Ethical, Cultural, and Legal Expectations

After completing the Riverbend City: Nursing Diversity and Ethics Mission in this unit, analyze the ethical, cultural, and legal issues surrounding Mr. Sibanda and his experiences at the shelter and the hospital. What was done well? What could have been done better? Discuss nursing codes of conduct and laws that apply in this situation. What nursing theory, philosophy, or model might have been used successfully in guiding the practice of nursing regarding Mr. Sibanda’s care? What could you do to better understand the patient and his culture?

Please follow the Scoring Guidelines: Applies relevant course concepts, theories, or materials correctly. Collaborates with fellow learners, relating the discussion to relevant course concepts. Applies relevant professional, personal, or other real-world experiences. Supports position with applicable knowledge. G.R.E.A.T paper, grammar rules apply. The paper should be written correctly and effectively. Relevance is important the paper should pertain to the reading and the assignment. Engage your audience. Incorporate your interpretation of the topic or issue. Add value to the paper. Raise question or provide new information on the topic.

You must make reference to the work of another writer (either as a quotation, paraphrase, or summary) to provide support for your ideas. The source can be the course text, another relevant book, any assigned readings, or an article you find on your own. When you incorporate the other writer’s ideas in your work, use APA citation style to give credit to that writer. Remember that an APA citation includes both the in-text citation (the author’s last name and the year of publication) and the full reference for the source.

Introduction: Welcome to Riverbend City

Expository Text:
In Riverbend City, a Southern Inlet freight train has derailed, spilling dangerous chemicals into the soil, air, and water. The surrounding Rondo neighborhood has been evacuated, and residents have been relocated to a Red Cross shelter at a nearby university.
One of the evacuees is Vimbo Sibanda, a 55-year-old diamond miner from Zvishavane, Zimbabwe who is visiting his American family for the first time in many years. Unfortunately, the medical system in Zimbabwe is among the world’s most inadequate, and Mr. Sibanda has not had a medical examination for over a decade. At the Red Cross shelter, two public health nurses discover that Mr. Sibanda has a badly infected foot that may be the result of untreated diabetes. He is then transported to Riverbend City Medical Center, where the treatment of Mr. Sibanda poses a number of complicated ethical and cultural dilemmas.

Instructional Text:
For nurse leaders, ethical dilemmas that have no simple solution are a common occurrence. Often these ethical dilemmas relate to cultural issues. As you watch Mr. Sibanda’s case, evaluate the degree to which you feel the nurses and nurse leaders responded appropriately. Ask yourself if you would have responded differently in these situations. Keep in mind that not everything in this mission is an example of model professional behavior, and as you watch, keep a critical eye.

Characters in this Mission:
Grace Fowler, Public Health Nurse
Kimberley Fuller, Public Health Nurse
Carl Lauderback, RN-Nurse Supervisor, RCMC
Stewart Mason, EMT
Sheila Meeks, RN-Day Shift Triage Nurse, RCMC
Matthew Sibanda, Student
Vimbo Sibanda, Diamond Miner
Edmond Yee, MD-ER Medical Director, RCMC

Scene 1: Beck University, Red Cross Shelter, Medical Area

Expository Text: After the chemical spill, the Sibanda family is evacuated to a Red Cross shelter. Matthew Sibanda approaches a public health nurse about his uncle’s foot.
Instructional Prompt: Click on the highlighted characters.

