NURS 8002 Ethics and the DNP-Prepared Nurse
NURS 8002 Ethics and the DNP-Prepared Nurse
Doctoral level-prepared nurses play an essential role in addressing the actual and potential health needs of their communities. They collaborate with the community members to identify the resources that can be used to optimize their health outcomes. The nurses also promote change to ensure continuous improvement in the implementation of initiatives to enhance their health. Therefore, this blog examines the most important challenges in my community, their importance, and practice interventions that can be implemented to address them.
The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:
- Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.
- Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.
- Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.
One of the most important challenges in my community is the rise in lifestyle diseases. There has been a rise in the rate of lifestyle diseases including diabetes, obesity, overweight, and hypertension in the community. The rise is attributed to the minimal engagement of the community members in healthy lifestyles and behaviors that include healthy diets and active physical activity. The problem affects mostly the young and middle-aged populations (Sathe & Hiwale, 2020). The population’s predisposition is linked to its increased access to unhealthy foods and sedentary lifestyles such as too much screen time and consumption of sugar-rich diets. The second most important challenge in my community is substance abuse. A significant proportion of the young population in the community abuses drugs such as amphetamine, marijuana, and cocaine. Factors such as peer pressure, low level of knowledge, and easy access to drugs have contributed to the problem (Sathe & Hiwale, 2020). Interventions that aim at addressing the issue should be implemented to enhance the overall health and wellbeing of the community members.
Importance of the Challenges
The rise in lifestyle diseases and substance abuse in the community is important in several ways. First, lifestyle diseases such as obesity, hypertension, and overweight affect the quality of life of the affected populations. It lowers their productivity through the time and resources spent in managing them (Meyer et al., 2019). Lifestyle diseases also increase the burden experienced by the community members. Often, the affected populations require frequent hospital visits and hospitalizations, which affect their productivity and community development. Lifestyle diseases also predispose the affected to early mortalities due to disease-associated complications (Atroshi, 2020). Substance abuse is also important due to its health effects. Accordingly, substance abuse predisposes the community members to drug dependence. It also increases their risk of other health problems that include cancer, upper respiratory tract infections, low immunity, and premature mortality (Meyer et al., 2019). Consequently, interventions that address the issues should be implemented to ensure optimum public health.
Practice Change Interventions
One of the practice change interventions that can be implemented to address the above challenges is health education. Community members should be educated about the importance of healthy lifestyles and the effects of their current challenges. Health education is an important tool for creating awareness and stimulating change from the affected and populations at risk. Health education will also strengthen the effective utilization of community resources to address the challenges (Bednarek et al., 2018). The other practice intervention that can be implemented to address the challenges is the adoption of effective and responsive policies. Accordingly, community policies that eliminate easy access to drugs by the community members should be adopted. The policies should also strengthen the creation of safe communities that support healthy living and enhanced access to healthy diets (Meyer et al., 2019). Therefore, the above interventions will minimize the population’s vulnerability to health challenges.
Doctoral-prepared nurses play an essential role to play in the promotion of optimum public health. They explore issues of priority in their communities and implement responsive interventions to address them. The identified issues in my community include a rise in lifestyle diseases and substance abuse. Therefore, interventions to address them should be implemented for the overall health and wellbeing of the community members.
Atroshi, F. (2020).Personalized Medicine, in Relation to Redox State, Diet and Lifestyle.BoD – Books on Demand.
Bednarek, A., Bodajko-Grochowska, A., Zarzycka, D., Emeryk, A., &Cichosz, E. (2018).Physical activity of adolescents in the prevention of lifestyle diseases.Pielegniarstwo XXI wieku / Nursing in the 21st Century, 17(3), 32–37. https://doi.org/10.2478/pielxxiw-2018-0025
Meyer, J. P., Isaacs, K., El-Shahawy, O., Burlew, A. K., &Wechsberg, W. (2019). Research on women with substance use disorders: Reviewing progress and developing a research and implementation roadmap. Drug and Alcohol Dependence, 197, 158–163. https://doi.org/10.1016/j.drugalcdep.2019.01.017
Sathe, N., &Hiwale, A. (2020).Achieving Wellness by Monitoring the Gait Pattern with Behavioral Intervention for Lifestyle Diseases.In X.-S. Yang, S. Sherratt, N. Dey, & A. Joshi (Eds.), Fourth International Congress on Information and Communication Technology (pp. 209–218). Springer. https://doi.org/10.1007/978-981-32-9343-4_17
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.
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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.
• 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!
