Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.

A Sample Answer For the Assignment: Capella Solution to Ethical Dilemma Faced by A Health Care Professional Case Study

Title: Capella Solution to Ethical Dilemma Faced by A Health Care Professional Case Study

Introduction

WHETHER YOU ARE A NURSE, A PUBLIC HEALTH PROFESSIONAL, A HEALTH CARE ADMINISTRATOR, OR IN ANOTHER ROLE IN THE HEALTH CARE FIELD, YOU MUST BASE YOUR DECISIONS ON A SET OF ETHICAL PRINCIPLES AND VALUES. YOUR DECISIONS MUST BE FAIR, EQUITABLE, AND DEFENSIBLE. EACH DISCIPLINE HAS ESTABLISHED A PROFESSIONAL CODE OF ETHICS TO GUIDE ETHICAL BEHAVIOR. IN THIS ASSESSMENT, YOU WILL PRACTICE WORKING THROUGH AN ETHICAL DILEMMA AS DESCRIBED IN A CASE STUDY. YOUR PRACTICE WILL HELP YOU DEVELOP A METHOD FOR FORMULATING ETHICAL DECISIONS.

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Main Points Case Studies in Ethics Consider the ethical quandary that the health care professional faces in the selected case study. Pay close attention to details that will assist you in analyzing the situation using the three components of the Ethical Decision Making Model. Please keep in mind that the case study may not contain all of the information you require for the assignment. In such cases, you should consider a wide range of possibilities before drawing any conclusions. Please, however, identify any hypotheses that you make. Incident 2: Repeat Emergency Department Admissions — A Resource Issue Matt Losinski had just finished reading an article about a study of the overuse of emergency services in hospitals in central Texas. He gave a sardonic half-smile, indicating that County General Hospital (CGH) might be experiencing the same issue. Losinski, as CEO, saw other hospitals’ problems as potential problems at CGH, a 300-bed acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was founded as a county-owned hospital; however, the county decided to exit the hospital business ten years ago, and the assets were donated to a not-for-profit hospital system. Even though CGH no longer receives the tax subsidy it did when it was county-owned, the new owner has maintained a strong public service orientation; it must look to itself for fiscal health. The study data revealed that nine residents of a central Texas community had visited emergency departments (EDs) a total of 2,678 times in the previous six years. For the previous four years, one resident had been seen in an emergency department 100 times per year. Given that an emergency room visit can cost $1,000 or more, the nine residents had used $2.7 million in resources. These frequent users of ED services were in their forties, spoke English, and were split evenly between men and women. Losinski saw the issue as a manifestation of Wilfredo Pareto’s classic 80/20 rule. Losinski immediately forwarded the article to Mary Scott, his chief financial officer (CFO), and asked her to meet with him after reading it. Scott dropped by Losinski’s office late the next day and asked him why he thought the article was a priority. Scott reminded Losinski that Medicaid covered 75% of eligible ED costs and that cross subsidies from privately insured and self-pay ED admissions covered the majority of the unpaid additional costs. Losinski and Scott had a good working relationship, but her indifferent response irritated him. Losinksi was curious about how the ED at CGH was used. He asked the administrative resident, Aniysha Patel, to collect data on the use rates of people who were repeatedly admitted to the ED. Patel’s findings to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few individuals were repeatedly admitted to the ED and accounted for hundreds of visits in the previous year.

