Question

Case Study

Ms. Bell, aged 65 years, is under the care of RN Jane. Ms. Bell had a total hip replacement yesterday. She told Jane that her pain was intolerable, then she groaned loudly and said, "Ohhh, I hurt worse than I have ever hurt before in my life, please help me, please, please, I can’t stand it anymore! Please give me something for pain now." When Jane assessed her level of pain, Ms. Bell described her pain as the highest level, 10 on a 10-point pain scale. Her blood pressure and pulse were slightly elevated as compared to her last documented vital signs. Jane proceeded to check Ms. Bell’s orders but discovered something very unusual. The surgeon ordered her IV pain medication only every 6 hours instead of the typical 3-hour frequency for patients with 1-day postoperative hip replacements. Ms. Bell would have to wait 3 more hours for her next IV pain medication. Jane returned to Ms. Bell’s room to explain her current pain order and inform her she would call the surgeon now. By that time, Ms. Bell was crying out with pain and moving her head from side to side. Jane felt such empathy and concern for her. She briefly tried to comfort her with words and acts of kindness, but she needed to return quickly to the unit to call the surgeon for a new order. When he answered, she began informing him of her assessment of Ms. Bell and the 6-hour interval order, but he abruptly and loudly interrupted her and stated, "I meant to order that medication every 6 hours. She does not need more frequent pain medication because of some past problems with prescription pain medications. Please do not call me unless you have critical information that needs my attention."
Jane was shocked, and many conflicting thoughts rushed through her mind. Why did he not want Ms. Bell to have more frequent pain medication, like other postoperative patients in his care? Was it really about her past use of prescription medications? Ms. Bell had a total hip replacement less than 24 hours ago and was in excruciating pain! Jane asked herself what she should do. After some reflection, she notified the nursing supervisor, who then reviewed the case and decided to call the surgeon. The supervisor stated the surgeon seemed somewhat approachable and decided to order a 1-time dose of IV pain medication to relieve her immediate pain. By that time another hour had passed, so Jane administered the medication as quickly as she could in an effort to relieve Ms. Bell’s pain.
In the relationship between Jane and the surgeon, what ethical issues are going on between them? To answer, explore the history and research on the nurse–physician relationship in the chapter. What bioethical principles did the surgeon violate with Jane and his patient, Ms. Bell?

Answer 1

The surgeon violated the bioethical principles of beneficence and patient autonomy in the nurse-physician relationship.

Step-by-step explanation:

In the relationship between Jane and the surgeon, several ethical issues are going on. The surgeon violated the bioethical principles of beneficence and patient autonomy. By ordering the IV pain medication every 6 hours instead of the typical 3-hour frequency, the surgeon compromised Ms. Bell's pain management and failed to prioritize her well-being. Furthermore, the surgeon's disrespectful and dismissive attitude towards Jane violated the principles of respect and professionalism in the nurse-physician relationship.

The surgeon abruptly and loudly interrupted Jane while she was trying to explain her assessment of Ms. Bell's pain and the 6-hour interval order. This demonstrates a lack of communication and respect between the two healthcare professionals. Jane felt empathy and concern for Ms. Bell's excruciating pain and tried to comfort her before contacting the surgeon. However, the surgeon's order for less frequent pain medication goes against typical postoperative protocols and may not adequately address Ms. Bell's pain. This raises concerns about the surgeon's patient advocacy and the prioritization of Ms. Bell's well-being.