 Key Questions are

especially helpful when trying to guide action; when using them to analyze the situation,

I was able to ask questions that justified my thinking post-situation. When looking in

retrospect, I most definitely should have voiced concern in gowning up before entering

the room, no matter how the nurse would respond; the 8 key questions solidified my

thinking and I will make sure to use them when faced with a situation similar to this. My

findings from this situation implicates the “go with the flow” attitude nursing students

have towards their nursing preceptors; while it’s important for nursing students to follow

their preceptors, it’s also important for them to make and follow their own judgments as

well. In the future, I will make sure to voice my concern whenever situations like this

arise and utilize the 8 key questions in order to promote better practice in the workplace

and develop myself into the nurse I envision myself to be.

HEALTHCARE ASSOCIATED INFECTIONS AND ETHICAL DISTRESS 6

References

Tirado-Conte, G., Freitas-Ferraz, A. B., Nombela-Franco, L., Jimenez-Quevedo, P.,

Biagioni, C., Cuadrado, A., & Macaya, C. (2016). Valvular Heart Disease:

Incidence, Causes, and Impact of In-Hospital Infections After Transcatheter

Aortic Valve Implantation. The American Journal Of Cardiology, 118403-409.

doi:10.1016/j.amjcard.2016.05.012

Hoogervorst-Schilp, J., Langelaan, M., Spreeuwenberg, P., de Bruijne, M. C., & Wagner,

C. (2015). Excess length of stay and economic consequences of adverse events in

Dutch hospital patients. BMC Health Services Research, 151-7.

doi:10.1186/s12913-015-1205-5

James Madison University. (n.d.). The Madison collaborative: Ethical reasoning in

action. Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml

American Nurses Association (2015). Code of Ethics for Nurses with Interpretive

Statements. Retrieved from http://nursingworld.org/DocumentVault/Ethics-

1/Code-of-Ethics-for-Nurses.html