Does Work Overload Justify Negligence?

Does Work Overload Justify Negligence? Muhammad Qasim Introduction According World Health Organization (WHO), Pakistan is one of the 57 countries with acute deficiency of healthcare workforce and with no well-defined human resource development policy in place. The country is facing dual burden of communicable and non-communicable diseases with Doctor to patient ratio of as high as one doctor per 1254 population (WHO, 2013). The health care’s facilities remain overcrowded by patients, specially the public sector, which result in work overload and stress among the healthcare professionals. Medical officers (MOs) and Post graduate trainees have duty hours as long as 90 hours per week. Healthcare professionals under stressful condition and work overload are more prone to commit negligence and medical errors. The consequences of medical negligence range from a minor harm to loss of human life. This paper will discuss medical negligence, malpractice in relation to work overload in the light of ethical principles and theories. Moreover, some recomme ndation will be put forward to minimize negligence, establish proper reporting system and minimize work overload among healthcare provider. Scenario A 27 years old male was admitted to the general surgery ward with gunshot injury. He was on injection Nalbuphine10 mg as per need. This patient was constantly complaining of severe pain. The assigned nurse assessed his pain and informed the doctor about his condition. She also informed that the patient has already received Nalbuphine up to its maximum limit i.e. four doses in the last 8 hours. The doctor was overwhelmed with the workload of ward and emergency unit as well. He told the nurse that the patient and his family are exaggerating the condition. Meanwhile, the doctor visited the patient and informed the nurse that he has reassured the patient and his family. After one hour, the patient developed breathing difficulty and went into respiratory arrest. Patient was resuscitated promptly for twenty minutes, but he did not revive, and hence expired. The family showed a strip of tablets Lorazepam 2mg, and added that two tablets are given to the patient on the advice of the duty doct or. It was found that the drug was neither mentioned in patient’s file nor was it verbally ordered to the nurse. The doctor requested not to report the incidence. Later on inquiry revealed that consequences occurred due to additive effect of concurrent CNS depressants. Issue Analysis In the above scenario, the patient was in acute pain, the family was worried about his restless condition. His cries and complaints were disturbing other patients in the units. Doctor was burdened with too many responsibilities and had to manage the patients in ward, recovery room, and emergency department at the same time. Being overwhelmed with too many responsibilities he advised two tablet of Lorazepam 2 mg per oral without mentioning in patient file without considering the prior high deses of Nelbuphine. Consequently, due to the additive effect of the concurrent CNS depressants patient collapsed, and after an attempt of unsuccessful cardio-pulmonary resuscitation (CPR) patient expired. This was violation of ethical principles of beneficence and non-maleficence. Moreover, the doctor’s intention was not to harm the patient however, he bypassed the nurse, did not indicate the order in patient’s file, and handed over written prescription to the father of the patient. The poor father brought the medicine and gave to the patient, which resulted in fatal consequences. It was breach in his duty toward his patient and violation of Hippocratic Oath (Cruess Cruess, 2014). It is also evident from the scenario that doctor wanted to just keep the patient calm and get rid of his pain complain. So, he prescribed a high dose of another sedative medicine for the sake of his ease. Though his intentions was not to harm the patient and was also over loaded with too many responsibilities but, my question is, does work overload justify negligence which cost a human life? Discussion Malpractice is negligence on part of an individual within a professional capacity. According to Beauchamp and Childress (2001) negligence is the absence of due care either intentionally imposing risk of harm or unintentionally but, carelessly in a given situation. Principle of beneficence is central to healthcare and healthcare professionals are expected to be beneficent toward their patients in any circumstances. According to Mustafa (2013) â€Å"Beneficence refers to the promotion of welfare, denoting acts of mercy, unstinting love and selfless humanity† (p.2). However, in this case the doctor not only failed to be beneficent but also committed such an act which resulted in sentinel event. He prescribed the CNS depressant beside he knew that the patient had already received 40 mg of nelbuphine since morning. It was the commission of a maleficent act on his part which, resulted in loss of a precious human life (Beauchamp Childress, 2001). Being in the professional boundary of a doctor, he was trusted upon by the patient and family and was expected to be beneficent toward patient in any case. On contrary, it could be argued that, his intention was not to harm the patient. He just wanted to keep the patient in rest and pain free. In Addition, doctor was overburdened with other responsibilities. He had to take care of other patients so, on the bases of utilitarian theory he was justified to take into consideration the care of other patients as professional obligation. Additionally, it was not only the patient but also the worried family members and other patients in the ward who were disturbed due to his cries and complains. So his decision of prescribing sedative pills was for the benefit of large number of people (Beauchamp Childress, 2001). Though, his workload was more than usual, and he had to fulfill too many responsibilities at a time. However, it neither allows him to be negligent in patient care, nor permit him to violate Hippocratic Oath in which, he had promised that â€Å"he will lead his life and practice his art with integrity and honor by using his power wisely† (Zafar, 2006). His action was deficient as