COMMUNICATION AND DELEGATION OF CARE A CASE STUDY IN ETHICS

Marianne, a five-year Emergency Department (ED) nurse, admits a 65-year-old male patient (“A”) found unconscious on the street. Police/ EMT reports include a history of homelessness, battery, and a fall. Marianne completes an initial assessment of the patient, who is drowsy but 4 responds appropriately to questions. However, he is unable to recall the incident. “A” has a sizeable swelling over his right temple. He receives intravenous therapy, labs, and a CT scan. The CT was negative, labs are within normal limits, and his alcohol level is .04. Two hours after admission to the ED, the patient’s temperature rises to 101.5. He becomes increasingly confused and combative. Marianne reports these findings to the ED physician, who orders additional labs and a lumbar puncture. At this same time, Marianne’s charge nurse (CN) approaches her, asking Marianne to admit a multiple trauma patient (“B”). Marianne updates the CN on the status of patient “A” and relays her concerns that this patient’s condition is worsening. The CN replies “that homeless drunk can wait” … “multiple trauma cases take priority”. If you were Marianne, how might you react? In a narrative response, consider the following as you plan your “best case/ worst case” interventions in this challenging scenario. • Priorities/ time constraints • Patient acuity level • Available ED staff / qualifications • Code of Ethics for Nurses • Ethical principles of autonomy, beneficence, fidelity, and justice