Now read the case of Nurse Mary and Social Worker Matthew and apply what you’ve learned from the readings. 
The Case of Nurse Mary and Social Worker Matthew 

Mary is a 60-year old widow living with her parents, both of whom are in their late 80’s and suffering from various degrees of Dementia. Both are lucid enough to refuse to go into long-term care, and Mary has vowed to keep them with her at all costs. A few years ago, Mary was laid off from her 20-year career as a pharmaceutical sales rep and returned to school, graduating last year with an RN degree. Although inexperienced, she was fortunate to obtain a day-shift position in a small rural hospital. The location and hours are critical requirements for her, as she cannot afford to hire someone to watch her parents in the evenings.

Due to economic shifts, the hospital is barely managing to stay solvent and has introduced staffing cuts and cost-containment actions. Over the past three months, Mary has witnessed or been aware of several incidences where patients have fallen, been discharged without proper medications, or were given wrong information related to their condition. Mary is also aware that one of the attending physicians she works with, Ted, often comes to work exhausted from moonlighting full time at another hospital, and is notorious for making medication errors and failing to complete patient charts. When she can, Mary tries to mitigate any harm to the patients by correcting the chart notes, calling down to the pharmacy or suggesting to the patient that they get in touch with the staff social worker, Matthew, as needed. Mary trusts Matthew and he has become a good friend. Mary’s supervisor is notorious for bullying inexperienced nurses like Mary. Afraid to make waves, Mary has said little, but has kept a log of the incidents.

This morning, she discovered that her patient, a woman using an analgesia pump post-surgery, was lethargic, disoriented and registering a low respiratory rate. Fearing the medication dose was too high, Mary tried to reach Ted, the only doctor on call but he did not respond. Reaching her supervisor, Mary apprised her of the situation and asked if she would check on the patient. The supervisor responded that she was in the middle of several ‘crises’ of her own, and that Ted was probably very busy, as well. She advised Mary to simply keep an ‘eye on’ the patient over the next hour. She stated that if Mary bothers her or Ted again before the hour is up, she would move Mary to the night shift. Knowing that this is the only hospital within proximity to her home, and that the supervisor and Ted have many friends within the hospital’s administration chain, Mary decides to wait the hour and promises the supervisor that she will not make any additional trouble. While she waits and feeling increasingly troubled by this, Mary reaches out to the social worker, Matthew, and tells him about the situation. She makes him swear not to tell anyone for fear she will lose her job. Having also been bullied by Mary’s supervisor, Matthew agrees to not tell anyone. After speaking with Matthew, Mary throws away her notebook. An hour later, Mary calls Ted and he reduces the patient’s medication without incident.

Please discuss the following questions from either the perspective of Mary or Matthew:

What are the choices that either Mary or Matthew faces? Discuss as many options as you can think of and what the consequences of each might be.
Why do you think Mary or Matthew may be experiencing moral distress?
Discuss what you think Mary or Matthew should do. Be sure to analyze the impact on any relevant stakeholders (those who could be significantly impacted by your decision) in formulating your response. Justify your position using the appropriate moral theories and ethical principles we have studied. What resources could Mary or Matthew utilize to address the moral distress he or she feels? What other resources could you suggest for an institution?

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