compared to a reasonable and prudent professional under given circumstances (Burkhardt and Nathaniel). Moreover his act was a serious carelessness and maleficent in nature for the client which cost his life. Such negligence is not justifiable on the basis of any legal or moral grounds. Secondly, he bypassed on duty nurse who was responsible for the administration of the medication. It was breach of duty on his part to fail to enter the order in patient’s file. Being responsible for patient’s care, and employ of the institute, he was supposed to follow due course of actions of patient care. Moreover, the concurrence of opiates and sedatives would not have occurred if the doctor had followed proper procedure of prescription. On other hand, it could be claimed that, the ultimate goal of his decision was to relieve suffering of patient. Violating proper procedure of prescription and administration was probably intended to provide prompt relief. However, the nurse could have moved with the doctor in his visit to the patient to argue on the dosage about concurrence. Furthermore, the doctor might have thought about giving prescription to the patient’s attendant will take less time and so prompt relief; he therefore broke the chain of flow of proper protocol. The society expects professionally and morally sound decisions from the doctors. As a part of healthcare team, they are supposed to follow the policies and abide by the rules of the institute they work in. furthermore, â€Å"patients have the right to a quality of care which is marked both by high technical standards and by a humane relationship between the patient and health care providers† (Exter, 2009). In the scenario, the doctor’s noncompliance regarding proper procedure of prescription was below the acceptable standards and violation of his professional obligation. According to American medical association the doctor’s responsibilities include to be ever vigilant for the benefit of patient, and to bear their part in sustaining its institutions and burdens† (Cruess Cruess, 2014). A large number of doctors’ misjudgments and medication errors are corrected by dispensing pharmacist or medication nurse if proper protocols are followed (Al-shara, 20 11). Finally, his request to the nurse about covering the incidence was a professional misconduct as this was a sentinel event. However, the nurse properly followed the virtue of veracity and dared to report the incident. Resultantly, the inquiry revealed that the additive effect of the concurrent CNS depressants was due to negligence in clinical judgment and careless behavior of the doctor. It could be argued that the incidence occurred unintentionally, and its reporting could endanger the doctor’s carrier. In addition, reporting of the incidence could have cost his job and even his license of practice. Is it acceptable to take such risks in a country like Pakistan where there is already shortage of doctors? The negligent behavior of the doctor cost a precious human life, even though he requested the nurse not to uncover the incident. This could be measured a serious misconduct and makes his trustworthiness and moral integrity questionable. According Pakistan medical and dental council the physicians need to attempt highest level of competence and all necessary skills and knowledge, and they will be responsible for their actions (Zafar, 2006).Considering the nature of the event, it was the moral and professional obligation of the nurse to report the incidence promptly. Proper reporting system could prevent future mishaps. Nurse was right in her decision to report the incident on the basis of utilitarian theory for benefit of long number of prospective patients (Burkhardt and Nathaniel, 2008). Recommendation Healthcare providers need to be competent, skillful, and vigilant to provide efficient care to the patients. They should comply with the Hippocratic Oath and trust and expectations of the society. Sound knowledge of bioethics and Islamic ethics can make a difference and should be the part of curricula across the disciplines of healthcare. Proper policies, procedures and protocols need to be implemented and monitored for compliance at institutional, provincial and country level. The government must consider the establishment of new institutions and policy for staffing and scheduling of healthcare professional to cater the needs of growing population and minimize work overload. The proper reporting and analysis should be carried out following an incidence. Conclusion In the conclusion, malpractice on the basis of work overload could not be justified on any moral or legal grounds. Healthcare professionals should comply with the entrusted expectations of patients and society. They are expected to demonstrated optimal level of clinical and professional competencies and skills to meet challenges of the respective professions. Human life is precious and should always be respected. References Al-Shara, M. (2011). Factors contributing to medication errors in Jordan: a nursing perspective. Iranian journal of nursing and midwifery research, 16(2), 158. Barach, P., Moss, F. (2001). Delivering safe health care: safety is a patients right and the obligation of all health professionals.BMJ: British Medical Journal,323(7313), 585. Beauchamp, T. L., Childress, J. F. (2001). Principles of biomedical ethics. (5th ed.). New York: Oxford University Press. Burkhardt, M. Nathaniel, A. (2008). Ethics and Issues in Contemporary Nursing (3rd ed.) Australia: Delmar Cruess, R., Cruess, S. (2014). Updating the Hippocratic Oath to include medicines social contract. Medical education, 48(1), 95-100. Exter, A. (Ed.). (2009). International Health Law and Ethics: Basic Documents. Maklu. Scheffler, R. M., Liu, J. X., Kinfu, Y., Dal Poz, M. R. (2008). Forecasting the global shortage of physicians: an economic-and needs-based approach. Bulletin of the World Health Organization, 86(7), 516-523B. WHO (2007).Global Health Observatory Data Repository. Retrieved from World Health Organization website: http://apps.who.int/gho/data/node.main.A1444?lang=en Zafar , M. H. (2006). Pakistan Medical Dental Council: Code of Ethics. Retrieved April 8, 2014, from http://www.pmdc.org.pk/Ethics/tabid/101/Default.aspx#6

