Feb 23, 2024 Discussion: Individual Right Versus the Collective Good NURS 8100
A Sample Answer For the Assignment: Discussion: Individual Right Versus the Collective Good NURS 8100
Most recent successes in improving public health have had to deal with the tension between individual rights and the collective good. Although anti-smoking campaigns and laws prohibiting smoking in public places protect people from the negative health effects of second-hand smoke, some argue that they violate the rights of those who choose to smoke.
Requiring childhood immunizations has helped prevent diseases such as polio and measles, but some parents believe they have the right to decide whether or not to immunize their children.This tension exists in the allocation of scarce resources as well, from providing adequate staff coverage to deciding how much health care to provide. Given the nurse’s role in policy and health care delivery, it is critical to comprehend the dynamics of this conflict, as well as the legal and ethical implications.
The US has one of the highest healthcare spending in developed nations, and healthcare costs have increased dramatically in the past decades. One significant challenge to containing health care costs is administrative inefficiency related to the various components of the payer/provider/patient interface (Nunn et al., 2020).
The administrative costs occur in various forms, including prior authorization and eligibility determinations, claims processing and payment, and quality measurement. High administrative costs are particularly important contributors to high healthcare expenditures, which show the need for reforms to decrease costs in the US (Nunn et al., 2020). The high US administrative healthcare costs reflect the inefficiencies of the current healthcare system.
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Administrative costs cannot be eliminated, even in a public healthcare system, but they can be reduced through technology, policies, and practices. Policymakers across the US envision using technology to reduce administrative overhead and processes before and after care (Cutler, 2020).
The policymakers argue that healthcare technology can be implemented to facilitate the scheduling of patients’ appointments, manage patient communications, bill patients, and collect payments, which will lower administrative costs. For instance, they are pushing for policies for all facilities to have electronic medical records since they streamline patient care processes.
I agree with the policymakers that policies are needed requiring facilities to have certain technologies that streamline healthcare delivery. While healthcare organizations currently budget more than a quarter of their spending toward administrative tasks, technology has a great opportunity to simplify a patient’s care and reduce administrative costs.
Hospitals should put a greater emphasis on healthcare technology that increases patients’ choice and access to care (Cutler, 2020). The focus of the technology should be to remove barriers to healthcare appointments and provide direct, transparent pricing for every patient care aspect.
References
Cutler, D. M. (2020). Reducing administrative costs in US health care. The Hamilton Project Policy Proposal, 9, 3-25.
Nunn, R., Parsons, J., & Shambaugh, J. (2020). A dozen facts about the economics of the US healthcare system. Economic Facts. Washington, DC: The Hamilton Project.
Thanks for the insightful discussion. From your discussion, I have learned that with herd immunity not everybody but the majority of the people can receive vaccination that leads to immunity of a disease. If enough people are vaccinated, it can create a ‘herd immunity’ that protects even those who cannot be vaccinated for medical reasons or because they are too young (Giubilini et al., 2018).
For example, measles is highly contagious and can easily spread in a population that is not immune. But if most people in the population are vaccinated against measles, then the disease cannot spread as easily. That is because when there are enough people who are vaccinated, it becomes very difficult for the disease to find new hosts (people to infect). So even those who can’t be vaccinated (such as newborns) benefit from herd immunity.
The decision about whether or not to get vaccinated for COVID-19 will be based on an individual’s specific risk factors and health history (Farah et al., 2022). However, most healthcare workers should consider getting vaccinated, as they are more likely than the general population to come into contact with people who are infected with the virus.
The Centers for Disease Control and Prevention (CDC) recommends that all healthcare workers receive the vaccine for both seasonal flu and H1N1 (swine flu), as these viruses are similar to COVID-19 (Randolph & Barreiro, 2020). In addition, those who work in healthcare facilities should routinely practice good hand hygiene and respiratory etiquette to help prevent the spread of infection.
