Read this statement, select a topic from the bullet pointed topics, and then answer the questions listed below.  “People can feel trapped by internal as well as external factors. External situations are more visible: poverty, unemployment, racism, abusive relationships, violence, injustice….Internal factors can be just as compelling, but external factors are all calls to action for social justice.”

Select a current example of a population that is oppressed by life experiences or factors in the environment. Here are some populations from which to choose:

· Teen girls captured for human trafficking in sex trade

· Teen boys trapped by poverty in violent gangs

· Children caught in abusive homes

· Homeless schizophrenics

· Elderly Alzheimer’s patients whose family financially exploits them

· Wounded warriors suffering from PTSD (Post-Traumatic Stress Disorder)

1. How can a nurse make sense of the travesty of oppression that causes so much human suffering?

2. What moral obligation do nurses have to prevent human entrapment rather than just caring for victims of violence? How could nurses advocate for an end to oppressive conditions such as poverty and racism?

3. When nurses observe an under-served population trapped by one or more of these external factions, what should be done? How should a nurse begin to mobilize awareness to address issues entrapping the population being served?

4. How does the Code of Ethics guide the nurse in mobilizing forces to address this social issue?

5. If nurses ignore forces trapping the population they serve, what is the most likely set of outcomes five years from now?

Respond to students

Children caught in abusive homes

How can a nurse make sense of the travesty of oppression that causes so much human suffering?

· Child abuse mostly occur at home at the hands of people the child knows them well and they could be parents, babysitters, or the family’s friend. Nurses should know that child abuse is common in all societies, and they must have roles to help these kids and to stop this travesty of oppression that causes so much child pain and suffering. Nurses must have enough knowledge and training to discover the possible conditions of child abuse and treatment that can be not visible and not show any signs of abuse. Sometimes, nurses can observe the signs od abuse during general assessment and physical check in the emergency or during the routine check up visits. Nurses can notice a sudden change in the child’s behavior and sometimes they have difficulty to concentrate. Sometimes, nurses should pay extra attention to explore hidden and invisible cases of child abuse because not all signs are easily visualized.  (Jack, et all, 2021).

What moral obligation do nurses have to prevent human entrapment rather than just caring for victims of violence? How could nurses advocate for an end to oppressive conditions such as poverty and racism?

· Nurses are in unique and special position to observe the child abuse and violence conditions and to understand the environment of these behaviors against kids. This will increase nurses’ responsibilities and obligations to prevent such conditions. The priority action that the nurse can do when facing suspected cases of child abuse is to remove the child from the abusive situation and then report the suspected cases to the competent authorities. Nurses should do a holistic and complete assessment and history for unusual findings that indicate the possible abuse to confirm the abusive behaviors. Nurses must document all findings with detail. During that, nurses must provide a secure and safe environment for the abused children. Providing comfort, and reassure the child is very important in this regard. (Holman, 2019, p. 296). Nurses should promote self-esteem and assess for feelings of shame and guilt and avoiding asking the child probing questions. Also, nurses should provide care to parents and assess for their socioeconomic status and if they have any problem and offer a possible help and support and provide appropriate and available resources for them. Sometimes, poverty, racism, and other social, economic, familial problems are the causes for the parents’ abusive behavior toward their kids and helping to solve this issue will help to safe children and reduce or even eliminate these unwanted behaviors.

When nurses observe an under-served population trapped by one or more of these external factions, what should be done? How should a nurse begin to mobilize awareness to address issues entrapping the population being served?

· When nurses observe some population trapped by some external factors, they must assess and analyze the whole situation to understand the reason behand that and how to remove these people form these situations. Also, nurses can offer the best possible and available resources to serve and help these population and provide them with life essentials and the basic live requirements. Nurses can work with social resources to understand and to address the underlying issues that entrapping these population. Nurses should establish a trusted and therapeutic relationship with population being served and work to support them with the required health services.

How does the Code of Ethics guide the nurse in mobilizing forces to address this social issue?

· In the Code of Ethics, provision 8 stated that “the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy and reduce health disparity” (Fowler, 2015, p. 129). Health disparity and injustice in distributing the healthcare services and resources is one of the causes behind some violence, abuse, and neglects problems and continuing of this issue will aggravate the violence and abuse conditions and increase the risk of health deterioration and will impact the outcome of the victims. Many poor and homeless people, abusive child’s and adults, and older adults who are exploited because of their chronic disorders or have cognitive and mental status impairment are at high risk for health problems due to health disparities and inadequate health care access. According to the code of ethics, provision 8, health is a universal right and must be provided for all people regardless of races, ethnicities, age, gender, socioeconomic status, or diagnosis and nurses always have responsibilities and obligations to advance health, and human rights, and to offer all best possible actions and interventions to reduce the disparities (Fowler, 2015, 137).

