You are the registered nurse on duty at a skilled nursing facility. Judy, a 35-year-old, full-time nurse’s aide on the day shift, has been with the skilled nursing facility for 10 years.

Be sure to apply an appropriate problem-solving/decision-making model (Traditional Problem-Solving Process, Managerial Decision-Making Model, The Nursing Process, or the Integrated Ethical Problem-Solving Model) in determining what you should do. Justify your decision with supporting evidence.
Learning Exercise Analysis Assignments
In solving the Learning Exercise, you must select a formal problem-solving or decision-making model and apply each step of the model to reach a decision about the best way to address the problem.
Writing Expectations—1-2 pages, double-spaced, in length, not counting title page and references. APA format required (title page, citations in body of paper, and reference list). The steps of the problem-solving or decision-making model chosen should be used as subheadings for the paper. Each analysis should include a brief introduction and conclusion.
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LEARNING EXERCISE 4.10
The Untruthful Employee (Marquis & Huston, 2012)
You are the registered nurse on duty at a skilled nursing facility. Judy, a 35-year-old, full-time nurse’s aide on the day shift, has been with the skilled nursing facility for 10 years. You have worked with Judy on numerous occasions and have found her work to be marginal at best. She tries to be extra friendly with the staff and occasionally brings them small treats that she bakes. She also makes a point of telling everyone how much she needs this job to support her family and how she loves working here. She has a disabled daughter who relies on her hospital-provided health insurance to have her health-care needs met. Most of the other staff seem willing to put up with Judy’s poor work habits, but lately, you have felt that her work has shown many serious errors. Things are not reported to you that should have been—intake and output volumes that are in error, strange recordings for vital signs, and so on. She has tried to cover up such errors, with what you suspect are outright lies. She claims to have bathed patients when this does not appear to be the case, and has said some patients have refused to eat when you have found that they were willing to eat for you. Although the chief nursing officer acknowledges that Judy is only a marginally adequate employee, she has been unable to observe directly any of the behaviors that would require disciplinary action and has told you that you must have real evidence of her wrongdoing in order to for her to take action. During morning report, you made a specific request to Judy that a confused patient, Mr. Brown, assigned to her, be assisted to the bathroom, and you told her that someone must remain in the room to assist him when he is up, as he fell last evening. You also told Judy that when in bed, Mr. Brown’s side rails were always to be up. Later in the morning, you take Mr. Brown his medication and notice that his side rails are down and after pulling them up and giving him his medicine, you find Judy and talk with her. She denies leaving the side rails down and insisted someone else must have done it. You caution her again about Mr. Brown’s needs. Thirty minutes later, you go by Mr. Brown’s room and find his bed empty and discover he is in the bathroom unattended. As you are assisting Mr. Brown back to bed, Judy bursts into the room and pales when she sees you with her patient. At first, she denies that she had gotten Mr. Brown up, but when you express your disbelief, she tearfully admits that she left him unattended but stated that this was an isolated incident and asked you to forget it. When you said that it was her lying about the incident that most disturbed you, she promised never to lie about anything again. She begged you not to report her to the chief nursing officer and said she needed her job. You are torn between wanting to report Judy for her lying because of concerns about patient safety and also not wanting to be responsible for getting her fired. To reduce the emotionalism of the event and to give yourself time to think, you decide to take a break and think over the possible actions you should take.
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ASSIGNMENT: Evaluate this problem. Is this just a simple leadership–management problem that requires some problem solving and a decision or does the problem have ethical dimensions? Using one of the problem-solving models in this chapter, solve this problem. Compare your solution with others in your class.
DISPLAY 1.2 TRADITIONAL PROBLEM-SOLVING PROCESS
1. Identify the problem.
2. Gather data to analyze the causes and consequences of the problem.
3. Explore alternative solutions.
4. Evaluate the alternatives.
5. Select the appropriate solution.
6. Implement the solution.
7. Evaluate the results.
DISPLAY 1.3 MANAGERIAL DECISION-MAKING MODEL
1. Determine the decision and the desired outcome (set objectives).
2. Research and identify options.
3. Compare and contrast these options and their consequences.
4. Make a decision.
5. Implement an action plan. 6. Evaluate results.
DISPLAY 1.5 INTEGRATED ETHICAL PROBLEM-SOLVING MODEL
1. DETERMINE whether there is an ethical issue or/and dilemma.
2. IDENTIFY the key values and principles involved.
3. RANK the values or ethical principles which—in your professional judgment—are most relevant to the issue or dilemma.
4. DEVELOP an action plan that is consistent with the ethical priorities that have been determined as central to the dilemma.
5. IMPLEMENT your plan, utilizing the most appropriate practice skills and competencies.
6. REFLECT on the outcome of this ethical decision-making process.

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