Case PresentationTrying to Be HeardJoanna is an experienced nu.docx

Case Presentation
Trying to Be Heard
Joanna is an experienced nurse. She has worked on the same
medical-surgical unit for the past 15 years. During a Saturday
night shift, Mrs. Kelly, an 82-year-old patient diagnosed with
COPD, complains of abdominal pain. Joanna assesses Mrs.
Kelly, who has been a patient on the unit many times in the
past. The patient’s vital signs are within normal limits and there
is no significant change from past readings. However, Joanna
still feels uneasy. Not only does Mrs. Kelly complain of pain,
but also she looks sick to Joanna, who senses there is something
seriously wrong. Joanna calls the medical resident, who tells her
to call back if there are any changes in the vital signs. As the
shift progresses, Joanna becomes more convinced that Mrs.
Kelly is seriously ill. Although there are no changes in Mrs.
Kelly’s vital signs, she calls the resident a second time. The
resident yells at Joanna and tells her to stop bothering him.
After a couple of hours, Joanna decides to call her supervisor,
who checks Mrs. Kelly and encourages Joanna to “get a grip.”
Joanna repeatedly checks on Mrs. Kelly, who remains awake
throughout the night. The next morning, Joanna reports her
assessment to the charge nurse and asks her make sure someone
evaluates Mrs. Kelly’s abdominal pain. The charge nurse
responds, “Don’t worry about her. If there is anything seriously
wrong, she will let us know.” When Joanna returns after 2 days
off, she learns that Mrs. Kelly died on Sunday evening of a
ruptured abdominal aortic aneurism. Joanna spends that evening
crying at the nurses’ station, barely able to take care of her
patients.
BUSI 3331- Business Negotiations - 205
Subject: WrittenAssignment-Case_01_Negotiation-Thawing

Salary Freeze
Dear Students,
The document “Case_01_Negotiation-Thawing Salary
Freeze”attached to this assignment is the first of your video
cases which contribute to the 25% Cases-component of your
course's grade. It is a groupassignment (2 students per group),
and is due on April11th,2017. Your submission report has to
include the following parts:
1)Description of the case in your own words, relating it to key
negotiation terms (300-450 words)
2)Answers to the questions inserted into the text of the case.
3)Analysis of situations in terms of mutual perceptions, goals,
positions vs. interests, possible alternatives, where each of
Katherine and Alisa did well, and what each could have done to
improve her respective position.
BUSI
3331
-
Business
Negotiations
-
20
5
Subject:

Written
Assignment
-
Case_01_Negotiation
-
Thawing
Salary
Freez
e
Dear
Students
,
Th
e
document
“Case_01_Negotiation
-
Thawing
Salary
Freeze
”
attached

to
this
assignment
is
the
first
of
your
video
cases
which
contribute
to
the
25%
Cases
-
component
of

your
course's
grade.
It
is
a
grou
p
assignment
(2
students
per
group),
and
is
du
e
o
n
Apri

l
11t
h
,
201
7
.
Your
submission
report
has
to
include
the
following
parts
:
1
)
Description

of
the
cas
e
in
your
own
words,
relating
it
t
o
key
negotiation
term
s
(300
-
450
words
)

2
)
Answers
to
the
question
s
inserted
into
the
text
of
the
case
.
3
)
Analysis

of
situation
s
in
terms
of
mutual
perceptions,
goals,
positions
vs.
interests,
possible
alternatives,
where
each
of
Katherine
and

Alisa
did
well,
and
what
each
could
have
done
to
improve
her
respective
position
.
BUSI 3331 PMU-Fall 2016-2017

Case3-Thawing Salary Freeze Page 1
Case 1
Negotiation: Thawing the Salary Freeze
BUSI 3331 PMU-Fall 2016-2017
Reference Concepts
===============================================
================
BUSI 3331 PMU-Fall 2016-2017

The Meeting
A: Hi Katherine.
K: Hi Alisa, how are you?
A: I’m good thanks.
K: It was OK coming over here, no problem?
A: Yeah, yeah, no problem. So I called this meeting, I know we
are in the final stages of
negotiating the contract. Just recently I found out the executives
got incredibly large
bonuses and I thought there was no more money. This is very
frustrating. I didn’t
know anything about this. I didn’t understand why I wasn’t
notified, basically on such
an important point. I’m ready to call the New York Times and
scream bloody murder
because this is unacceptable for me not to know this important
point. And I don’t
understand why you wouldn’t tell me the truth.

