Chapter 15 Summary Case: Search for Truth “There is nothing,” says Plato, “so delightful as the hearing or the speaking of truth”—for this reason there is no conversation so agreeable as that of the man of integrity, who hears without any intention to betray, and speaks without any intention to deceive. —Thomas Sherlock Learning Objectives • Explain how the spoken word may not always clearly describe the intent of the message. • Describe how values are intertwined in the communication process and how they can be instrumental in changing the course of one’s journey through life. To laugh often and love much; to win the respect of intelligent persons and the affection of children; to earn the approbation of honest citizens and endure the betrayal of false friends; to appreciate beauty; to find the best in others; to give of one’s self; to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to have played and laughed with enthusiasm and sung with exultation; to know even one life has breathed easier because you have lived—this is to have succeeded. — Ralph Waldo Emerson Virtues, Values, and Communications • Each person must evaluate what values and moral strengths are important. • When responding to the discussion questions following the closet drama in this chapter, apply the virtues and values presented as the pillars of moral strength. Communications • Exchange of thoughts, messages, or information through speech, signals, writing, or behavior. – The art and technique of using words effectively to impart information or ideas. – Includes both verbal and nonverbal messages. – Requires a sender, a message, and an intended recipient, the receiver. Case Characters: Athens Medical Center (AMC) • Ms. Ophelia Cicero: AMC, survey coordinator and tour guide Case Characters: Inspection Survey Team • Mr. Daniel Marcus: Administrative reviewer • Mr. Damon Antonio: Nurse reviewer • Ms. Margaret Galeria: Nurse trainee • Dr. Machiavelli: Physician reviewer Case Characters: Magistrate and Counselors • Magistrate: Hearing officer • Counselor Hadrian: Counsel representing Marcus • Counselor Luke: Counsel representing Dr. Machiavelli and Damon Case Characters: Health Review Council • Mr. Bruce Verus: Marcus’s manager • Ms. Carol Titus: Mr. Verus’s manager Case Settings (1 of 2) • Rome – Mr. Marcus’s hometown • Health Review Council – Entity responsible for evaluating the quality of care in health centers from Rome to Athens • Courtroom of Chief Magistrate – Site of the hearing in Athens Case Settings (2 of 2) • Athens Health Center – Local medical facility in Athens Marcus was assigned to review • Pelopidas Street Inn – Hotel where reviewers lodged Marcus’s Work Marcus worked for the Health Review Council, whose mission was to visit health centers from Rome to Athens and review the qua ...

1. Chapter 15
Summary Case:
Search for Truth
“There is nothing,” says Plato, “so delightful as the
hearing or the speaking of truth”—for this reason
there is no conversation so agreeable as that of
the man of integrity, who hears without any
intention to betray, and speaks without any
intention to deceive.
—Thomas Sherlock
Learning Objectives
• Explain how the spoken word may not always
clearly describe the intent of the message.
• Describe how values are intertwined in the
communication process and how they can be
instrumental in changing the course of one’s
journey through life.
To laugh often and love much; to win the respect

2. of intelligent persons and the affection of children;
to earn the approbation of honest citizens and
endure the betrayal of false friends; to appreciate
beauty; to find the best in others; to give of one’s
self; to leave the world a bit better, whether by a
healthy child, a garden patch or a redeemed
social condition; to have played and laughed with
enthusiasm and sung with exultation; to know
even one life has breathed easier because you
have lived—this is to have succeeded.
— Ralph Waldo Emerson
Virtues, Values, and Communications
• Each person must evaluate what values and
moral strengths are important.
• When responding to the discussion questions
following the closet drama in this chapter, apply
the virtues and values presented as the pillars of
moral strength.
Communications
• Exchange of thoughts, messages, or information
through speech, signals, writing, or behavior.
– The art and technique of using words
effectively to impart information or ideas.
– Includes both verbal and nonverbal

3. messages.
– Requires a sender, a message, and an
intended recipient, the receiver.
Case Characters:
Athens Medical Center (AMC)
• Ms. Ophelia Cicero: AMC, survey coordinator
and tour guide
Case Characters:
Inspection Survey Team
• Mr. Daniel Marcus: Administrative reviewer
• Mr. Damon Antonio: Nurse reviewer
• Ms. Margaret Galeria: Nurse trainee
• Dr. Machiavelli: Physician reviewer
Case Characters:
Magistrate and Counselors
• Magistrate: Hearing officer
• Counselor Hadrian: Counsel representing
Marcus
• Counselor Luke: Counsel representing Dr.
Machiavelli and Damon