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Week 10 Discussion Rubric
Post by Day 3 of Week 10 and Respond by Day 5 of Week 10
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Week 10 Discussion
Ethics and the DNP-Prepared Nurse
Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. Ethical conflicts can emerge from intractable treatment disagreements or when patients, surrogates, or clinicians perceive their goals related to care and outcomes are being thwarted by the incompatible goals of others. The primary ethical conflicts perceived in the ICU relate to medical decision-making and treatment goals, especially regarding the benefit or harm of aggressive treatment. (Pavlish, 2020). In the article by Pavlish (2020), it states that delaying or avoiding conversations about prognosis and treatment options appears to increase the probability of continuing aggressive and sometimes unwanted treatments for patients with serious and life-limiting conditions. For example, patients with heart failure are often not referred for palliative care services until the last month of life because advanced care planning is frequently delayed. Other researchers found that Medicare recipients with cancer received high-intensity treatments relative to their poor prognosis in the last weeks of life. Providing intensive therapies may certainly be indicated in some cases; however, when patients know that medical interventions are not likely to improve their condition, they often refuse or decrease intense measures (Pavlish, 2020). When a person can no longer communicate their needs and will, the healthcare professionals involved need to know how to respect their dignity in daily care. Many healthcare professionals have asked for more knowledge and training about dignity ing the care of older persons (Rejno et al., 2020). The American Nurses Association (2015) Code of Ethics is fundamental to providing a framework for ethical decision-making and guiding practice. Advanced practice registered nurses, specifically nurse practitioners with doctor of nursing practice degrees, are on the frontline of patient care as ethical leaders and advocates (Vermeesch et al., 2018). Throughout my nursing career, I have experienced many ethical challenges. One that comes to mind is a patient who was considered to have no brain activity. The family did not want to have him taken off of life support. They had a well-known acupuncturist come and perform treatment on the patient. It was sad to watch the family hand on this way. After a week or so, the family decided to have the patient taken off of life support. As a DNP-prepared nurse, I expect to face families who are not ready to let go of their loved ones. I also expect patients who would want to try alternative therapies over pharmaceutical treatment, when the latter would be a better treatment.
Pavlish, C. L. (2020). A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit. American Journal of Critical Care, 29(1), 49–58. https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2020915
Rejnö Å, Ternestedt B-M, Nordenfelt L, Silfverberg G, Godskesen TE. Dignity at stake: Caring for persons with impaired autonomy. Nursing Ethics. 2020;27(1):104-115. doi: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. doi:http://dx.doi.org/10.1097/01.NEP.0000000000000383
This is an exceptional work. You have provided an insightful and thoughtful discussion about ethical issues relevant to the DNP-prepared nurse. In concurrence, ethical issues are associated with adverse consequences such as reduction in quality of patient care, moral distress, and challenging clinical relationships (Brown, 2020). DNP-prepared nurses are particularly susceptible to ethical issues and moral distress due to their mentorship and leadership roles. Nurses and other medical workforce often look to them for proper ethical decisions (Markey et al., 2021). In relation to the ethical issues, the other ethical issue that nurses often encounter is science versus spirituality. Healthcare is mostly based on science and driven by result. However, this may obstruct religious beliefs especially where religion limits medical interventions (Taylor et al., 2018). Nurses are required to provide medical care to patients to alleviate suffering and enable patients to focus on self-care. However, for patients with strong spiritual or religious beliefs, the focus may be on strict compliance with their religious guidelines. As a result, nurses find it challenging to balance the unique differences of patients and the clinical practice.
Brown, J. P. (2020). Ethical dilemmas in healthcare. In Safety ethics (pp. 67-82). Routledge.
Markey, K., Ventura, C. A. A., Donnell, C. O., & Doody, O. (2021). Cultivating ethical leadership in the recovery of COVID‐19. Journal of nursing management, 29(2), 351-355. https://doi.org/10.1111/jonm.13191
Taylor, C., Lynn, P., & Bartlett, J. (2018). Fundamentals of nursing: The art and science of person-centered care. Lippincott Williams & Wilkins.
Ethical Issues Relevant to DNP-prepared Nurse
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.
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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.
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
Tiffany, your focus on the ethical issues relevant to DNP-prepared nurse was well done and outstandingly detailed. I agree with you on the idea that DNP-prepared nurse should be aware of the significant ethical issues that they may encounter. Although many nurses undergo requisite education and clinical training prior to certification, they still face challenges in addressing ethical issues in the clinical practice (Rushton et al., 2021). As such, nurses can take various initiatives to hone their skills in dealing with ethical dilemmas. For instance, nurses can address ethical issues by gaining experience and associating with patients over time. Nurse should also interact more with well-seasoned nurses and knowledgeable nurse managers for guidance on ethical situations that they cannot address. Well-seasoned nurses and knowledgeable nurse managers can promote educational environments where ethical issues can be discussed regularly (MacLaren, 2018). Having open discussion about ethical issues is essential in enabling nurses to learn from their colleagues on how to deal with ethical issues and also from the mistakes of others. Importantly, nurses should always review ANA Code of Ethics for ethical guidance (Stievano & Tschudin, 2019).
