NURS 8002 Ethics And The DNP-Prepared Nurse

The ethical issues relevant to the DNP-prepared nurse include informed consent and fidelity. Informed consent is based on a patient’s right to decide for themselves. The DNP prepared nurse must respect patients’ right to decide and protect those patients who are unable to decide for themselves (Varkey, 2021). Informed consent stems from the ethical principle of autonomy. The principle of autonomy entails a person’s right to choose and the ability to act on that choice. DNP prepared nurse has a responsibility of respecting patients’ right to autonomy. Autonomy reflects the belief that every competent individual has the right to determine their course of action (Vikas et al., 2021). DNP prepared nurse should be aware that the right to free choice rests on the patient’s competency to decide.

Fidelity means faithfulness and keeping promises and is the ethical foundation of nurse-client relationships. Patients have an ethical right to expect nurses to act in their best interests. As the DNP prepared nurse function in the role of patient advocate, they are upholding the principle of fidelity. The DNP nurse demonstrates fidelity when they represent the patient’s viewpoint to other members of the healthcare team (Graf et al., 2020). Fidelity is also demonstrated when the DNP prepared nurse avoids letting their own values influence their advocacy for clients. Thus, the DNP prepared nurse should support the patient’s decision even when it conflicts with the nurse’s preferences or choices.

The above issues compare to the ethical issues I have encountered in my practice since providers often encounter challenges when patients or their guardians fail to give consent. We have experienced lawsuits after providers failed to obtain consent from patients, and the interventions provided led to adverse effects. We have also had lawsuits when providers failed to keep the promises they made to patients, and the patients prosecuted them for failing to act in their best interest.

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References

Graf, W. D., Epstein, L. G., & Pearl, P. L. (2020). Practical Bioethics during the Exceptional Circumstances of a Pandemic. Pediatric neurology, 108, 3–4. https://doi.org/10.1016/j.pediatrneurol.2020.04.011

Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119

Vikas, H., Kini, A., Sharma, N., Gowda, N. R., & Gupta, A. (2021). How informed is the informed consent?. Journal of family medicine and primary care, 10(6), 2299–2303. https://doi.org/10.4103/jfmpc.jfmpc_2393_20

Module 5, Week 10 Initial Post (Stein)

COLLAPSE

There are many ethical issues that the DNP-prepared nurse will encounter throughout their journey; however, from an executive leadership lens these dilemmas will be plentiful and evolve over time. In the acute care setting, “relevant collectives in health care—including groups of clinicians, patients, nonclinical workers, administrators, and institutions themselves—have diverse and often overlapping memberships and interests that might conflict (Phelan, 2020).” This can be related to the long standing ethical dilemma of healthcare providers feeling as though they are advocating for the care their patients need, while “the hospital” is pushing them to get those same patients discharged. It seems in this setting business and care providing, mixed in with regulation agencies and reimbursements makes the best plan of care for a patient confusing and can feel rushed. Another layer specific to Maryland is the use of a Global Budget Revenue (GBR) system that causes another set of obstacles for providers and patient care plans in the acute care setting. “Under GBR contracts, each hospital’s total annual revenue is known at the beginning of each fiscal year. Annual revenue is determined from a historical base period that is adjusted to account for inflation updates, infrastructure requirements, population driven volume increases, performance in quality-based or efficiency-based programs, changes in payer mix and changes in levels of UCC. Annual revenue may also be modified for changes in services levels, market share shifts, or shifts of services to unregulated settings (HSCRC, 2021).”

An additional ethical dilemma that can be encountered from higher level leadership includes, “Institutional transparency and conflicts of interest can affect patients and constituents’ relationships—most importantly, those of clinicians and their patients. Health care organizations’ interests and their potential conflict with interests of others under their authority are of great ethical significance, as partiality can threaten fiduciary obligations clinicians owe to patients (Phelan, 2020).” In the setting of rural Maryland, the population density is not high and there are a lot of clinicians who know their patients on a personal level or may have a slightly removed connection to them that is unavoidable. The description of “small world” runs true in western Maryland and can cause conflicts for clinicians and nursing staff when providing care in their workplace.

To conclude, Phelan (2020) states, “Given uncertain futures for health care systems, we should expect organizational considerations to be central in designing and delivering health care services. We can look to this issue for guidance about ensuring reasonable expectations of clinicians,responsibly navigating clinicians’ collective negotiations with employers,enabling justifiable adjudication of disciplinary action against organization members,maintaining cultures that discourage misconduct,sufficiently communicating and responsibly leveraging organizations’ aims to promote shared decision making,⁷ crafting solutions when there are few or no alternatives,⁹ and maintaining good public relations to foster trust.”

References:

Phelan, P. S. (2020). Organization ethics for US health care today. AMA Journal of Ethics, 22(3), 183-186. https://doi.org/10.1001/amajethics.2020.183.