K: Well I think we should take a step back. I absolutely told
you the truth with regard to
the wage increase. Across the board there are absolutely no
increases to be offered.
The money that you’re mentioning is related to bonuses
awarded to executives for
last year’s performance and came from last year’s budget.
A: I didn’t know about this.
K: Honestly, it’s not something that is part of this negotiation
because I do not have the
ability to go into last year’s budget to try to help the employees
for this year. I’m
given a pool of money, which is this year’s money. The fact that
certain people have
been awarded at year end, a bonus and the fact that this payout
may occur at some
time during this year is completely unrelated.
A: I should have known this information. If this is something
that is a company thing, and
I have negotiated in good faith thinking the money is not there,
finding out about this,

BUSI 3331 PMU-Fall 2016-2017
you can imagine how frustrated I am. So I want to know, really
I’m not calling you a
fibber, but I don’t believe that there is no money. I’m having a
hard time wrapping
my brain around that.
K: I want to mention two points. First, you are new to this
industry, and I don’t want to
mention that many times because I want the fact that we are
going to be working
together or years, I have been doing this for 10 years, and there
are things that you are
not familiar with and this is one of them.
A: Case in point is that this should have been explained.
K: Absolutely not. That’s my exact point in the opposite.
A: You don’t think I should have known about this important
information? It’s money,
it’s money. It’s the budget.
K: Absolutely not. And the budget relates to last year’s revenue.
Again, we can keep

going on this or we can work on the points that can actually
help the employees.
A: I think that you are trying to avoid discussing this because
you know that it would be
an integral part of this discussion.
K: It’s last years numbers, based on revenues from two years
ago, when those numbers
come in, that bonuses are awarded. It’s completely different.
And I must say that I am
personally offended that you are now saying that this is in some
way, a fraudulent
nondisclosure and our company prides itself on full disclosure
of its financials and
taking care of its employees. You’re going along a very thin
line here saying that
you’re questioning my ethics.
A: I’m not personally attacking you.
K: Well you’re saying that I didn’t disclose something that
relates to another year’s
budget and that somehow that is not full disclosure, I just don’t
agree.
A: Well see that’s where we keep butting heads, you keep
saying the money is last years,

but you see the money is still in this year’s budget.
K: It’s not. The payout is this year, out of last year’s budget.
The cheques are being cut
this year but it’s completely unrelated.
A: I don’t understand that.
K: We’ve had several meetings now; I do understand that the
number one point is salary
increases. It’s not a matter on negotiating and finding the
number, there is no money
to be had on salary increases, neither in management or non
management is awarded
a single dollar. My pay stayed the same, I’m more than happy to
show you my pay
stub, as well as disclose the fact that it’s just not on the table
for negotiation.
A: No thank you, I don’t want to see you pay stub.
K: We’re spending a lot of time on an issue that I have no
leeway to change at all.
A: Well what about the bonus that’s going to next year? Why
don’t you give that money
to the people, as opposed to once again, giving it to the upper
management?

BUSI 3331 PMU-Fall 2016-2017
K: Well what happens at the end of the year is going to
determine if there’s a bonus. The
fact that there was a bonus last year does not mandate that there
is going to be a bonus
this year. I don’t have funds.
A: But there is money waiting around obviously to be given to
somebody as a bonus.
K: At year end, if there is money available, depending on how
revenues go from now
until the end of the year, and depending on the managements’
performance at the end
of the year, that’s a determination that can happen. I can’t say
right now.
A: Well the dollar amount you’re saying, but it’s clear to me
according to the way things
have been working that someone is going to get a bonus.
K: And I think that is the wrong assumption. There are years
when the company does not

do well that it does not award bonuses. We have had years
where the company is
running negative and bonuses are not awarded. So you’re
talking about money that
possibly, could be, if revenue turns around, could be awarded at
year end. And you
and I are going to have a negotiation next year, and if the
company does better, we
are going to have more money to award the employees.
A: Why can’t it be allocated differently? How can you help me
get that money to my
workers? That’s the issue here.
K: I think what we need to do, and what we can address and
work with, is that there is
nothing that can be done on the salary increase. But I can
formulate bonus
distributions, providing bonuses to the employees based on this
year’s revenue.
A: I definitely don’t understand why this wasn’t presented
before.
K: Because we were discussing the salaries of the individuals,
you came to me wanting a

