In the case study, the problem is that there is poor coordination of work between the various health care professionals who provide care to a patient.

Ethical Dilemma of Health Care – team nursing practice

The selected case study is the one about team nursing practice. In the case study, the problem is that there is poor coordination of work between the various health care professionals who provide care to a patient. In analyzing the case, the ethical decision-making model is used. This model consists of the following: moral awareness, moral judgment, and ethical behavior.

Moral Awareness
This is the initial step in the ethical-decision making model. A person recognizes that the situation has a moral issue (Lincoln & Holmes, 2013). In the case study, the people involved include registered nurses (RNs) who are staffs at the hospital, a nurse manager, a charge nurse, and physicians. Communication in the team nursing practice is hierarchical. The RNs report to the team leader, who will then report to the doctors and other members of the healthcare team. Communication in the team nursing practice was by and large ineffective. This is because sometimes it takes a long time for the message to be conveyed from members at the top of the hierarchy to those at the bottom, and vice versa. A lack of communication, or poor communication, between the team members could be damaging in a team nursing because of the shared workload (Mattila et al., 2014). Patients have a higher likelihood of becoming uncomfortable with many team members delivering care to them. They may see this as distracting. The only instance when the communication was useful was when the nursing assistants/RNs were communicating among themselves.

This situation has a moral issue in that the healthcare team members sometimes provide specific procedures on their patients without first obtaining informed consent and without informing the patients about the benefits and risks of a given medical procedure. The factors that contributed to the issue/problem include poor communication or a lack of communication among the team members. Some team members, for instance, physicians, conducted a medical procedure on a patient with the assumptions that other members, namely RNs, had already obtained informed consent from the patient when this was apparently not the case. As such, the ethical principle of autonomy was violated.

Moral Judgement
In this second step of the ethical-decision making model, the decision maker will formulate and evaluate possible choices and likely outcomes. In essence, the possible solutions are identified (Lincoln & Holmes, 2013). In regards to the case study, the possible solutions include adopting one of the following interventions: total patient care, practical nursing, or primary nursing. These are some potential solutions that can help to get rid of the problem of coordination of work and poor communication among health care professionals, and possibly improve patient care and patient outcomes.

Ethical Behavior
In this final step, the solution is selected, and the decision maker must act. This solution should be a morally right one, and the decision maker follows through on it (Lincoln & Holmes, 2013). As regards the case study, the selected intervention or solution is to replace team nurse practice with primary nurse practice, in which a single RN will provide patient care on an individual basis when the patient gets admitted until when he/she is discharged. Primary nursing will facilitate the creation of a good nurse-patient relationship given that the patients would be able to establish trust and become comfortable with the performance of the RN while offering care (Mattila et al., 2014). Primary nursing practice will foster professional collaboration by decreasing the problems of coordinating the work and improving communication between the healthcare professionals. Also, the solution will enable the healthcare professionals to adhere to the ethical principle of patient autonomy since a single nurse will be caring for a single patient, and would be able to observe all the ethical principles while providing the care properly.

Lincoln, S. H., & Holmes, E. K. (2013). A need to know: An ethical decision-making model for research administrators. Journal of Research Administration, 39(1): 200-235

Mattila, E., Pitkanen, A., Alanen, S., Leino, K., Luojus, K., Rantanen, A., & Aalto, P. (2014). The effects of the primary nursing care model: A systematic review. Journal of Nursing and Care, 3(205): 556-579

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