NURS 8000 Week 5: Ethical Issues Relevant to the Doctorally Prepared Nurse

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NURS 8000 Week 5: Ethical Issues Relevant to the Doctorally Prepared Nurse

Duties that include upholding the interests of society as a whole (Silva & Ludwick, 2006). The fundamental nursing ethics, which include nonmaleficence, beneficence, autonomy, and justice, are taught to new nurses. According to Silva and Ludwick (2006), there is a social compact between society and nurses that allows nurses to practice with the idea that they are committed to the greater welfare of society. When initiating change or providing treatment, , especially at the Doctor of Practice (DNP) level. Health inequalities, social determinants of health, cultural competency, and social justice are just a few of the ethical dilemmas DNP-prepared nurses will encounter. According to Peirce & Smith (2008), ethical conundrums will increase as the range of practice for .

DNP-trained nurses are more likely to encounter patients who refuse treatment. DNP nurses understand that a patient has the right to refuse treatment if he or she can make an informed decision. As a patient, you have the option of choosing your own path. The greater good will create an ethical quandary for DNP-prepared nurses. Furthermore, DNP-prepared nurses must educate their coworkers. If the patient refuses treatment, the DNP-prepared nurse must acknowledge that she or he has fulfilled their duty to act in the best interests of the patient as well as their commitment to the welfare of society. The scenario described above occurs far too frequently in my current day-to-day practice. I see patients on a regular basis as an APRN.

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A Sample Answer For the Assignment: NURS 8000 Week 5: Ethical Issues Relevant to the Doctorally Prepared Nurse

Title: NURS 8000 Week 5: Ethical Issues Relevant to the Doctorally Prepared Nurse

Nurses at all levels of practice and care will encounter ethical issues. It is important for a DNP-prepared nurse to be aware of significant ethical issues they may encounter. DNP-prepared nurses “are on the frontline of patient care as ethical leaders and advocates” (Vermeesch et al., 2018). This means that DNP-prepared nurses not only need to be aware of ethical issues they may encounter, but also understand how their role impacts the resolution of ethical issues. As a DNP-prepared nurse, we will be the ones other nurses and medical professionals look to in a variety of ethical situations. For this discussion post, I focus on two significant ethical issues: collaboration between health care providers and patient’s families during critical illness and patients with reduced consciousness.

Initiating and collaborating communication between health care providers and family members during times of critical illness can be an ethical challenge. Sometimes this communication is not intiatied until late in the patient’s disease progression, and this can be an issue. The families might not understand the severity of the patient’s illness and be unable to make health care decisions. By involving the family members early on, the nurse may alleviate some of the misunderstanding. According to Pavlish et al. (2020), “families not only benefit from family conferences but also value the opportunity, especially if provided time to share their perspectives.” Initiating the family’s involvement early on can help reduce ethical predicaments that may arise.

Patients with reduced consciousness, whether they are under sedation or not, is an ethical concern. A patient may arrive to a emergency room or medical unit unconscious, with no identification or family present, and the health care providers must make decisions based on what they believe is best for the patient. This can become an ethical issue because since the patient has altered consciousness, the health care team does not know that patient’s health care wishes. “Patients with reduced consciousness are vulnerable and completely dependent on the care and concerns of others” (Rejno et al., 2020). This can be a tricky ethical situation for a nurse to navigate.

There are many times patients are unable to sign consent for surgical procedures and their families or legally authorized persons are not available. Sometimes there is conflict on which family member should be informed or make decisions for the patient when they are unable to provide consent. Oftentimes there is confusion because the nurse on the unit taking care of the patient does not know who to contact, and when the patient arrives to the surgical unit, it becomes even more confusing. This causes delays with care and brings up ethical concerns.

