Reflection Paper: Ethical and Legal Aspects of Healthcare ...



Reflection Paper: Ethical and Legal Aspects of Healthcare and the Role of the Advanced Practice Nurse

Jill Collins

Washburn University

September 17, 2012

Reflection Paper: Ethical and Legal Aspects of Healthcare and the Role of the Advanced Practice Nurse

Healthcare providers are faced with many obstacles and struggles as they attempt to provide competent and quality care to their patients. There are many legalities to consider that often become part of these obstacles. There are also several ethical concerns a provider must consider which may or may not hinder what the provider considers to be competent and quality care. This paper will reflect on the legal and ethical aspects of healthcare for the advance practice nurse as viewed by this author.

There are three ethical principles that primarily guide my practices as a student and will continue to provide guidance in my future role as an advanced practice nurse. I think these three are primarily what most providers take into consideration when providing healthcare. Those three principles are beneficence, autonomy and justice.

Autonomy refers to an individual’s right to make his/her own decisions in regard to healthcare. This principle initially was the hardest for me as a provider to acknowledge. The reason for this is that I personally believe science and medicine have proven that certain actions have been shown to produce the greatest results and that people should want to follow these recommendations. I initially had the expectation that every patient would always make the choice to do what I told him/her was best. I soon found out this was not the case and although I am getting better about accepting this fact, it sometimes still remains a struggle for me to let it go. For example, we know that people with paroxysmal atrial fibrillation (PAF) should be on an anticoagulant unless they can always specifically tell when the irregularity begins and are able to see a healthcare provider within 48 hours if it has not resolved. Science and research tell us that after this 48 hour period, blood clots are likely to form in the atria and increase an individual’s risk for stroke, pulmonary embolism and myocardial infarction. I had a patient in clinical not long ago who had PAF and his current episode had been going on longer than 48 hours. He was not willing to be hospitalized for anticoagulation because he did not have insurance. For the same reason, he did not want to start warfarin therapy. He felt that the frequent blood draws would be too expensive. As a provider, I really wanted him to either agree to be hospitalized or start warfarin before leaving but I realized that all I could do was give him any and all information in regard to his situation and then let him make his own decision. This happened over a month ago and I still think about him on almost a daily basis and hope he is doing okay. I often wonder if there was more that I could do to convince him to change his mind. Although these types of situations still bother me, I feel I have grown throughout my practicums. I have gone from doing everything I can possible do short of begging someone to do the “right” thing to now providing the appropriate education and asking the patient how he/she wishes to proceed.

Beneficence is essentially doing no harm, being kind and promoting the good in others. I feel this is the reason why many people go into healthcare fields and is certainly the reason why I chose this particular career path. An example of this in my current practicum would be whenever I have patients who do not have insurance, I will often go out of my way to find resources for them to get medications, additional follow-up care and any other resources they may need. I also very carefully consider my plan of care for each and every patient. I am constantly thinking about what I may be missing of if there is any possibility that what I am considering may cause problems for the patient. I do this from a legal aspect as well but I primarily do it because I would absolutely be devastated if I were ever the cause of harm to anyone. I know this will continue into my future practice.

Justice, in my own words, is simply doing what is right and treating everyone fairly and equally. I don’t know that I can give a specific example of this I just know that I give the same attention, respect and thought into the plan of care for the homeless alcoholic drug-addict in one room as I do the well-respected member of the community in the next room. I may have to help the homeless person more in regard to finding resources to carry out my plan of care but the plan would still be the same for any given diagnosis and the way I treat them as a human-being would be the same. This will remain the same for me in my future practice.

The legal aspects of healthcare are much more confusing and probably worry me more because I realize that one mistake could mean the end of the career path that I have chosen. There are so many rules and regulations to be aware of. I think I will likely never learn them all! There are several considerations in this area that I specifically take into account and will continue to do so in the future. First of all, I feel is important to be familiar with the state nurse practice act. This essentially outlines what you can and cannot do as a nurse practitioner in your current state of residence. Many items vary in regard to practice guidelines so I feel it is of utmost importance to be familiar with this wherever one may choose to practice.

Secondly, one needs to always be familiar with the specific rules and regulations in the facility he/she practices in. Legalities can vary from facility to facility depending on the level of care that is provided and it is important to be familiar with the specifics. Not only are the specifics of the facility one is working in important, it is also essential to be familiar with common practices and treatment guidelines within the community/area you are practicing in. An example of this would be knowing what infectious agents are common in the community you are working in so that you can develop an appropriate treatment plan. Pneumonia for example may be treated with a certain group of antibiotics in Kansas but may be treated differently in the New England states because the common offending organisms may be different. If one were to move to one of these states and apply the same plan of care as they would have in Kansas, they may end up causing more problems for the patient and eventually end up in trouble.

Another legal aspect would be to know what the expectations and practices are of your supervising physician if your state requires you to have one. It is important to be familiar with this because if you make an error, you may be jeopardizing your supervising physician as well as yourself. It is important that any decision you make as a provider will be supported and defended by your supervising physician.

Finally, it is obviously very important to practice evidence-based guidelines and know current recommendations. It is important for to be familiar with medications I commonly prescribe and know what their labeled and off-label uses and recommendations are. I must be aware of what is reasonable and prudent within my scope of practice and maintain these boundaries at all times. These steps don’t guarantee that I will be covered if something goes wrong but the likelihood of losing my license or causing serious harm to someone greatly decreases.

This reflection paper addresses course outcome number seven which is incorporating principles of ethical and legal practice in primary care settings. This reflection paper also addresses program outcome number six which is incorporating ethical and legal principles in healthcare policies.

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