Dialogue 01: Matthew Sibanda is concerned about his uncle’s foot.
MATTHEW: Hello, nurse? It looks like you’re busy, but could you help us out, please?
KIMBERLEY:  Of course. What can I do for you?
MATTHEW:  This is my uncle. He’s from Zimbabwe and he flew in a few days ago to visit my family. Ever since he got here, he’s been limping and he says he’s dizzy. And his foot looks like it’s infected or something.
KIMBERLEY (Speaks to Vimbo slowly and somewhat loudly):  Well, let’s have a look. Sir? Does your foot hurt?
MATTHEW:  Um, you don’t have to talk to him like that.
VIMBO (friendly):  We speak English in Zimbabwe, young lady.
KIMBERLEY:  Oh. No offense intended, sir. Could you please sit here and take off your shoe and sock?
VIMBO:  Sure. Wow, what a crazy day it’s been. I picked a bad time to visit my family in Riverbend City, didn’t I?
KIMBERLEY:  You sure did. This is usually a pretty quiet city. Let’s take a look at your foot, sir. Is this area painful to the touch?
VIMBO (wincing):  Yes, it is somewhat tender.
KIMBERLEY:  Sir, there’s definitely some infection here. This looks serious. Have you seen a doctor in Zimbabwe about this?
VIMBO (laughs): A doctor? I don’t remember the last time I’ve seen a doctor.
MATTHEW:  Zimbabwe isn’t exactly the health capital of the world. There are barely any hospitals left and the life expectancy is less than 50 years old. Mugabe pretty much destroyed everything. Then there was a cholera epidemic a few years ago and a lot of our relatives died.
KIMBERLEY:  Wow. That’s awful. Sir, I’m really worried about your foot. Do you have diabetes?
VIMBO:  No, no, no, there’s nothing wrong with me. I’m a diamond miner. It’s physical work and we get scrapes and cuts all the time.
KIMBERLEY: Well, I’d like to ask one of the other nurses to take a look at your foot. Like I said, I’m concerned about the level of infection you’ve got going on here.

Dialogue 02: Kimberley asks another public health nurse to look at Mr. Sibanda’s foot.
KIMBERLEY: Grace, this is Mr. Sibanda. He’s visiting from Zimbabwe. Will you please take a look at his foot?
GRACE:  Ouch! That looks serious. Mr. Sibanda, may I check your pulse?
VIMBO:  Of course.
GRACE:  Your pulse and respiratory rate are both a bit high. I’ll be honest, sir — this looks like a very serious infection. I think you need to go to the hospital right away.
VIMBO:  A hospital? I don’t need to go to a hospital. It will heal on its own.
GRACE:  Mr. Sibanda, sometimes the body is able to fight off infection, and you’re right, things heal on their own. However, sometimes the infection overwhelms the body’s defenses and a condition called sepsis can set in. Sepsis can progress extremely quickly and it can be life threatening.
MATTHEW:  Whoa! Is it that bad?
GRACE:  Yes, it is that bad. Even if we get you treatment right away, sir, I don’t know if they’ll be able to save your foot.
VIMBO (alarmed): My foot? You want to cut off my foot?
GRACE:  We’ll have to see what the doctors say, sir. You should be aware that amputation is a possibility.
VIMBO:  Amputation? Are you crazy? I am a diamond miner and I have to provide for my family. If you take off my foot, we’ll all die.
GRACE:  Well, let’s just get you to the hospital and…
VIMBO:  No hospital! I’m not letting some crazy doctor saw off my foot. Matthew, come on. We’re leaving right now.

Dialogue 03: The nurses talk Mr. Sibanda into going to the hospital.
GRACE: Sir, I’m very sorry. I can see I’ve alarmed you quite a bit.
KIMBERLEY:  We’re just worried. We want to make sure you get the medical treatment you need.
MATTHEW:  My uncle comes from a place where people in power can’t be trusted. It’s insane over there. And that is why he’s so fearful.
GRACE:  I understand, and again, I’m sorry that I spoke to you the way I did. Please let us call an ambulance and take you to the hospital. Nobody is going to do an amputation unless you give them permission. They might be able to treat the infection with medication.
VIMBO:  No hospital. People die when they go to hospitals.
MATTHEW:  Uncle, it’s not like that here. We have good hospitals in America. I had my appendix out in the hospital and nothing bad happened.
VIMBO:  But I don’t have the money for that.
GRACE:  You don’t have health insurance?
MATTHEW: Health insurance? He’s from Zimbabwe. They barely even have a health care system.
KIMBERLEY:  Don’t worry about the cost, sir.
VIMBO:  But if I can’t pay, they won’t see me.
KIMBERLEY:  Emergency rooms will admit anyone who needs treatment. That’s how it works here.
MATTHEW:  Uncle, please. Let them call the ambulance. I promise you, the hospital is a safe place. And I’ll go with you.
VIMBO:  Okay. But no one is going to cut off my foot.