If nurses ignore forces trapping the population they serve, what is the most likely set of outcomes five years from now?

· Ignoring these people and the forces and factors trapping them will lead to just one outcome which is the worsening of their conditions and deterioration of their physical, psychological and emotional conditions and they will lose their social relationship. These population most likely will experience many problems later in life and “the greater the severity of abuse, violence, and exploitation, the higher the likelihood of negative outcomes” (CFCA, 2014). Poor self-esteem and feeling marginalized and exploited from others also are among the consequences that could result from ignoring these peoples’ situations. These people are at risk for physical and mental health problems, substance abuse disorders and low productivity and children specifically will experience developmental and cognitive impairment and delay. Additionally, the victims of abuse, violence, neglect and exploitation can suffer from many other problems such as depression, smoking, obesity, malnutrition, and sexual disorders (WHO, 2020).

Student2

Oppression and human suffering are not sensible and nurses must understand risk factors for individuals and groups that are at high risk. For instance, being aware of the risks of children caught in abusive homes is important in order to recognize signs and symptoms of occurence. Educating the public and family members of these occurrences is also important in prevention of abuse.

Nurses have a moral obligation to prevent human entrapment as mandatory reporters for abuse and neglect, and as maintaining the integrity of social justice and respect for vulnerable persons who may not be able to express their full autonomy.

Nurses can advocate for an end to abuse in childhood homes by also aiding in resources for a family in poverty. Recognizing traits of a potential abuser such as substance abuse, poverty, high stress environments.

Nurses can begin to mobilize awareness by fairly allocating resources, being an open and honest voice for those who are oppressed and lobbying for change. Mobilizing awareness can be done by talking with not only other healthcare professionals, but local state representatives. At an individual level the nurse can educate families and individuals about signs and symptoms of abuse. The nurse can also provide resources and referrals to social services that may help families in high stress situations.

The Code of Ethics emphasizes that nurses integrate social justice into practice by addressing underlying conditions of health, addressing unjust systems and influencing those in power to help improve healthcare (Fowler, 2015). As advocates, nurses should lobby for justice.

If nurses ignore forces trapping the population they serve, in the next few years health across the globe will decline and communicable disease will be more prominent in underserved areas.

Here is a picture that highlights a few traits of possible abusers.

Respond to 2 more students

What patient safety goal(s) were violated?

The patient safety goals that were violated in this case were, identifying patients correctly and using medicines safely. The nurse did not do her safety checks before administering the medications by checking the five rights of medication administration. By ensuring the patient’s name and date of birth matched the patient’s chart and the patient’s wristband before administering medications could have prevented this medication error. She did not compare the medications with the patient’s orders either, which is another violation of patient safety goals.

What would you report in the RCA as the cause?

When reporting in the RCA, the nurse should report understaffing, communication errors and failing to complete safety checks when administering medications as the cause. With one nurse calling off and the CNA being pulled to a different unit, nurse Bonnie had several tasks to complete at the same time between getting medications for several patients as well as answering the phone and changing orders which distracted her from completing the proper steps of medication administration.

How would you prevent this from happening the next time?

Following along with the national patient safety goals, the patients should be identified using at least two identifiers, such as the patient’s name and date of birth (The Joint Commission, 2021). The nurse should check the patient information three times, once when pulling the medications, once outside the patient room, and once with the patient when administering the medication. Even during busy times, no medication should be administered without verifying the patient information. The nurse should also compare the medication against the patient’s orders, according to the national patient safety goals (The Joint Commission, 2021). Bringing the order sheet when pulling the medications should help to prevent mistakes as well.

(Evlogiadis, 2017).

What provision of the Code of Ethics was violated?

Provision 4 of the Code of Ethics was violated when the nurse did not perform the standard measure of safety checks before administering medication to the client. Provision 4 states “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.” (Fowler, 2015, p.59). In this situation, The Code outlines that although the nurse had distractions and less than desirable circumstances surrounding the medication error, ultimately she is responsible and accountable for her actions of giving the medication to the wrong patient because she did not follow the standard of practice for medication administration safety.

What actions are taken against the nurse?

