Using Information Technology: Trends and Issues In Nursing ...



Ethical And Legal Dilemmas – Making Ethical DecisionZarah Vila2961822Athabasca UniversityEthical And Legal Dilemmas“Nurses are guided in their everyday lives by their personal values and beliefs about what is right and good. Such personal beliefs define nurses’ sense of morality and influence how they customarily make decisions and react to usual problems” (Cohen & Erickson, 2006, p. 776). The ethical issues that a nurse face everyday at work is a challenge, especially when those people around you have different moral views. Regardless of the conflicting views, ethical issues should be addressed and decided adhering to the nursing code of ethics. According to Canadian Nurses Association (2008), “Code of ethics will be an ethical basis from which nurses can advocate quality work environments that support the delivery of safe, compassionate, competent and ethical care” (p. 2). The purpose of this paper is to present and discuss about a sample case study related to ethical and legal dilemmas at workplace in terms of its summary, the application of ethical algorithm to case study, identification of ethical issues from nursing perspective, and its recommended nursing actions and interventions. SummaryThe sample case study is based on the second critical thinking question in chapter four at . The said website is the online version of the Nursing 250 course text by Blais and Hayes (2011). Based on the given scenario, the writer will assume the nurse manager role of a medical-surgical unit with a twenty-five-bed capacity. As being the supervisor of a unit of twenty-six staffs, I have come to know that one of the senior nurse clinicians is a thief. The said nurse steals varied and valuable items, including cash from patients and staffs. Nevertheless, she was often the first person to give the writer support whenever there are conflicts in the unit and her nursing expertise is exceptional among the staffs. As a result, the writer is morally distressed because I know that this staff is not doing right. Assuming the nurse manager role, the writer feel uncomfortable of reporting her because nobody might believe me, as this senior nurse is well – liked and highly respected by both patients and co-staffs. To help me deal with this ethical dilemma, the writer will use the ethical decision – making algorithm found in Blais and Hayes (2011) text to appraise this scenario as noted in Table 1.DiscussionThis case study is an example of an action – focused ethical problem. In Blais and Hayes’s 2011 (brackets around years) text, it was noted that implementing the action is harder than the decision itself. Dealing with the said type of ethical problem need the guidance of nursing code of ethics to assist the professionals in making ethical decisions base on the standards and core values in nursing practice. In addition, the moral distress as a nurse manager in the given case study was evident. Assuming the nurse manager role, the writer cannot carry out the right action due to pressure or fear of backlash from other staffs and patients. In this situation, the ethical dilemma is either talking to the concerned staff about the unethical behavior followed by an investigation or ignoring the senior nurse clinician’s behavior because nobody might believe you. Moreover, the ethical principle of veracity has been breached, making it an ethical issue. According to College of Nurses of Ontario (2014), “Honesty is an essential ingredient in ensuring that the client trust is maintained and that the client’s vulnerable position is not abused by the nurse” (p. 6). Clearly, the senior nurse clinician made an ethical violation with stealing money from patients and staffs, thus immediate disciplinary action is required. Undoubtedly, the act of theft is a professional misconduct on the nurse’s part and should be held accountable for what she has done. According to Canadian Nurses Association (2008), being passive about the situation and not reporting or intervening the unethical behavior means tolerating this act. Based on Cohen and Erickson’s 2006 study, the first step in resolving this ethical dilemma, the nurse manager should recognize that an ethical value has been compromised and an acknowledgement that something is not right. It should be discussed with the head management about the scenario to support the nurse manager’s feelings, as well as going through the policies with the group. Second, validating the case if it is absolutely an ethical issue and if legal consultation is needed. The nurse manager’s moral distress should also be discussed to help bring the issue into focus. Next step is to analyze and start solving the problem using duty – based approach. It has been noted that “actions are chosen based on the duties and rights of those involved, even though outcomes may not be optimal” (Cohen & Erickson, 2006, p. 779). Furthermore, the nurse manager with colleagues support should call the attention of the senior nurse clinician, family members or patients to hear their sides regarding this matter before the start of the investigation. The chosen solution should adhere to the institution’s policy, most especially to the nursing code of ethics. Overall, the rights of patients and their safety must be highly regarded. ConclusionThe sample case study on ethical dilemma with its possible recommendation has been discussed, along with the ethical decision – making model presentation. In summary, the ethical and legal issue in nursing practice is imminent and being aware of one’s values are essential in making ethical decisions. The nurses who are facing ethical dilemma can have feelings of anxiety, frustration or moral distress, however, it