Professional Development Exercises

You be the Judge The patient was to undergo a fundoplication surgery to repair an esophageal hernia. The procedure involves the insertion of an esophageal dilator, which at this institution is performed by the anesthesia team. In this particular instance, the dilator was to be inserted by a nursing anesthesia student. The student introduced herself to the patient immediately before the procedure. She used her first name only and stated that she was a registered nurse who would be working with the nurse anesthetist and the anesthesiologist. The student referred to the nurse anesthetist by first and last names and to the anesthesiologist using the term doctor and his last name. During the insertion of the dilator, the student tore the lining of the esophagus. This required an open procedure to be performed, which resulted in complications for the patient. The patient sued for lack of informed consent, inadequate supervision, and negligence. Specifically, the patient argued that he had the right to know if a student was to perform any part of the procedure and that he had the right to refuse such participation. The court returned a verdict in favor of the patient on the part of inadequate supervision. As stated in the institution’s written policies, the student was to be supervised by an anesthesiologist, not merely a nurse anesthetist.
Questions
Is the patient correct in asserting that he has a right to know the names and status of individuals who will be performing this procedure? Does the manner in which the student introduced herself and the two other team members have relevance in this case? Was the informed consent deficient to the degree that there was a lack of informed consent by the patient? How would you decide this case?
Case study
A patient is admitted to your surgical center for a breast biopsy under local anesthesia. The surgeon has previously informed the patient of the procedure, risks, alternatives, desired outcomes, and possible complications. You give the surgery permit form to the patient for her signature. She readily states that she knows about the procedure and has no additional questions; she signs the form with no hesitation. Her husband, who is visiting with her, says he is worried that something may be said during the procedure to alarm his wife.
Questions
What do you do at this point? Do you alert the surgeon that informed consent has not been obtained? Do you request that the surgeon revisit the patient and reinstruct her about the surgery? Since the patient has already signed the form, is there anything more you should do?
Case study
Now consider the ethical issues that such a scenario raises. Which ethical principles is the husband in this example most portraying? Which ethical principles should guide the nurse in working with this patient and family member?

Jimmy Chang, a 20- year- old college student, is admitted to your institution for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission. His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because “Jimmy has suffered enough.”
You are his primary nurse and must assist in somehow resolving this impasse.
What do you do about the informed consent form? Who signs and why? Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective. Did you come to the same conclusion using both an ethical and a legal approach