4. Case Characters:
Health Review Council
• Mr. Bruce Verus: Marcus’s manager
• Ms. Carol Titus: Mr. Verus’s manager
Case Settings (1 of 2)
• Rome
– Mr. Marcus’s hometown
• Health Review Council
– Entity responsible for evaluating the quality of care in
health centers from Rome to Athens
• Courtroom of Chief Magistrate
– Site of the hearing in Athens
Case Settings (2 of 2)
• Athens Health Center
– Local medical facility in Athens Marcus was assigned
to review
• Pelopidas Street Inn
– Hotel where reviewers lodged

5. Marcus’s Work
Marcus worked for the Health Review Council,
whose mission was to visit health centers from
Rome to Athens and review the quality of patient
care. He traveled much of the time, writing,
consulting, educating, and reviewing the quality of
care rendered to the people. His travels took him
to hundreds of health centers in villages and cities.
Marcus’s Last Assignment
• This closet drama describes Marcus’s last
assignment to review the quality of patient care
at the Athens Health Center.
– This case illustrates:
• How real-life events can become distorted
through political alliances.
• How good and truth, in the final analysis,
can triumph over wrong.
Memorable Quotes Often Ignored By Corporate
Leaders for Self-Preservation
The most striking contradiction of our civilization is
the fundamental reverence for truth, which we
profess and the thorough-going disregard for it,

6. which we practice.
—Vilhjalmur Stefansson
The withholding of truth is sometimes a
worse deception than a direct misstatement.
There is an idiom in truth which falsehood
never can imitate.
—Lord Napier
To seek for the truth, for the sake of knowing
the truth, is one of the noblest objects a man
can live for.
—William Ralph Inge
Discussion
1. Describe the ethical and legal issues in this
closet drama as they relate to the various
characters.
2. Describe the virtues and values at play.
3. Describe why you think there was a breakdown
in communications between Dr. Caesar and
Marcus.

7. Discussion
4. In light of the fact that 70% of diagnoses are
made as the result of labs tests, would you
expect Marcus to inquire what the lab results
had revealed about the patient’s state of
health?
5. Describe your overall impression of this case,
and how you would have handled it if you were
Marcus.
Discussion
6. After considering yourself in the position of
each character in this closet drama, describe
which role you would have chosen to play.
Explain your choice of character.
7. How would you describe the culture of the
Health Review Council?
8. Utilizing the communications process in Fig.
15-2, how would you describe the values of
each character in this case?
Slide 1Slide 2Learning ObjectivesSlide 4Virtues, Values, and
CommunicationsCommunicationsCase Characters: Athens
Medical Center (AMC)Case Characters: Inspection Survey
TeamCase Characters: Magistrate and CounselorsCase
Characters: Health Review CouncilCase Settings (1 of 2)Case
Settings (2 of 2)Marcus’s WorkMarcus’s Last AssignmentSlide
15Slide 16Slide 17Slide 18DiscussionDiscussionDiscussion

8. Chapter 11
Employee Rights
and
Responsibilities
Learning Objectives
• Describe and understand the rights of
employees.
• Describe the responsibilities of employees in the
workplace.
• Discuss what professionals can do to improve
professional relationships.
Employment at Will
• The employer or employee may terminate
employment at any time:
– Unless there is a contract in place that
specifies the terms and duration of
employment.
– Public policy considerations.
– Implied covenant of good faith and fair

9. dealing.
An at will prerogative without limits
could be suffered only in an anarchy,
and there not for long, it certainly
cannot be suffered in a society such as
ours without weakening the bond of
counter balancing rights and
obligations that holds such societies
together.
—Sides v. Duke
Public Policy Exceptions
Prohibiting Termination
• Public policy exception to the employment-
at-will doctrine provides that employees
may not be terminated for reasons
contrary to public policy.
• Public policy originates with legislative
enactments.
Freedom from Discrimination
– Disability − Religion
– Age − Sex
– Race − National origin

