NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Sample Answer for NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics Included After Question

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

Required Readings (click to expand/reduce)

 

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

 

Phelan, P. S. (2020). Organizational ethics for US health care today. AMA Journal of Ethics, 22(3), 183–186. https://doi.org/10.1001/amajethics.2020.183

 

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

 

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

 

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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.

Photo Credit: ibreakstock / Adobe Stock

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.

A Sample Answer For the Assignment: NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Title:  NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

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

A Sample Answer 2 For the Assignment: NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Title:  NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Excellent ethical case study Kelly, I have experienced similar situations over the years. One, in particular, is a mother and daughter I treat now. The mom has many issues, including anxiety, depression, and is in a bad marriage. The daughter is always pleasant, and before seeing her, she was diagnosed with attention deficit and a slight learning disability. Every time mom comes in, she demands I give her something for her attitudes and behavior, which I think might stem from poor parenting, but that’s for another discussion. The girl does not exhibit any signs of anxiety, depression, oppositional defiant, or other mood disorders. Mom will tell me I have to do something because she can’t take her behaviors anymore and states this isn’t just preteens, that she has always been like this, and that the only time she behaves is at grandma’s, with whom she tries to stay with often.

I find treating teenagers to be very difficult because often they disagree with what the parent is saying, and though you are to advocate for the child, at the end of the day, the parent has a say on what happens. Teenagers though they are dependants, deserve the same human dignity as you would give to any patient. Rejno et al. (2020) state that protecting one’s dignity should be done by showing respect for a person’s identity and autonomy, which can be very difficult to uphold when the parent controls the situation.

References

Rejnö, Å., 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

A Sample Answer 3 For the Assignment: NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Title:  NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

To add onto your ethical dilemma, some of these families will have their dementia loved ones sent to the Emergency Department for evaluation or medication adjustment. We often run into the same issues when trying to educate the family on the dangers of over or under medicating their loved ones. They will feel it is necessary to admit their family members to the hospital, not understanding that a strange environment, strange people, and changes in medications will exacerbate their symptoms and often cause more harm than good.

In the acute care setting we have an ethics committee to consult and get involved in order to ensure patients are getting the best and most ethical care; however, these cases are more relevant than we even realize and they aren’t involved in every case. Unfortunately, ethics is often consulted too late and they have to help make decisions on end-of-life care versus life-saving care.

Your role is a precarious one to be in more days than not, but it sounds like you are able to remove your emotions out of the situation and truly do what is best for the patient.

Nice work!

I was in a class the other day with a paramedic that works in one of the emergency rooms. I very vaguely was discussing a patient of mine who has had multiple preventable emergency room visits. This woman, off the very vague description I gave, knew who I was speaking of. By name. I am really hoping to be able to make the changes necessary to help, at least deter, if not prevent, sending patients to the ER for behaviors

A Sample Answer 4 For the Assignment: NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Title:  NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

,

This post is very important to me and I am sorry to hear about your client. Working in mental health, I experience issues with medications quite often. I have many patients that are forced to take medications for their safety and the safety of others but that is certainly an ethical dilemma and something I struggle with. Then, there are the additional issues you bring up of family involvement as well as how much is too much or to little. I sometimes think dealing with family is harder than dealing with patients and it is hard for me to want to give them input (on certain aspects of care) because they have difficulty being subjective. I do not mean about life saving measures or anything like that but with mental health it is a challenge when they have medical power of attorney and want to medicate a family member with schizophrenia into a stupor. I consider that example and others like it to be an example of an ethical dilemma and I think it is something I should work against.

Thank you for that response. I will say, I have often had patients who have tried to utilize a power of attorney to have things done. I am really a strong advocate of my patients. I do not feel that having mild dementia or schizophrenia or other diagnosis makes a person incapable of making a choice. Guardianship is different. I actually have a patient who has schizophrenia, never treated until recently with hospital admission related to a UTI. Upon discharge, she declined further treatment. Her daughter went through all the work to obtain guardianship so she would “have” to take medications. Once she realized that in an outpatient setting, without court order, we are still unable to force medications on a person, she was so bewildered. This lady truly did/does need the help so I am glad she finally complied, she is now so much better, so I am glad her daughter was able to get her take medication.

A Sample Answer 5 For the Assignment: NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

Title:  NURS 8002 Week 10 Discussion: The Doctorally Prepared Nurse: Ethics

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.

Resources:

Olejarczyk, J. P. (2021, August 13). Patient rights and ethics. StatPearls [Internet].

NURS 8002 Week 10 Discussion The Doctorally Prepared Nurse Ethics
NURS 8002 Week 10 Discussion The Doctorally Prepared Nurse Ethics

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 Nursing66(11), 2510–2519. https://doi.org/10.1111/j.1365-2648.2010.05425.x

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Grading Rubric Guidelines

Performance Category 10 9 8 4 0
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic decisions.

  • Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions
  • Evaluates literature resources to develop a comprehensive analysis or synthesis.
  • Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion
  • Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.
  • Evaluates information from source(s) to develop a coherent analysis or synthesis.
  • Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.
  • Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.
  • Demonstrates little or no understanding of the topic.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) without any interpretation/evaluation.
  • The posting uses information that is not valid, relevant, or reliable
  • No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
  • Information is not valid, relevant, or reliable
Performance Category  10 9 8 4 0
Application of Course Knowledge –

Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations

  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;
  • Applies concepts to personal experience in the professional setting and or relevant application to real life.
  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.
  • Applies concepts to personal experience in their professional setting and or relevant application to real life
  • Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content
  • Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Does not demonstrate a solid understanding of the principles and concepts presented in the lesson
  • Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.
  • Posts are superficial and do not reflect an understanding of the lesson content
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored
  • No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category  5 4 3 2 0
Interactive Dialogue

Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.

(5 points possible per graded thread)

  • Exceeds minimum post requirements
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.
  • Replies to a post posed by faculty and to a peer
  • Summarizes what was learned from the lesson, readings, and other student posts for the week.
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days
  • Replies to a question posed by a peer

Summarizes what was learned from the lesson, readings, and other student posts for the week.

  • Meets expectations of 2 posts on 2 different days.
  • The main post is not made by the Wednesday deadline
  • Does not reply to a question posed by a peer or faculty
  • Has only one post for the week
  • Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments
  • Does not post to the thread
  • No connections are made to the topic
  Minus 1 Point Minus 2 Point Minus 3 Point Minus 4 Point Minus 5 Point
Grammar, Syntax, APA

Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

  • 2-3 errors in APA format.
  • Written responses have 2-3 grammatical, spelling, and punctuation errors.
  • Writing style is generally clear, focused, and facilitates communication.
  • 4-5 errors in APA format.
  • Writing responses have 4-5 grammatical, spelling and punctuation errors.
  • Writing style is somewhat focused.
  • 6-7 errors in APA format.
  • Writing responses have 6-7 grammatical, spelling and punctuation errors.
  • Writing style is slightly focused making discussion difficult to understand.
  • 8-10 errors in APA format.
  • Writing responses have 8-10 grammatical, spelling and punctuation errors.
  • Writing style is not focused, making discussion difficult to understand.
  • Post contains greater than 10 errors in APA format.
  • Written responses have more than 10 grammatical, spelling and punctuation errors.
  • Writing style does not facilitate communication.
  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
0 points lost       -5 points lost
Total Participation Requirements

per discussion thread

The student answers the threaded discussion question or topic on one day and posts a second response on another day. The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement

per discussion thread

The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

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