NURS 6512 Assignment Ethical Concerns
NURS 6512 Assignment Ethical Concerns
It is not uncommon for nurses advanced practice nurses to encounter situations where a patient’s wishes regarded their health are in conflict with the family’s wishes, professional experience, or evidence hence creating ethical dilemmas (Haahr et al., 2020). Therefore, it is important for an advanced practice nurse to make informed decisions that can positively impact the patient’s condition. The case considered in this assignment is for a 60-year-old man who was diagnosed with inclusive body myositis several years ago and is currently facing a rapid decline in his condition. While the patient prefers to be at home and get end-of-life care from there, the wife is of the opinion that her husband is admitted to the inpatient care setting.
Making a better decision regarding this case requires particular assessment information. Inclusive body myositis exposes the patients to falls; hence this patient is at risk of falling (Weihl, 2019). I would assess the patient’s quality of life and ability to undertake daily life activities. Assessing the proficiency of the home caregiving would be key in determining whether the partner can offer good care and give moral support.
An appropriate response to this scenario requires that I consider ethics as an advanced practice nurse. Guided by nursing ethics, I would strive to educate the family and the patient to ensure that they have sufficient knowledge regarding the condition and how the family can help take care of the patient. After the assessment, I would also collaborate with the patient’s wife and other family members to help come up with an appropriate care plan which is likely to have a better impact on the patient’s condition. These actions are in accordance with the principles of beneficence and nonmaleficence, which involve doing the right and good thing for the patient and doing no harm (McDermott-Levy et al., 2018). I would also ensure that I treat the patient’s medical details with confidentiality.
References
Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), 258-272. https://doi.org/10.1177%2F0969733019832941
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing Outlook, 66(5), 473-481. https://doi.org/10.1016/j.outlook.2018.06.013
Weihl, C. C. (2019). Sporadic inclusion body myositis and other rimmed vacuolar myopathies. CONTINUUM: Lifelong Learning in Neurology, 25(6), 1586-1598. Doi: 10.1212/CON.0000000000000790
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?
In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.
To Prepare
Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.
• Based on the scenarios provided:
o Select one scenario, and reflect on the material presented throughout this course.
o What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
o Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.
The Lab Assignment
Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.
By Day 6 of Week 11
Submit your Assignment.
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Grading Criteria
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Week 11 Assignment Rubric
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Week 11 Assignment
Week 11: The Ethics Behind Assessment
Consider the following scenarios:
• You are a nurse at a large county hospital. One of your patients is leaning toward selecting a certain radical treatment for cancer, to which the family is in opposition. The family is concerned about making the correct decision and asks for your advice.
•
• The state of Oregon has passed a “Death with Dignity” act that allows for euthanasia in certain situations. One of your patients suffering from terminal cancer is thinking of moving there to take advantage of this law and asks your opinion.
Throughout this course, you have explored a wide range of health assessments and abnormal examination findings. Although you have predominantly focused on the procedural aspects of health assessment, this week, you will focus on ethical considerations that should be taken into account when advising patients or their families.
This week, you will consider how evidence-based practice guidelines and ethical considerations factor into health assessments. You will also evaluate health assessment concepts related to sports physicals and well-child and well-woman examinations.
Learning Objectives
Students will:
• Apply evidence-based practice guidelines to make an informed healthcare decision
• Apply ethical considerations to a health assessment response
• Apply concepts, theories, and principles relating to sports physicals and well-child and well-woman examinations
• Identify concepts, theories, and principles related to advanced health assessment
________________________________________
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 24, “Sports Participation Evaluation”
In this chapter, the authors describe the process of a sports participation evaluation. The chapter also states the most common conditions encountered in a sports participation evaluation.
• Chapter 25, “Putting It All Together”
In this chapter, the authors tie together the concepts introduced in previous chapters. In particular, the chapter has a strong emphasis on the patient-caregiver relationship.
Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester, UK: Wiley Blackwell.
Furman , C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack of an informed consent discussion. American Journal of Alzheimer’s Disease & Other Dementias, 29(7), 590–595. doi:10.1177/1533317514525829.
Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papilloma virus. BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29. Retrieved from http://www.biomedcentral.com/1472-6939/15/29
Maron , B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of preparticipation cardiovascular screening for athletes. Nature Reviews Cardiology, 12(6), 375–378. doi:10.1038/nrcardio.2015.21
May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J. A. (2014). Pediatric sports specific return to play guidelines following concussion. The International Journal of Sports Physical Therapy, 9(2), 242–255. PMCID: PMC4004129. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004129/
American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule). Retrieved from https://www.harmonyhpi.com/WCAssets/illinois/assets/IL_MedicaidProviderManual_PEM_AdultPHGsForProviders.pdf
This resource provides recommendations for preventative pediatric healthcare from infancy through adolescence. The periodicity schedule covers a variety of areas, from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.
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Rourke, L., Leduc, D., & Rourke, J. (2017). Rourke Baby Record. Retrieved from http://rourkebabyrecord.ca/
This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.
Document: Final Exam Review (Word document)
Required Media (click to expand/reduce)
Module 4 Introduction
Dr. Tara Harris reviews the overall expectations for Module 4. Consider how you will manage your time as you review your media and Learning Resources for your Case Study Lab Assignment and your Final exam (3m).
Sports Participation Evaluation – Week 11 (12m)
________________________________________
Assignment 1: Lab
Rubric Detail
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Content
Name: NURS_6512_Week_11_Assignment_Rubric
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Write a detailed 1-page narrative (not a formal paper) addressing the following:
· Explain the health assessment information required for a diagnosis of your selected patient (include the scenario number). Points Range: 30 (30%) – 35 (35%)
The response clearly, accurately, and thoroughly explains detailed health assessment information required to diagnose the selected patient, with correct scenario number included. Points Range: 24 (24%) – 29 (29%)
The response accurately explains health assessment information required to diagnose the selected patient, with correct scenario number included. Points Range: 18 (18%) – 23 (23%)
The response vaguely explains health assessment information required to diagnose the selected patient, with scenario number, correct or inaccurate, included. Points Range: 0 (0%) – 17 (17%)
The response lacks and/or inaccurately explains assessment information required to diagnose the selected patient, with scenario number inaccurate or missing.
Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature. Points Range: 45 (45%) – 50 (50%)
The response clearly, accurately, and thoroughly explains detailed evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with clear, accurate, and thorough justification using three or more different references from current evidence-based literature. Points Range: 39 (39%) – 44 (44%)
The response accurately explains evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with accurate justification using at least three different references from current evidence-based literature. Points Range: 33 (33%) – 38 (38%)
The response vaguely explains evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with vague and/or inaccurate justification using two to three different references from current evidence-based literature. Points Range: 0 (0%) – 32 (32%)
The response inaccurately explains or lacks evidence-based practice guidelines and ethical considerations applied by an advanced practice nurse in responding to the scenario, with inaccurate or missing justification using two or fewer references from current evidence-based literature.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. Points Range: 3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. Points Range: 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.
The patient is in advanced-stage cancer, and the effective discussion should be on life care and discussion of wishes and needs. In the case presented, the patient has tested positive for advanced-stage cancer and is presented in the emergency unit for cardiac arrest. In this write-up, I will provide a detailed narrative explaining the health assessment information required for a diagnosis regarding the presented case.
I would determine the cardiac arrest using an ECG and the life-saving measures as defined in the ACL protocols (Nelson & Lewis, 2017). Once I am able to stabilize the patient, I would ask the boyfriend if the patient has an advanced directive or will concerning the resuscitation status. The advanced directive is a legal document relaying more information on the life savings of the patient (Rossetti, 2017). In this case, I would ask the boyfriend who can connect to the next of kin in case the boyfriend is not the next of kin. This would happen if the patient is unconscious or does not have the mental capacity to make important decisions. Effective decisions for resuscitation would wait, but until then, I will make every attempt to stabilize the patient.
I will respect the wish of the patient and the family. If the patient and the family agree that they need all interventions and the patient is stable on life support machines, then further investigation into brain function and viability will be conducted (Ozmen et al., 2019). Diagnostic testing would reveal the extent of brain damage and cardiopulmonary stability that would aid in determining the status of my patient and viability. I will then discuss the patient’s condition with the family to get ready for any result that would come from the treatment offered to the patient.
A confirmation that the brain cells of the patient are dead and the family is not ready to stop the life support measures, the hospital can change the status of the patient to “do not resuscitate” with approval from two physicians (Nelson & Lewis, 2017). However, providers will ensure that the family confirms the decision. This would be important in avoiding ethical dilemmas.
