NUR 740 Discussion 2.1: Intersection of Policy and Ethics in APN Practice
NUR 740 Discussion 2.1: Intersection of Policy and Ethics in APN Practice
Moral qualities are fundamental for any medical care personnel. Essentially, the term ethics is derived from the Greek word ethos, denoting significant character (Olson & Stokes, 2016). In its most straightforward context, the terms ethical values or moral qualities are all-inclusive guidelines of conduct that accord a commonsense premise to recognizing what sorts of activities, expectations, and intentions are valued (Olson & Stokes, 2016). Ethics are moral rules that administer how an individual or a gathering will act or behave. The emphasis relates to the good and atrocities and incorporates the dynamic course of deciding definitive outcomes of those actions.
Each individual has their inherent viewpoints of morals and ethics. Ethics within the context of medical services are significant on the grounds that medics should perceive health care situations and settle on great decisions and choices in light of their qualities while keeping inside the regulations that oversee them (Goudreau & Smolenski, 2013). To rehearse ably with honesty, nurses, similar to all medical service experts, should have guidelines and direction within the framework of their profession. The American Nurses Association (ANA) has fostered the inclusive ethical guidelines for this reason. Noteworthy, the Code of Ethics for Nurses with Interpretive Statements (CENIS) was originally derived to offer essential insights into policy frameworks for executing nursing obligations in away that aligns with the currently set quality nursing care standards, inaddition to the professional ethical duties.
In its basic understanding, ANA’s Code of Ethics for Nurses with Interpretive Statements simply entail the agreement or guarantee that nurses are performing up to their level bests to accord quality care for their patients and the entire community through collaboration with their colleagues in the process (Goudreau & Smolenski, 2013). In this respect, nurses can adequately satisfy/accomplish their ethical mandates and professional responsibilities. The subsequent policy requires nurses to always uphold/emphasize the safety of human rights and related professional ethical framework. Nurses should lay out connections of trust and give equal/fair nursing administrations in relation to the specific healthcare needs of their patients, without prejudice or biases.
However, contemporary nursing practitioners are increasingly exposed to relatively challenging situations or dilemmas in their lines of duty, which sometimes conflict with their underlying ethical prerequisites. For instance, while the fundamental professional code of ethics for an APN nurse is to always offer quality care and protect the safety of their patients, they may get caught in end-of-life decision circumstances involving their patients. Precisely, such issue may lead to ethical concerns, especially if the patient is unable to make decisions for themselves, thus requiring their loved ones or family members to make the decision. In this perspective, the associated nursing practitioner is necessitated to not only focus on the provision of quality care but also adhere to the pre-existing formal Code of Ethics to derive appropriate solution (Olson & Stokes, 2016). Like other nursing practitioners, regardless of their individual moral values, APN nurses are mandated to execute their duties as per their professional code of ethics.
References
Goudreau, K. A., & Smolenski, M. (Eds.). (2013). Health policy and advanced practice nursing: Impact and implications. Springer Publishing Company.
Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation, 7(2), 9-20.
The Intersection of Policy and Ethics in APN Practice
A strong sense of ethics is vital to any area of healthcare including nursing. The Code of Ethics for Nurses (American Nurses
Association [ANA], 2015) creates the ethical norm for the profession and offers a handbook for nurses to assess ethical issues and make appropriate decisions. It is comprised of four principles: autonomy, beneficence, justice, and non-maleficence. It is also based on Florence Nightingale’s theory and conceptualizations of nursing (Gaines, 2021). Two provisions that stand out as particularly applicable to the Advanced Practice Nurse (APN) are provisions 8 and 9. Provision 8 suggests that collaboration within the discipline and maintenance of the concept that health is a right for all individuals allows for best practice and better patient outcomes (Haddad & Geiger, 2021). Provision 9 explains that nurses must band together in committees, organizations, or groups with a unified voice in order to fight for social justice and positively contribute to health policy (Haddad & Geiger, 2021). These provisions allow for consistent improvement in the care provided by the profession.