7% salary increase; there is salary freeze across the board. But I
am willing to come
to the table and say, the employees, I am very well aware,
contribute to the revenues
of this company and if they can’t receive it in salary increase,
we can take a look at
the revenues at year end and we can make an exception, we can
work with them on
formulating a new type of structure, that has a bonus
component.
A: OK, I would definitely like this in writing.
K: What I suggest is that I draft this; I will get this to your desk
so that you can review it
and then we can meet on Tuesday and not lose much time. And I
will get that to your
desk by tomorrow morning.
A: Ok that would be fabulous. I really appreciate that, and I
hope that it’s a little more
smooth sailing.
K: And I do too. It’s really important that the employees feel
really good about their jobs
and I think we are on the right track to get there.
A: OK, I’d like to think so. Alrighty Katherine.

K: Ok then I will see you on Tuesday and if you don’t get that
document by morning, and
then just contact my office.
BUSI 3331 PMU-Fall 2016-2017
Assignment
1) Read the conversation, then describe it in your own words,
relating it to key
negotiation terms.
2) Answer the questions inserted into the text.
3) Analyze situations in terms of mutual perceptions, goals,
positions vs. interests,
possible alternatives, where each of Katherine and Alisa did
well, and what could
each have done to improve her respective position.
4) Organize your above reflections into a 10-minute class
presentation.

*****************************************************
*******************
Case Presentation
Beneficence Versus Nonmaleficence
A middle-aged nurse recounts an incident that she believes
relates to the principle of nonmaleficence. As a senior nursing
student she was responsible for the care of a man who had a
shotgun wound to his abdomen. Surgery had been performed,
and the surgeon was unable to adequately repair the damage.
The man was not expected to survive the day. He was, however,
awake and strong, though somewhat confused. He had a fever of
107° Fahrenheit. He was receiving intravenous fluids and had
continuous nasogastric suction. The man begged for cold water
to drink. The physician ordered nothing by mouth in the belief
that electrolytes would be lost through the nasogastric suction if
water were introduced into the stomach. The student had been
taught to follow the physician’s orders. She repeatedly denied
the man water to drink. She worked diligently—giving iced
alcohol baths, taking vital signs, monitoring the intravenous
fluids, and being industrious. He begged for water. She
followed orders perfectly. After six terrible hours she turned to
find the man quickly drinking the water from one of his ice
bags. She left the room, stood in the hallway, and cried. She felt
she had failed to do her job. As a result of the gunshot wound,
the man died the next morning. Today her view of the situation
is different.
Think About It
Weighing Harm Against Benefit
· Was this patient harmed? Discuss your answer.
· What was the benefit of the nothing-by-mouth order?
· Discuss whether the harm of thirst or the benefit of
maintaining nothing by mouth should take precedence.

· What other ethical principles are relevant?
· Why did the student experience such extreme
distress?
NONMALEFICENCE
The principle of nonmaleficence is related to beneficence.
Whereas beneficence requires us to prevent or remove harm,
nonmaleficence requires us to avoid actually causing harm.
Included in this principle are deliberate harm, risk of harm, and
harm that occurs during the performance of beneficial acts.
Most ethicists today tend toward the Hippocratic tradition that
says to first do no harm (the principle of nonmaleficence),
placing this principle above all others. It is obvious that we
must not commit acts that cause deliberate harm. This principle
prohibits, for example, experimental research when it is fairly
certain that participants will be harmed, and the performance of
unnecessary procedures for economic gain or solely as a
learning experience.
Nonmaleficence also means avoiding harm as a consequence of
doing good. In such cases, the harm must be weighed against
the expected benefit. For example, sticking a child with a
needle for the purpose of causing pain is always bad—there is
no benefit. Giving an immunization, on the other hand, while
causing similar pain, results in the benefit of protecting the
child from serious disease. The harm caused by the pain of the
injection is easily outweighed by the benefit of the vaccine. In
day-to-day practice, we encounter many situations in which the
distinction is less clear, either because the harm caused may
appear to be equal to the benefit gained, because the outcome of
a particular therapy cannot be assured, or as a result of
conflicting beliefs and values. For example, consider analgesia
for patients with painful terminal illness. Narcotic analgesia
may be the only type of medication that will relieve very severe
pain. This medication, however, may result in dependence and
can hasten death when given in amounts required to relieve
pain. Cammon and Hackshaw (2000) offer another common