10. – Creed − Pregnancy
– Color − Filing OSHA complaints
Equal Pay Act of 1964
• Prohibits wage disparities based on sex.
• Prohibits discrimination in payment of wages for
women and men performing substantially equal
work in same establishment.
• Wages may be unequal as long as they are
based on factors other than sex, for example:
– Formalized seniority system.
– System that objectively measures earnings by
quantity or quality of production.
Refuse to Participate in Care
• Refusal to participate in elective abortion upheld.
• Refusal to participate in therapeutic abortion is
insubordinate.
• Some pharmacists refuse to fill birth control
prescriptions.
Caregiver’s Right (1 of 2)

11. The nurse in the operating suite refuses to
participate in an elective abortion.
• Discuss how an organization might fairly
address this dilemma.
Caregiver’s Right (2 of 2)
• Legal issues
– Employee’s right to religious freedom
– Organization’s responsibility to provide care
• Ethical issues
– Nonmaleficience
– Professional codes of ethics
Questioning Patient Care
• Public policy clearly mandates an obligation to
serve the best interests of patients.
• Persistence to get the proper treatment for the
patient is an absolute duty.
• Case: Paving Her Way to Heaven
Suggesting Change of Physician (1 of 3)
Physician failed to return the nurse’s calls.
Because of the patient’s deteriorating

12. condition, the family contacted the nurse.
After the nurse advised the patient’s family
as to her concerns, a member of the
patient’s family asked her what they
should do. The nurse advised that she
would reconsider their “choice of
physicians.” The nurse was terminated
because she had advised the patient’s
family to consider changing physicians.
Suggesting Change of Physician (2 of 3)
• What action might the hospital might take?
• What should the jury do? Discuss your
answer.
• Discuss the legal issues in this case.
• Discuss the ethical issues in this case.
• What was the court’s decision?
Suggesting Change of Physician (3 of 3)
The North Carolina Court of Appeals held
that the nurse stated a claim for wrongful
discharge in violation of public policy. The
nurse’s termination for fulfilling her
responsibilities as a practicing nurse violated
state public policy and was a factual
question for jury determination.

13. One’s dignity may be assaulted, vandalized,
and cruelly mocked, but it cannot be taken
away unless it is surrendered.
—Author unknown
Freedom from Disruptive Behavior
• Includes freedom from verbal outbursts and
physical threats.
• Prevent disruptive events from occurring.
• Deal with events in real time to prevent staff or
patient harm.
• Initiate post-event review, actions, and follow-up.
Freedom from Bullying
• Bullying includes:
– Abusive conduct
– Threats
– Humiliating behavior
– Name calling
– Personal insults
Impact of Bullying
• Lowers morale
• Reduces productivity

14. • Increases absenteeism
• Increases turnover
• Negatively affects patient safety
Freedom from Sexual Harassment
• Employees have a right to be free from sexual
harassment.
• Sexual harassment includes:
– Requests for a sexual favors.
– Sexual advances, condition employment.
– Unreasonably interfering with employee's
work.
– Creating intimidating or offensive working
environment.
Treatment with Dignity and Respect
• Right to be treated with dignity and respect fairly
and consistently.
• Respond to employee complaints and concerns.
Freedom from Intimidation
• Those in power often abuse power
through threats, abuse, intimidation, and

15. retaliatory discharge.
• Employees who become targets of a
vindictive supervisor often have difficulty in
proving a bad-faith motive.
• Some states (e.g., Connecticut, Maine,
Michigan, and Montana) have enacted
legislation that protects employees from
terminations found to be arbitrary and
capricious.
Privacy and Confidentiality
• Health status privacy
• Fine line to protecting one’s privacy
• Reality Checks
– Your Mail Has Been Intercepted
– Trust Is Pivotal to Success
Family Medical Leave
• Employees have a right to take a medical leave
of absence under the Family and Medical Leave
Act (FMLA).
• 12 work weeks of unpaid leave during any 12-
month period for:
– Birth of a child
– Placement of adopted foster child
– Care of immediate family member