An example of when healthcare policy does not align with the ethical practice of advanced practice nursing is in regards to beneficence and Do-Not-Resuscitate (DNR) orders. There is a case in my state, Florida, where a deteriorating, unconscious, and unidentifiable man was brought into the emergency department (ED) with the words “Do Not Resuscitate” tattooed across his chest with the “Not” specifically underlined (Washington Post, 2017). This rose the ethical and legal question of the providers working that day on whether or not to resuscitate the man if he were to go into cardiac arrest. Ultimately, the DNR chest tattoo was honored after review by the ethics committee of the hospital (Washington Post, 2017). Many APNs will encounter instances at some point in their career in which they will need to advocate for a patient’s best interest as well as honor the wishes of the patient or the Medical Power of Attorney (POA). Family members who are not the patient’s legal POA sometimes try to persuade providers to ‘do everything’ and resuscitate their loved one who has previously signed a DNR. While the APN might want to honor the family member’s request and might feel as if they are hurting them emotionally by not doing so, they are legally obligated to honor the DNR form. Therefore, honoring a DNR could be an ethical issue for an APN because they could be torn between honoring the wishes of the patient or POA who signed the DNR versus the family member who is against the DNR. The actions the APN might take include sitting down with the family member and explaining the patient’s condition and that resuscitation can sometimes worsen the patient’s outcomes. They might also need to delicately inform them that only the person who signed the form make revoke the form (Florida Department of Health, 2018). They might perform these particular actions to ease the pain of the family member and increase their understanding while keeping the patient’s best interest and wishes in mind.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements (2nd ed.).
Florida Department of Health. (2018). Do not resuscitate. Florida Health. https://www.floridahealth.gov/about/patient-rights-and-safety/do-not-resuscitate/faq-page.html#:~:text=If%20they%20signed%20the%20DNRO,one%20to%20sign%20the%20form.
Gaines, K. (2021). What is the nursing code of ethics? Nurse.org. https://nurse.org/education/nursing-code-of-ethics/
Haddad, L. M., & Geiger, R. A. (2021). Nursing ethical considerations. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Washington Post. (2017). A Florida man collapsed with a ‘do not resuscitate’ tattoo. Doctors didn’t know what to do. Tampa Bay Times. https://www.tampabay.com/news/health/A-Florida-man-collapsed-with-a-Do-Not-Resuscitate-tattoo-Doctors-didn-t-know-what-to-do_163184360/
The Code of Ethics for Nurses with Interpretive Statements was developed to ensure that nurses carry out their duties according to the ethical standards and quality of nursing care. It consists of nine provisions and their accompanying interpretive statements which serve three key roles. First, it provides the ethical values, duties, obligations, and professional ideals of nurses collectively and individually. Second, it is the nursing profession’s nonnegotiable ethical standard. Finally, it is an expression of nursing’s own understanding of its commitment to society (CNNe, 2021). The statements provide a succinct explanation of the ethical values, duties, and obligations of every nurse For instance, the first provision stipulates that nurses practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. The second provision explains that the primary commitment for nurses is to patient. The statements require nurses to show ethical competence in professional life (CNNe, 2021).
The ethical theories or frameworks impacting health, human rights, and social justice in the context of healthcare policy or law include utilitarianism as demonstrated in the public health policy that requires forceful quarantine for people suffering from communicable diseases like Covid-19. The Public Health Service Act (42 U.S. Code § 264) authorizes the US secretary of health and human services to take necessary steps which include forceful quarantine to prevent the spread of communicable diseases. This law applies utilitarianism which holds that actions are right if they stand to benefit the majority (Smith et al., 2019). The theory holds that the most ethical choice is the one that will produce the greatest good for the greatest number of people (Smith et al., 2019). This theory has the potential to impact health, human rights, and social justice. For instance, it impacts human rights if the action standards infringe on the rights of the minority to benefit the majority. For instance, using the Public Health Service Act (which applies utilitarianism) to forcefully force those who were infected with Covid-19 infringed on the freedom of movement of the victims. It also brought out the question of whether it was just to manipulate people to get vaccinated for Covid-19.
When healthcare policy or law does not align with the ethical practice of APN practice, the APN may take several actions that conform to the code of ethics. An example can be a case where continued pregnancy is likely to make a heart condition to worsen and result in life-threatening emergency. The best thing to do is to terminate the pregnancy which is against the law but conforms to the ethical practice of putting the life of the patient first. In this case, the nurse can take several actions. The first action may be to seek professional advice from a nursing body like the American Nurses Association. The second action may be to explain to the patient to understand the condition and make an informed decision on whether to continue the pregnancy or seek an abortion. The third action may come after solving the case and may involve advocating for changing the law to allow for abortion in such cases. Advocacy can help in health policy reforms (Smith et al., 2019)
References
CNNe, K. C. R. M. R. (2021). The new nursing scope and standards of practice. Nephrology Nursing Journal, 48(3), 276-278. https://doi.org/10.37526/1526-744X.2021.48.3.276
Doe, M. J. (2022). Nursing ethics embedded in nursing theoretical frameworks. Nursing Science Quarterly, 35(2), 270-272. https://doi.org/10.1177/08943184211070579 (Links to an external site.)
Smith, M. J., Thompson, A., & Upshur, R. E. (2019). Public health as social justice? A qualitative study of public health policy-makers’ perspectives. Social justice research, 32(3), 384-402. Doi https://doi.org/10.1007/s11211-019-00327-7