Scene 2: RCMC, ER AMBULANCE BAY

Expository Text: Vimbo Sibanda is transported by ambulance to Riverbend City Medical Center. Because of the chemical spill, the hospital is overloaded with patients who need immediate medical attention. At the chaotic ambulance bay, an EMT presents Mr. Sibanda to Sheila Meeks, the ER triage nurse.
Instructional Prompt: Click on the highlighted characters.
Optional Content: Ambulance Report for Vimbo Sibanda

Dialogue 04: Tim breaks the news to Jamie.
STEWART: Sheila, this is Vimbo Sibanda. He’s 55 years old and has a severe foot infection.
SHEILA:  Was he injured in the chemical spill?
STEWART:  No, this is unrelated. He was evacuated to the Red Cross shelter and the public health nurses discovered his infection.
SHEILA:  That looks serious. Sir, do you have diabetes?
VIMBO:  No.
MATTHEW:  He might have diabetes, nurse. My uncle is from Zimbabwe and he doesn’t have access to medical care.
SHEILA:  He’s from Zimbabwe? Did you fly him here to get him treatment?
MATTHEW: What? No! I don’t like what you’re insinuating.
SHEILA:  Never mind, I’m sorry. Sir, I need to take your temperature…

Dialogue 05: Sheila decides that Mr. Sibanda does not need immediate care.
SHEILA: Sir, this looks like a very serious infection. We’re going to admit you and give you treatment as soon as we can. But as you can see, we’re extremely busy today because of the chemical spill. I’m afraid you’re going to have to wait for awhile.
VIMBO:  No, I won’t let them cut off my foot!
SHEILA:  Sir, we’re going to take very good care of you. Stewart, wheel him over to the corridor please.
STEWART: Are you sure, Sheila?
SHEILA:  Yes. He’s not in crisis, and we’re at capacity. More children from that elementary school just came in.
STEWART:  Okay. Are you sure there’s not a bed available?
SHEILA:  A bed? Are you kidding? We haven’t had a bed open in hours. We’ll get him treated as soon as we can.
STEWART:  Will do, Sheila. And you hang in there, okay? We’re lucky to have a triage nurse like you dealing with all this chaos.
SHEILA: Thanks, Stewart. We’ll get through this!

Dialogue 06: Matthew questions Sheila’s decision.
MATTHEW: Nurse! Please, are you sure my uncle doesn’t need to see a doctor right away? The nurses at the shelter said his infection was life-threatening.
SHEILA:  I’m very sorry that we can’t treat your uncle immediately. Normally it’s not so busy here, but there are people coming in from the chemical spill who are badly injured. We have to treat them first. Your uncle isn’t in immediate danger.
MATTHEW: This isn’t because…look, nurse, I know that people sometimes fly their relatives in from poor countries like Zimbabwe so they can get free medical care at emergency rooms. But that’s not what going on here. I promise. He just came to America to visit us.
SHEILA:  Please understand, my decision on how to prioritize your uncle’s care has absolutely nothing to do with who he is or where he’s from. You just happened to come here on the busiest day we’ve ever had. We’re going to take good care of your uncle and treat him as soon as possible.

Scene 3: RCMC, EMERGENCY ROOM

Expository Text: Vimbo Sibanda is moved to a hospital corridor and waits to be seen. Unfortunately, after about two hours, he loses consciousness — and then gets treated.
Instructional Prompt: Click on the highlighted characters.

Dialogue 07: Mr. Sibanda, who has partially regained consciousness, is examined.
CARL: What do we have?
EDMOND:  This man was waiting in the corridor on a gurney and he lost consciousness. As you can see, he has a severely infected foot. Mr. Sibanda? Can you hear me?
SHEILA: Oh no. I remember this man from triage.
CARL:  Why didn’t you send him in for immediate treatment?
SHEILA: On any other day, I probably would have. There were patients coming in from the chemical spill who were in crisis.
MATTHEW (angry):  I told you he needed to be seen right away!
EDMOND: Sheila, we need to do a serum blood glucose and baseline labs right away. There’s a very good chance this infection is septic.
MATTHEW:  What does that mean?
EDMOND: It means the infection has spread to his blood. That’s something we have to treat right away because it can be fatal.
MATTHEW:  Fatal? You stuck my uncle in the hallway for two hours when he could die?
CARL:  We’re going to take good care of your uncle, son.
EDMOND: Sheila, get this man a fingerstick glucose and baseline labs. This looks like a classic case of untreated diabetes.