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The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.Losinski asked his senior management team for recommendations to address the problem of ED overuse.Incident 9: The Missing Needle ProtectorE. L. Straight is director of clinical services at Hopewell Hospital. As in many hospitals, a few physicians provide care that is acceptable, but not of very high quality; they tend to make more mistakes than the others and have a higher incidence of patients going “sour.” Since Straight took the position 2 years ago, new programs have been developed and things seem to be getting better in terms of quality.Dr. Cutrite has practiced at Hopewell for longer than anyone can remember. Although once a brilliant general surgeon, he has slipped physically and mentally over the years, and Straight is contemplating taking steps to recommend a reduction in his privileges. However, the process is not complete, and Cutrite continues to perform a full range of procedures.The operating room supervisor appeared at Straight’s office one Monday afternoon. “We’ve got a problem,” she said, somewhat nonchalantly, but with a hint of disgust. “ I’m almost sure we left a plastic needle protector from a disposable syringe in a patient’s belly, a Mrs. Jameson. You know, the protectors with the red–pink color. They’d be almost impossible to see if they were in a wound.”“Where did it come from?” asked Straight.“I’m not absolutely sure,” answered the supervisor. “All I know is that the syringe was among items in a used surgical pack when we did the count.” She went on to describe the safeguards of counts and records. The discrepancy was noted when records were reconciled at the end of the week. A surgical pack was shown as having a syringe, that was not supposed to be there. When the scrub nurse working with Cutrite was questioned, she remembered that he had used a syringe, but, when it was included in the count at the conclusion of surgery, she didn’t think about the protective sheath, which must have been on it.“Let’s get Mrs. Jameson back into surgery.” said Straight. “We’ll tell her it’s necessary to check her incision and deep sutures. She’ll never know we’re really looking for the needle cover.”“Too late,” responded the supervisor, “she went home day before yesterday.”Oh, oh, thought Straight. Now what to do? “Have you talked to Dr. Cutrite?”The supervisor nodded affirmatively. “He won’t consider telling Mrs. Jameson there might be a problem and calling her back to the hospital,” she said. “And he warned us not to do anything either,” she added. “Dr. Cutrite claims it cannot possibly hurt her. Except for a little discomfort, she’ll never know it’s there.”Straight called the chief of surgery and asked s hypothetical question about the consequences of leaving a small plastic cap in a patient’s belly. The chief knew something was amiss but didn’t pursue it. He simply replied there would likely be occasional discomfort, but probably no life–threatening consequences from leaving it in. “Although,” he added, “one never knows.”Straight liked working at Hopewell Hospital and didn’t relish crossing swords with Cutrite, who, although declining clinically, was politically very powerful. Straight had refrained from fingernail biting for years, but that old habit was suddenly overwhelming.Incident 10: To Vaccinate, or Not?Jenna and Chris Smith are the proud parents of Ana, a 5–day–old baby girl born without complications at Community Hospital. Since delivery, the parents have bonded well with Ana and express their desire to raise her as naturally as possible. For the Smiths, this means breastfeeding exclusively for the first six months, making their own baby food using pureed organic foods, and not allowing Ana to be vaccinated.The Smiths are college educated and explain they have researched vaccines and decided the potential harms caused by them far outweigh any benefits. They point to the rise in autism rates as proof of the unforeseen risk of vaccines. Their new pediatrician, Dr. Angela Kerr, listens intently to the Smiths’ description of their research, including online mommy–blogs that detail how vaccines may have caused autism in many children.

The Smiths conclude by resolutely stating they’ve decided not to vaccinate Ana, despite the recommendations of the medical community.Dr. Kerr begins by stating that while vaccines have certainly sparked controversy in recent years, she strongly recommends that Ana become fully vaccinated. Dr. Kerr explains that vaccines have saved the lives of millions of children worldwide and have been largely responsible for decreases in child mortality over the past century. For example, the decreased incidence of infection with the potentially fatal Haemophilus influenzae type b, has resulted from routine immunization against that bacterium. Similarly, epidemics such as the recent outbreak of measles are usually associated with individuals who have not been vaccinated against that pathogen.Dr. Kerr goes on to endorse the general safety of vaccines by informing Ana’s parents that safety profiles of vaccines are updated regularly through data sources such as the federal government’s Vaccine Adverse Event Reporting System (VAERS). The VAERS, a nationwide vaccine safety surveillance program sponsored by the Food and Drug Administration and the Centers for Disease Control and Prevention, is accessible to the public at https://vaers.hhs.gov/index. This system allows transparency for vaccine safety by encouraging the public and healthcare providers to report adverse reactions to vaccines and enables the federal government to monitor their safety. No vaccine has been proven casual for autism spectrum disorder (ASD), or any developmental disorder. On the contrary, many studies have shown that vaccines containing thimerasol, an ingredient once thought to cause autism, do not increase the risk of ASD.Finally, Dr. Kerr reminds the Smiths that some children in the general population have weakened immune systems because of genetic diseases or cancer treatment, for example. It may not be medically feasible to vaccinate such children. Other children are too young to receive certain immunizations. Instead, these children are protected because almost all other children (and adults) have been vaccinated and this decreases their exposure to vaccine–preventable illnesses (VPIs). This epidemiological concept is known as “herd immunity.” As more parents refuse immunization for their healthy children, however, the rate of VPIs will increase. This puts vulnerable children at significant risk of morbidity and mortality. Routine childhood immunization contributes significantly to the health of the general public, both by providing a direct benefit to those who are vaccinated and by protecting others via herd immunity. Dr. Kerr concludes by stating that after considering the risks versus the benefits of immunization, most states require vaccinations before children can attend school. Parents may decide not to vaccinate under specific circumstances, however, which vary by state.Jenna and Chris Smith confirm their understanding of what Dr. Kerr has explained, but restate that they do not want Ana vaccinated at this time. Dr. Kerr is perplexed as to what to do.ReferencesIn Darr, K., In Farnsworth, T. J., & In Myrtle, R. C. (2017). Cases in health services management.