References
Nelson, A., & Lewis, A. (2017). Determining brain death: basic approach and controversial issues. American Journal of Critical Care, 26(6), 496-500. https://doi.org/10.4037/ajcc2017540
Ozmen, O., Aksoy, M., Atalay, C., Aydin, M. D., Dostbil, A., Ince, I., & Sener, E. (2019). Are unresponsive dilated pupils an indicator for brain death? an evaluation of Edinger Westphal nucleus in rabbits with brain death. Annals of Medical Research, 26(10), 2376-2381. https://annalsmedres.org/index.php/aomr/article/view/3711
Rossetti, A. O. (2017). Clinical neurophysiology for neurological prognostication of comatose patients after cardiac arrest. Clinical Neurophysiology Practice, 2, 76-80. https://doi.org/10.1016/j.cnp.2017.03.001
Total Points: 100
Name: NURS_6512_Week_11_Assignment_Rubric
Ethical Concerns
Ethics inform the care that nurses provide in their practice. The aim is to ensure safety and quality in addressing the patients’ care needs. Therefore, this paper explores the ethical concerns involved in caring for a 47-year-old man with ulcerative colitis who has no insurance. The patient has been admitted to the emergency room with extreme abdominal pain. He has not taken his medications for last few months and does not have any medical or prescription insurance.
Necessary Information
The additional information that should be obtained from the patient include symptom onset, duration, severity, precipitating, and relieving factors. Information on patient’s lifestyle such as alcohol use should also be obtained, as it can precipitate the disease. Physical assessment should identify if the patient is dehydrated or not, with diagnostic investigations such as complete blood count requested since the patient is at a risk of developing anemia.
Nursing Actions
Nurses and other healthcare providers act as advocates of their patients. They ensure the protection of their right to access high-quality, safe, and efficient care (Daly & Jackson, 2020; Molterer et al., 2020). Based on this, I would ensure the patient receives the care he needs despite lacking any medical or prescription insurance. Patients should not be discriminated in the care process based on factors such as ethnicity, race, or socioeconomic background.
Nurses should also demonstrate ethics in their practice. This includes ensuring the protection of principles such as informed consent, justice, beneficence, and non-maleficence. Therefore, an appropriate intervention in the case study would be protecting patient’s right to justice by providing the care that he needs. In addition, the nurse should alleviate any pain and suffering the patient has, hence, the principles of beneficence and non-maleficence (Mathibe-Neke, 2020; Moreau & Rudge, 2018).
Besides providing care the nurse should also collaborate with the social worker and link the patient with the existing insurance plans such as those in the Affordable Care Act plan. Such insurances will help the patient access the care he needs whenever he needs for ulcerative colitis. The nurse should also empower the patient about the effective management of his condition. This includes educating him about the causes, precipitating factors, and prevention (Butts & Rich, 2022; Grace & Uveges, 2022). The health education will help him take responsibility for his health. therefore, the consideration of the above interventions will promote ethics in the patient care process.
In summary, additional information and investigations should be performed on the client. Ethical principles should guide nursing actions. Patient empowerment should be considered. The aim should be relapse prevention for the patient’s optimum health and wellbeing.
References
Butts, J. B., & Rich, K. L. (2022). Nursing Ethics: Across the Curriculum and Into Practice. Jones & Bartlett Learning.
Daly, J., & Jackson, D. (2020). Contexts of Nursing: An Introduction. Elsevier Health Sciences.
Grace, P. J., & Uveges, M. K. (2022). Nursing Ethics and Professional Responsibility in Advanced Practice. Jones & Bartlett Learning.
Mathibe-Neke, J. M. (2020). Ethical practice in the nursing profession: A normative analysis. South African Journal of Bioethics and Law, 13(1), Article 1. https://doi.org/10.7196/SAJBL.2020.v13i1.00690
Molterer, K., Hoyer, P., & Steyaert, C. (2020). A Practical Ethics of Care: Tinkering with Different ‘Goods’ in Residential Nursing Homes. Journal of Business Ethics, 165(1), 95–111. https://doi.org/10.1007/s10551-018-04099-z
Moreau, J. T., & Rudge, T. (2018). How “care values” as discursive practices effect the ethics of a care-setting. Journal of Organizational Ethnography, 8(3), 298–311. https://doi.org/10.1108/JOE-04-2018-0024