example. Orders for patients to have nothing by mouth before
procedures and tests are common practice, unquestioned by
most nurses. The authors cite examples in which elderly
patients were denied food for up to 6 days as tests and
procedures were completed. The consequences of starvation in
the elderly are unquestionable, yet the practice of following
NPO orders for long periods of time is seldom questioned. As
nurses, we must be alert to situations such as these in which
harm may outweigh benefit, taking into account our own values
and those of patients.
BENEFICENCE
The principle of beneficence means to do good. It requires
nurses to act in ways that benefit patients. Beneficent acts are
morally and legally demanded by the professional role
(Beauchamp & Walters, 2007). The objective of beneficence
provides nursing’s context and justification. It lays the
groundwork for the trust that society places in the nursing
profession, and the trust that individuals place in particular
nurses or health care agencies. Perhaps this principle seems
straightforward, but it is actually very complex. As we think
about beneficence, certain questions arise: How do we define
beneficence—what is good? Should we determine what is good
by subjective, or by objective, means? When people disagree
about what is good, whose opinion counts? Is beneficence an
absolute obligation and, if so, how far does our obligation
extend? Does the trend toward unbridled patient autonomy
outweigh obligations of beneficence? Veatch (2002) asks
whether the goal is really to promote the total well-being of the
patient or to promote only the medical well-being of the patient.
We must keep these questions in mind as we practice.
The ethical principle of beneficence has three major
components: do or promote good, prevent harm, and remove
evil or harm. (See Figure 3–2.) Beneficence requires that we do
or promote good (Beauchamp & Childress, 2008). Even with the
recognition that good might be defined in a number of ways, it

seems safe to assume that the intention of nurses in general is to
do good. Questions arise when those involved in a situation
cannot decide what is good. For example, consider the case of a
patient who is in the process of a lingering, painful, terminal
illness. There are those who believe that life is sacred and
should be preserved at all costs. Others believe that a natural
and peaceful death is preferable to an extended life of pain and
dependence. The definition of good in any particular case will
determine, at least in part, the action that is to be taken.
The principle of beneficence also requires us to prevent or
remove harm (Beauchamp & Childress, 2008). In fact, some
believe that doing no harm, and preventing or removing harm, is
more imperative than doing good. All codes of nursing ethics
require us to prevent or remove harm. For example, the
International Council of Nurses (ICN) Code of Ethics for
Nurses (2006) says, “The nurse takes appropriate action to
safeguard individuals, families and communities when their care
is endangered by a co-worker or any other person.” Similarly,
the Canadian Nurses Association (CNA) Code of Ethics for
Registered Nurses (2008) says, “Nurses question and intervene
to address unsafe, non-compassionate, unethical or incompetent
practice or conditions that interfere with their ability to provide
safe, compassionate, competent and ethical care to those to
whom they are providing care, and they support those who do
the same” (p. 9).
Case Presentation
Noncompliance Versus Autonomy
Cora is a 45-year-old woman who looks years older than her
stated age. She has very limited monthly income and no health
insurance. Cora smokes two and one-half packs of cigarettes per
day. She has severe COPD with constant dyspnea and frequent
exacerbations. The nurse who sees her at a local free clinic is
interested in at least preventing further problems, and speaks to
Cora often about the importance of quitting smoking. The