In the postanesthesia care unit (PACU), patients have received anesthesia and other sedatives and may be unable to make decisions or express their needs. This means the PACU nurse must maintain the patient’s dignity as best as they can. Although a patient will wake up form the anesthesia, they are still in a vulnerable state, since the anesthesia medication can affect their judgment and decision-making skills for up to 24 hours. It is up to the PACU nurse to provide safe care and also help the patient make decisions.

References

Pavlish, C. L., Henriksen, J., Brown-Saltzman, K., Robinson, E. M., Warda, U. S., Farra, C., Chen, B., &Jakel, P. (2020). A team-based early action protocol to address ethical concerns in the intensive care unit. American Journal of Critical Care, 29(1), 49-61. https://doi.org/10.4037/ajcc2020915

Rejno, A., Ternestedt, B.-M., Nordenfelt, L., Silfverberg, G., &Godskesen, T. E. (2020). Dignity at stake: Caring for persons with impaired autonomy. Nursing Ethics, 27(1), 104-115. https://doi/org/10.1177/0969733019845128 Vermeesch, A., Cox, P. H., Baca, S., & Simmons, D. (2018). Strategies for strengthening ethics education in a DNP program. Nursing Education Perspectives, 39(5), 309-311. https://doi.org/10.1097/01.NEP.0000000000000383

Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. Ethical conflicts can emerge from intractable treatment disagreements or when patients, surrogates, or clinicians perceive their goals related to care and outcomes are being thwarted by the incompatible goals of others. The primary ethical conflicts perceived in the ICU relate to medical decision-making and treatment goals, especially regarding the benefit or harm of aggressive treatment. (Pavlish, 2020).

In the article by Pavlish (2020), it states that delaying or avoiding conversations about prognosis and treatment options appears to increase the probability of continuing aggressive and sometimes unwanted treatments for patients with serious and life-limiting conditions. For example, patients with heart failure are often not referred for palliative care services until the last month of life because advanced care planning is frequently delayed. Other researchers found that Medicare recipients with cancer received high-intensity treatments relative to their poor prognosis in the last weeks of life.

Providing intensive therapies may certainly be indicated in some cases; however, when patients know that medical interventions are not likely to improve their condition, they often refuse or decrease intense measures (Pavlish, 2020). When a person can no longer communicate their needs and will, the healthcare professionals involved need to know how to respect their dignity in daily care. Many healthcare professionals have asked for more knowledge and training about dignity ing the care of older persons (Rejno et al., 2020). The American Nurses Association (2015) Code of Ethics is fundamental to providing a framework for ethical decision-making and guiding practice.

Advanced practice registered nurses, specifically nurse practitioners with doctor of nursing practice degrees, are on the frontline of patient care as ethical leaders and advocates (Vermeesch et al., 2018). Throughout my nursing career, I have experienced many ethical challenges. One that comes to mind is a patient who was considered to have no brain activity. The family did not want to have him taken off of life support. They had a well-known acupuncturist come and perform treatment on the patient. It was sad to watch the family hand on this way. After a week or so, the family decided to have the patient taken off of life support. As a DNP-prepared nurse, I expect to face families who are not ready to let go of their loved ones. I also expect patients who would want to try alternative therapies over pharmaceutical treatment, when the latter would be a better treatment. 

References

Pavlish, C. L. (2020). A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit. American Journal of Critical Care, 29(1), 49–58.

https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2020915

Rejnö Å, Ternestedt B-M, Nordenfelt L, Silfverberg G, Godskesen TE. Dignity at stake: Caring for persons with impaired autonomy. Nursing Ethics. 2020;27(1):104-115. doi:10.1177/0969733019845128

Vermeesch, A., Cox, P. H., Baca, S., & Simmons, D. (2018). Strategies for strengthening ethics education in a DNP program. Nursing Education Perspectives, 39(5), 309-311. doi:http://dx.doi.org/10.1097/01.NEP.0000000000000383