MacLaren, J. A. (2018). Supporting nurse mentor development: An exploration of developmental constellations in nursing mentorship practice. Nurse education in practice, 28, 66-75. https://doi.org/10.1016/j.nepr.2017.09.014
Rushton, C. H., Swoboda, S. M., Reller, N., Skarupski, K. A., Prizzi, M., Young, P. D., & Hanson, G. C. (2021). Mindful Ethical Practice and Resilience Academy: Equipping nurses to address ethical challenges. American Journal of Critical Care, 30(1), e1-e11. https://doi.org/10.4037/ajcc2021359
Stievano, A., & Tschudin, V. (2019). The ICN code of ethics for nurses: a time for revision. International nursing review, 66(2), 154-156. https://doi.org/10.1111/inr.12525
In nursing, ethics are taught and expected to be maintained. They are formed off the principles of autonomy-the right to make choices, beneficence-to do good or prevent harm, justice-providing care equally, non-maleficence-to do no harm. I have also come across privacy-a right belonging to all people, dignity-worthy of respect and confidentiality-keeping patient information only in necessary places and people. Throughout a career in medicine, it is impossible to avoid experiencing a situation that one of these ethics will come into question.
As a doctorate prepared nurse (DNP), my intention is to continue in my role, at least in a part time aspect. In doing so, I have and will continue to run into circumstances in which the ethical value of autonomy is challenged. I provide psychiatric and mental health care to patients in nursing homes, assisted livings and in their homes. I typically experience the vignette shared by Rejno et al, in which the patient with dementia states she is fine being home alone and the daughter says she is not and they present opposing stories (2020), played out weekly.
One I experience frequently is families want to “medicate” their loved one to their liking. For example, Jane Doe is 96yo female with major depression, anxiety and mild dementia. One of her biggest problems is that she lives in an assisted living and feels unimportant to her family. When she lived on her own, she was able to join what she wanted, when she wanted. Now, family has to come pick her up, which doesn’t always happen. Two of her daughters will tell her she is ungrateful for everything they have done for her when she will tell them she wants to come home, that they just put her there so they do not have to deal with her. Maybe three weeks ago, she had a birthday party, afterwards she got upset and she was emotional having to go back to the assisted living and away from her family. She shared with me openly and remembered this happening. Her daughter called me to ask what I can give her to make her stop. I have explained multiple times that she is gets upset, she has a lifetime of less than the best coping skills when it comes to feeling wanted, needed or loved. I explain to her daughter that the patient tells me she feels as though her medications are in a good spot. That she doesn’t feel depressed, she feels she gets sad and frustrated because she doesn’t want to live in an assisted living. Jane goes out of her apartment, interacts with activities and multiple other residents, she is pleasant and smiling. That Jane would likely benefit more from counseling than a medication change, in which she refuses. Most recently, Jane has had an increase in tearful episodes and anxiety per the daughter. Her daughter has called me twice this week asking for her to get Ativan and really doing anything she could to convince me to give it to her, versus waiting for result of UA-she is prone to them and this is her behavior when she gets one. She even called the medical NP to see if he “would give her something to knock her out”. She started antibiotics yesterday for her UTI. The family even has a recorder set up in Jane’s apartment. Often, I get the distinct impression that family is asking for medication increases due to their own poor coping and feelings of guilt.
In a similar respect, however reversed, I am often advocating for patients to get medications. Families will often not want their loved one to have medication because, for example, “it is understandable that she has depression”. It often takes much education and support and time provide to family members to have them allow me to attempt anything. I often have to explain to them that it absolutely is understandable however due to multiple factors, dementia being one, they are not able to implement good coping skills and that depression is making them miserable therefor quality of life is impeded.
The ethics that are maintained in a facility have been shown to correlate with the values, or lack there-of, in an organization. When an organization does not uphold values, it becomes challenging for the staff as they will question their own work and it will decrease satisfaction. (Torkamen. 2020) I have seen this many times in some of the failcities that I round in. One aspect discussed by Rejno et al, (2020) is the right to dignity. I often see this become challenging to maintain with patients that reside on a memory care unit. I do believe this directly links to an organization neglecting to set forth routinely practiced ethics. At times this is not necessarily faulted as the workforce is understaffed. One of the facilities I round in pointed out they noticed a decrease in the care for dementia patients when their dementia training went online versus in person and hands on. This is one of the biggest gaps I see that needs help and why, at this time, my focus is here as far as my DNP project.
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
Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics and History of Medicine, 13(17), 1–10. https://doi.org/10.18502/jmehm.v13i17.4658
Week 10 initial post
Post an explanation of at least two significant ethical issues relevant to the DNP-prepared nurse.
