Interdisciplinary team participating

 

Scenario

You are a member of an interdisciplinary team participating in patient rounds at the start of your shift. You notice the physician charting that the patient is alert and oriented x3, but the patient was clearly confused, which the physician acknowledged during rounds.

How would you approach this scenario? Apply one of the ethical principles discussed in Dynamics of Nursing: Art and Science of Professional Practice to this scenario. Discuss how organizational culture can help manage errors.

Please do not provide so much research and instead, support the research, by using your own analysis and examples. How can you tie what you are writing into clinical examples you and your RN team face each day?

 

Sample Solution

This scenario presents a critical moment where a team member’s observation needs to be addressed to ensure patient safety. This is a situation that I, as a nurse, have encountered numerous times.

My approach would be to address the discrepancy in a professional and respectful manner, applying the ethical principle of Veracity – the duty to be truthful and honest in all interactions, especially those that affect patient care.

Here’s how I would approach the situation:

  1. Private Conversation: I would approach the physician privately, away from the other team members. This allows for a confidential discussion without interrupting rounds.

  2. Direct and Respectful Communication: I would state my observation directly, using a non-confrontational tone: “Dr. [Physician’s name], I noticed you charted the patient as alert and oriented x3, but during rounds, you acknowledged that the patient seemed confused. I’m concerned about this discrepancy.”

  3. Clarification: I would ask for clarification: “Could you please elaborate on your assessment of the patient’s mental status?”

  4. Collaboration: I would emphasize a collaborative approach to ensure accurate documentation and patient safety: “We want to make sure the chart reflects the patient’s true condition. Perhaps we should re-assess the patient together to ensure we are on the same page.”

Organizational Culture and Error Management

A supportive and open organizational culture is essential to managing errors. Here’s how a healthy culture can help:

  • Open Communication: A culture that encourages open dialogue, where team members feel comfortable expressing concerns, is crucial. If nurses feel comfortable voicing their observations, even if they differ from the physician’s assessment, it can help prevent errors.

  • Respect for Expertise: Valuing the expertise of all team members, regardless of their role, is critical. Nurses possess unique insights into patient care, and their observations should be valued.

  • Focus on Patient Safety: Organizations should have a strong commitment to patient safety, where errors are viewed as learning opportunities, not as blame. This creates a safe environment for reporting errors without fear of retribution.

  • Error Reporting Systems: Robust error reporting systems allow for the identification of trends, root cause analysis, and implementation of corrective actions to prevent future errors.

Clinical Examples:

  • Medication Errors: Nurses often notice discrepancies in medication orders or administration. An open culture allows them to comfortably bring these discrepancies to the attention of the physician.

  • Patient Deterioration: Nurses often notice changes in a patient’s condition before a physician might. A culture that values nursing observations can prevent missed opportunities for timely intervention.

By fostering an environment where team members feel comfortable communicating openly and respectfully, prioritizing patient safety, and learning from errors, healthcare organizations can create a culture that minimizes the likelihood of harmful mistakes.

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