NU 608 Reflection Paper - Brandy Schnacker MSN Portfolio



NU 608 Reflection Paper

Brandy Schnacker

Washburn University

NU 608 Reflection Paper

COURSE OUTCOME

Course outcome 7 which states incorporate principles of ethical and legal practice in primary care settings is what will be discussed within this paper (Brown, 2013). The end of program outcome that outcome 7 relates to is outcome 6. This outcome wants the learner to be able to integrate principles of ethics, quality and safety into practice (Washburn University School of Nursing (WUSN), 2012). By incorporating ethical and legal principles into my future practice I will be providing safe and quality care to my patients and their families.

REFLECTION ON TOPIC

Ethical principles and legal standards are incorporated into primary care settings so that the diverse characteristics and needs of individuals and their families are respected. There are many ethical principles that need to be followed within the primary care setting. The ethical principles that always come to my mind when discussing ethics in nursing whether it be as a register nurse or my new adventure into advance practice registered nurse are: beneficence, nonmaleficence, autonomy and justice (Editors, 2012). Beneficence relates to doing or promoting good which helps the client receive and achieve optimal outcomes for their healthcare. Nonmaleficence is to do no harm to a patient or their family. This principle can also be related to reporting suspected abuse to prevent further victimization of patients and their families. As practitioners by following the principle nonmaleficence we are also protecting our patients from chemically impaired nurses or other healthcare staff within our organization or our place of work. An additional ethical principle is autonomy which refers to the ability of a person to be self-directed or independent. For a practitioner this means that we need to respect the decisions of our patients and families when it revolves around their care. This can be further explained when looking at the example of working with a patient who chooses to refuse a medical treatment necessary to treat their illness; even though we as a healthcare provider do not agree with them, the practitioner must respect the decision the individual makes. The responsibility of the provider is to be sure the patient understands their options and the consequences of not completing the treatment. Another principle that is important in nursing is justice. The ethical principle justice refers to the fair and equal treatment of patients seen by me as a provider and also the providers that are in the office (Editors, 2012).

Confidentiality plays a very important role in a nurse practitioner’s daily work routine. Confidentiality is the right of the patient to have their information discussed only with those involved in their treatment. The Health Insurance Portability and Accountability Act (HIPAA) protect the patients by ensuring that the health care providers not disclose or use the patient’s information inappropriately (Limentani A. E., 1999). Ethical principles do not only relate to these four main principles, there can also be other principles that need to be followed while providing care to patients, however these are the principles that are highly important to me while I begin my new practice.

As providers we are expected to maintain a high level of professional competence, integrity and professional judgment in order to benefit the patients and their families we care for within our practices. To stay current with the latest advances in treatment, such as changes in medications, the nurse practitioner needs to continually be updating his or her knowledge. It is critical to follow the laws, regulations and policies of your state and organization. Taking an active role in the development of legislation or discussing proposed legislation with a legislator are also key ways that an individual can influence practice. By participating in professional organizations is a way to demonstrate professionalism within the practice. Participation allows the provider to talk with and to learn from other professionals in their profession. Following ethical principles within the primary care setting, the provider is to provide the best care for the patient without causing any harm physically or psychologically to the patient.

There are legal principles that nursing professionals must keep in mind when providing patient care: duty, breach, causation and damages (Editors, 2012). Duty can be defined as a legal obligation owed by one person to another person; this also refers to adhering to standards of care that are imposed by the state’s nursing board and the nurse practice act. Breach can be defined as a failure to fulfill the duties established or not meeting the appropriate standard of care for their patients. Causation can mean that a nurse did breach a duty, or failed to meet the standard of care, which caused the patient injury or an adverse outcome. Finally within the legal world of nursing there is the issue of damages, meaning a payment to compensate the patient for the outcome of care. Damages can be paid to help restore the patient to their condition prior to the injury or compensate for their future care created by the damages the patient received (Editors, 2012). Being aware of advances in health care and the professional standards are essential in assisting the nurse practitioner to provide quality care to patients and families.

Incorporating ethical and legal principles in the nurse practitioner practice creates a safe and trustworthy opportunity for the patients and their families to be seen in, have a discussion about their situation, and to be able to receive the appropriate care. Ethical principles are ways to do onto others as you would have done unto you. Legal principles have been developed to protect the patient and family as well as the healthcare providers who are given care to patients. As a person I want to be treated fairly and equally also as a provider I want to treat all my patients fairly and competently.

TOPIC WITHIN PRACTICUM

Within my practicum this semester I have witnessed a complication with legal and ethical principles. Within this practice and the organization there is a clause that states if you as a patient are fired from one provider or not following treatment then you cannot see another provider within the organization. An issue did arise that brought this clause into play for a patient recently. A patient was seen in the emergency room one night because she had run out of her pain medications. While she was in the emergency room she was assigned to the provider on call to see the next day for follow up. What had happened was that she was assigned to a provider within the same office that she was fired from. When that office learned of this patient being fired, they reassigned her to our office to be seen. After investigation into why this patient was fired (by reading the letter that was sent to her from the first practice), my office was under the impression that we did not need to see her due to the fact of being within the same organization of the firing practice of this patient. The patient was fired from the first practice because of not following the appropriate regulations with her pain medications and also not participating in the referrals that were offered to her. The nurse practitioner that I am following consulted the physician that was assigned to her to see if we needed to see her or not. The physician, the patient was assigned to, was under the impression that we did not have to see her within our office. After further investigation with the office manager then the decision was made to see her one time; because she was assigned to the organization as a city call patient. There were many ethical dilemmas that we were facing. One was nonmalefiance which is do no harm to patients. Which after deciding to see the patient I saw that if we did not see her we could have caused her harm by not assisting her with her medical needs. Also justice I believe played an important role in giving care to this patient. With justice you want to treat each patient equally and fairly. Since she was on our schedule we did want to treat her like our other patients by listening to her story of what has happened in the past and if we could adjust a treatment plan that she would be willing to follow. At this date in time she only did keep that appointment with us, has only used the phone to ask for more pain medications, and has not rescheduled a follow up for her appropriate screenings that were suggested. So due to her noncompliance the providers within this office have not refilled her pain medications.

TOPIC IN FUTURE PRACTICE

When reflecting on my practice of utmost importance to me is the ethical principle of nonmaleficence. I want to be sure that when treating patients they are treated just as I would want to be treated. Beneficence within my practice will be demonstrated by supporting and protecting the physical and psychological safety of each patient I will provide care too. Autonomy can be a difficult ethical principle to swallow for the fact that I want to help the patient the best way I know how, but if they are set against my plan of care I have to remember that they have the right to disagree with my plan at anytime they want. Justice within my practice is also very important to me, when I go to an office I want to be treated fairly and equally so this is how I will see and care for my patients. Within my practice I will stay abreast on the most current treatments and diagnostics to demonstrate to my patients a high level of professional competence. Following and complying with changing healthcare laws, regulations, nurse practice acts, licensing and standards of care will allow me to demonstrate to patients and their families my commit to their care.

REFERENCES

Brown, P. F.-B. (2013). NU 608 Health Care Practicum III. Washburn University. KS, USA.

Editors, L. E. (2012). Nursing Ethics and Legal Issues. Retrieved from :

Limentani, A. E. (1999). Legal and Ethical Issues in Medical Practice, Including HIPAA. Retrieved from J Med Ethics:

Limentani, A. E. (1999). The role of ethical principles in health care and the implications for ethical codes. Journal of Medical Ethics, Volume 25, 394-398.

Washburn University School of Nursing (2012). MSN Student Handbook. MSN Student Handbook. Topeka, Kansas, USA.

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