Feb 23, 2024 NURS 8002 Discussion Ethics and the DNP-Prepared Nurse
A Sample Answer For the Assignment: NURS 8002 Discussion Ethics and the DNP-Prepared Nurse
Thanks for your beautiful posting and discussion. You have talked about the ethical issues of informed consent and Fidelity and the DNP-prepared nurse. According to the American Nurses Association (2015), the Code of Ethics for Nurses provides the framework for ethical decision-making and guiding practice. As future doctor of nursing practice (DNP) degrees, we are on the frontline of patient care as ethical leaders and advocates. Nurse practitioners frequently encounter ethical dilemmas, and their identification is essential to effective resolution.
An innovative approach involving collaboration between a doctor of nursing practice (DNP) and doctor of philosophy (Ph.D.) faculty was used to address this need in a graduate nursing program. The results included a broader understanding of the synergy of the two educational backgrounds in translating and delivering evidence-based practices. The development and use of realistic case studies was a teaching strategy for ethics education. The unique backgrounds of each faculty member promote ethical practice among DNP students, which is essential to the profession.
Having ethical standards and knowing what is ethically acceptable in the healthcare field is necessary for all healthcare workers to care for their patients. I agree fidelity can be significant in the healthcare field and the lack of fidelity can result in a notable lack of ethical standards within a system. Fidelity can determine how well a DNP, RN, or, NP can fulfill their roles successfully as an advocate for their patients. This can be seen in the workforce today and can be expected after becoming a DNP. The education and skills that we learn as DNP students can help to minimize this in the healthcare system that we are in or we may be leaders in.
References
1. 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.0000000000000383Links to an external site.
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2. Hall, S., Lee, V., & Haase, K. (2020). Exploring the challenges of ethical conduct in quality improvement projects. Canadian oncology nursing journal = Revue canadienne de nursing oncologique, 30(1), 64–68.
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
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.
NURS 8002 Discussion Ethics and the DNP-Prepared Nurse
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
Week 10-discussion
COLLAPSE
Ethics play a crucial role in healthcare for those who perform patient care and especially for clinicians in leadership roles. As a DNP-prepared nurse, clinical staff will look to you for answers. A common issue in primary care is caring for a person who’s losing the ability to care for themselves. The case study that Rejno et al. (2020) present about “Anna” discusses an elderly woman who thinks she is doing fine, but the family sees the patient not eating, losing weight, and appearing disheveled. These situations are prevalent scenarios that can be very difficult for all parties involved. The patient is losing autonomy and dignity, it can be challenging for the family to see their loved ones like this, and providers have to make hard decisions about how to proceed. Often in my practice, families come in concerned about a family member who may be unsafe to drive, but taking away the ability to drive can cause quite a stir. These types of situations can often escalate, and as a DNP-prepared nurse working in leadership roles, you may be the person who has to step in deciphering what is best.
Considering many DNPs are nurse practitioners (NPs) and over three-quarters of NPs are in family practice, caring for patients with dwindling autonomy is an ethical dilemma that is often encountered (Vermeesch et al., 2018). Collaboration can be essential in these situations to assure the patient’s needs, and desires are met. Collaboration with colleagues like physical/occupation therapists, neuropsychologists, equipment companies, and care facilities can make a big difference. Vermeesch et al. (2018) did a study where NPs and nurses with PhDs collaborated to help educate students on ethical challenges and strategies. Considering DNP-prepared nurses have an education-based less on research and more on clinical practice. It seems collaboration with a Ph.D. for challenging ethical situations could be a largely beneficial care approach.
Another example of an ethically difficult situation is end-of-life scenarios. As a hospital nurse, there are often situations where the patient is not going to survive. End-of-life can be pretty difficult for the family to accept, especially if it is unexpected. As a DNP-prepared nurse, there are many possible roles in the hospital setting where you may encounter end-of-life dilemmas. You may be asked to oversee these patient scenarios or tasked to monitor and structure procedures for these situations. How the hospital system handles end-of-life care can make a significant impact in the community. Pavlish et al. (2020) show how having a team-based approach could lead to improved communication and better patient outcomes in an intensive care unit. By implementing regular evaluations of patient situations and educating staff, patients and families received more communications and spiritual support (Pavlish et al., 2020). I have seen these end-of-life situations on a poorly organized unit versus a unit that ran like a well-oiled machine, even within the same hospital system. Many factors play a role in poor outcomes for end-of-life situations. A significant problem is provider communication; providers are not communicating well with the new shift. They may not be doing well at keeping families up to date. They may not know when to call the Chaplin or palliative care services. Having a systematic approach and getting more education to providers seems like an excellent way to improve this healthcare gap.
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
Rejnö, Å., 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
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.
According to Henly et al. (2015), nursing is a research-based profession that builds on the practice of its science. Therefore, one would agree that both degrees are terminal degrees where one focuses on clinical practice and research and analysis. The Doctor of Nursing Practice (DNP) and the Philosophy in Nursing degree (Ph.D.) engage in leadership and collaboration where science and practice are required to provide high-quality care.
Also, one can not deter that there will be challenges obtaining a degree at this highest level. Still, it is essential to strive for excellence and be role models within the profession to participate in forums and enhance performance matrixes to improve the quality of patient care. One would agree that mental health has its challenges, but it is crucial to understand the individual despite their conditions.
The topic of crisis prevention intervention (CPI) is essential within the healthcare setting because it provides a basis for all personnel to engage and intervene safely with the mental health specialty while striving to improve the quality of care for this patient population. One needs to consider engaging with departments such as; quality control, nursing leaders, and educators to prepare the role out of a crisis prevention program within the facility. In conclusion, the role of the DNP is to scope areas or topics that need improvement and identify how to improve clinical practice supported by evidence-based research.
References
Henly, S. J., McCarthy, D. O., Wyman, J. F., Alt-White, A. C., Stone, P. W., McCarthy, A. M., Heitkemper, M. M. (2015). Emerging areas of nursing science and PhD education for the 21st century: Response to commentaries. Nursing Outlook, 63, 439–445.
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
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!
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 ResourcesDays 1–7, Weeks 10 and 11Discussion: Ethics and the DNP-Prepared NursePost 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 NursePost by Day 3 of Week 11 and respond to your colleagues by Day 6 of Week 11.
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
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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
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