Moral Dilemmas and Ethical Decisions in the Emergency Room (Essay Sample)

Moral Dilemmas and Ethical Decisions in the Emergency Room
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Moral Dilemmas and Ethical Decisions in the Emergency room
Introduction
Triage care is one of the most delicate areas of the nursing practice. This is because of factors such as urgency and overcrowding that are associated with it. Since most emergency situations are sudden and unexpected, the experience is typically agonizing and life threatening for most patientsCITATION Car121 \l 1033 (Carrus, 2012). In such cases, nurses are faced with ethical dilemmas such as deciding on which patients to be attended to first. During such instances, the nurses are expected to apply the health care policies that morally direct them when providing healthcare and treatment for patients in emergency situations.
The emergency department is known to be crowded. This can be attributed to elements such as inadequate staff, insufficient equipment and deficient space. For these reasons, patients are sometimes forced to wait for longer periods than expected before being attended to by a caregiver. Without doubt, this degrades the whole health care provision process. This also compromises the patients’ health and diminishes the nurses’ morale. And so, in the triage system, nurses are expected to manage such situations and ensure that the patients’ lives are no longer endangered CITATION Kim14 \l 1033 (Enard, 2014). Emergency cases should therefore be prioritized according to their urgency while following hospital policies and protocol.
Health Care Policies and Protocols in the Emergency Room
The emergency department is typically a 24/7 working area. It receives patients and victims in need of urgent medical treatment. The aim of this department is to restore the patients’ lives by preventing further harm to their health. It also ensures that their conditions are managed as successfully. Nurses in this department have an 8hr duty shift in which they are banned from leaving until other shift members are availableCITATION Kim14 \l 1033 (Enard, 2014). In charge of the nurses is an emergency department doctor. The doctor attends to all patients despite of their health disparities.
Protocol suggests that soon after the arrival of a prospective patient, the triage nurse takes him or her to the CPR room where vital signs are noted. A form is then issued and the patient advised to wait outside until he or she is called. While waiting, the doctor evaluates the patient. It is at this point that a decision is made on whether he can go home or not. The triage conditions of severity include anomalous physiological signs, devices of injury and concurrent diseasesCITATION Gor14 \l 1033 (Ehnfors, 2014). Priority cases take account of those of involved in mass accidents and the severely injured individuals.
With the exception of pregnant women, patients cannot be taken out of the emergency department. Stretchers and wheelchairs are used to transport the pregnant women from the ER department to the KP2 department. For the not so seriously injured patients who are not directed to the emergency department, they are advised to acquire some definite documents in the record keeping departmentCITATION Car121 \l 1033 (Carrus, 2012). From there on, they are re-evaluated after a few hours to establish the intensity of their conditions. The final disposition can consequently be recorded. If the patients’ urgency level is undeterminable, the more his or her case should be prioritized. Nurses are therefore expected to re-examine the patients after every few hours to ascertain those in need of re-triage.
A patient’s urgent need for treatment is not the only determinant of emergency care. There exist health care policies that affect emergency care as well. The 2010 Patient Protection & Affordable Care Act and the American College of Emergency Physicians Code of Ethics are just a few to mentionCITATION Car121 \l 1033 (Carrus, 2012). The PPACA aims at shaping the American triage healthcare system. It promotes the provision of quality healthcare with the purpose of endorsing best patient outcomes. It also promotes the freedom of choice such that patients can decide on where and when to receive treatment. It also promotes affordability of emergency room treatment. Last but not least, it shares the benefits of triage healthcare with other citizens. This is especially through establishment of insurance programs for the poverty-stricken and the elderly.
Other healthcare policies are contained in the American College of Emergency Physicians Code of Ethics document. It promotes and guides the provision of quality healthcare in the ER. Basically, it summarizes the responsibilities of ER physicians to their patients. It promotes ethicality and a sense of obligation towards the emergency patients. It contains principles such as the respecting the patients’ best interests, promoting patients’ welfare, responding quickly and expertly to emergency healthcare, communicating honestly with one’s patients, respecting patient privacy while keeping confidential information undisclosed, fair treatment for all patients and working cooperatively for the patients’ best interests among othersCITATION Kim14 \l 1033 (Enard, 2014).
These triage policies prioritize the patients’ health care on their assessments as carried out by the doctors. The cases are also prioritized based on their complaints and vital signs. The process of checking and determining their vital signs ensures that the ER patients are immediately and appropriately attended to. It also ensures that the emergency department resources are properly utilized and that patient safety and best patient outcomes are upheld CITATION Jos14 \l 1033 (Ransom, 2014). The information obtained is then keyed into the triage navigator for further treatment and evaluation. All these policies aid in the decision making process during the provision triage treatment.
Impacts of Healthcare Disparities on Treatment Decisions
Patients arriving in the emergency room have different conditions in terms of urgency and severity. This impacts the decisions made by the care givers in regards to which cases to prioritize and attend to first. Factors that influence the prioritization process include age, severity of one’s complaints, vital signs and concurrent conditions. Patients with gunshot wounds, stab wounds or those having suffered from cardiac arrests are taken to the trauma room where they are resuscitatedCITATION Gor14 \l 1033 (Ehnfors, 2014).
Health care disparities affect treatment decisions in many and different ways. For example, patients involved in accidents and those who are severely injured are immediately taken in for treatment. In such a case, the urgency of medical healthcare is considered. In other cases, age is well-thought-out. Infants and the elderly are prioritized when making treatment decisions. A patient’s insurance cover also determines the treatment and decision making process. An insured patient is most likely to be attended first unlike an uninsured patient CITATION Jos14 \l 1033 (Ransom, 2014). These factors not only determine how fast the patient is attended to but also the treatment process and medications to be used. A patient may negatively react to certain medications hence the need to evade such.
Because of these disparities, some hospitals and health organizations have defined their triage systems through color coding. These color codes include:
* Red where patients need urgent medical attention. These patients have life threatening diseases or injuries.
* Yellow where patients need urgent attention but not as much as the red patients.
* Green where patients have minor injuries and non-life –threatening conditions.
* Black where patients are deceased
* White where patients have no injuries.
The nurses can also apply evidence based decision making strategies such as the EBP decision making and use of the emergency severity index. This tool stratifies patients into five groups depending on their treatment urgency. Conceptually, the emergency severity index deduces the caregiver’s decision making process to four important questions. These are the following:
* Is the patient in need of urgent life-saving intercession?
* Should the patient wait?
* How many resources will this patient require?
* Which are the patient’s vital signs?
Answering these questions will therefore guide the nurse on determining how urgent it is for that particular patient to be treated.
Health care policies for uninsured individuals
The emergency health care system cares for all persons regardless of their abilities to pay for insurance. However, the insufficient insurance coverage leads to declining health plans and medical crises which intimidate doctors and nurses when providing quality healthcareCITATION Kim14 \l 1033 (Enard, 2014). Enard advocates for the expansion of health coverage for the uninsured...