should not hinder a nurse in acting the best interest of the patients and their family. Table 1Ethical Decision – Making ModelNURSING ACTIONCONSIDERATIONS1. Identify the moral aspects.The ethical dilemma is either to approach the senior nurse clinician about the issue on theft or ignore the behavior. There is conflict between the values of honesty and harmony/relationship with co – workers. The nurse manager wants to do the right thing but feel awkward because nobody might believe her, as the concerned staff was well – liked by staffs and patients.Her choice will probably be affected by her concern for the patients and the awareness that her staff has been doing unacceptable behavior.2. Gather relevant facts related to the rmation about the senior nurse clinician, patients and staffs who are affected by the said issue. Any witnesses or other staffs should also be asked for questioning.3. Determine ownership of the decision.The decision is being made for the senior nurse clinician. The nurse manager should be the one deciding in bringing the situation known to the nurse clinician, staffs, patients and their family.4. Clarify and apply personal values.Although she was in moral distress, the nurse manager values honesty and standards of nursing practice/code of ethics. The personal values of nurse clinician should also be confirmed.5. Identify ethical theories and principles.The nurse manager would uphold the principle of veracity by approaching the nurse clinician and telling her that stealing is ethically unacceptable. Failing to report or being passive about it negates the principles of justice and veracity.6. Identify applicable laws or agency policies.Health Profession Act, Code of Ethics in applicable nursing body, the hospital’s policy on professional misconduct.7. Use competent interdisciplinary resources.RN licensing body in applicable province, management support8. Develop alternative actions and project their outcomes on the client and family. Possibly because of the limited time available for ethical deliberations in the clinical setting, nurses tend to identify two opposing, either – or alternatives.Option 1: Ignore the nurse clinician’s unethical behavior then she will continue her wrongdoings, thinking she can always get away with it.Option 2: Rebuke the nurse clinician, telling her that stealing is unacceptable. Suspension may occur while investigation is ongoing9. Apply nursing codes of ethics to help guide actions. Codes of nursing usually support autonomy and nursing advocacy.Preserving Dignity and being accountable to your own practice.10. For each alternative action, identify the risk and seriousness of consequences for the nurse.Ignoring or being passive means condoning the act. If the nurse manager approaches the nurse clinician and reports her, she risks the other staffs and nurse clinician’s anger. 11. Participate actively in resolving the issue.Meeting with the nurse clinician to hear her side. Reporting the issue to the head management.12. Implement the action.Implement the appropriate course of action.13. Evaluate the action taken.Nurse validating that she did the right thing. Feedback from patients, family members and staffs.Referencesnote change of font; need hanging indentsBlais, K. K., & Hayes, J.S. (2011). Professional nursing practice: Concepts and perspectives (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.Canadian Nurses Association. (2008). Code of ethics for registered nurses. Ottawa, ON: Canadian Nurses Association. Retrieved June 30, 2014, from , J., & Erickson, J. (2006). Ethical dilemmas and moral distress in oncology nursing practice. Clinical Journal Of Oncology Nursing, 10(6), 775-783. doi:10.1188/06.CJON.775-780College of Nurses of Ontario. (2014). Professional conduct. Professional misconduct. Toronto, ON: College of Nurses of Ontario. Retrieved July 2, 2014, from , T. C. (2013). Understanding Unethical Behavior. Missouri State Board Of Nursing Newsletter, 15(3), 12.Zarah . Well done! You have certainly honored the spirit of the assignment. I appreciate the exploratory depth of the ethical issues from nursing perspective. You made great efforts to include the literature.You introduced many concepts; super!. Take time to introduce the model fully. There are many such models and we need to be clear. If we were using the ethical decision-making algorithm, as developed by Catalano (2000), to assist the nurse in working through an ethical and/or legal dilemma, we could organize our work around the steps of her model, as you have, and use headings for each of Catalano’s (2000) thirteen steps involved in the algorithm identifying moral aspects; gather relevant facts related to the issue; determine ownership of the decision; clarify and apply personal values; identify ethical theories and principles; identify applicable laws or agency policies; use competent interdisciplinary resources; develop alternative actions and use project outcomes on the client and/ or family; apply nursing code of ethics to help guide actions (codes of nursing usually support autonomy and nursing advocacy); for each alternative action, identify risk and seriousness of consequences for the nurse;participate actively in resolving the issue; implement the action; and evaluate the action taken and use these to organize and structure the content within the paper.Catalano, J. (2000). Nursing now: Today’s issues, tomorrow’s trends. (2nd ed.). Philadelphia: F.A. Davis. A visual depiction of the algorithm was welcome.Just for learning, here are a few examples of alternative options for citations:For example, the phenomena of a culture of blame is a theme that I see in your lovely work, therefore, we might use a citation such as, A “Culture of blame” is cited in the patient safety literature and describes reluctance of healthcare professionals to report adverse client-centered events out of fear of reprisal or assignment of blame at the level of the individual worker (Kohn, Corriagan, & Donaldson, 2002; Baker, et al., 2004).Then on the reference page we would see:Baker, G.R., Norton, P.G., Flintoft, R.B., Brown, A., Cox, J., Etchells, E., et al. (2004). The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal, 170(11). DOIKohn, L.T., Corrigan, J.M., and Donaldson, M.S. (Eds.). (2000). To Err is human: Building a safer health system. Washington D.C.: National Academy Press.As always, it is my hope that something in my comments will resonate and be helpful for your learning.Warmly, Yvonne30.5+ 3.5+4.25+4.