I Need To Know Where I Came From To Know Where I Am Going Essay example

Growing up I learned the stories of my ancestors and how all of them were immigrants. I felt a need to learn their stories because I thought â€Å"I need to know where I came from to know where I am going†. I believe I stand on the shoulders of my ancestors and my accomplishments are not my own but resulted due to what they accomplished in their lives. I view my family history as building blocks with each generation improving, if only in millimeters. My ancestors came from Germany, Sweden and Bohemia. Three of my great-grandparents were immigrants. My parents both knew their grandparents and had a relationship I find it amazing to be so close to the immigrant generation yet so far away. I say far away because the language and customs are gone. We are completely â€Å"American† but in writing this paper I realized the values of the old countries remain alive and well within the current generation. The maternal side of my family contains Swedish and Bohemian ethnicities. My maternal grandmother was 100% ethnic Swedish. My great-grandparents arrived in America in between 1874 and 1888. The section on parenting issues for parents of color in Diller (2011) while my grandparents were not people of color they were immigrants which made them different. I wonder what experience my grandmother had growing up in a home with parents who were born in another country, spoke a different language and had different customs. I knew Grandma was raised by immigrant parents but I never thought how that would affect their parenting style and if the children were teased because their parents were different and how their parents helped the children deal with it. I now wish I had spoken to my grandmother about this and how it was to grow up in... ...ow my great-grandfather’s ethnic identity, his self-image of being German, was impacted (Diller, 2011). I can’t begin to understand how my great-grandfather must have felt during this time knowing the country he chose to become a part of and was a upright citizen in thought he was suspect in some way just because he was German. Knowing someone in my family was forced to assimilate, to give up his native language to take on English the language of the domnianat culture, made me angry and sad (Diller, 2011). I myself would personally love to be able to speak German along with the other native languages of my ancestors. I know the values I have written about provide mere snapshots of the cultural values of my ancestors but I believe they impact the way I live my life and view the world. So how does all of this affect my identity and place in American society?