References
Farah, W., Breeher, L., Shah, V., Hainy, C., Tommaso, C. P., & Swift, M. D. (2022). Disparities in COVID-19 vaccine uptake among health care workers. Vaccine. https://doi.org/10.1016/j.vaccine.2022.03.045
Randolph, H. E., & Barreiro, L. B. (2020). Herd immunity: understanding COVID-19. Immunity, 52(5), 737-741. https://doi.org/10.1016/j.immuni.2020.04.012
Giubilini, A., Douglas, T., & Savulescu, J. (2018). The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine, Health Care and Philosophy, 21(4), 547-560. https://link.springer.com/article/10.1007/s11019-018-9829-y
To prepare:
When have you encountered a tension between the individual right and the collectivegood in your nursing practice? With information from the Learning Resources in mind, consider relatively recentexamples of health care policy that demonstrate this tension. For this Discussion, selectone example of timely health care policy that allows you to evaluate the tensionbetween individual rights and the collective good. Conduct additional research asnecessary using credible websites and the Walden Library.
Discussion: Individual Right Versus the Collective Good NURS 8100
By Day 3
Post a cohesive response that addresses the following: In the first line of your posting, identify a health care policy. Explain the tension between individual rights and the collective good. Analyze the ethical and legal considerations of the policy.Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues posting adding to the discussion of thetension and legal and ethical considerations (beneficence, malfeasance, autonomy, andjustice).Note: Please see the Syllabus and Discussion Rubric for formal Discussion questionposting and response evaluation criteria.Return to this Discussion in a few days to read the responses to your initial posting.
Note what you learned and/or any insights you gained as a result of the commentsmade by your colleagues.Be sure to support your work with specific citations from this week's LearningResources and any additional sources.Submission and Grading InformationGrading CriteriaTo access your rubric:Week 6 Discussion RubricPost by Day 3 and Respond by Day 6To participate in this Discussion:Week 6 Discussion
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Learning Resources
Note: To access this week’s required library resources, please click on the link to theCourse Readings List, found in the Course Materials section of your Syllabus.Required ReadingsBodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinicalapproach (7th ed.). New York, NY: McGraw-Hill Medical. Chapter 13, “Medical Ethics and Rationing of Health Care”
This chapter discusses the four principles of medical ethics—beneficence,malfeasance, autonomy, and justice, and views current health care conditionsthrough these lenses. Distributive justice, allocation of limited health careresources, rationing, and the ethics of health care financing are also examined.Bae, S., & Brewer, C. (2010). Mandatory overtime regulations and nurseovertime. Policy, Politics & Nursing Practice, 11(2), 99–107.Note: You will access this article from the Walden Library databases.
The authors examine the effect of government regulations on health care issues bystudying nurse overtime. They discovered that states with mandatory overtimeregulations had higher total RN work hours.Blum, J. D., & Talib, N. (2006). Balancing individual rights versus collective good inpublic health enforcement. Medicine & Law, 25(2), 273–281.Note: You will access this article from the Walden Library databases.
This article examines the balance of public good and individual liberty through theexamples of policies regarding communicable disease and childhood immunization. The
impact of the U.S. Supreme Court Case, Jacobson v. Massachusettson health carepolicy is discussed.Pauly, B. (2008). Harm reduction through a social justice lens. International Journal ofDrug Policy, 19(1), 4–10.Note: You will access this article from the Walden Library databases.
The author discusses the ethical issue of marginalized groups, such as the homeless,and their barriers to health care. The philosophy of harm reduction and various socialjustice theories are examined as possible guides to a policy initiative.
Ruger, J. P. (2008). Ethics in American health 2: An ethical framework for health systemreform. American Journal of Public Health, 98(1), 1756–1763.Note: You will access this article from the Walden Library databases.Wieck, K. L., Oehler, T., Green, A., & Jordan, C. (2004). Safe nurse staffing: A win-wincollaboration model for influencing health policy. Policy, Politics & Nursing Practice,5(3), 160–166.Note: You will access this article from the Walden Library databases.Optional Resources
Fowler, M. (2008). Guide to the code of ethics for nurses: Interpretation and application.M. D. M. Fowler (Ed.). Silver Spring, MD: The American Nurses Association, Inc.O'Connor, J. C., MacNeil, A., Chriqui, J. F., Tynan, M., Bates, H., & Eidson, S. K.(2008). Preemption of local smoke-free air ordinances: The implications of judicialopinions for meeting national health objectives. Journal of Law, Medicine & Ethics,36(2), 403–412.Rogers, E. M., & Peterson, J. C. (2008). Diffusion of clean indoor air ordinances in thesouthwestern United States. Health Education & Behavior, 35(5), 683–697.Trentham, M. (2009). Patient abandonment—What is it really? ASBN Update, 13(1).
