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Heather Durkin
Medical Error Contributes to Ethical Predicament
Introduction
Sterility is an important aspect of healthcare and should be followed precisely and strictly
when needed in order to prevent contamination and infection. Breaking sterility in any sterile
defined as those in which the surgical site is free from infection and inflammation and in which
neither the respiratory nor the gastrointestinal nor the urinary tract are opened” (2016). Many
countries have introduced requirements to decrease the rate of infection from sterile procedures.
Germany in particular has a goal of complete sterility and has stated, “A national campaign for
the creation of targeting zero health-care associated infections and zero tolerance for unsafe
completely sterile procedure with a rate of zero due to microorganisms in the air and other
factors, I believe that people should try their best to work with this mindset during sterile
procedures to avoid infections. According to the German Medical Science Publishing House,
“The harvesting of bone marrow is performed under aseptic conditions comparable to those
during a surgical puncture” (2010). The procedure I examined where sterility was broken and a
Background
During one of clinical experiences, I was faced with an ethically difficulty situation. I
observed a medical error while attending a procedure where a physician was performing a bone
marrow biopsy on a patient’s iliac crest. As this was a sterile procedure, I paid close attention to
contamination risk. The physician washed his hands, set up the aspiration kit on the bedside table
and put on his sterile gloves. During the procedure, I noticed that the physician had turned his
MEDICAL ERROR CONTRIBUTES TO ETHICAL PREDICAMENT 3
back to the sterile field because the table was positioned behind him. I knew this was wrong but I
did not say anything because I did not want to cause a distraction during the procedure and I was
afraid to confront the physician. A more ethical reaction would have been to notify the physician
that the sterile field was broken. This situation caused me moral distress. Moral distress occurs
when one knows the right action to take but feel restrained to do so. I knew that the physician
was not performing the procedure in a sterile manner, but I was afraid to confront the physician
because at the time I felt powerless as a nursing student. There were also two other nurses in the
room during the procedure so I felt that it was not my place to tell the physician what he was
doing wrong. I knew that he was more trained than I was and that he might get upset. If I could
go back to this situation, I would have made the ethically correct action and I would have
politely informed the physician that the sterile field had been broken and made sure that he used
another kit.
Methods/ Findings
To analyze this situation I am using the James Madison University Eight Key Questions.
The questions are provided as a source to guide in the decision making process. The eight
principles of fairness, outcomes, responsibilities, character, liberty, empathy, authority and rights
all aid in making an ethical decision. They challenge you to weigh the risks and benefits to make
The Eight Key Questions can apply to the situation that I encountered in clinical and by
using this tool I can answer each of the key questions based on the most ethical actions that I
would consider. When considering fairness, I would have had to be reasonable to both the patient
and the doctor. It would be fair for the patient to know that doctor was not using a sterile
technique and fair to the doctor to tell him that so that he does not repeat this error in the future.
MEDICAL ERROR CONTRIBUTES TO ETHICAL PREDICAMENT 4
When looking at outcomes, I could have notified the doctor about his wrongdoing, which could
have prevented an infection for the patient. As far as responsibilities, it was the doctor’s
responsibility to carry out procedure safely and it was also my responsibility to notify the doctor
Character defines what action best reflects who I am and the person I want to become. As
a nurse, I want to ensure that safety is always being followed. To guarantee this, I have to
confirm that others are also following the aspects of safety to prevent patient harm. It is
important to ensure that the patient is safe while receiving the biopsy. Liberty involves freedom
and personal autonomy. I had the freedom to speak up and the patient’s autonomy would have
allowed the patient to decide whether or not she wanted to continue. Speaking to the doctor and
allowing the patient to make a decision are two actions that I should have taken. For empathy,
one should consider how they would act if a loved one was in the situation. If I was present and
this procedure was on one of my family members, I would make sure that everything was done
correctly and that high safety standards were observed. Authority is a big deal in health care
because according to the law and principles of the health care institution, you are expected to be
safe and act in the patient’s best interest. In this situation, the health institution expects the doctor
to perform the procedure carefully and safely and as a nursing student, I am expected to ensure
patient safety and collaborate with the health care team. When analyzing the topic of rights, it
was the patient’s right to know that the doctor was not following sterility and the doctor’s right
to know that he made a medical error. These Eight Key Questions act as a framework that can
guide anyone in the decision making process by highlighting very important values.
Another tool that can be used to guide one’s actions to create an ethical decision is the
American Nurses Association code of ethics. One provision listed in the code of ethics that I felt
MEDICAL ERROR CONTRIBUTES TO ETHICAL PREDICAMENT 5
applied to the ethical situation was provision eight, which states, “The nurse collaborates with
other health professionals and public to protect human rights, promote health diplomacy, and
reduce health disparities” (2009). The provision explains that every human being has the right to
the highest attainable standard of health and I believe that the patient in my situation had the
right to the safest possible procedure. The provision also states that the nurses must bring
attention to human rights violations in all settings and that collaborating with the healthcare team
is essential. I think that it is vital that there is effective communication and collaboration between
the members of a healthcare team. In this particular scenario, I think it is important that there was
collaboration with the doctor about following safety and making sure no patient’s rights are
violated. The ANA code of ethics helps to direct nurses in their actions to ensure that the most
Conclusion
From this experience, I have learned that the correct course of action is to speak up and
not be afraid of the consequences. It is important to act in the safest manner for both the patient
and oneself. Breaking sterility is an example of a medical error, one of the most severe risks to a
patient. The most important goal of modern hospital hygiene and infection control is to give
patients the best possible protection against avoidable hospital acquired infections (Tacconelli
2016). I believe this to be true and after following the Eight Key Questions and ANA code of
ethics, I know that if I were ever faced with this situation again, I would immediately speak up to
the doctor. I want to be sure that any kind of hospital acquired infection, or any risks that puts the
patient in danger is avoided. Overall, I believe that this situation was a learning experience and I
now will be able to use these tools to make correct ethical decisions and support patient’s rights
References
Below, H., Ryll, S., Empen, K., Dornquast, T., Felix, S., Rosenau, H., & ... Kramer, A. (2010).
Impact of surface disinfection and sterile draping of furniture on room air quality in a
cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow,
16. doi:10.3205/dgkh000153
National Student Nurses’ Association, Inc. (2009). Code of Ethics: Part II, Code of academic
Tacconelli, E., Müller, N. F., Lemmen, S., Mutters, N. T., Hagel, S., & Meyer, E. (2016).