Ethical decision-making at an individual level and one’s ethical behavior can be viewed in three primary steps using an ethical decision-making model.First is one’s moral awareness, recognizing the existence of an ethical dilemma. This is the pathway to establishing the need for an ethical decision. This awareness is an individual sensitivity to one’s values and personal morals.Once a personal awareness is evident, we can make a judgment in deciding what is right or wrong. This sounds simple, yet there are a number of variables driving this personal judgment. One variable is the individual differences and cognitive bias we all have based on our personal history and experiences. A second variable is the organization. This variable may be influenced from a group, organizational or cultural perspective. A code of conduct or standards of behavior may also influence our judgment.This model, operating in a dynamic fashion, leads us to our ethical behavior; taking action to do the right thing. Is the right thing the same decision for everyone? Obviously not. We are all influenced my multiple factors in our decision-making.This decision-making model can help us understand the pathway to our ethical decisions.

Ethical Case Studies

Consider the ethical dilemma the health care professional faces in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).

Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.

Open and Close IconReducing Hospital Readmissions

Caleb Powell was preparing the agenda for the upcoming executive leadership meeting and he shook his head ruefully. As chief executive officer for Virginia County Regional Hospital (VCRH), Caleb believes that a key piece of VCRH’s future success lies in reducing readmission rates, not only in the areas identified by federal guidelines, but across the board. A few weeks ago, he read a piece from the National Institutes of Health discussing strategies associated with reduction in readmission rates. He decided that he wanted to discuss the issue in detail with his leadership team.

Caleb’s goal is to align the hospital’s strategic planning with the goal of reducing readmissions. The stakes are high; under provisions of the Affordable Care Act, hospitals with higher than expected 30 day readmission rates for heart failure, heart attack and pneumonia are penalized with reduced payments. Historically, hospitals (including VCRH) have struggled to avoid the penalties, but Caleb believes that a focused approach will allow them to be successful. He also believes that reducing readmission rates will improve patient satisfaction, which has become a key metric in measuring hospital quality.

Caleb’s initial research into this issue revealed that while many facilities were incurring the Centers for Medicare and Medicaid Services (CMS) penalties, there was still significant variability in terms of hospitals implementing successful strategies for reducing their readmission rates. However, several themes have emerged. Hospitals that established partnerships with physicians, physician groups and other local hospitals have had greater success. In addition, a clear discharge planning process and nurse driven medication reconciliation have also been associated with reducing the risk of readmissions.

At the same time, Caleb is concerned that an aggressive policy to avoid readmissions could be construed as too focused on the hospital’s bottom line and indifferent to patient needs. The last thing he wants is to create a policy that prevents patients from seeking or receiving care. Caleb hopes that this meeting will begin a productive discussion around developing strategies to improve VCRH’s performance in this area.

Caleb’s email to the executive leadership team with the agenda for the meeting included the following note:

“As we research the readmission rate issue for improvement, we need to be aware that we cannot add additional days to the patient’s initial stay. It’s a balancing act. We also cannot hinder a patient from coming back into the hospital for a readmission. I’ll be asking for your input about whether we should create a system to profile health care providers whose patients have high readmission rates.”

Old School or Out of Touch?

Corey Davidson is the new Emergency Department Director at Crosby Community Hospital. When he was hired, the hospital administrator explained that the first order of business would be for Corey to develop a system for documenting the reappraisal process for physicians applying for reappointment to the medical staff and for clinical privileges. At the time of his interviews, Corey didn’t think much of this focus, but now that he has been on the job for several months, he realizes that there was a very specific reason: Dr. Lacey.

Dr. Lacey has been practicing medicine in Crosby County longer than the hospital has existed, and has treated virtually everyone who works in the hospital. With his twinkly blue eyes and white hair, Dr. Lacey was Crosby’s very own Dr. Santa. Dr. Lacey’s reputation used to be unassailable, but unfortunately age and declining health are taking a toll on his skills. Complicating the situation is the fact that Dr. Lacey is seen as a beloved icon by anyone who didn’t actually work with him.

When Corey logs onto his email one Monday morning, he finds a request to meet with Margaret Truman, Director of Nursing. When they meet, she wastes no time in explaining what she wants to discuss.

“You’re going to have to do something about Dr. Lacey… or rather, Dr. Lasix, as the nursing staff are currently calling him”

“What’s happened?” Corey asks, somewhat nervously.

“Well, you know how we’ve been moving toward a more evidence– based approach to diagnosis and treatment in the ED” Margaret says. One of the areas where we’ve established some solid guidelines is regarding patients presenting with shortness of breath.”

Corey nods. “Yes, I remember you presented on piloting the use of the guidelines.”

“That’s just it — Dr. Lacey is completely unwilling to use them” Margaret says. We’ve come to terms with his unwillingness to use the electronic health record — that’s a battle we just weren’t going to win — but this is getting serious. He’s gotten it into his head that Lasix is the drug of choice for anyone who comes in with dyspnea. This goes against the guidelines we’ve assembled, but he won’t listen to a mere nurse — especially when he’s ordering meds for a patient.

