NURS 8000 Discussion: Ethics

NURS 8000 Discussion: Ethics

NURS 8000 Discussion: Ethics

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

I found your post well stated. You mentioned about a lot off different ethical issues faced by nurses. One of the ethical issue which I find interesting is about medication nonadherence especially in adolescent client whose parents or guidance to take control of how they take medication. Most adolescent below 17 years old age can’t make their own decision which makes it difficult for healthcare provider to start treatment without the acceptance and consent of the parents or guidance of a minor.

According to Disla et al., (2022), Ppysicians should encourage minors to involve their parents when they request confidential services. This includes attempting to ascertain the minor’s reasons for not involving his or her parents as well as correcting any misconceptions that may be motivating their objections.Where the law does not require it, physicians should allow a competent minor to consent to medical care and not notify parents unless the patient consents. Physicians may assess competence for most minors, depending on the gravity of the decision.

For instance treating adolescent can be very critical as the parents have to sign informed consent. A patient started therapy due to anxiety from his father divorcing his mother. His mothr got custody and the child enroll in therapy and the patient could talk with the therapist alone and then with the mother. As the patient turn 18 she does not want her mother to participate in the therapy session and the therapy should not disclosed any information to the mother per patient. The patient started using drugs and had unprotective sex. An ethical problem that the therapist face is whether she had an obligation to disclose something to the patient’s mother ( Behnke, 2018).

References

Behnke, S. H. (2018, March). Confidentiality in the treatment of adolescents. Monitor on Psychology. https://www.apa.org/monitor/mar02/confidentiality

Disla de Jesus, V., Liem, A., Borra, D., & Appel, J. M. (2022). Who’s the boss? ethical dilemmas in the treatment of children and adolescents. FOCUS, 20(2), 215–219. https://doi.org/10.1176/appi.focus.20210037

As referenced in Week 2, Discussion 2, nurses are perceived as having very high ethical standards (Gallup, 2013). Doctorally prepared nurses should be able to consider ethical issues from multiple viewpoints. In this week’s media presentation, the experts discuss ethical challenges encountered by nurses as they assume leadership positions and as they engage in research.

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Week 5 Discussion

Nurses are important links in healthcare delivery considering that they interact most with the patients. The interactions subject them to high cases of the ethical dilemma of which they are expected to uphold high standards of ethical values. The DNP nurses encounter various ethical issues including a case where a nurse prescribes a medication to the patient but the patient does not want to take the medicine because their cultural values do not allow it (Haahr et al., 2019).

A second example involves a scenario where research practices where the nurse may explore social patterns and how they affect health outcomes. In this case, the nurse may focus on the sexual orientation and while the study aims at providing useful information for EBP implementation, it could expose the participants’ sexual identity and thus compromise the need for confidentiality (Van der et al., 2017).

The nurses must evaluate their practices to ensure that their actions result in no harm to the patients. The issues encountered by the DNP nurse are similar to the once experienced in the course of practice; though, the issues related to the research may be more challenging. For example, while it is important to keep the patients’ information confidential, the healthcare providers have also to share such data in determining the determinants of health and appropriate health interventions to engage in (Aitamaa et al., 2019). Furthermore, the issue of cultural differences is common and all healthcare providers are likely to encounter them (Rainer et al., 2018).

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.

NURS 8000 Discussion: Ethics Reference

Aitamaa, E., Suhonen, R., Puukka, P., & Leino-Kilpi, H. (2019). Ethical problems in nursing management – a cross-sectional survey about solving problems. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4245-4

Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2019). Nurses’ experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), 258-272. https://doi.org/10.1177/0969733019832941

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. https://doi.org/10.1111/jocn.14542

Van der Linden, S., Maibach, E., Cook, J., Leiserowitz, A., Ranney, M., Lewandowsky, S., Árvai, J., & Weber, E. U. (2017). Culture versus cognition is a false dilemma. Nature Climate Change, 7(7), 457-457. https://doi.org/10.1038/nclimate3323

When a pregnant lady is brain dead, she cannot acknowledge the fetus. Therefore, the mother lacks the moral responsibility to keep the fetus alive (Akhyari, Lichtenberg & Boeken, 2019; Paternoster et al., 2017; Staff & Nash, 2017). Being uninsured and lacking an advance directive that states that the mother intends to be kept alive to save the unborn child, prolonging life is considered unethical. In the case of a 26-year-old woman who is 20 weeks pregnant, ethical and legal considerations are vital.

