Addressing Horizontal Violence in Medication Wasting

Case Description

This scenario involves an elderly male patient experiencing agitation in the Intensive Care Unit (ICU), requiring immediate and skilled nursing intervention. But as the scenario unfolds, Learners are placed in a position of simulated horizontal violence related to unsafe medication administration. The scenario begins with the patient’s escalating agitation, prompting a physician’s order for restraints and sedation. However, the Learner observes a peer nurse (NPC) administering a higher, incorrect dosage. Following this, the peer nurse (NPC) requests that the Learner sign off on the incorrect waste, creating a high-pressure ethical dilemma for the Learner.

As the scenario unfolds, the patient becomes oversedated and their condition decompensates. Learner critical actions include patient reassessment, realizing change in vital signs, applying oxygen on the patient, removing wrist restraints, and clearly communicating with the team. The Learner should also acknowledge unsafe practices from their peer (NPC). The scenario concludes with a debriefing led by a nurse manager (NPC) in their office, where the Learner receives and acknowledges feedback, reflects on their ability to uphold safe medication administration procedures and maintains professionalism despite difficult team dynamics. Overall this allows Learners to experience simulated horizontal violence, recognize horizontal violence, and discuss safe medication administration practices.

Learning Objectives

Knowledge
1. Recall medication administration rights and procedures, accurately identifying incorrect dosages.
2. Recognize and interpret changes in patient mental status and decompensating vital signs.
3. Identify unprofessional behavior and resist the influence of peer pressure.

Skills
1. Perform focused assessments and obtain vital signs.
2. Apply wrist restraints appropriately and safely.
3. Address conflict and horizontal violence professionally, fostering constructive dialogue.
4. Demonstrate active listening and integrate constructive feedback effectively.

Attitude
1. Reflect critically on the principles of integrity, ethics, and professionalism in nursing practice.
2. Value the impact of horizontal violence and retaliation on professional development and team dynamics.
3. Promote a culture of mutual respect, trust, and open communication within the healthcare team.