Dialogue 08: Edmond is angry that Mr. Sibanda didn’t receive treatment immediately.
EDMOND (angry): Sheila, why was this man parked in the corridor? You should know better than that!
SHEILA:  Dr. Yee, this man was not in crisis when the EMTs brought him in. The 17 children from the school were, and so were the three people who showed up in respiratory distress from being exposed to the chemical spill. And so were the two gangbangers who got shot in a drive-by over the right to sell crack in McAfee Park. The man was stable when the EMTs brought him in and there wasn’t an open bed to be had.
EDMOND: He came in by ambulance? And you stuck him in the hallway? Sheila, you’ve got to be kidding me!
CARL (a little angry):  Whoa, Edmond, calm down! Sheila’s been doing the best she can under some very difficult circumstances.
SHEILA: There’s no need to speak to me like that, Dr. Yee. I made a judgment call based on the information I had.
CARL:  This has been an incredibly stressful day for everyone. Let’s concentrate on giving this man the treatment he needs.

Dialogue 09: Dr. Yee and the nurses talk to Mr. Sibanda.
SHEILA:  Mr. Sibanda? Can you hear me?
VIMBO (groggily): Where am I?
CARL:  You’re in the hospital, sir.
MATTHEW: Everything’s going to be okay, uncle.
EDMOND:  You have a severely infected foot. We also suspect that you have untreated diabetes.
VIMBO (groggy): My foot… they said you might cut it off…
EDMOND:  Mr. Sibanda, we’re running some tests, and it’s too soon to know what needs to be done. But I have to be honest with you — amputation might be necessary. We just don’t know yet.
VIMBO (agitated): I won’t let you cut off my foot!
MATTHEW (sighs):  My uncle doesn’t want to amputate his foot because he’s a miner. Work is very hard to come by in Zimbabwe, and his children and grandchildren depend on his support. And also, his religious beliefs say that the body has to be intact.
SHEILA:  Is that part of Islam?
MATTHEW:  What? No. Why do you assume he’s a Muslim? Because he’s from Africa and because he has beliefs you don’t understand?
SHEILA:  I’m sorry.
MATTHEW:  My uncle is a Christian. But the Christianity they practice in Zimbabwe, it’s combined with traditional cultural beliefs, and he’s dead set against amputation.
CARL:  We understand that. We want to do what’s best for your uncle. Let’s see what the test results say before we make any decisions.

Mission Summary

Congratulations. You have completed the Nursing Diversity and Ethics Mission.
Consider the ethical and cultural issues that the nurses and nurse leaders encountered in this mission. If you were a nurse leader at the shelter or at Riverbend City Medical Center, how would you have handled these situations?

Summary Document Content

NURSING DIVERSITY AND ETHICS MISSION
In this mission, a visiting diamond miner from Zimbabwe named Vimbo Sibanda was evacuated to a Red Cross shelter with his family after a chemical spill. At the shelter, public health nurses discovered that his foot was severely infected, so they sent him to Riverbend City Medical Center. Unfortunately, RCMC was overwhelmed by victims coming in from the chemical spill, so triage nurse Sheila Meeks directed the EMT to park Mr. Sibanda in a hospital corridor to await treatment. Mr. Sibanda’s nephew, who accompanied him to the hospital, suspected that his uncle was not being treated promptly because the triage nurse thought he has flown to America exclusively for the purpose of receiving free medical treatment. After waiting for two hours, Mr. Sibanda lost consciousness before finally being treated. The doctor informed him that amputation may be necessary. Mr. Sibanda was adamant about avoiding amputation because of religious and economic considerations.
LEARNING OUTCOMES:
For nurse leaders, ethical dilemmas that have no simple solution are a common occurrence. Often these ethical dilemmas relate to cultural issues. This mission illustrated a situation filled with ethical “gray areas.” The learner should evaluate the degree to which the nurses, nurse leaders, and other members of the medical team responded appropriately in these situations.
The course competency associated with this mission is:
Apply ethical, cultural, and legal expectations within professional nursing practice.
RESOURCES:
This mission contained one downloadable resource:
Ambulance Report for Vimbo Sibanda