Emergency in the Factory

Case Study: Emergency in the Factory

Thompson Brothers Steel is a medium-sized regional steel manufacturing factory. The factory has a small health clinic staffed with a part-time occupational physician and a full-time master’s-level occupational health nurse. The occupational health nurse assists the doctor when he is present, and the rest of the time the nurse runs health and safety programs, performs screenings, and certifies that the employees are up-to-date on their safety training certifications. The doctor diagnoses and treats work-related injuries, educates the employees, and sees anyone not feeling well on the day that he is present. Mr. Jackson is a 29-year-old employee who came to the factory’s clinic complaining of abdominal pain. He stated that he has been in pain for the past couple of days, but in the past couple of hours the pain has become intolerable. The findings of the examination were dull pain in the upper abdomen that became sharp as it moved to the lower right abdomen, loss of appetite, nausea, significant abdominal swelling, and a fever of 102° F. The doctor suspects that Mr. Jackson has appendicitis and that his appendix is at high risk of rupturing. The doctor asks the nurse to call for an ambulance, but Mr. Jackson insists he wants to drive himself to the hospital. Because the doctor is concerned Mr. Jackson’s pain may impair his driving, he insists the patient should not drive. Mr. Jackson agrees to call his wife to transport him to the hospital. The nurse calls the emergency room to alert them to Mr. Jackson’s arrival.

Discussion Questions

1. Identify positive examples of Interprofessional Collaboration in this case study.
2. Identify the Core Competencies or Sub-competencies that you see demonstrated.
3. What specific issues are most apparent to you?
4. Identify the appropriate Core Competency and its corresponding Sub-competencies that would be helpful in resolving this issue.
5. Describe how you would apply the identified Sub-competencies to resolve this issue.

In this case study, several positive examples of interprofessional collaboration are evident:

1. Doctor-Nurse Collaboration: The doctor and nurse work in tandem, with the nurse assisting the doctor during examinations and taking charge of health and safety programs in the absence of the physician.
2. Doctor-Patient Communication: The doctor effectively communicates with Mr. Jackson about his condition, the need for urgent medical attention, and the potential risks of driving in his current state.

Core Competencies Demonstrated:

1. Interprofessional Communication: Both the doctor and nurse exhibit effective communication skills in coordinating care for Mr. Jackson and conveying essential information to him.
2. Interprofessional Teamwork and Collaboration: The doctor and nurse function as a team, each contributing their expertise to address the patient’s needs promptly.

Specific Issues:

1. Patient Autonomy vs. Medical Recommendation: Mr. Jackson insists on driving himself despite the doctor’s concern about his condition potentially impairing his ability to drive safely.

Appropriate Core Competency and Sub-competencies:

1. Values and Ethics: This core competency encompasses sub-competencies like patient autonomy, recognizing ethical dilemmas, and applying ethical principles in decision-making.

Application of Sub-competencies:

To resolve the issue of Mr. Jackson’s insistence on driving:

1. Patient Autonomy: Respect Mr. Jackson’s autonomy by acknowledging his desire to drive while ensuring he understands the potential risks due to his medical condition.
2. Recognizing Ethical Dilemmas: Acknowledge the conflict between respecting Mr. Jackson’s autonomy and ensuring his safety given the suspected medical emergency.
3. Applying Ethical Principles: Emphasize the importance of prioritizing his health and safety while also considering his preferences. Discuss potential consequences of driving versus waiting for his wife or the ambulance.

In practice, the nurse or doctor could engage Mr. Jackson in a conversation that respects his autonomy while highlighting the seriousness of his condition and the potential risks involved in driving himself. They can negotiate a solution that aligns with Mr. Jackson’s autonomy while ensuring his safety, possibly involving his wife or waiting for the ambulance to transport him promptly. This approach upholds ethical principles while addressing the immediate medical need.