16. – Serious health condition
Whistleblowing
• Someone “who, believing that the public interest
overrides the interest of the organization he
serves, publicly blows the whistle if the
organization is involved in corrupt, illegal,
fraudulent, or harmful activity.”
• Organizations often describe their whistleblower
policy in their compliance manuals.
• Demotion, intimidation, reassignment, reduction
in work hours, or constructive discharge are
prohibited by law.
Employee Responsibilities (1 of 4)
• Know your patient.
• Educate and encourage patients to ask
questions.
• Be compassionate.
• Comply with state and federal regulations.
• Comply with hospital policy.
• Comply with assigned duties.
• Honor and respect patients’ rights.
Employee Responsibilities (2 of 4)

17. • Maintain confidentiality.
– Compliance officer and confidentiality.
• Adhere to safe practices.
– Follow hand hygiene guidelines.
• Admit to mistakes.
• Adhere to professional standards.
Employee Responsibilities (3 of 4)
• Maintain professional relationships.
– Shoot the Consultant
– Sexual harassment
• Nurse’s relationship with patient
• Physician’s inappropriate house call
• Avoid relationships with a patient’s spouse
Employee Responsibilities (4 of 4)
• Report unethical behavior.
• Protect patients from harm.
• Report patient abuse.
• Stand as a patient advocate.
• Work with team spirit.
• Maintain professional competencies.
• Encourage teamwork.

18. Professional Competencies
• Have current understanding of one’s area of
specialization and practice.
• Continuation education.
• Current in knowledge and skills.
Helpful Advice (1 of 4)
• Do not say:
– The physician is not here when he or she is.
– The physician will soon be here when he or
she has already left the building.
– This will not hurt, when you know it will.
– You are busy when you are not.
Helpful Advice (2 of 4)
• Take responsibility for caring and
communicating.
• Include the patient in the decision-making
process.
• Take the time to explain to patients the risks, the
benefits, and alternatives to each course of
treatment.

19. • Listen to what the patient is saying without
interruption.
Helpful Advice (3 of 4)
• Show respect and sensitivity to the patient’s
needs.
• Do not make fun of a patient’s decision-making
capacity.
• Avoid demeaning and criticizing a patient’s
wishes because of his or her frail condition.
Helpful Advice (4 of 4)
• The feelings of the family and those of patient
may differ.
• Continue to improve competencies.
• Remember that patients can be challenging.
• Patient handbooks and employee training.
• Patients also have rights and responsibilities.
Caregiver’s Pledge
I will be compassionate.
I will not neglect my duties and responsibilities.

20. I will read instructions and follow protocols.
I will seek verification of questionable orders.
I will report concerns for patient safety (e.g., staffing
concerns).
I will not assume responsibilities beyond my capabilities.
I will call for help when a patient’s medical needs suddenly
change.
I will continuously improve my skills and participate in
continuing education opportunities.
Review Questions
1. Describe the rights of employees.
2. Describe under what circumstances an
employee has a right to refuse to participate in
a patient’s procedure.
3. Does a nurse have a right to question the care
being rendered to a patient? Explain your
answer.
4. Is the employment-at-will concept appropriate
in today’s society?
5. Describe the responsibilities of employees as
described in this chapter.

21. 6. Describe what caregivers can do to build a
spirit of teamwork and improve the quality of
patient care.
Review Questions
Slide 1Learning ObjectivesEmployment at WillSlide 4Public
Policy Exceptions Prohibiting TerminationFreedom from
DiscriminationEqual Pay Act of 1964Refuse to Participate in
CareCaregiver’s Right (1 of 2)Caregiver’s Right (2 of
2)Questioning Patient CareSuggesting Change of Physician (1
of 3)Suggesting Change of Physician (2 of 3)Suggesting Change
of Physician (3 of 3)Slide 15Freedom from Disruptive
BehaviorFreedom from BullyingImpact of BullyingFreedom
from Sexual HarassmentTreatment with Dignity and
RespectFreedom from IntimidationPrivacy and
ConfidentialityFamily Medical LeaveWhistleblowingEmployee
Responsibilities (1 of 4)Employee Responsibilities (2 of
4)Employee Responsibilities (3 of 4)Employee Responsibilities
(4 of 4)Professional CompetenciesHelpful Advice (1 of
4)Helpful Advice (2 of 4)Helpful Advice (3 of 4)Helpful Advice
(4 of 4)Caregiver’s PledgeReview QuestionsReview Questions