Use verbal scenarios to boost ethics training
May 1, 1998 4 minutes read
Use verbal scenarios to boost ethics training
Teaching aides about ethics does not need to be done by the textbook. Instead, why not turn the class into a discussion that poses different ethical situations?
One Florida home care agency has found that aides enjoy having the chance to talk about how they might handle different ethical situations as they arise.
"Normally, we just lectured them on our policies and procedures about ethical issues and communications," says Janice Powers, RN, BSN, director of Citrus Memorial Home Health Agency in Inverness, FL. The agency, located 70 miles north of Tampa, has about 20 home health aides.
"Then the aides sometimes would come back and say they are faced with issues that are not addressed in the inservices, things that you don't think of mentioning all the time," Powers says.
In response, the agency's aide supervisor Jeanine Saunders, RN, developed examples of 20 different scenarios to present during an inservice with aides. The scenarios include some ethical situations that the agency had experienced in the past, as well as some potential ethical situations.
Each scenario is numbered, and each home health aide will draw a number corresponding to one scenario. Then the nursing supervisor will draw a number and read the scenario. "And the aide who drew that number will say how she will handle that," Powers says.
A brief discussion of the scenario might follow.
Here's Citrus Memorial Home Health Agency's ethical situation examples:
1. The patient says, "The aide that was here yesterday didn't clean up after herself and told me to start washing myself. I don't want her again!"
2. The patient says, "My toenails need cutting. Will you do it? What do you mean you can't cut nails? I think I am going to get another agency."
3. "I have some ointment that needs to be put on my back after the bath. OK?" the patient asks.
4. The patient's caregiver says, "You take such good care of my mother. We want just you to take care of her."
5. "My husband really got upset with me last night," the patient says. (New bruises noted on upper arms, and aide inquires about these.) Patient finally says her husband grabbed her and threw her into a chair. Patient says, "Please don't tell anyone."
6. "I understand one of your nurses, Carolyn, is very sick and is having surgery."
7. "I let Carol, the home health aide, borrow $200. I hope she will remember to pay me back."
8. The patient asks you to do something that is inappropriate, such as transport her. You tell her that you can't. She is insistent. You call the supervisor to reinforce what you said. The supervisor tells you to tell her, "You have enough money to take care of transportation yourself." How do you react?
9. You observe bruises on a patient's buttocks and left arm. Patient states he fell into the tub last night, and he or she asks you not to tell anyone.
10. The patient asks you to come back at 5 p.m. to go to the drugstore for him or her. The patient has no one else to do this for him or her.
11. Male patient requests that you wash private areas, although you know he is very capable of doing this himself. You feel that this has sexual connotations.
12. Patient has a gun that he is waving around, is threatening suicide but may be capable of harming you also.
13. Male caregiver is constantly making remarks, as to, "Let's get together after you finish work," or "What are you doing tonight?"
14. Patient asks aide to call the doctor to get an order for a shower.
15. Aide arrives at patient's home, and the patient says she has already done her own care but, "Please come in and have coffee, and I'll sign your log."
16. The nurse has on the care plan for the aide to change the wafer on a colostomy patient.
17. On your first visit to a male patient, the caregiver instructs you to shave the patient with a safety razor, and you are aware the patient is on blood thinners.
18. You go into a patient's home and wash your hands and don gloves. The patient asks, "Why are you doing that?" You explain, and then the patient says, "Well, you are the first to do that."
19. Upon arrival to the patient's home, you find that he is tied in bed. The caregiver says that he wanders at night, and she didn't want to have to get up to watch him.
20. Care plan says patient can shower. You attempt to put patient in shower and find this very unsafe, and you explain this to the patient and the patient's caregiver. They are adamant and insist on the patient having a shower.
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