Write a 700- to 1050-word reflective journal in which you answer the following questions:
o What were the ethical issues presented in the simulation?

o What decision-making steps did you take to ethically address these issues?
o What ethical perspectives or lenses did you use to make your decisions in the simulation?
o How did these ethical perspectives or lenses influence your decisions?
o How might concepts from this simulation relate to your workplace?
Dilemma 1
You are a supervising nurse in Seva Medical Centers Ob/Gyn department. Earlier today a minor unwed mother in the early stages of labor was admitted accompanied by her parents. As your night shift begins you see a few emails about the situation.
From Subject
Brenda Willis Patient to watch
From: Brenda Willis
Patient to watch
Just a quick note as your shift starts:
Near the beginning of my shift we admitted a 16-year-old mother Rachel Banks. Shes in her tenth hour of labor now. Her parents have been with her and they have chosen to limit the amount of medication and other medical assistance weve administered for personal reasons. Given the length of her labor however her situation could worsen. Keep a close eye on her. Im not sure her parents understand how dangerous her situation could get.
Brenda Willis RN
Shift Supervisor
Seva Medical Center
Harold Mills Staffing Adjustment
From: Harold Mills
Staffing Adjustment
Due to recent financial shortfalls weve had to cut back on staff in your department. This readjustment of personnel will reduce the number of on-call physicians available during your shift. We have confidence that our exemplary nursing staff under your capable leadership can adjust to this restructuring with a minimum of difficulty.
Harold Mills
VP of Human Resources
Seva Medical Center
Stan Kirk Visitor
From: Stan Kirk
We just had a visit from a Joseph Banks brother of a sixteen-year-old patient Rachel Banks. He was really upset. He said Rachels parents were punishing her for getting pregnant before she was married and withholding painkillers and treatment. According to Joseph the whole family had a big argument and the father said Rachel was being judged and if God wants the child to survive it will be Him not the hospital who protects her.
I told him the staff here would do everything they could to keep Rachel and her child safe but I also reminded him that Rachels a minor and legally that means the parents make the call. The last thing we need is a big lawsuit.
In the end I convinced him not to go into Ob/Gyn and make a scene but I thought I should tell you about the incident just in case.
Stan Kirk
Seva Medical Center
Harold Mills Annual Performance Review
From: Harold Mills
Annual Performance Review
Just a reminder: Well be conducting your annual Performance Review this week. Be sure to review your Job Description so you can discuss with us in detail how you fulfill the requirements of your role and how youve attempted to meet your goals. Also please keep Rians advice on ethical decision making in mind. Finding leaders who can make ethical decisions is one of Sevas highest priorities.
Heres your current job description:
Shift Supervisor
Assists the Head Nurse in managing nursing staff by shift. Is clinically knowledgeable and able to perform all duties of staff under their supervision. Collaborates with physicians in assuring that care regimens for all patients are carried out by shift staff. Skilled in communication team-building and electronic medical records systems.
Keep up the good work
Harold Mills
Human Resources
Seva Medical Center
You check Rachels chart and notice that she has not been given any meds or been seen by the physician on duty who is attending another emergency. Fetal distress is not currently critical but it has been increasing gradually as has Rachels own distress and fear. The parents have clearly stated they dont want any assistance and the assigned nurse has acquiesced in that desire but you are concerned that Rachel and the baby may be moving toward irreversible medical danger if some intervention is not made. Although the unit is short-staffed the hospital does have a chaplain on staff who could be summoned quickly.
As you reflect on the situation you realize that its all a pretty sticky mess. However you dont have to face the problems alone since Seva has Rian Brown the companys Ethics Officer to assist. The time seems right to contact the Ethics Coach.
Issues in your Dilemma
Thanks for visiting with me today. Youre rightyou have a tough problem. I am pleased that you are willing to work through the problem by email today. I think you will find this method useful.
The first step is to figure out exactly what the problem is what the issue is that you are facing. By breaking the problem down into small parts you can see the dilemma more clearly. If you want some additional help in sorting through the issue check my Ethics Coach posting for this page. Remember that the Ethics Coach changes on each page with information specific to your current task.