Outcomes for the assignment:
Use the SBAR template/headings to record the mock consult engaged in in class.Develop an annotated bib with articles from the recent ethics literature to education ethics committee members about the issues being addressed.
Assignment instructions:The written report contains two parts:A summary of the consultation including recommendations. This should be no longer than three pages, double-spaced, using the framework in the SBAR Consult Summary
Form available in 2GU.Annotated bibliography. Three articles you would use to educate your committee about the issues that arose in your case. In addition to the citation, you should include a short (one paragraph) summary of each article and why you chose it. These should NOT be course readings.
Be sure to upload the assignment as one, not two, documents.Sample Annotated BibliographyLin, Y., Lee, W., Kuo, L., Cheng, Y., Lin, C., Lin, H. (2013). Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: A quasi- experimental study. BMC Medical Ethics, 14(8), 1-8. http://www.biomedcentral.com/1472-6939/14/8 Links to an external site.. This paper evaluates the improvement in patient privacy following many interventions put in place in a large overcrowded Emergency Department (ED). Interventions included environmental space reorganization at the departmental level, as well as bioethics education and training to all employees and encouraging ethics consultations at the institutional level. The authors ultimately stress the importance of building an ethical environment in the organization to improve quality of patient care. This paper is therefore highly relevant to the above ethics consultation: As in the consult, this paper stresses the importance of applying ethics at the institutional level to achieve staff satisfaction, patient dignity and extraordinary care.Mah, R. (2009). Emergency department overcrowding as a threat to patient dignity. Canadian Journal of Emergency Medicine, 11(4), 365-369. http://doi.org/10.1017/S1481803500011428 Links to an external site.. This paper evaluates a patients’ basic right to dignity, and how ED overcrowding frustrates this right. Many violations are evaluated, including insufficient personal space, inadequate access to food and water, and privacy violations. The authors conclude that for ED overcrowding to change, it must be viewed as an ethical and autonomous rights problem, not simply a departmental problem. I believe this paper is relevant to the above ethics consult as it stresses the violation to basic human dignity that results from ED overcrowding. This concern was expressed by many stakeholders in the consult, and as the authors suggest, efforts to ameliorate were only applied when viewed as an institutional ethical problem.Moskop, J. C., Geiderman, J. M., Marshall, K. D., McGreevy, J., Derse, A. R., Bookman, K., McGrath, N., & Iserson, K. V. (2019). Another look at the persistent moral problem of emergency department crowding. Annals of Emergency Medicine, 74(3), 357-364. https://doi.org/10.1016/j.annemergmed.2018.11.029 Links to an external site.. This paper specifically provides insight into the moral stress from both a patient and provider standpoint in an overcrowded ED. It brings in the ethical principles of autonomy, justice, beneficence and non-maleficence in describing the moral stress. The paper concludes by stating that ED overcrowding is potentially the most prevalent moral dilemma in Emergency Medicine today, and that for overcrowding to change, viewpoints from multiple stakeholders must be addressed. I therefore believe this paper is relevant to the above ethics consult as it identifies the importance of considering different perspectives and ideas to ultimately implement change, as was accomplished in the consult.Here are the details of the case study we presented.Nurse manager: before we get started, I want to summarize the situation that has brought us all here. Ms. Johnson is a 39 yo african american female. G3P1 admitted at 27 weeks to the antepartum unit with chronic HTN with superimposed Pre-eclampsia, as well as fetal complications of fetal growth restriction and absent end diastolic flow. She has a history of Gestational Diabetes Mellitus, uncontrolled hypertension, and obesity.Orders for BP monitoring and management, continuous fetal monitoring and biweekly fetal ultrasound have been placed. During her second week of admission, the pt started making comments that she only wanted african american providers and nurses. Her OB group is a mixed practice. The OB ‘s have attempted to comply with her request as best as possible. Her BP has remained uncontrolled and dangerously high because she refuses to take her medication as prescribed. For her treatment of pre-eclampsia and fetal lung maturity and neuro protection, Magnesium sulfate was ordered. The patient refused the magnesium stating members in her family and her doula did not believe it was necessary for her to have. Many discussions were had with the pt and family regarding her care and treatment plans, as well as implications for fetal and maternal health concerns by NICU, OB, and perinatology. At some point while monitoring the baby, non reassuring fetal heart rate patterns were noted, and the team ordered more frequent fetal monitoring. Eventually the patient began refusing fetal monitoring, BP monitoring and all medications. The plan was to deliver at 34 wks. Around 33 wks, the fetal growth restriction was worsening and now the fetal blood flow was absent and reversed. It was recommended to proceed with delivery now by Perinatology. Despite this recommendation, the patient has continued to refuse all care. She also started accusing the Caucasian physicians in the group of racism. Nurses and providers implemented all chains of command and attempted conversations with family and doula to no avail. The patient’s nurses have escalated these concerns to me, and I made the decision to consult the ethics team and get the entire care team together to discuss the issues at hand.