Running Header: ETHICS AND THEORY: PATIENT SAFTEY 1

Ethics and Theory: Concern for Patient Safety

with Noncompliance of Personal Protective Equipment

Breanna Bosley

James Madison University

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Ethics and Theory: Patient Safety
Introduction

In the health care field protecting yourself and others from the spread of infection is an

important aspect that needs to taken seriously. Thankfully, organizations have implemented the

use of infection control programs to reduce the spread of infection to others. In the Study of

Efficacy of Nosocomial Infection Control, infection control programs were proven to be

effective. Hospitals with these practices reduced their infection rates by 32% while hospitals

without these infection control measures increased infection rates by 18% (Collins, 2008). With

these outstanding statistics on the success rate of infection control measures, one would question

why anyone would ignore these protocols or try to cut corners. But a recent survey conducted by

Kimberly-Clark Professional found that 89% of healthcare professionals said they had observed

workers not wearing safety equipment when they should have been (Pyrek, 2011). With these

statistics, the importance of infection control measures in the healthcare field is evident and

needs to be addressed further.

Background

The subject of rejection of infection control measures is one that I have experienced

personally in my clinical rotations. One incident that stands out is a time I witnessed a nurse not

implement her personal protective equipment, or PPE, correctly. As the nurse finished her report,

I inquired about the PPE we were supposed to use when in a patient’s room. She stated that

because she had a very busy schedule she wouldn’t have time to put on the PPE before attending

to the patient. She went on to further state that not using the PPE wasn’t a big deal because she

wouldn’t be spending a lot of time in the room so the chance for the spread of infection was

minimal. During our conversation I didn’t address her statement about not wearing her PPE. I

simply kept the statement to myself and continued with tasks I needed to complete. Looking
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Ethics and Theory: Patient Safety
back now, I should have politely confronted her statement about not wearing her PPE. It was not

only her safety that was at risk but the safety of her other patients, coworkers and even myself. If

this polite confrontation didn’t work, I should have followed by addressing my clinical instructor

or charge nurse as infection control is not something to take lightly. I now realize that this

situation caused me to experience moral distress. I knew that the right course of action was to

address the fact that the nurse should be wearing her PPE when entering the room for any length

of time. I knew this was the right thing to do to protect anyone she came in contact with but my

personal inhibition to the situation prevented me from doing so. Because I was only a “student”

nurse I felt that addressing her would make her angry at the fact that I questioned her knowledge

and authority. Looking back on the situation, I should have placed all my feelings of how she

would react aside and done what was best for the patient and others.

Methods/Findings

To analyze this situation I faced, I will be using the JMU 8 Key Questions to devise a

system for making ethical decisions. These questions include the topics of fairness, outcomes,

responsibilities, character, liberty, empathy, authority, and rights (Madison Collaborative, 2013).

The JMU 8 Key Questions help the person faced with a moral dilemma or distress with the task

of making a decision that provides the best solution. To address fairness, I take into

consideration the question of “How can I act equitably and balance legitimate interests?” In

regards to my situation, I think of the fairness to the staff, other patients and myself. By not

donning her PPE when entering the patients room, other people are unfairly exposed to the

infectious agent. Because of this I should have taken fairness into account and addressed the

situation appropriately. The next question that relates to the situation is outcomes. To address

outcomes, I take into consideration the question of “What achieves the best short and long term
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Ethics and Theory: Patient Safety
outcomes for me and all others?” It is very evident that politely addressing the nurse’s statement

would have provided the best outcomes for everyone. In regards to short term outcomes, the

patient, staff and myself that was working with the nurse on that day would have been protected.

As for long term outcomes, the nurse’s future health would also be protected. The next question

is responsibilities. To address responsibilities, I take into consideration “What duties and

obligations apply?” For this situation, it was my obligation to protect others from the infectious

agent. This could have been done by wearing PPE therefore, it was my duty to address the

nurse’s statement. Furthermore, the next question to be considered when addressing this incident

of moral distress would have been character. To address character, I take into consideration

“What action best reflects who I am?” For this situation, the action that would best reflect who I

am would have been to address the nurse’s statement. To ignore this statement that could

possibly endanger others doesn’t accurately portray who I am. The next question to be

considered would be liberty. To address liberty, I take into consideration “How does respect for

personal autonomy apply?” For this situation, I recognize the need to respect her personal

choices but when other’s health is at risk, this personal autonomy should not override safety.

Another important question to take into consideration is empathy. To address empathy, I needed

to consider “What would I do if I cared deeply about those involved?” For this situation if I were

to put myself in the shoes of another patient that this nurse was to encounter, I would have

recognized the importance to address her statement. Another patient could have been on the

brink of recovery but the nurse not following infection protocol exposed them to an organism

that compromised their health. If empathy would have been considered, it would have caused a

different action to be taken. The next question to be considered is authority. To address authority,

I needed to consider “What do legitimate authorities expect of me?” For this situation, the
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Ethics and Theory: Patient Safety
authority of others, such as the American Nurses Association Code of Ethics, is implemented.

The ANA Code of Ethics lists certain provisions that the nurse should follow. Provision three

relates to this situation of moral distress very well. It states that the nurse promotes, advocates for

and protects the rights, health and safety of the patient (American Nurses Association, 2015).

This Code of Ethics provision shows the relevancy of addressing the nurse’s statement. If I had

addressed her statement, I would have been advocating for the safety of the other patients and

therefore using the ANA Code of Ethics as guidance to the correct action. The final question to

be considered is rights. To address rights, I needed to consider “What rights apply?” For this

situation, the right of safety to other patients should have been addressed. By this nurse not

wearing her PPE, the rights of other patients are infringed upon. For this reason, I should have

addressed the nurse’s statement using rights as a place of reasoning.

Conclusion

In conclusion, we have all faced a difficult ethical situation in life but it is how we handle

this difficult situation that determines the severity of the outcomes. Through this situation of

moral distress, I have learned that there are many factors to be considered when making a

decision. The JMU 8 key questions provides a thorough method of making the best decision

possible for all involved and analyzes many different aspects of the situation. These questions

are also important for other induvials to recognize and implement in their lives when faced with

a difficult situation. In regards to my personal situation with the nurse, I should have addressed

her statement regarding the PPE. I should have explained to her the consequences of her

potential action and how it was very important for the safety of others. In the future, I will make

sure to speak up when faced with a statement or action that I find troubling or that puts other

individuals at risk for harm.

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Ethics and Theory: Patient Safety
References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements, 11-

13. Retrieved from http://www.nursingworld.org/ethics/code/protected_nwcoe303.html

Collins, A. S. (2008). Preventing health care–associated infections, Chapter 41. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK2683/

Madison Collaborative. (2013). Eight key questions, 2-10. Retrieved from

https://www.jmu.edu/mc/8-key-questions.shtml

Pyrek, K. M. (2011). Addressing the challenges of PPE non-compliance. Retrieved from

http://www.infectioncontroltoday.com/articles/2011/10/addressing-the-challenges-of-

ppe-non-compliance.aspx