Working in an emergency room gives rise to ethical dilemmas. Due to time restraints and the patient’s cognitive impairment and lack of medical history, complications can and do occur. The nurse has very little time to get detailed patient information. He or she must make a quick assessment and take action based on hospital protocol. The organized chaos of the emergency room presents unique ethical challenge, which is why nurses are required to have knowledge of ethical concepts and principles.
Questions to Consider
To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.
• How does a triage nurse decide which patient gets seen first?
• How does health disparity affect the triage nurse’s decision making?
• What ethical and moral issues does the triage nurse take into account when making a decision?
• What are triage-level designations?
Your supervisor has asked you to do a 15-minute oral presentation at a staff meeting about a recent issue that occurred at another hospital in town. Following an industrial accident, two patients arrived at the emergency room of that hospital at the same time, presenting with very similar inhalation injuries. The hospital received a great deal of negative press due to how the patients were triaged in the ER. Your supervisor would like you to use the specifics of this case to review triage procedures and best practices at your facility. Here are the details:
• One is a 32-year-old firefighter, Frank Jeffers, who is presenting with respiratory difficulties that he obtained while evacuating victims of an industrial accident. He is a married homeowner and father of two young boys. He has lived in the community all his life. He has full and comprehensive health insurance through his employer.
• The other is Brent Damascus, a 58-year-old man. Brent is presenting with respiratory difficulties with the same intensity as Mr. Jeffers above. He is well known at the hospital emergency room, as he is a frequent visitor with various complaints, including asthma, headaches, and tremors. He is homeless, unemployed, and uninsured. He stays many nights at the YMCA and eats lunch at the soup kitchen. He has lived in the community for over 10 years and has been arrested several times for petty theft.
Preparation
Create a 15-minute presentation (3–4 pages) that examines the moral and ethical issues that occurred when triaging these two patients and the best practices for managing this in the future.
Divide your draft into a number of talking points that you can summarize neatly. Keep in mind that an oral presentation requires slightly different language than an essay. The aim is to communicate your message so keep sentences simple and focus on the key points you want to deliver. Address the following in your presentation:
• Explain the health care policies and protocols that are in place that direct triage care in an emergency situation.
• Explain how health care disparities impact treatment decisions.
• Identify the health care policies that are in place that direct care for uninsured individuals. Is there a difference in how these individuals are triaged?
• Describe the moral and ethical challenges nurses can face when following hospital policies and protocols. Is there a conflict when a severely injured person is also uninsured?
• Recommend evidence-based strategies that should be applied for managing the care of uninsured and indigent population.
