In the nursing field, ethics are a set of rules or moralprinciples that governs the actions and decisions made by nurses in theworkplace. Throughout our course of study and clinical attachments in nursing,we will definitely face situations which puts us in a dilemma, and we wouldhave to count on our ethical decision-making skills to overcome the problem.
As nurses, I believe its our duty to provide care for ourpatients and ensure their wellbeing throughout their visit in the hospital. In thisscenario, I was faced with a dilemma if I should confront SEN Sng again andreport to a superior or keep quiet and do nothing about the situation. If I wereto confront SEN Sng and make a report to the superior, I would get her into troubleand she would dislike me throughout the 2 weeks and may even make my attachmentan unpleasant one by trying to find fault with me. Im afraid that she mightscold me as well. On the other hand, if I do nothing about the situation, thepatient might suffer from air embolism. Air embolism occurs when air bubbles enter a blood vessel andblock the blood flow. Air embolism might cause stroke, heart attack or respiratory failure if theembolism or air bubbles travel to the brain, heart or lungs respectively (Healthline,2018). A single small air bubble will not cause much problems, but largeror multiple air bubbles should be removed (theNursePath, 2016).
According to astudy done by Pant, Deepanjali, the minimum amount of air which will causepatient to show symptoms of air embolism is 20ml if air per second and 70 – 150ml of air per second can be fatal to the patient. The maximum safe amount ofair is still unknown (Pant, Narani & Sood, 2018).The mortality rate of venous air embolism ranges from 23% to 50% (Balakrishnan,Noor & Curran, 2016). The true incidence of venous air embolism isnot known due to the difficulty in documenting the diagnosis (Natal & Doty,2018). I would also question SEN Sng on the reason why she is annoyed bymy comments, and her reason for not wanting to take action regarding the air bubbles.Maybe she was in a rush? In thisscenario, SEN Sng has breached nonmaleficence. As nurses, one of our goals isto ensure we protect the patient’s safety and prevent injury. By not takingaction regarding the air bubbles despite being prompted to, SEN Sng’s actions posesa potential danger or harm to the patient.
Running normal saline for the patientprovides a benefit for the patient, however, the IV drip contains air bubblesin it which may cause venous air embolism to the patient. In this situation, therisks outweigh the benefit. She did not take actions despite being confrontedby me, in fact, she got annoyed at my comments instead.
SEN Sng has also displayednegligence. Her duty was to administer normal saline safely, she realised therewas a mistake, but she did not want to immediately act upon it. There was abreach in duty when she did not take actions even when she was aware of the airbubbles in the IV drip, which poses a potential danger to the patient. In orderto prevent causation and damages, it is therefore my responsibility tointervene. SEN Sng did not have integrity as she realises her mistake but didnot do anything about it. She also displayed an unprofessional misconduct. By administeringthe normal saline for the patient as soon as possible, SEN Sng displayed beneficence.
I displayedbeneficence, paternalism and justice by confronting SEN Sng a second time andletting her know that the bubbles should be removed twice, as I am protectingthe patient.I wouldbe displaying beneficence and paternalism again if I decide to report theincident to a higher authority to take action and change the IV drip set, as I ammaking a decision that is best for my patient. In addition, I would also bedisplaying the principal of veracity. However, veracity would also be breachedif I decide to not take any actions against SEN Sng. In thisscenario, SEN Sng should confess to her mistakes and act appropriately, whichis to change the IV drip set.
However, after being reminded by me that the airbubbles should be removed, she still did not take any actions. I have the rightto make the decision and intervene immediately or else the patient might beharmed. I also have the right to make the decision, as by doing so, I would beabiding to the principal of ethics, against SEN Sng’s actions which breachedseveral principals, codes of ethics, professional conduct and nursing negligence.