ETHICS AND THE DNP-PREPARED NURSE NURS 8002

A Sample Answer For the Assignment: ETHICS AND THE DNP-PREPARED NURSE NURS 8002

Expressing respect for patient’s autonomy means acknowledging that patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their clinicians’ recommendations (Sedig, 2016). As human, we have our own beliefs, but as health care providers, we must learn to respect the belief of others, even if it does not coincide with our own.

According to Sedig (2016), when taking care of patients as a DNP-prepared nurse, you must respect patient’s autonomy by giving them the information needed to understand the risk and benefits of a proposed intervention, as well as the reasonable alternatives, so they can make independent decisions.

Fidelity as an ethical principle, is about ensuring that you’ve done everything possible to make sure your actions align with high standards and values. For health care professional the only thing guiding their choices in patients care is strong morals and a nursing code of ethics (Team, 2022). As healthcare providers, our clients will normally trust us, it is important that we keep up those values.

As you stated above, while working, as a risk manager, I have seen many cases where patient’s autonomy or fidelity were not valued. Most of the time when we make an encounter with these patients, they are at a vulnerable period and the last thing they need is not to trust the people that are taking care of them.

Reference

Sedig, L. (2016). What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree? AMA Journal of Ethics, 18(1), 12–17. https://doi.org/10.1001/journalofethics.2017.18.1.ecas2-1601

‌ Team, S. E. (2022, October 18). Fidelity in Nursing: Nursing Ethical Principles – SimpleNursing. Simple Nursing. https://simplenursing.com/fidelity-in-nursing/#:~:text=Fidelity%2C%20as%20an%20ethical%20principle

In nursing, ethics are taught and expected to be maintained. They are formed off the principles of autonomy-the right to make choices, beneficence-to do good or prevent harm, justice-providing care equally, non-maleficence-to do no harm. I have also come across privacy-a right belonging to all people, dignity-worthy of respect and confidentiality-keeping patient information only in necessary places and people. Throughout a career in medicine, it is impossible to avoid experiencing a situation that one of these ethics will come into question.

As a doctorate prepared nurse (DNP), my intention is to continue in my role, at least in a part time aspect. In doing so, I have and will continue to run into circumstances in which the ethical value of autonomy is challenged.

I provide psychiatric and mental health care to patients in nursing homes, assisted livings and in their homes. I typically experience the vignette shared by Rejno et al, in which the patient with dementia states she is fine being home alone and the daughter says she is not and they present opposing stories (2020), played out weekly.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: ETHICS AND THE DNP-PREPARED NURSE NURS 8002 

One I experience frequently is families want to “medicate” their loved one to their liking. For example, Jane Doe is 96yo female with major depression, anxiety and mild dementia. One of her biggest problems is that she lives in an assisted living and feels unimportant to her family. When she lived on her own, she was able to join what she wanted, when she wanted.  Now, family has to come pick her up, which doesn’t always happen.

Two of her daughters will tell her she is ungrateful for everything they have done for her when she will tell them she wants to come home, that they just put her there so they do not have to deal with her. Maybe three weeks ago, she had a birthday party, afterwards she got upset and she was emotional having to go back to the assisted living and away from her family. She shared with me openly and remembered this happening. Her daughter called me to ask what I can give her to make her stop.

I have explained multiple times that she is gets upset, she has a lifetime of less than the best coping skills when it comes to feeling wanted, needed or loved. I explain to her daughter that the patient tells me she feels as though her medications are in a good spot. That she doesn’t feel depressed, she feels she gets sad and frustrated because she doesn’t want to live in an assisted living. Jane goes out of her apartment, interacts with activities and multiple other residents, she is pleasant and smiling.

That Jane would likely benefit more from counseling than a medication change, in which she refuses. Most recently, Jane has had an increase in tearful episodes and anxiety per the daughter. Her daughter has called me twice this week asking for her to get Ativan and really doing anything she could to convince me to give it to her, versus waiting for result of UA-she is prone to them and this is her behavior when she gets one.

She even called the medical NP to see if he “would give her something to knock her out”. She started antibiotics yesterday for her UTI. The family even has a recorder set up in Jane’s apartment. Often, I get the distinct impression that family is asking for medication increases due to their own poor coping and feelings of guilt.

In a similar respect, however reversed, I am often advocating for patients to get medications. Families will often not want their loved one to have medication because, for example, “it is understandable that she has depression”.  It often takes much education and support and time provide to family members to have them allow me to attempt anything. I often have to explain to them that it absolutely is understandable however due to multiple factors, dementia being one, they are not able to implement good coping skills and that depression is making them miserable therefor quality of life is impeded.

The ethics that are maintained in a facility have been shown to correlate with the values, or lack there-of, in an organization. When an organization does not uphold values, it becomes challenging for the staff as they will question their own work and it will decrease satisfaction. (Torkamen. 2020) I have seen this many times in some of the failcities that I round in. One aspect discussed by Rejno et al, (2020) is the right to dignity. I often see this become challenging to maintain with patients that reside on a memory care unit.

I do believe this directly links to an organization neglecting to set forth routinely practiced ethics.  At times this is not necessarily faulted as the workforce is understaffed.  One of the facilities I round in pointed out they noticed a decrease in the care for dementia patients when their dementia training went online versus in person and hands on. This is one of the biggest gaps I see that needs help and why, at this time, my focus is here as far as my DNP project.

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

Discussion: Ethics and the DNP-Prepared Nurse

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.

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.

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!

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

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.  

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

Thank you for your post. I found the two ethical topics you discussed informative. Informed consent, in my opinion, has a very simplistic principle, all patients have a right to determine what level of care they receive. Healthcare professionals provide educational information and alternatives to the interventions they will provide and the patient makes an informed decision on the treatment they desire (Shah, 2022).

Medical professionals have a legal and ethical obligation to provide informed consent and must ensure that the decision is made by cognitively stable individual or face substantial consequences (Shah, 2022). As DNP-prepared nurses this may not always be so simple, as there are several barriers that could arise in any given situation, therefore we must remain unbiased and do what is right for the patient.

While working in the NICU I confronted several cases of parental medical decision making which required some heavy consideration and explanation to allow the parent to make an informed decision on an infant’s care. Often in the NICU, premature infants’ comorbidities are reduced when they are provided a mother’s breast milk as opposed to artificial formulas (McGlothen-Bell et al., 2019).

Unfortunately, in this situation the mother was unable to develop a sufficient amount of breast milk to provide the infant, therefore, it was recommended that donor breast milk be used. The mother was appalled when this was first recommended but with several medical professionals’ educational information presented, the mother of the infant was able to make an informed decision of care for her child. Despite the barriers that DNP-prepared nurses may face we must determine a proper way for individuals to make an informed decision no matter the circumstances.  

References:

McGlothen-Bell, K., Cleveland, L. M., & Pados, B. F. (2019). To consent, or not to consent, that is the question. Advances in Neonatal Care, 19(5), 371–375. https://doi.org/10.1097/anc.0000000000000651Links to an external site.

Shah, P. (2022, June 11). Informed consent. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK430827/