The nurse who made these mistakes will be scheduled to have a meeting with at least their charge nurse, unit manager, and supervisor. Depending on the results of the RCA there may or may not be more people involved in the meeting, such as hospital staff higher than the supervisor and members who completed the RCA. Based on the results of the RCA report the nurse will be given disciplinary actions and/or warnings as defined by board recommendations.

Another response

1. What patient safety goal(s) were violated?

The safety goal that was violated in this scenario was patient identification. One of the Joint Commission’s national safety goals includes identifying patients correctly (The Joint Commission, 2021). The Joint Commission states that health care providers should use two patient identifiers to make sure that the correct medication or treatment is given to the patients (The Joint Commission, 2021). In this scenario, if Bonnie used two patient identifiers before administering the medication she would have likely noticed she was in the wrong room. The other goal violated in this scenario is the use of medications safely (The Joint Commission, 2021). The nurse never keeps medications in their pockets and always has the order sheet when taking medications out of the pyxis. These actions often lead to medication errors and could have contributed to this scenario. Using the five rights of administration including right patient, right medication, right route, right dose, and right time could have helped Bonnie prevent the error from occurring and realize she was with the wrong patient.

2. What would you report in the RCA as the cause? 

RCA, also known as root cause analysis, is a method that is used to analyze any serious event that has taken place that has led to accidents (Patient Safety Network, 2019). This method helps identify the underlying problems that increase the likelihood of why an error/incidence has occurred (Patient Safety Network, 2019). An RCA usually begins with any data collection and/or interviews of the involved participants (Patient Safety Network, 2019). In this scenario, the nurse mistakenly gave patient A the wrong medication due to being distracted and not double-checking the medication with the correct patient. The root cause analysis identified by the RCA team would be that the nurse was distracted by a phone call from a physician and did not double-check the medication again prior to administering, which is what had resulted in the medical error. The RCA is a type of plan that identifies the who, what, when, where, and why of an incident that has occurred.

3. How would you prevent this from happening the next time?

This specific nurse should be followed up with to ensure she can provide safe patient care. The nurse may need additional training or to be reprimanded if applicable. In the future, the nurse should ensure to have their order sheet and pay close attention to patient identifiers. Multiple complementary strategies should be implemented on the floor to ensure medication errors like this one are less likely (The Joint Commission, 2021). According to The Joint Commission (2021), nurses should identify patients correctly by utilizing two patient identifiers. The nurse should also verbally involve the patient in the verification process if applicable by going through the medications with the patient (The Joint Commission, 2021). Medication errors are preventable events that can lead to adverse effects and unfavorable outcomes.

4. What provisions of the Code of Ethics were violated?

Several provisions were violated in this scenario. Provision 3 states that the nurse should protect the rights, health, and safety of the patient (Fowler, 2015). The nurse should have gone through the rights of medication administration before giving any medications to her patient. If she had done this, she would have immediately noticed that the medications she had did not belong to this patient. Provision 4 states that the nurse has authority, accountability,  and responsibility in practice to make decisions and act in a way that promotes health and provides optimal care (Fowler, 2015). The nurse should never have gone to the PYXIS without her order sheet, and she should have clearly separated Patient A and Patient B’s medications before putting them in her pocket. This could have been done by putting each patient’s medication in a clearly labeled plastic bag, or not withdrawing more than one patient’s medications at a time if there was a possibility they could get mixed up.

5. What actions are taken against the nurse? 

Consequences for a nurse who makes a medication error may result in disciplinary action by the state board of nursing, job dismissal, and possible civil or criminal charges. The course of action taken against the nurse who administered the wrong medication to the wrong patient should be determined based on the number of errors the nurse has previously made and any harm caused to the patient. In this scenario, the nurse caught the error, notified the physician, and monitored the patient for adverse effects. The nurse is not new to the unit and should know the protocol for obtaining and passing medications; therefore, given that the medication error didn’t result in a severe adverse effect to the patient, the nurse should be given a written warning and the nurse manager should use this incident as a learning process for all staff on the unit.

In this case, the nurse committed malpractice when she administered the wrong medication to the patient. Malpractice is common in nursing practice, and the nurse must be treated according to applied laws and regulations in the state that the nurse works in and the facility she works with. In this case, where there is no adverse effect on the patient, the Quality and the Legal department in the facility can give a warning to the nurse for the malpractice that she committed and she also should be given a warning that she is “responsible for having knowledge of federal, state, and local law, and facilities policies that govern prescribing and dispensing medications, preparing and administering medications, and evaluating client’s responses to medications” (Holman, et al 2019, p. 11).