An RN working in the Intensive Care Unit (ICU) is caring for a patient with an acute
gastrointestinal hemorrhage related to liver failure that resulted from alcoholic cirrhosis.
During hand-off report at the end of the shift, the outgoing RN states to the incoming RN, I
have been in that room all day, transfusing blood products and giving medications. It’s so
much work for really no reason. I don’t know why this patient drank to the degree he did
to destroy his liver. He did this to himself. What a waste of resources. I heard his family
wants to get him on a list for a liver transplant.
After reflecting on the above scenario, discuss the following points
What is the most appropriate way for the incoming RN to approach this situation? Include
ethical and legal considerations.
What is the role of the RN in regard to addressing the value system of other health care
workers that may have a negative impact of the delivery of patient care? Include ethical
and legal considerations.
Nurses routinely offer 24-hour care to patients in hospital. The role of the staff Registered
Nurses (RNs) is typically fulfilled at the bedside where they frequently contact patients who are
on illicit drugs but are seeking health care services. The nurses come across complex personal as
well as clinical situations that require a high level of expertise, competence, and skill for
successful achievement. Research by Van Boekel., 2013 indicated that the attitudes of health
care practitioners working with patients on illicit drugs constitute a crucial predictor of the
willingness to interact with these patients.
In the case provided, the incoming RN nurse should approach it differently. She should
not let the views of her colleague deter her from providing quality care to the patient. It is her
moral responsibility to provide quality care to the patient regardless of their health condition.
The incoming nurse should also find some time and talk to the outgoing RN letting her know that
it is vital for them to maintain close surveillance on this patient so as they can address their
multiple medical comorbidities and the patient’s risk of acquiring health problems. Moreover,
she emphasize that patients require non-judgmental and emphatic care which is essential in
strengthening health seeking behaviors to solving acute and chronic conditions.
Stigmatization attitudes of clinicians toward patients with unhealthy drug use have been
associated negatively with empowerment and poor outcomes (Van Boekel., 2013). Therefore,
registered nurses should encourage their colleagues to express determination to provide high
quality care to patients using drugs. A RN can also be in the recommend healthcare institutions
to introduce organizational support and contextual factors such as procedures and policies
associated with provision of therapeutic and unbiased care. This will encourage positive
encounters to be maintained within the health care system which in turn will encourage patients
to adhere to ongoing medical assessment and treatment for their dependency on drugs and other
Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among
health professionals towards patients with substance use disorders and its consequences
for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131(1), 23-