Health Services Cost Review Commission. (2021). Global budget revenue adjustments. Retrieved 3 November 2021 from, https://hscrc.maryland.gov/Pages/gbr-adjustments.aspx.

You are likely already upholding ethics in nursing and healthcare delivery in your current nursing practice experience. As mentioned in the introduction for this week, a patient-focused approach that promotes the delivery of safe, quality, and cost-effective healthcare for promoting positive patient outcomes represents a fundamental alignment to ethical principles for the delivery of healthcare. In your journey toward becoming a DNP-prepared nurse, you will continue to uphold ethical principles in your nursing practice and will likely continue to serve as an advocate for adhering to these principles in all you do.

Photo Credit: ibreakstock / Adobe Stock

For this Discussion, reflect on the case studies/scenarios related to ethical challenges presented in this week’s Learning Resources. Think about how these ethical challenges may mirror your own experiences in nursing practice. Consider what other ethical challenges may arise in your own nursing practice or as you continue your program of study.

I feel transparency and dignity are two significant ethical issues relevant to the DNP-prepared nurse. In the article by Phelan (2020), transparency and trust “can affect patients and constituents’ relationships—most importantly, those of clinicians and their patients.” This statement relates to clinicians and the institutions they work for. As a nurse, I have witnessed patients being lied to or providers failing to mention updates on patient care. You would not initially think that updating a patient on their healthcare would fall under trust, but it falls under transparency with the patient.

For example, I have witnessed providers tell patients a medication was one thing when it was something different to soothe the patient. I have seen this primarily with those that seek specific medications. My biggest one is providers not reading EKGs and just signing off on them. This has led to missing active heart attacks. Transparency goes a long way for patients. Not telling a patient their results for a full lab workup because that is not the issue they came for has also been a big issue in healthcare.

In an article by Rejno et. al., (2019), healthcare professionals should, “help and benefit patients in need.” This article talked about dignity and autonomy for patients who could not make sound decisions. This is equally important for all patients. Each patient should be treated like he or she has been heard, even if you cannot actually hear them.

For example, We have all more than likely encountered a stroke patient. A stroke patient is sometimes left unable to speak. I think it is safe to say we have all witnessed healthcare providers speak to these patients and guess what they are trying to say. I did not know this fell under the category of dignity.

As a DNP-prepared nurse, I will encounter these same situations, but my job will be to correct these ethical issues. Yes, I may know the best way to care for someone, but allowing them the autonomy to tell me what they would like for their health would help. Being transparent with the patient would help provide better care. Being truthful would allow healthcare providers the chance to perform continuity of care correctly. Afterall, “The doctor-patient relationship lies at the heart of health care, and patient trust is a fundamental aspect of that relationship” (Holman, 2017).

Holman, T. (2017). Dignity Health | The Doctor-Patient Relationship is Built on Trust. Dignityhealth.org. https://www.dignityhealth.org/articles/how-to-build-patient-trust-to-improve-the-doctor-patient-relationship

Phelan, P. S. (2020). Organizational ethics for US health care today.Links to an external site. AMA Journal of Ethics, 22(3), 183–186. https://doi.org/10.1001/amajethics.2020.183Links to an external site.

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:10.1177/0969733019845128Links to an external site.

To prepare:

Review the case studies/scenarios related to ethical challenges presented in this week’s Learning Resources.
Reflect on ethical challenges related to the organization or at the point of care that you may have encountered in your nursing practice.
Consider what new ethical challenges you might face once you obtain your doctoral degree.

By Day 3 of Week 10

Post an explanation of at least two significant ethical issues relevant to the DNP-prepared nurse. Then explain how these issues might compare to the types of issues you have encountered in your practice. Be specific and provide examples.

Post an explanation of at least two significant ethical issues relevant to the DNP-prepared nurse.

According to Ulrich et al., in a recent study conducted over 422 questionnaires were used in the analysis to ask the most frequently occurring ethical issues nurses encountered. Out of these issues a DNP-prepared nurse would be most affected by protecting patient rights, and patient autonomy (Ulrich, 2010).

The 1973 American Hospital Association patient bill of rights was the first bill of rights written specifically for patients. One important patient right includes informed consent. The following elements are required for documentation during the discussion, 1). The nature of the procedure, 2.) the risks and benefits of the procedure, 3.) reasonable alternatives, 4.) risk and benefits of alternatives, and 5.) Assessment of the patient’s understanding of elements. which include the right to be informed of potential harm to the body and right to autonomy or self-decision making (Olejarczyk, 2021).

Patient Autonomy literally means self-rule and refers to living and making decisions according to one’s own reasons or motives. A patient who can defend his or her judgments has the right to make decisions that do not coincide with what the clinician believes is beneficial to the patient. A patient’s autonomy is violated when family members or members of a health care team pressure a patient or when they act on behalf without the patient’s permission (in a non-emergent situation) (Olejarczyk, 2021).