Covid-19 vaccine mandate for health care workers gained a lot of publicity towards the end of last year. It was very important to have a policy that would guide health care workers due to COVID-19 vaccine hesitancy that was rampant in all population sectors for different reasons.
A regulation was established to ensure all staff who were eligible to receive a COVID-19 vaccine would do so by January of this year before providing any care or treatment (Centers for Medicare & Medicaid Services, 2021). It was the responsibility of companies especially skilled long-term care facilities to establish a policy that would ensure those who qualified to be exempted did so in alignment of the guidelines established by the federal laws.
Tension between Individual Rights and the Collective Good.
In the health care world, herd immunity has been promoted especially in community nursing. It is very important because with herd immunity not everybody but the majority of the people can receive vaccination that leads to immunity of a disease. This makes infection transmission to be unlikely leading to the entire population being protected.
This would cover even those who are not eligible for vaccinations. It is therefore important for bedside staff to be vaccinated. However according to Farah, Breeher, Shah, Hainy, Tommaso & Swift (2022), there are major disparities in actual vaccination rates among different health care workers (HCWs).
Advanced practice staff who spend the least amount of time with patients have statistically received the vaccines than nurses and support staff. The probability of an infected support staff spreading COVID-19 would likely be higher because the close proximity of proving care with activities of daily living like showers may not be completed with full personal protective equipment (PPE) in place.
There are HCWs who are hesitant to receive the COVID-19 vaccine. Bellanti (2021), refers a delay in acceptance or outright refusal of vaccines as vaccine hesitancy. Those staff members who decline to receive the vaccine even when they are eligible to get it cannot work in some hospitals or nursing homes. This creates a further challenge with staff shortage already being a major concern.
It is an undeniable fact that every person has a right to choose what goes in their body but it would not be wise to put people at risk if it was avoidable. To decline to get a vaccine because of misinformation, fallacies, or myths is unfortunate. This is relevant to the COVID-19 vaccine.
Ethical and Legal Considerations of the Policy.
There are different factors that surround the mandate for COVID-19 vaccination policy among HCWs. Perez, Paul, Raghuraman, Carter, Odibo, Kelly & Foeller (2022), point out the nature of HCWs make them have a high occupational risk for contracting and transmitting the COVID-19 infection after exposure. Legally and ethically it would therefore be fair to give them a priority to receive the vaccines first.
Getting to a point of herd immunity would also be critical. This is not achievable if the vaccine is not accessible on a global level. According to Hosseini (2021), one of challenges of COVID-19 vaccine is whether the manufactures of the vaccine can be forced to share information with competitors so that availability of the vaccine across the globe can be reached quickly. It would be ethically meaningful to look at infectious diseases as public rights instead of individual needs.
Education is key to knowledge. It is important to acknowledge vaccinations have been an important tool that has been used to contain some dangerous diseases in the past. According to Gurenlian, Eldridge, Estrich, Battrell, Lynch, Morrissey, Araujo, Vujicic & Mikkelsen (2022), it would be for the greater good to further educate HCWs on topics like virology and epidemiology.
Reference
Bellanti, J. A. (2021). COVID-19 vaccines and vaccine hesitancy: Role of the allergist/immunologist in promotion of vaccine acceptance. Allergy and Asthma Proceedings, 42(5), 386–394. https://doi.org/10.2500/aap.2021.42.210063
Centers for Medicare & Medicaid Services. (November, 2021). Biden-Harris Administration Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers.https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care#:~:text=All%20eligible%20staff%20must%20have,beliefs%2C%20observances%2C%20or%20practices.
Farah, W., Breeher, L., Shah, V., Hainy, C., Tommaso, C. P., & Swift, M. D. (2022). Disparities in COVID-19 vaccine uptake among health care workers. Vaccine. https://doi.org/10.1016/j.vaccine.2022.03.045
Gurenlian, J. R., Eldridge, L. A., Estrich, C. G., Battrell, A., Lynch, A., Morrissey, R. W., Araujo, M. W. B., Vujicic, M., & Mikkelsen, M. (2022). COVID-19 Vaccine Intention and Hesitancy of Dental Hygienists in the United States. Journal of Dental Hygiene, 96(1), 5–16.