= 42.25/5021.1/25 or 85%Exceeds ExpectationsMeets ExpectationsPartially Meets Expectations?Fails to Meet ExpectationsContentContent is worth 70% of the assignment gradeMark (35): 30.5Addresses all aspects of assignment in sufficient depthAddresses most aspects of assignment in sufficient depthAddresses most aspects of assignment, although not in sufficient depthDoes not address most aspects of assignment and/or fails to do so in sufficient depth??Supports main points with references,? examples, illustrations, and explanationsSupports main points with less than two of references examples, illustrations, and explanations?Supports main points with examples, illustrations, and explanations, but fails to include published referencesDoes not use references,? examples, illustrations, or explanations????Demonstrates understanding and application of informationDemonstrates understanding of information, but could enhance application? Demonstrates ability to apply? information, but understanding of concept is weakDoes not demonstrateunderstanding or application of information??Integrates information from at least three sources into body of paperIntegrates information from two sources into body of paperIntegrates information from one source into body of paperDoes not use supporting documentation in body of paper; though you have a refrerence page, none of the sources are cited in the body of the paper?OrganizationOrganization is worth 10% of the assignment gradeMark (5): 3.5Introduction, and conclusion are clearly identifiable and well developed; introductory comments are interesting as well as informative; well-written conclusion that brings "closure" to the paper Introduction,?? and conclusion are clearly identifiable, but need to be further developed; rather than conclusion bringing closure to the paper, it merely? summarizes what has been previously statedIntroduction,?? or conclusion are not clearly identifiable or are not well developed?Introduction and conclusion are not clearly identifiable and well supported; introductory comments fail to capture the interest of or to inform the reader; rather than a conclusion, paper appears to simply “stop” when the writer runs out of things to say??Sequence of thought is logical and ideas are well developed; smooth transition between paragraphsUsually the sequence of thought is? logical and ideas are well developed; smooth transition between most paragraphsSometimes the sequence of thought is logical and ideas are well developed; smooth transition between some paragraphsRarely is the sequence of thought logical and ideas well developed; seldom uses smooth transition between paragraphs??Contains excellent?? supporting points; the points are clearly made and developed and move presentation of ideas forward in a logical mannerContains adequate supporting points; the points are clearly made and developed and move presentation of ideas forward in a logical mannerContains few supporting points or the points are not clearly made and developed, failing to move presentation of ideas forward in a logical mannerRarely contains?? supporting points; the points are? not clearly made and developed nor do they move presentation of ideas? forward in a logical manner?PresentationPresentation is worth 10% of the assignment gradeMark (5): 4.25Meets minimum assigned lengthN/AN/ADoes not meet minimum assigned length??No major errors in spelling, punctuation, and grammarFew errors in spelling, punctuation, and grammarRepeated specific types of errors in spelling, punctuation or grammar, e.g. paper consistently has subject-verb disagreement? Numerous errors in spelling, punctuation, and grammar???Professional appearance of document, tone of voice, word choice and sentence structureChallenge in one of the following: appearance of document, tone of voice, word choice, or sentence structureChallenge in two of the following: appearance of document, tone of voice, word choice, or sentence structureChallenge in three or more of the following: appearance of document (font size or style, use of white space, use of headings), tone of voice, word choice, or sentence structure (incomplete sentences; run-on sentences; incorrect subject-verb agreement, etc.)?APA Requirements?Title page completeTitle page has minor errorsTitle page incomplete or inaccurate No title page??APA requirements are worth 10% of the assignment gradeMark (5): 4Reference section includes three or > sources,? correctly cited? Reference section includes adequate depth of sources, 3 or > but with some citation errors Reference section includes limited sources, and/or consistent formatting errorsNo reference section ??References within the body of the paper included and? correctly citedReferences in the body of the paper with few errors (very minor) in citation References within the body of the paper included, with multiple incorrect citationsNo correctly cited references within the body of the paper? ................
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