Then explain how these issues might compare to the types of issues you have encountered in your practice. Be specific and provide examples.

Protecting patient rights have been an issue in the past due to limited space in our clinic. Patient information on computer screens and conversations regarding patient health information can be easily overheard. To rectify this issue or department managers have asked for screen protectors, patient information to be covered whenever left on the desk, and taller cubicle space.

Informed consent has also been addressed in our clinic. When patients agree to care management, there was no written consent or agreement. Stakeholders then agreed to add an excerpt explaining care management, benefits to agreeing to the program, an opportunity to opt out, and a place on the website to go for additional questions and information. Patient are now required to sign a consent before care management begin.

Resources:

Olejarczyk, J. P. (2021, August 13). Patient rights and ethics. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK538279/.

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. https://doi.org/10.1111/j.1365-2648.2010.05425.x

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

By Day 5 of Week 10

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an alternative approach to the ethical issue described by your colleague.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 10 Discussion Rubric

Post by Day 3 of Week 10 and Respond by Day 5 of Week 10

To Participate in this Discussion:

Week 10 Discussion

What’s Coming Up in Week 11?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will consider the role of the DNP-prepared nurse as an advocate for promoting positive social change.

Next Week

To go to the next week:

Week 11

Module 5: Ethics and Issues for Social Change Advocacy

Ethics and the application of ethical principles is of supreme importance in nursing practice and healthcare delivery. So much of what nurses and healthcare professionals do daily stems directly from an ethical point of reference or frame. Providing patient care and ensuring patient safety while enhancing quality and diminishing costs are all well-intended and ethical practices that you likely already engage in your nursing practice. A strong ethical awareness and adherence to ethical guidelines is just one way you will positively impact your patients in your role.

What’s Happening This Module?

Module 5: Ethics and Issues for Social Change Advocacy is a 2-week module—Weeks 10–11 of the course—in which you examine the role of the DNP-prepared nurse in upholding and abiding by professional standards for the delivery of ethical nursing practice. You will also reflect on how the role of the DNP-prepared nurse is central to social change advocacy for the improvement of healthcare and nursing quality, the positive impact on patient outcomes, and positive impacts on the community as a whole. In Week 10, you will review resources that highlight potential ethical issues in healthcare and nursing practice. You will engage with your colleagues in a Discussion that will focus on the significant ethical issues you reviewed that are relevant to the DNP-prepared nurse. In your Blog Assignment for Week 11, you will consider how you anticipate enacting a personal and professional commitment toward social change advocacy as a DNP-prepared nurse.

What do I have to do?	When do I have to do it?
Review your Learning Resources	Days 1–7, Weeks 10 and 11
Discussion: Ethics and the DNP-Prepared Nurse	Post by Day 3 of Week 10 and respond to your colleagues by Day 6 of Week 10.
Blog: Positive Social Change and the DNP-Prepared Nurse	Post by Day 3 of Week 11 and respond to your colleagues by Day 6 of Week 11.

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Go to the Week’s Content

Week 10

Week 11

Week 10: The Doctorally Prepared Nurse: Ethics

What does it mean to uphold ethics in advanced nursing practice? What strategies and considerations are important for ensuring the ethical and safe delivery of healthcare as a DNP-prepared nurse?

This week, you will examine ethical issues relevant to the role of the DNP-prepared nurse. You will explore ethical issues you may likely encounter in nursing practice and reflect on potential strategies to mitigate ethical violations in practice.

Learning Objectives

Students will:

Analyze ethical issues related to the role of the DNP-prepared nurse
Analyze ethical issues encountered in professional nursing practice

Learning Resources

Required Readings (click to expand/reduce)

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

Phelan, P. S. (2020). Organizational ethics for US health care today. AMA Journal of Ethics, 22(3), 183–186. https://doi.org/10.1001/amajethics.2020.183

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

Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics and History of Medicine, 13(17), 1–10. https://doi.org/10.18502/jmehm.v13i17.4658

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

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_8002_Week10_Discussion_Rubric

	Excellent 90%–100%	Good 80%–89%	Fair 70%–79%	Poor 0%–69%
Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.	40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources.	35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references.	31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references.	0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references.
Main Posting: Writing	6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style.	5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style.	4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Posting: Timely and full participation	9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date.	8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date.	7 (7%) – 7 (7%) Posts main Discussion by due date.	0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date.
First Response: Post to colleague’s main post that is reflective and justified with credible sources.	9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic and may have some depth.	0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
First Response: Writing	6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
First Response: Timely and full participation	5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.	9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic and may have some depth.	0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
Second Response: Writing	6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
Second Response: Timely and full participation	5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Total Points: 100

Name: NURS_8002_Week10_Discussion_Rubric

NURS 8002 Ethics and the DNP-Prepared Nurse