situation becomes very frustrating for all involved when Cora
returns repeatedly for increasingly severe problems, having
failed to quit smoking. Cora, of course, becomes labeled as
noncompliant. During a particularly severe exacerbation, the
nurse says to Cora, “You know you are committing suicide by
continuing to smoke.” Cora’s reply is, “You don’t understand. I
live alone. I have no money, no friends, no family, and will
never be able to work. I know the damage I’m doing, but
smoking is the only pleasure I have in life.”
Think About It
Do Nurses Coerce Patients?
· In attempting to persuade Cora to stop smoking, to
what degree is the nurse violating Cora’sright to autonomy?
· Does Cora have the right to choose to continue
smoking?
· If rights and responsibilities are correlative, how
should the clinic respond to Cora’scontinuing to smoke? Would
you suggest that the clinic continue to serve Cora, even though
she is not following the plan of care?
· To what degree is coercion employed in situations
such as Cora’s? Is coercion an appropriate strategy?
RESPECT FOR AUTONOMY
As you would expect, the ethical principle of respect for
autonomy denotes the ethical obligation to honor the autonomy
of other persons. The word autonomy literally means self-
governing. Autonomy denotes having the freedom to make
choices about issues that affect one’s life, free from lies,
restraint, or coercion. Respect for autonomy is closely linked to
the notion of respect for persons, and is an important principle
in cultures where all individuals are considered unique and
valuable members of society.
field: r2ImageTitle
FIGURE 3–1 Principles of Ethics

field:
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Implied in the concept of autonomy are four basic elements.
First, the autonomous person is respected. It is logical that
those choosing the nursing profession would inherently value
and respect the unique humanness of others. This element is
essential to assuring autonomy. Second, the autonomous person
must be able to determine personal goals. These goals may be
explicit and of a global nature, or may be less well defined. For
example, the patient with an ankle injury may have a goal to
return to athletic play within 2 weeks of the injury, or may
simply wish to be pain free. In either case the patient develops
personally chosen goals that are consistent with a particular
lifestyle. Third, the autonomous person has the capacity to
decide on a plan of action. The person must be able to
understand the meaning of the choice to be made and also
deliberate on the various options, while understanding the
implications of possible outcomes. Imagine, for example,
ordering from a restaurant menu written in a language you do
not understand. You have the freedom and responsibility to
make a choice, but cannot make a meaningful choice without an
understanding of the various foods offered. When we believe
that a patient is not able to comprehend the meaning of choices,
goals, or outcomes, we say that the person is incompetent to
make decisions, or lacks decision-making capacity. There are
certain groups of patients that are generally thought of as
unable to make informed choices. Children, fetuses, and those
with mental impairments are among these groups. Fourth, the
autonomous person has the freedom to act upon the choices. In
situations where persons are capable of formulating goals,
understanding various options, and making decisions, yet are
not free to implement their plans, autonomy is either limited or
absent. Autonomy may also be limited in situations where the
means to accomplish autonomously devised plans do not exist.

An example is seen in the case of the indigent person who has
no health care insurance. This person may choose to have, for
example, a pancreas transplant in lieu of insulin injections, but
has no financial means to meet this goal. In order to assure
autonomy, each of the four elements must be present to a
reasonable degree.
A number of factors may threaten patient autonomy. The
patient’s role is a dependent one. The patient seeks health care
assistance because of a real or perceived need and, as a result,
can be perceived as dependent upon the health care provider.
The role of the health care professional, on the other hand, is
one of power. This power is based upon knowledge and
authority and is inherent in the role. This complementary
relationship, while a necessary one, can lead to violations of
patient autonomy because the patient may not have the strength
of will to exert his or her own autonomy.
ASK YOURSELF
Is the Patient Role a Dependent One?
· Describe a time when you or a family member
experienced the role of hospitalized patient.
· How did you or your family member feel when
interacting with members of the health care team, who were
dressed, while you or your family member were in pajamas or a
hospital gown or, worse yet, naked?
· Describe the degree to which you or your family
member were able to maintain dignity and autonomy.
Health care professionals are often insensitive to the ways in
which the health care industry systematically dehumanizes and
erodes the autonomy of consumers. Patients are forced to
comply with rules that require them to be and act dependent.
Immediately upon admission to a hospital, patients are disrobed,
asked questions about personal and private matters, forced to
relinquish money and belongings, and expected to remain in a
bed, emphasizing the dependency of the patient role. We place
patients in rooms with doors that are seldom closed and ask