Hosseini, M.(2021). A Covid Competition Dilemma: Legal and Ethical Challenges Regarding the Covid-19 Vaccine Policies during and after the Crisis. Public Governance, Administration and Finances Law Review, 6(1), 51–63. https://doi.org/10.53116/pgaflr.2021.1.5
Perez, M. J., Paul, R., Raghuraman, N., Carter, E. B., Odibo, A. O., Kelly, J. C., & Foeller, M. E. (2022). Characterizing initial COVID-19 vaccine attitudes among pregnancy-capable healthcare workers. American Journal of Obstetrics & Gynecology MFM, 4(2). https://doi.org/10.1016/j.ajogmf.2021.100557
Patient acuity is rising while registered nurses (RNs) at the bedside are dwindling. The State of Texas nursing shortage is at an average of 11.06% of its registered nurse slots unfilled (Wieck, Oehler, Green, & Jordan, 2004). American Nurses Association (ANA) Principles for Nurse Staffing (1999) served as a framework for policy change. Nurse strategists undertook the challenge with the overall intent to provide excellent patient care.
An example to address nurse staffing and the ensuing problems is the California Staffing Ratio Law. Nurse-to-patient ratios (NPR) are a direct association between errors and the number of RNs. Moghri, Kokabisaghi, & Tabatabaee’s (2021) studies on NPR show that a high ratio affects the quality of treatment, increases adverse events, and raises the patient’s hospitalization period. It is a perfect example of the tension that significantly affects nurses’ individual rights and the collective good.
Addressing the nursing shortage issues in health care institutions is both challenging and controversial. Suppose a patient’s prolonged hospitalization period can cost the hospital financial strains. Hospitals are businesses; the median length of stay was six days, the median total cost was $11,267, and the median cost per day was $1,772 (Study: Covid-19 hospitalization costs, outcomes in 2020 improved over time, 2022). Nevertheless, at what cost will it have on nurses’ rights?
Nurses are sworn to follow a set of ethics such as Beneficence & Nonmaleficence. While health care providers are obligated to help people in need, we must do not harm (Bodenheimer & Grumbach, 2009). Nurses are overworked and unable to provide good care for their patients and consequently consider leaving their jobs. The tension between ethical and legal consideration leave nurses in a dilemma.
For example, a nurse will work overtime hours to help the hospital organization but is at risk of committing a medical error that can lead to legal consequences. Mandatory overtime laws prohibit healthcare facilities from requiring employees to work more than their regularly scheduled hours except during a health care disaster that increases the need for health care personnel unexpectedly (Bae & Brewer, 2010). On the other hand, hospitals are still experiencing staffing shortages to care for their patients.
Reference
Bae, S.-H., & Brewer, C. (2010). Mandatory Overtime Regulations and Nurse Overtime. Policy, Politics, & Nursing Practice, 11(2), 99–107. https://doi.org/10.1177/1527154410382300
Bodenheimer, T., & Grumbach, K. (2009). Understanding Health Policy : A Clinical Approach: Vol. 5th ed. McGraw-Hill Professional.
Moghri, J., Kokabisaghi, F., & Tabatabaee, S. S. (2021). Nurse staffing norms in a hospital: Determining a golden standard using a new estimation method. International Journal of Healthcare Management, 14(4), 1367–1372. https://doi.org/10.1080/20479700.2020.1760586
Study: Covid-19 hospitalization costs, outcomes in 2020 improved over time. Texas A&M Today. (2022, January 3). Retrieved April 4, 2022, from https://today.tamu.edu/2022/01/03/study-covid-19-hospitalization-costs-outcomes-in-2020-improved-over-time/
Wieck, K. L., Oehler, T., Green, A., & Jordan, C. (2004). Safe Nurse Staffing: A Win-Win Collaboration Model for Influencing Health Policy. Policy, Politics, & Nursing Practice, 5(3), 160–166. https://doi.org/10.1177/1527154404266578
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