The Hendricks/Smith Model posits that one needs to undertake various processes before making a decision. The very first undertaking would be to gather data or conduct an assessment on the patient (Fero, Herrick, 7 Hu, 2011). There are several relevant data concerning the patient such as lack of insurance, the position of the mother, the position of the fetus and the status of the mother. The case reveals that the patient is brain dead. Secondly, the model stipulates that one needs to make a diagnosis of the patient, in which case the patient is brain dead. Third, planning for the various outcomes need to occur.

In the present case, there are two options: supporting the mother’s position which is to keep the lady alive until a Cesarean delivery is conducted or supporting the husband who wants it to be terminated in order for his wife to be relieved. Following the planning process, Hendricks/Smith model states that the case manager must now make a decision. According to Nishimura et al. (2016), the older the baby when its mother is confirmed brain-dead, the higher its chances of survival. In the present case, and given the information about the husband’s lack of support for the pregnancy, it would be prudent for the case manager to prioritize the life of the fetus by supporting the mother’s position. Therefore, the mother will be kept on the life support machine until such a time that the Cesarean delivery option will be implemented. Thereafter, the state of the woman will be evaluated to determine if she will continue using the life support or she will be terminated.

I agree with the analysis of my peers because based on the Herrick/Smith model, a baby born at 20 weeks will have a 20 to 30 percent survival chances and a 40 percent chance of seriously being disabled (Pikto-Pietkiewicz et al., 2019). The older the baby, the less the risk of severe disability. In the scenario, the best ethical outcome would be to maintain the pregnancy until such as time that a Cesarean is conducted. The absence of an advance directive from the pregnant woman makes this the best ethical decision. Adopting the African-American culture for the scenario does not alter the chosen option. In the African-American population, terminating the woman’s life would be tantamount to killing, which is not supported by the culture.

References

Akhyari, P., Lichtenberg, A., & Boeken, U. (2019). Successful transplantation of a heart donated 5 months after brain death of a pregnant young woman. The Journal of Heart and Lung Transplantation, 38(10), 1121.

Fero, L. J., Herrick, C. A., & Hu, J. (2011). Introduction to care coordination and nursing management. Sudbury, MA: Jones & Bartlett Learning.

Nishimura, T., Kohama, K., Osako, T., Yamada, T., Tanaka, H., Nakao, A., & Kotani, J. (2016). Case of 24-week fetus delivered from mother on life support with brain-death from suicide attempt: Ethical issues associated with severe complications. Acta Medica Okayama, 70(5), 389-392.

Paternoster, M., Saccone, G., Maruotti, G. M., Bianco, C., Casella, C., Buccelli, C., & Martinelli, P. (2017). Ethical challenges in pregnant women with brain injury. The Journal of Maternal-Fetal & Neonatal Medicine.

Pikto-Pietkiewicz, I., Okniński, A., Wójtowicz, R., & Wójtowicz, M. (2019). The Management of a Thirteen Weeks Pregnant Woman Rendered Brain-Dead Following a Ruptured Aneurysm. The Journal of Critical Care Medicine, 5(3), 111.

Staff, L., & Nash, M. (2017). Brain death during pregnancy and prolonged corporeal support of the body: A critical discussion. Women and Birth, 30(5), 354-360.

To prepare:

• Reflect on ethical challenges that you have encountered in your nursing practice.
• Think about the information the experts shared in this week’s media presentation, focusing on the ethical challenges they have encountered as nurse leaders or scientists, as well as information presented in other Learning Resources.
• With this information in mind, consider what new ethical challenges you may face once you obtain your doctoral degree.

Post a cohesive response that addresses the following:

• Describe two or more significant ethical issues relevant to the DNP- or PhD-prepared nurse.
• Explain how these issues might compare to the types of issues you have already encountered in your practice.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.