“The thing is — Lasix can be an effective treatment in some cases, but it isn’t recommended as the first treatment option for a patient who has been brought into the ED. There are a number of situations where Lasix can actually be harmful. If the patient has pneumonia or dehydration, they shouldn’t be given Lasix at all. The guidelines we established specifically call for delaying the use of Lasix until a definitive diagnosis of heart failure can be confirmed by chest Xray and laboratory studies.”

A thought occurs to Corey. “Why are you coming to me today with this? Did something happen over the weekend?”

“That’s exactly why I’m here,” says Margaret. “We had a patient present Saturday night with confusion and difficulty breathing. Dr. Lacey ordered Lasix and chest xrays, but the nurse assisting him suspected sepsis. The patient had come in from a nursing home and her skin was not in good shape. Sure enough, the patient had a particularly nasty pressure sore.

“The problem is that Dr. Lacey will not listen to the nursing staff and his own skills are less than they used to be. In this case, the nurse was able to convince him to follow the guidelines, but honestly, nurses have their own work to do and it doesn’t include watching over a doctor to make sure he doesn’t actually harm anyone.”

Corey nods, glumly aware that he is going to be the person who took away Dr. Santa’s ER privileges.

Open and Close Icon Measles Making A Comeback

Piper Banks is the medical director for Open Arms, a non-profit medical clinic and wellness center serving low-income patients in an urban neighborhood. On most days, Piper loves her job and the work her clinic is able to do for people in the community, but lately there has been a problem that is beyond frustrating. This past summer, the city experienced a significant measles outbreak. Thousands of people were exposed to the measles and 78 cases were confirmed. Of the 78 cases, 73 involved unvaccinated children in the city’s East African immigrant community.

What Piper finds most troubling is not that the “herd immunity” was compromised, though that does trouble her. Worse, in her opinion, was the fact that members of the anti vaccination community were distributing fliers and talking to families in the affected community. The anti vax activists reportedly told people that the measles outbreak had been created by the government in order to pressure immigrant parents to vaccinate their children. One of Open Arms’ primary goals has been to counter the fear and misinformation that anti vaccine groups have been spreading in the community for nearly a decade. That misinformation specifically promotes the purported vaccine autism link, despite extensive research disproving those claims. This is troubling, because there is a high incidence of autism within the community and parents are justifiably concerned.

Despite her frustration, Piper hasn’t given up hope. Religious leaders and trusted health care providers in the community have been enlisted by clinic staff members to convince parents to protect their children by getting the measles mumps rubella vaccine.

At a staff meeting, Piper asks for insights to the situation. Felicia Cruz, the clinic pediatrician, expresses optimism about the situation. “Since the measles outbreak, I’ve seen several parents who’ve refused to inoculate their children come in,” she says. “They’re still nervous — very nervous, in fact — but they’re more open to believing us than I’ve ever seen.”

Nasra, an intern at the clinic who is working toward a master’s degree in public health, adds “I was recently talking with a woman who said that the imam at her mosque has been very blunt. He said If you care about your child, you must vaccinate. I think it’s important to make sure parents know how devastating these diseases are. I heard that the anti vaxers were trying to set up measles parties to deliberately expose unvaccinated children to children with measles. We need to explain to these parents that they are playing with fire.”

“I wonder how many parents would make different choices if they could actually see the effects of these diseases” says Emily, a clinic nurse. “People have forgotten how devastating these diseases used to be. They think that if they feed their children a nutritious diet, then these vaccine–preventable diseases will be mild. Sometimes I wish I could take them to the cemetery and show them all the little headstones from when we didn’t have vaccines.”

Piper is encouraged by these comments, and by the fact that the clinic has been administering almost twice as many vaccines since the measles outbreak as they had the previous year. Still, she worries about how to counter the information being spread by the anti vaccination activists and respond in an ethical way to parents who don’t want to vaccinate their children.

Ethical Decision-Making Model

Ethical decision-making at an individual level and one’s ethical behavior can be viewed in three primary steps using an ethical decision-making model.

First is one’s moral awareness, recognizing the existence of an ethical dilemma. This is the pathway to establishing the need for an ethical decision. This awareness is an individual sensitivity to one’s values and personal morals.

Once a personal awareness is evident, we can make a judgment in deciding what is right or wrong. This sounds simple, yet there are a number of variables driving this personal judgment. One variable is the individual differences and cognitive bias we all have based on our personal history and experiences. A second variable is the organization. This variable may be influenced from a group, organizational or cultural perspective. A code of conduct or standards of behavior may also influence our judgment.

This model, operating in a dynamic fashion, leads us to our ethical behavior; taking action to do the right thing. Is the right thing the same decision for everyone? Obviously not. We are all influenced my multiple factors in our decision-making.

This decision-making model can help us understand the pathway to our ethical decisions.