them to wear bed clothing. Workers who are strangers to
patients freely enter and leave the patients’ rooms, making
privacy impossible. Regardless of patients’ personal habits or
knowledge of their own health care, they are forced to bathe at
certain times, eat at certain times, and take medications at
certain times, and are often prohibited from practicing self-care
measures that may have been their habits for many years.
Patients are expected to follow each plan that is made.
Otherwise, they will be labeled difficult or noncompliant. For
all the lip service given the importance of autonomy, health care
professionals are often guilty of creating a climate of
dependency for patients—of coercing otherwise autonomous,
intelligent, and independent adults into essentially a very
dependent role.
In cultures that do not regard all people as being of equal worth
and in cultures that respect social structure above individual
rights, autonomy is less important. Where slavery exists, where
women are expected to be subservient to men, where minority
races are not respected, or where children are exploited, the
notion of autonomy is meaningless. Autonomy cannot thrive in
a climate that does not allow for either the independent
planning of personal goals or the privilege of examining and
choosing options to meet goals.
Recognizing Violations of Patient Autonomy
Often, nurses and other health care workers fail to recognize
subtle violations of patient autonomy. This especially occurs
when nurses perceive choices to be self-evident. At least four
factors are related to this failure. First, nurses may falsely
assume that patients have the same values and goals as
themselves. This state of mind compels some nurses to believe
that the only reasonable course of action is the one that is
consistent with their own values. This leads to faulty
conclusions. For example, if an elderly person chooses to stay
in her own home, even though to others she seems incapable of
caring for herself, her choice might be viewed as unreasonable
and might become grounds to believe the patient is incompetent

to make decisions. In other words, “If you don’t make the
choices that seem correct to me, you must be incompetent to
make decisions.” In truth, the elderly person may recognize that
life is drawing to a close and may want to remain in familiar
surroundings, maintain dignity, remain independent, and
prevent needless depletion of her life savings. The decision is
based upon her thoughtful consideration of the consequences of
staying home versus the consequences of living in a long-term
care facility. There are some who would insist that she should
be allowed to stay at home, even if she places herself at
considerable danger, as long as she does not jeopardize the
autonomy of others.
The second cause of failure to recognize subtle violations of
patient autonomy lies in our failure to recognize that
individuals’ thought processes are different. Discounting a
particular decision as incorrect may not take into consideration
the fact that people process information in different ways. For
example, there are those whose thought processes are very
logical and methodical, and there are others who think in ways
that are creative and free-flowing. It is particularly important to
recognize these types of differences when several people are
working together to come to a common decision. What is
obvious to one will not be obvious to all—not necessarily
because of a difference in values, knowledge base, or intellect,
but because of different backgrounds and styles of thinking
(Harrison & Bramson, 1982). This is an important consideration
when collaborating with patients, families, and other
professionals.
The third cause of failure to recognize subtle violations of
patient autonomy lies in our assumptions about patients’
knowledge bases. It is easy for us to forget that we have gained
a specialized body of knowledge through nursing education and
work experience. Knowledge about basic anatomy and
physiology, disease process, the mechanism of action of drugs,
and so forth is so ingrained in our minds that it is easy to
presume everyone has at least some of the same type of

knowledge. We often assume patients have more knowledge
than is reasonable for them to have. Consequently, we may
discount or criticize patients’ decisions, even though flaws lie
in the patients’ level of knowledge, rather than the
appropriateness of decisions. Recall that an understanding of
the choices, outcomes, and implications is inherently necessary
for autonomous decision making. The nurse must accurately
assess the patient’s level of understanding in order to assure
autonomy.
Most people accept the concept of autonomy, but few are
prepared to accept total autonomy for every person in every
situation. The ethical principle of respect for autonomy does not
require you to respect all autonomous actions no matter how
irrational the decision or horrible the results might be. Although
you value the principle of respect for autonomy, you must
simultaneously uphold responsibilities to yourself and to other
people who could be harmed by a patient’s choices. This can be
a difficult distinction to make. To the extent that it is
unreasonable accept the autonomous decisions and actions of all
people in all circumstances, we are called to respect the
principle of autonomy, rather than each autonomous action
(Gillon, 1985).
The fourth cause of our failure to recognize subtle violations of
patient autonomy lies in the unfortunate fact that in some
instances the “work” of nursing becomes the major focus. This
produces a climate of industrious habit. As we go about our
work—doing procedures, giving medications, writing care
plans, and trying to keep up a frantic pace—attentiveness to
patient autonomy is sometimes neglected. In today’s climate of
advanced technology, fiscal uncertainty, staffing reductions,
and bottom-line management, we should guard against focusing
on work rather than caring.
·

Case PresentationTrying to Be HeardJoanna is an experienced nu.docx

Case PresentationTrying to Be HeardJoanna is an experienced nu.docx

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