Movie Essay on Cool Hand Luke

Individuals who tend to change their ideas and perspectives in relation to the others tend to show or express conformity. On the contrary, non-conformity would be the tendency of the individuals to keep their belief system and point of views even in the presence of others. This 1967 movie, which began by flashing the word â€Å"violation† in the screen, illustrates or describes how the life of a free-spirited vagabond named Lucas â€Å"Luke† Jackson stirs up the lives of others in a struggle of conformity and non-conformity in reaching an ultimate freedom. From the very beginning of the movie, the audience is already presented with non-conformity and disobedience to the law or authority. The character, Luke, was first introduced in the movie by cutting the heads off parking meters. He was obviously drunk and his actions are against the law, and thus were brought to court where he was asked to defend his side. According to the findings of Flloyd Allport’s studies, conformers usually do not make extreme judgments whenever they are in the presence of others. On the other hand, since Luke was a non-conformer, he does not deviate from his own beliefs, but rather deviates from the society. Instead of defending his self, his strong spirit remained and he told the court that he was just trying to settle up some old scores. It may suggest that he had previous problems or violations regarding parking rules, thought there were no clues given about it. His deviance irritated those in authority and caused him to be thrown in Florida prison, receiving a punishment which does not fit his crime. In the prison, he becomes part of a chain gang, and his individual life becomes entangled with the other inmate’s lives. People who are sent to prison usually tends to conform to the authority who maintains the order, however, Luke who had been a non-conformer even before being sent to the prison does not. He still continues to throw cheerful comments and all-around bravado against the authority in the prison. He always finds something wrong in the prison system and boldly states this with cheerful remarks. This type of non-conformity is opposite to the type of conformity called the â€Å"normative influence†. Instead of being afraid of disapproval by conforming to the expectations of the other inmates in the prison, Luke does not conform to their expectations. He gets the approval of the other inmates by continuing his non-conforming personality and by exceeding the expectations of his inmates. A scene in the movie shows how he raised a bet to eat 50 boiled eggs in one hour, resulting to an applause or raised fame inside the prison. His deviance and stubbornness even became more evident when he fought a boxing match with another prisoner named Dragline. He was beaten and defeated by Dragline in the match. However, he persists on not giving up and tried to stand up everytime he falls down. The match only ended when Dragline walked away from it. Such actions, stubbornness and non-conformity led to the development of conformity among other prisoners towards him. Moreover, Luke shared his experience of being a buck private during his entire service to the military when he first entered the Florida prison. He received several medals that recognize his bravery, courage and may even show his humanitarian side, while in the service. These medals did not only show his performance as a private but also gave proof of his deviance to authority. It can be thought that he does not receive any promotion or his performance is not seen by his superiors because he was having a hard time in obeying authority. On the other hand, it may also suggest that he receives promotion after receiving the medals, but gets demoted afterwards because of his non-conforming personality. The other prisoners used what they know of Luke as a standard of someone they can idolize. In addition to this, Luke’s individuality as compared to the others and his relative status in comparison with group stands out, proving that he may be someone who can be admired. Luke becomes well known in the minds of the prisoners and the authority alike by escaping several times from prison. In one of his escapes which actually took a very long time, Luke sends a magazine to his inmates or other prisoners containing a photograph. The photograph shows Luke together with two beautiful women and because of this, the inmates felt thrilled and their expectations or admiration towards Luke increased. His status in relation to the others prisoners was raised because of his competence and cunning intelligence as proved by his escapes. On the other hand, he was later on caught and because he was already notorious, the prison authorities already marked him and he was beaten severely. In one of the scenes, Lucas Jackson was even placed in â€Å"the box† to prevent him from trying to escape during the death of his mother. The authorities thought that Luke might use the death of his mother as an alibi to escape again, and the authorities do not want this to happen. They even give harder or heavier punishments to Luke as compared to the other inmates until at last, Luke’s spirit was shattered and he conforms to the authority. The veneration which the other prisoners had towards look was lost as the deviant spirit of Luke was shattered. He was treated with utmost care by his fellow inmates after he was severely beaten because of their admiration of his greatness, as proved by the picture he has sent them. However, Luke was already delirious because of the pain he had suffered and admits to the other prisoners that it was merely a fake. He even added that it cost him a lot to pay for it. By the time that Luke had recovered from his injuries, the admiration which the other prisoners had already has a crack on it and the movie shows how they kept their distance from Luke. They somehow do not believe his admission and persuaded their selves to believe falsely of his greatness. They do not want to believe the harsh reality of an individual who is being pursued by the authority. This result to a â€Å"real enforcement pressure† which somehow tells a false compliance of the prisoners to the myth they created about Luke and a false reinforcement (Centola et.al. p.1036). The punishment which was given to him by the authorities, of digging a large hole, filling and digging it up again, further decreased his fame and eventually led to a struggle to death. The prisoners felt shame everytime they were to look at Luke. Luke, who wanted to maintain the approval of his inmates and wanting a rest for his body, conformed to the authority after he collapsed from exhaustion. He was seen by the prisoners begging for mercy from the Boss or the head of the prison authority. He wanted them to stop from beating him. Such conformity finally destroyed the admiration which he gained through his deviant attitude or behavior before. His conformity to the authority led to the non-conformity of the prisoners towards Luke. A scene in the movie shows a prisoner tearing up the picture of Luke together with the two beautiful ladies. When Luke collapsed, he was no longer helped by the other prisoners and he had a hard time going to his own bed. Finally, everyone deserted him and he was again alone. Nonetheless, he mustered his strength and spirit to once again escape from prison. He was successful and this even resulted to the escape of another prisoner, Dragline. The last scenes movie took place in a church where Luke went in to resort to God. The authority, especially Dragline, tried to bring him back. However, despite the stress which was given by his current condition, he maintains his independence by disobeying and mocking the captain (Asch, p.569). The authorities disgusted with his actions, announce that it was â€Å"a failure of communication† and shot him to death. After his death, Dragline immortalized Luke by telling his legend and his blissful escapes to the other prisoners; Luke becoming an embodiment of the prisoner’s rebellious desires. If Luke had decided to return, then he would be defeated and become like the other prisoners who would need to conform to the authority in order to stay alive. However, his non-conformity led to the continuation of Luke the hero and to an ultimate, personal freedom. Luke’s death supports the thought or concept that an individual will not be able to win against the system and clearly shows the â€Å"violation† of the human spirit. References Asch, S. E. Effects of Group Pressure Upon the Modification and Distortion of Judgments. Journal of Soc. Psychology. Centola, D., Willer, R., & Macy, M. The Emperor's Dillema: A Computational Model of Self-Enforcing Norms. American Journal of Sociology. Pearce, D. (November 1, 1967). Cool Hand Luke. New York: Warner Bros.   

Teachers Can Start Using Technology - 833 Words

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