Question

Ethical Issues

Using the South University Online Library, write a 3 to 5-page paper in a Microsoft Word document on an ethical issue of your choice. The topic should relate to an ethical issue facing public health professionals today on either a management or a clinical level or both. Your paper should include the following questions:

Describe the ethical issue involved and discuss the history of this issue, including any pertinent policies or precedents.

Discuss the major stakeholders involved in the issue and their respective roles.

Discuss and apply at least one of the major ethical theories and the ethical decision-making process to the issue.

Define the factors involved that can influence the issue or final decision.

Discuss the impact of a diverse population on the ethical issue.

Discuss the impact of a diverse staff on the issue.

Your final paper should adhere to the following guidelines:

The paper should be 3 to 5 pages long.

The paper must have a title page.

The paper must use proper APA style for citing sources and references.

The paper must have a minimum of five current references. Note that primary peer-reviewed references are preferred.

Submission Details:

Support your responses with examples.

Cite any sources in APA format.

Name your document SU_HSC3000_W3_Project_LastName_FirstInitial.doc.

Submit your document to the Submissions Area by the due date assigned.

Answer 1

Nusing Ethics in day to day patient care:

Every day, nurse managers tackle an array of responsibilities – from staff leadership, patient care, and budgeting to record keeping, hiring and training – that come with a host of ethical dilemmas.

Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care, problematic clinical relationships, and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it. Nurse managers, in particular, are susceptible to ethical issues and moral distress because of their leadership and mentoring roles. Nurses and other medical staff look to managers for appropriate and ethical decisions.

Before stepping into a role as a nurse manager, registered nurses (RNs) should understand the role ethical decision-making plays in the day-to-day work

students explore the foundations of ethical management and leadership from professors with real-world experience. The coursework not only covers the fundamentals of ethical nursing but delves deep into controversial case studies, giving students the chance to examine alternative viewpoints and develop reasoning skills.

For nurse managers, ethical decision making stems from the American Nurses Association (ANA) Code of Ethics, which was developed as a guideline for nursing responsibilities “in a manner consistent with quality in nursing care and the ethical obligations of the profession

Nurses’ Code of Ethics:

The ANA adopted its first code of ethics in 1950. Since then, it has undergone several revisions to offset advances and changes in research, technology, law and overall challenges in nursing. The guidelines are divided into nine provisions that cover topics that include human dignity, confidentiality, moral virtue and healthcare as a right. The ANA said each of the provisions covers topics important to the challenges of nursing in the 21st century.

“The code is particularly useful in today’s healthcare environment because it reiterates the fundamental values and commitments of the nurse, identifies the boundaries of duty and loyalty and describes the duties of the nurse that extend beyond individual patient encounters,” the ANA said in a statement.

Daily, nurse managers face a barrage of decisions and must maintain ethical fortitude to ensure the health, safety, and wellbeing of the patients and staff.

Common Ethical Situations for Nurse Managers

Even though nursing is a fast-paced job with new challenges daily, many nurse managers report facing similar ethical dilemmas. A recent study found the most frequently occurring and stressful ethical situations are protecting patients’ rights, staffing, advanced-care planning, and decision making. Exacerbating the problem is the large number of inexperienced nurses entering the field, many who have never faced healthcare-related ethical questions. Such challenges make experienced nurse managers all the more critical to daily healthcare needs nationwide.

The following are some other examples of common ethical situations that nurse managers face:

1. Honesty vs. Withholding Information – Family members may want to withhold medical information from the sick to protect their emotions. However, patients have the right to know about their medical conditions. Deciding how to share this information, especially if it goes against the family’s beliefs, can be a touchy situation. The ANA advocates for truthtellling, or veracity, as a key factor in nurse-patient relationships.
2. Science vs. Spirituality – Healthcare, which is science-based and results-driven, can impede on religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering, and to allow patients to concentrate on self care. For patients or their families with strong religious or spiritual convictions, the focus may be on adhering to a strict set of guidelines.
   The ANA’s code of ethics states nurses respect the “unique differences of the patient,” including “lifestyle, value system, and religious beliefs.” However, respect for the beliefs “does not imply that the nurse condones those beliefs or practices on a personal level.”
3. Healthcare Needs vs. Resource Allocation – The rising cost of healthcare is increasingly putting nurse managers at odds with budgeting constraints and patient needs. A large number of medical facilities have scarce resources which puts patients at risk for not getting the care they need. These resources range from medical equipment to healthcare staff. Research suggests nurse leaders must include staff in the budgeting process so they can better understand the needs and demands.
4. Autonomy vs. Beneficence – Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care. The ANA highlights that it is important for nurses and nurse managers to understand patient backgrounds and individual circumstances to inform the patient of the medical necessity.
   “Using ethical principles to arrive at a solution should be done in an atmosphere of caring, respect, openness, and honesty. This process should be based on a sound ethical, decision-making model, using the best evidence-based-practice guidelines available,” the ANA explains.