RE: Discussion – Week 5

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Ethics is defined as social obligations that encompass preserving the greater good of society (Silva & Ludwick, 2006). Entry-level nurses are taught the foundational nursing ethics of to include nonmaleficence, beneficence, autonomy, and justice. Silva & Ludwick (2006) suggests there is a social contract nurses enter into with society which gives nurses permission to practice with the understanding of commitment to the greater good of society. Incorporating nursing ethics is essential for nurses to utilize when implementing change or care, especially at the Doctor of Practice (DNP) level. There are so many ethical situations DNP-prepared nurses will face that are centered around health disparities, social determinants of health, cultural competency, and social justice, just to name a few. Peirce & Smith (2008) urges as the scope of practice expands for advanced practice registered nurses (APRNs), so will ethical dilemmas.

DNP-prepared nurses will undoubtedly be placed in scenarios related to a patient making the decision to refuse treatment. DNP-prepared nurses understanding if a patient has adequate decision-making capacity, it is within his or her right to refuse care. Knowing, patients have the right to autonomy. DNP- prepared nurses will face the ethical dilemma of ensuring the greater good in society. Equally important, DNP-prepared nurses have the duty of increasing the knowledge of others. If DNP-prepared nurses educated his or her patient on all treatment options and the patient opt to not undergo treatment, the DNP nurse must come to terms that he or she has fulfilled their role to do no harm, as well as the commitment to the greater good of society. The scenario discussed above is all too familiar in my current everyday practice. As an APRN, I see patients on a daily who refused adjunct treatment to medication interventions. Specifically, my patient population with severe anxiety and depression. I encourage them to seek therapy in combination with medication management. I have a high percentage of patients who adamantly refuses therapy and opts only for medication interventions.

DNP-prepared nurses will, at some point, face the population of patients who are underinsured or not insured at all. How do DNP-prepared nurses ensure patients with healthcare disparities receive the essential services to promote the better good of society? DNP-prepared nurses must explore all community resources to help patients with health insurance disparities gain access to services needed. Currently, I know all too well the hardship patient with health insurance disparities face. As an APRN, I have patients tell me they can afford their medications. I always go the extra mile to explore indigent prescription programs, manufacture coupons, and prescription saving cards to help my patients get their medication. As a future DNP nurse, I will continue to explore all avenues to ensure the greater good of my patients and society.

References

Peirce, A. G., & Smith, J. A. (2008). The ethics curriculum for Doctor of Nursing Practice programs. Journal of Professional Nursing, 24(5), 270-274.

Silva, M., Ludwick R., (March 20, 2006). “Ethics: Is the Doctor of Nursing Practice Ethical?” OJIN: The Online Journal of Issues in Nursing. Vol. 11 No. 2

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8 months ago

RE: Discussion – Week 5

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Good point. Ethics are moral principles and social obligations that govern human behaviors. Often ethics arise when choices have to be made and the options available are not either clear or ideal. The choice picked could result in a decline in the quality of care offered to patients by nurses or can lead to a problematic clinical relationship. Nurses are obligated to preserve the greater good of society; however they encounter ethical challenges that compromise the provision of quality care in a healthcare setting (Ulrich et al., 2010). Nurses should practice with an understanding of commitment to the greater good of society. Therefore, they should adapt the several targeted related interventions that are useful in addressing the complex patient issues they encounter daily.

Reference

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010).

Everyday ethics: ethical issues and stress in nursing practice. Journal of advanced

nursing, 66(11), 2510-2519.

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Margaret Harvey Walden Instructor Manager

RE: Discussion – Week 5

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As a nurse with many years working with those who have severe and persistent mental illness, it does not surprise me that many do not want to add therapy to their treatment plan. I am not sure if they are looking for a “quick fix” or do not believe in the merits of therapy, but I have seen the same thing you describe, over and over again. Thank you so much for sharing.

I really believe all nurses  want to practice safely and ethically. I believe all new graduates enter the nursing profession with a good moral conscious and projects they will practice ethically. Then a new nurse gets hired and finds themselves working on floors that are understaffed for the level of acuity of the patients. Some leave to work at other places. Others continue to try to practice within the constraints they find themselves in. Other times, nurses cut corners, and tragically put patients at risk because they feel so overworked.

