NURS 8002 Discussion Ethics and the DNP-Prepared Nurse
NURS 8002 Discussion Ethics and the DNP-Prepared Nurse
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.
According to Henly et al. (2015), nursing is a research-based profession that builds on the practice of its science. Therefore, one would agree that both degrees are terminal degrees where one focuses on clinical practice and research and analysis. The Doctor of Nursing Practice (DNP) and the Philosophy in Nursing degree (Ph.D.) engage in leadership and collaboration where science and practice are required to provide high-quality care. Also, one can not deter that there will be challenges obtaining a degree at this highest level. Still, it is essential to strive for excellence and be role models within the profession to participate in forums and enhance performance matrixes to improve the quality of patient care. One would agree that mental health has its challenges, but it is crucial to understand the individual despite their conditions. The topic of crisis prevention intervention (CPI) is essential within the healthcare setting because it provides a basis for all personnel to engage and intervene safely with the mental health specialty while striving to improve the quality of care for this patient population. One needs to consider engaging with departments such as; quality control, nursing leaders, and educators to prepare the role out of a crisis prevention program within the facility. In conclusion, the role of the DNP is to scope areas or topics that need improvement and identify how to improve clinical practice supported by evidence-based research.
References
Henly, S. J., McCarthy, D. O., Wyman, J. F., Alt-White, A. C., Stone, P. W., McCarthy, A. M., Heitkemper, M. M. (2015). Emerging areas of nursing science and PhD education for the 21st century: Response to commentaries. Nursing Outlook, 63, 439–445.
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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.
To prepare:
- 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!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 10 Discussion Rubric
Post by Day 3 of Week 10 and Respond by Day 5 of Week 10
To Participate in this Discussion:
Week 10 Discussion
What’s Coming Up in Week 11?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will consider the role of the DNP-prepared nurse as an advocate for promoting positive social change.
Next Week
Module 5: Ethics and Issues for Social Change Advocacy
Ethics and the application of ethical principles is of supreme importance in nursing practice and healthcare delivery. So much of what nurses and healthcare professionals do daily stems directly from an ethical point of reference or frame. Providing patient care and ensuring patient safety while enhancing quality and diminishing costs are all well-intended and ethical practices that you likely already engage in your nursing practice. A strong ethical awareness and adherence to ethical guidelines is just one way you will positively impact your patients in your role.
What’s Happening This Module?
Module 5: Ethics and Issues for Social Change Advocacy is a 2-week module—Weeks 10–11 of the course—in which you examine the role of the DNP-prepared nurse in upholding and abiding by professional standards for the delivery of ethical nursing practice. You will also reflect on how the role of the DNP-prepared nurse is central to social change advocacy for the improvement of healthcare and nursing quality, the positive impact on patient outcomes, and positive impacts on the community as a whole. In Week 10, you will review resources that highlight potential ethical issues in healthcare and nursing practice. You will engage with your colleagues in a Discussion that will focus on the significant ethical issues you reviewed that are relevant to the DNP-prepared nurse. In your Blog Assignment for Week 11, you will consider how you anticipate enacting a personal and professional commitment toward social change advocacy as a DNP-prepared nurse.
| What do I have to do? | When do I have to do it? |
| Review your Learning Resources | Days 1–7, Weeks 10 and 11 |
| Discussion: Ethics and the DNP-Prepared Nurse | Post by Day 3 of Week 10 and respond to your colleagues by Day 6 of Week 10. |
| Blog: Positive Social Change and the DNP-Prepared Nurse | Post by Day 3 of Week 11 and respond to your colleagues by Day 6 of Week 11. |
Go to the Week’s Content
Week 10: The Doctorally Prepared Nurse: Ethics
What does it mean to uphold ethics in advanced nursing practice? What strategies and considerations are important for ensuring the ethical and safe delivery of healthcare as a DNP-prepared nurse?
This week, you will examine ethical issues relevant to the role of the DNP-prepared nurse. You will explore ethical issues you may likely encounter in nursing practice and reflect on potential strategies to mitigate ethical violations in practice.
Learning Objectives
Students will:
- Analyze ethical issues related to the role of the DNP-prepared nurse
- Analyze ethical issues encountered in professional nursing practice
Learning Resources
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Required Readings (click to expand/reduce)
Working in the transitional care unit hospital, I have witnessed numerous of re-admissions from outpatient procedures and inpatient. Re-admit issues are patients not adhering to discharge plans, medication adherence, and not showing up to follow-up appointments. Lack of not adhering to discharge plans patients sometimes develop an infection at the procedure sites, which causes longer recovery time for patients. Also, not adhering to medication regimens could lead to adverse drug events. Hospital re-admit is associated with adverse patient outcomes and results in high financial costs. Due to the increased cases of hospital re-admit for both inpatient and outpatient procedures, Medicare and Medicaid Services have penalties hospitals/providers for their 30-days re-admit rates based on reimbursement fees.
Some intervention that could help reduce re-admit of patients and aligning the AACN Essentials of DNP are:
Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking – DNP-prepared nurses could help reduce re-admit of patients by employ principles of business, finance, economics, and health policy to develop and implement effective plans for practice-level and system-wide practice initiatives that will improve the quality-of-care delivery. Analyze the cost-effectiveness of practice initiatives accounting for risk and improvement of health care outcomes (AACN, 2006). An example of essential II, DNP-prepared nurses could implement a transitional care process adhering to Medicare and Medicaid concerns about re-admit and hospital/provider penalties cost. Transitional care processes are designed to prevent re-admit by conducting teach-back methods (checking comprehension of information learned). The patient or caregiver demonstrates what they have learned in their plan of care information to the nurse. Another intervention is the implementation of a discharge checklist- this is where nurses go over with patients before discharging a patient’s living situation, need for prosthetic items, need for home health, availability of a caregiver, transportation needs to go to follow-up appointments. Also, medication reconciliation before discharge- this is where medications are reviewed before discharge to ensure that all medication changes (new medication, dose change on previously prescribed medication, and elimination of medication) are accurate in patient’s medical records (Pugh et al., 2021). These interventions could help reduce the cost of re-admit issues in outpatient procedures and inpatient.
Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes Employ effective communication and collaborative skills to develop and implement practice models, peer review, practice guidelines, health policy, and standards of care (AACN, 2006). An example of essential VI is where DNP- prepared nurses collaborate with other team members to help prevent patients re-admit. Some interventions include communicating medical plans in front of patients during physician team rounds. Discussions are held in the patient rooms and engaging patients regarding discharge treatment plans involving physician teams, nurses, and other team members. Another intervention is collaborating with staff routinely to assess patients for rehabilitation services during discharge planning to PT/OT at home, PT/OT outpatient, inpatient rehabilitation, or SNF (Pugh et al., 2021).
Reducing the number of patient falls on a medical/surgical hospital floor.
Other issues that I have witnessed in the hospital are high fall incidence in the med surg floors. Patient falls and re-admit are two of the biggest Centers for Medicare and Medicaid Services list of non-reimbursable events in the hospital. Patient falls on the hospital floors are problematic safety concerns that can be prevented with the correct intervention protocol. Falling can range from minor bruises and abrasions to more severe results such as fractures, lacerations, head injuries, and even death. Some patients are not even aware of being identified as fall risk patients while in the hospital (Cuttler et al., 2017). Fall risk identification should be placed on patients’ communication board in the room, place a yellow wristband on patients, and place a fall risk sign on the outside door of patients to help prevent falls on the hospital floor. Also, making sure on staff shift, patients bed exit alarm are turned on.
Some intervention that could help reduce patient falls in hospital floor and aligning the AACN Essentials of DNP are:
Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care. Design, select, use, and evaluate programs that evaluate and monitor outcomes of care, care systems, and quality improvement, including consumer use of health care information systems (AACN, 2006). Using essential IV to prevent patient falls in the hospital setting is critical. DNP-prepared nurses could implement fall risk interventions such as using the bed exit alarm alerting nurses when a patient attempts to get out of bed. While the bed exit alarm is integrated into the patient’s bed, staff can ensure the patients belonging are at arm’s reach. Also, using the patient’s electronic health records (EHR) to document fall risk intervention conducted on staff shift. Implementing bed alarms on, offering toileting, and remaining with the patient when they are out of bed can help reduce falls in the hospital setting
Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes. DNP-prepared nurses could collaborate with staff and patients on the importance of adhering to fall intervention in the hospital. Some interventions to help prevent falls in the hospital are having in place a fall safety agreement. This agreement included the patient being educated on fall risk prevention strategies and acknowledging that falling can cause serious injuries. Also, conducting an in-service staff safety huddle during shift change. In safety huddles, the staff are instructed to ensure all patients receive the fall prevention education, fall risk health assessment, and documented and a signed patient fall safety agreement upon admission or transfer to the unit. Also, collaborating with staff to ensure high-risk fall patients are provided with nonskid socks, gait belts, and yellow wrist bands are all safety interventions to reduce patient fall risk on the hospital floor (Bargmann & Brundrett, 2020).
Kind Regards,
Reference
American Association of College of Nursing. (2006). The esstenial of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety. Oxford University Press, 185(2), 28-34. https://doi.org/10.1093/milmed/usz411
Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119
Pugh, J., Penney, L., Noel, P., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., & Leykum, L. (2021). Evidence based processes to prevent readmissions: more is better, a ten-site observational study. BMC Health Serv Res, 29(89). https://doi.org/10.1186/s12913-021-06193-x
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
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_8002_Week10_Discussion_Rubric
| Excellent
90%–100% |
Good
80%–89% |
Fair
70%–79% |
Poor
0%–69% |
|||
| Main Posting:
Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. |
40 (40%) – 44 (44%)
Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. |
35 (35%) – 39 (39%)
Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. |
31 (31%) – 34 (34%)
Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. |
0 (0%) – 30 (30%)
Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. |
||
| Main Posting:
Writing |
6 (6%) – 6 (6%)
Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
5 (5%) – 5 (5%)
Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
4 (4%) – 4 (4%)
Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. |
0 (0%) – 3 (3%)
Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. |
||
| Main Posting:
Timely and full participation |
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation. Posts main Discussion by due date. |
8 (8%) – 8 (8%)
Meets requirements for full participation. Posts main Discussion by due date. |
7 (7%) – 7 (7%)
Posts main Discussion by due date. |
0 (0%) – 6 (6%)
Does not meet requirements for full participation. Does not post main Discussion by due date. |
||
| First Response:
Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
||
| First Response: Writing |
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
||
| First Response: Timely and full participation |
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
3 (3%) – 3 (3%)
Posts by due date. |
0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
||
| Second Response: Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)
Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting. |
7 (7%) – 7 (7%)
Response is on topic and may have some depth. |
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth. |
||
| Second Response: Writing |
6 (6%) – 6 (6%)
Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)
Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)
Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)
Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. |
||
| Second Response: Timely and full participation |
5 (5%) – 5 (5%)
Meets requirements for timely, full, and active participation. Posts by due date. |
4 (4%) – 4 (4%)
Meets requirements for full participation. Posts by due date. |
3 (3%) – 3 (3%)
Posts by due date. |
0 (0%) – 2 (2%)
Does not meet requirements for full participation. Does not post by due date. |
||
| Total Points: 100 | ||||||