stakeholders in modern healthcare engage in translational medicine as:

1. Primary stakeholders: those individuals ultimately and directly affected, either positively or negatively, by the healthcare outcomes (e.g., patients, the immediate family members, caregivers of patients who cannot represent themselves),
2. Key stakeholders: individuals who may or may not be primary stakeholders, but have a significant influence on the decision-making process (e.g., relatives, friends or caregivers empowered by a legal document or directive to make healthcare decisions on behalf of the patient),
3. Secondary stakeholders: individuals indirectly affected by the outcomes, or indirectly involved in the patient’s care process,
4. Allied stakeholders: individuals who are involved in the patient’s care, but are indirectly affected by the healthcare outcome (e.g., medical, dental, nursing and pharmacy staff, other hospital employees, insurance agents, legal staff and lawyers).

Major Ethical theories and Ethical Decision making:

The study reviewed 20 currently-available structured ethical decision-making models and developed an integrated model consisting of six steps with useful questions and tools that help better performance each step:

(1) the identification of an ethical problem;

(2) the collection of additional information to identify the problem and develop solutions;

(3) the development of alternatives for analysis and comparison;

(4) the selection of the best alternatives and justification;

(5) the development of diverse, practical ways to implement ethical decisions and actions;

(6) the evaluation of effects and development of strategies to prevent a similar occurrence. From a pilot-test of the model, nursing students reported positive experiences, including being satisfied with having access to a comprehensive review process of the ethical aspects of decision making and becoming more confident in their decisions. There is a need for the model to be further tested and refined in both the educational and practical environments.

the identification of an ethical problem:

Our findings underscore the importance of ethical issues that nurses frequently experience across a range of clinical practice settings and the amount of stress these issues engender in the nurses. Several important conclusions can be drawn from our findings. First, although more than two-thirds of our respondents cited protection of patient rights as their most frequent ethical issue, they identified staffing inadequacies as the most stressful issue. Without sufficient staffing it is difficult to meet the ethical standards of professional practice. Understaffing and other organizational and systematic barriers could preclude nurses from meeting many of their primary responsibilities, including protecting the rights of individual patients and families, alleviation of suffering, and preserving their own integrity. Today's healthcare environment is driven by discordant demands to provide high quality care and to manage costs with diminishing resources. Nurses seem to be doing more and more with these limited resources, but “Even when the provider does the best he or she can, it may not feel good enough

Final Decision making:

An urgent need exists for both national and international strategies to retain a qualified workforce. Healthcare institutions should consider the range of ethical problems that nurses encounter in their work and how it impacts their level of stress and their ability to do good for their patients. Ethics support, including ethics committees, bioethicists and senior nurse mentors are all needed to mitigate the loss of providers that regrettably might occur due to these ethical challenges.

Diverse Population in Ethical Issue:

The sample of 422 Registered Nurses (RNs) was predominantly female (95.1%), White (84.1%), and middle-aged [mean age 45.9 9SD 10.80 years]. The majority worked full-time (67.2%), and practised in various types of direct patient care facilities (e.g., acute, specialty, sub-acute, and long-term care). This cohort was experienced in their professional practice [mean 19.8 (SD 11.6) years], but had been in their current positions for less than 10 years [mean 7.7 (SD 7.95) years]. Less than half were prepared with an Associate degree or Diploma (43.9%), while more than one in three had a Baccalaureate degree (37.8%) and 18.3% were prepared at the Master's level or higher. The distribution of responses from the four states was fairly similar: Maryland (29.3%), Ohio (25.7%), California (23.3%), and Massachusetts (21.7%). Both Maryland and California had a smaller percentage of Whites and a higher percentage of Blacks compared to the other two states [χ² = 34.19, df=9, p<.001]. Massachusetts had a higher percentage of Baccalaureate-prepared nurses compared to the other three states [χ²=24.19, df=12, p=.019].

Ethical Issue Impacts on Staff:

• Ethical issues in clinical practice are increasingly problematic for nurses in all parts of the world.
• Nurses often feel uncomfortable in addressing the ethical issues they encounter in patient care.
• Ethics-related stress may be linked to job satisfaction and retention of nurses