According to Ulrich et al., in a recent study conducted over 422 questionnaires were used in the analysis to ask the most frequently occurring ethical issues nurses encountered. Out of these issues a DNP-prepared nurse would be most affected by protecting patient rights, and patient autonomy (Ulrich, 2010).
The 1973 American Hospital Association patient bill of rights was the first bill of rights written specifically for patients. One important patient right includes informed consent. The following elements are required for documentation during the discussion, 1). The nature of the procedure, 2.) the risks and benefits of the procedure, 3.) reasonable alternatives, 4.) risk and benefits of alternatives, and 5.) Assessment of the patient’s understanding of elements. which include the right to be informed of potential harm to the body and right to autonomy or self-decision making (Olejarczyk, 2021).
Patient Autonomy literally means self-rule and refers to living and making decisions according to one’s own reasons or motives. A patient who can defend his or her judgments has the right to make decisions that do not coincide with what the clinician believes is beneficial to the patient. A patient’s autonomy is violated when family members or members of a health care team pressure a patient or when they act on behalf without the patient’s permission (in a non-emergent situation) (Olejarczyk, 2021).
Then explain how these issues might compare to the types of issues you have encountered in your practice. Be specific and provide examples.
Protecting patient rights have been an issue in the past due to limited space in our clinic. Patient information on computer screens and conversations regarding patient health information can be easily overheard. To rectify this issue or department managers have asked for screen protectors, patient information to be covered whenever left on the desk, and taller cubicle space.
Informed consent has also been addressed in our clinic. When patients agree to care management, there was no written consent or agreement. Stakeholders then agreed to add an excerpt explaining care management, benefits to agreeing to the program, an opportunity to opt out, and a place on the website to go for additional questions and information. Patient are now required to sign a consent before care management begin.
Olejarczyk, J. P. (2021, August 13). Patient rights and ethics. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK538279/.
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: Ethical issues and stress in nursing practice. Journal of Advanced Nursing, 66(11), 2510–2519. https://doi.org/10.1111/j.1365-2648.2010.05425.x
Ethics as a DNP prepared nurse
I am currently a BSN instructor and I teach ethics. I have also been a bedside nurse and it is interesting to see the different ethical dilemmas between the two. I have experienced ethical dilemmas regarding patient care many times. For example, I have worked in psychiatric mental health and for me, every single restraint is an ethical dilemma. I believe that every involuntary admission and forced medication is an ethical dilemma. By definition, ethical dilemmas are created when there are two equally difficult (“bad”) choices to choose from. It is inherently hard and meant to cause conflict in the mind of the person that has to make the choice. I have seen many people treat those choices too lightly, I have seen nurses restrain someone for less than critical situations, for example, which I think is both ethically and morally wrong. It makes me think of the article provided to us about dignity and standards of patient care. The article states that part of human dignity is to honor autonomy and treat all with respect and integrity (). Unfortunately, with patients that have mental illnesses, we sometimes need to remove their autonomy for safety, but we should make a concentrated effort into preserving their dignity. We should give them choices where we can and limit them as little as possible. Humanity is humanity after all, the ethical principle of justice tells us that. I think as a psych NP with the leadership role I receive here I will better be able to create change for this patient population. As a provider, I can resist orders until absolutely necessary because sometimes even though a patient is a challenge, they are not deserving of restriction. On a system-wide level, I can advocate for policies that adapt to this way of thinking.
With teaching I have experienced ethical dilemmas for different reasons. Perhaps two students miss an exam for different reasons. One, due to having a infectious illness and the other did not have childcare. Those are both unfortunate circumstances, but they are not the same. In nursing school, we go in understanding the time commitment and dedication that will be required. Perfect example, I had a busy week and I am submitting this initial post Thursday morning not Wednesday night but I understand the consequences of that and I accept them. Back to the previous example, being sick with something that can be given to others is excusable but childcare issues are not, in my opinion. It is not an easy decision to make and dealing with nursing students and the different issues that arise with them are in some ways harder than bedside. One reason is because the way to make these decisions is less defined. The Journal of Ethics published an article which I think can address this an other issues, and it is referring to organizational ethics. The article discusses ethics on a higher level that has solutions that leave very few loopholes and promote reasonable and communicated expectations for all involved (Phelan, 2020). In the example of nursing education, with my DNP in leadership I think that I could tighten up policies so there is less confusion about standards, whether about grades, attendance, professionalism, etc.
Phelan, P. (2020). Organizational ethics for US healthcare today. AMA Journal of Ethics. doi: 10.1001/amajethics.2020.183.
Rejno, A., Ternestedt, B., Nordenfelt, L., Silfverberg, G., & Godskesen, T. (2019). Dignity at stake: Caring for persons with impaired autonomy. Nursing Ethics. https://doi.org/10.1177/0969733019845128