I often wonder how other nurses respond when they see nurses (both new grads or seasoned professionals) feel so overwhelmed by their workload that they omit doing things or cut corners in other ways. For example, when a nurse sees another nurse who does not report an error or skips the education part in a patient’s care due to time constraints, I wonder what happens. Do they normally report it, or at the very least confront the offending nurse? Are they fearful of the repercussions? Are they too stressed to care because they are on overload and do not have the resources needed? Do they see other nurses not practice ethically, and just follow their actions?

I am not sure what changes with time, but I have often seen a nurse become more cynical after practicing for a while. Any thoughts on why this happens?

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Dr. Harvey, I believe workplace “Burnout” is a major factor in nurses becoming cynical over time. As you mentioned, there is a major shortage of nurses which, often, leads to nurses taking shortcuts to ” get the job done”. When nurses take shortcuts multiple times without a near sentinel event, using best practice is thrown

RE: Discussion – Week 5

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Week 5 Discussion

According to Silva & Ludwick (2006), ethics is defined as social obligations that encompass preserving the greater good of society. Entry-level nurses are taught the foundational nursing ethics to include nonmaleficence, beneficence, autonomy, and justice (Silva & Ludwick, 2006).  Even though ethical issues are bound to arise in almost every professional’s life, nurses such as a Ph.D.- or a DNP nurse usually encounter various ethical issues almost daily in their efforts to offer care and safety to the patient, largely thanks to the complex medical issue. The standards of practice and ethics require that nurse’s practice with justice, act with beneficence, and uphold all the ethical principles (LoBiondo-Wood & Haber, 2017). However, it is becoming increasingly challenging for the nurses to uphold all the standards and practice with ethics due to the pressures and complex moral choices nurses have to make.

 One of the significant ethical issues is the informed consent ethical issue. As DNP or PhD-prepared nurse, one of the requirements is quickly translating knowledge into practice which may lead to having to obtain informed consent from children or individuals lacking the cognitive ability to provide such (Trautman et al., 2018). Therefore, the nurse is faced with the dilemma of determining when it is appropriate to obtain informed consent from others on their behalf.  The other issue is disclosing a patient’s medical condition entailing whether to tell the patient the truth regarding his/her condition even if it will impact negatively or deceiving the patient. There is an obligation to tell the patient the truth versus the principles of nonmaleficence.

Even though the issues discussed may be slightly different from the issues already encountered in my practice, the common denominator is that they all revolve around the patient. For instance, one of the ethical issues already experienced in practice is informed consent while working with vulnerable groups such as children and patients exposed to undue influence. It is a challenge deciding on how informed consent should be obtained. In addition, while one of the issues identified relates to research work involvements by a DNP or Ph.D. prepared nurse, the ethical issues I have already experienced are practice related. However, the solution to all the ethical issues lies following the nursing ethical principles (Rainer et al., 2018) in spite of the cases occurring in different settings.

In conclusion, ethical principles guide healthcare providers on how to address emerging ethical issues. Ethical issues are prone in the healthcare system and so nurses and other healthcare providers must be prepared to handle them in the right way possible without compromising the patients’ values and dignity.

References

LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-e-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), 3446-3461. Doi: 10.1111/jocn.14542

Silva, M., Ludwick R., (March 20, 2006). “Ethics: Is the Doctor of Nursing Practice Ethical?”

OJIN: The Online Journal of Issues in Nursing. Vol. 11 No. 2

Trautman, D. E., Idzik, S., Hammersla, M., & Rosseter, R. (2018). Advancing scholarship through translational research: The role of PhD and DNP prepared nurses. Online Journal of Issues in Nursing, 23(2). Doi: 10.3912/OJIN.Vol23No02Man02