Nurse Jane and the Surgeon
Ms. Bell, aged 65 years, is under the care of Registered Nurse Jane. Ms. Bell had a total hip
replacement yesterday. She told Jane that her pain was intolerable, and then she groaned
loudly and said, Oh, I hurt worse than I have ever hurt before in my life. Please help me,
please, please, I cant stand it anymore! Please give me something for pain now. When Jane
assessed her level of pain, Ms. Bell described her pain as the highest level, 10 on a 10-point
pain scale. Her blood pressure and pulse were slightly elevated as compared to her last documented vital signs. Jane proceeded to check Ms. Bells orders but discovered something
very unusual. The surgeon had ordered her IV pain medication for only every 6 hours
instead of the typical 3-hour frequency for patients with 1-day postoperative hip replacements.
Ms. Bell would have to wait 3 more hours for her next IV pain medication. Jane returned to Ms. Bells room to explain her current pain order and inform her that she would call the surgeon now. By that time, Ms. Bell was crying out with pain and moving her head from side to side. Jane felt such empathy and concern for her. She briefly tried to comfort her with words and acts of kindness, but she needed to return quickly to the unit to call the surgeon for a new order. When he answered, she began informing him of her assessment of Ms. Bell and the 6-hour interval
order, but he abruptly and loudly interrupted her and stated, I meant to order that medication
every 6 hours. She does not need more frequent pain medication, because of some past problems with prescription pain medications. Please do not call me unless you have critical information that needs my attention. Jane was shocked, and many conflicting thoughts rushed through her mind. Why did he not want Ms. Bell to have more frequent pain medication, like other postoperative patients in his care? Was it really about her past use of prescription medications? Ms. Bell had a total hip replacement less than 24 hours ago and was in excruciating pain! Jane asked herself what she should do. After some reflection, she notified the nursing supervisor, who
then reviewed the case and decided to call the surgeon. The supervisor stated the surgeon
seemed approachable and decided to order a one-time dose of IV pain medication to relieve her immediate pain. By that time, another hour had passed, so Jane administered the medication as quickly as she could in an effort to relieve Ms. Bells pain.
Questions
Review the chapter content.
1. In the relationship between Jane and the surgeon, what ethical issues are going on between them? To answer, explore the history and research on the nursephysician relationship in the chapter. What bioethical principles did the surgeon violate with Jane and his patient, Ms. Bell?
2. Of the ethical competencies presented in the chapter, which ones did Jane demonstrate with Ms. Bell during the process?
3. Did Jane do the right thing by calling her supervisor? What other actions, if any, should she have taken?
