Case Study: an Expensive Source of Contamination

Case Study: An Expensive Source of Contamination

James is a nurse manager with responsibility over three 30-bed units in a large metropolitan medical center affiliated with a large university. Over five years, a team of staff nurses and university faculty gathered data on the rates of hospital acquired infections on the three units. Infection rates were low and stable during the first four years, but rose dramatically at the beginning of the fifth year and showed a gradual upward trend throughout the fifth year. Many patients’ hospital stays were prolonged because of hospital acquired infections and three elderly patients died from hospital acquired pneumonia.

Completing the systematic investigation, James and the nurse research team concluded that the rising infection rates began when they adopted a new hospital-wide very costly medication delivery system. With the new system, the nurses pushed carts to each patient’s bedside. The nurses moved back and forth from the carts to the patients’ bedsides and used an attached electronic scanner to validate patients’ identification. Onsite investigation revealed that, even though the nurses were washing their hands properly between patients, the carts and scanners themselves had become harbors for pathologic organisms. Further, the team was unable to find any evidence-based strategy for preventing or eliminating the source of infection.

Representing the research team, James presented the data to the hospital’s research council and subsequently to the hospital administration. After a four-month delay, James received a letter explaining that the medication systems would not be investigated further. The letter recommended that he conduct education sessions with the nurses focusing on infection control and stressing the importance of hand washing.

Think About It 1. What are the professional and personal values that support James’s research project? 2. How do these values connect with ethical principles? 3. What institutional versus personal values conflict in this situation? 4. What strategies can James and the research team employ that would maintain their ethical integrity without risking their employment? 5. What happens when a nurse manager “rocks the boat” in an organization in order to satisfy ethical principles?

Feedback 1. It is impossible to know with a certainty what values support an individual’s actions, but in this case it would seem that James acted from a sense of responsibility and a desire to remove potential harm — i.e., beneficence.

2. Anytime a nurse strives to help a patient, to support a patient’s decision and to remove harm, ethical principles are in evidence. The nurse doesn’t need to know the name of the principle or be able to define it, but the action demonstrates adherence to principle-based values.

3. The institution is often viewed as the “bad guy” in discussions of ethics in the workplace. But, even when institutional decisions conflict with individuals’ decisions, the institutional policy may adhere to ethical principle on another level. In this instance, the institution may understand that there is ultimate benefit to patients if staff is more efficient with the medication carts. Their solution of educating the staff to utilize the equipment in a way that reduces risk of infection adheres to the principles of beneficence and justice. Justice may be involved since more people will have access to health care that is efficient.

4. Since James is an employee of the facility, it is his responsibility to abide by the policy in a way that is most beneficial to patients. He could provide educational sessions to his staff and then re-test the medication carts for evidence of success or failure.

5. Although it can be dangerous to “rock the boat” in institutional settings, managers who adhere to ethical principles, while thoughtfully considering the implications for both the patients and institution, will likely be valued within the organization.