Nursing Roles and Value Western Governors University Nursing Roles and Value NVT2 Competency 724. 7. 1 Ethical Leadership Competency 724. 7. 2 Continuing Competency in Nursing Marisha Grimley Course Mentor March 04, 2012 Nursing Roles and Value The purpose of this paper is to evaluate a case study addressing ethical leadership, analyzing application of standardized code of ethics on nursing practice, and discussing issues in safety for quality patient care.
This paper will support the importance of confidentiality when discussing protected patient information. In addition, the need for continuing education and training for nursing through identification of Federal and State regulations as applied to nursing practice will be addressed. The discussion will touch on how these regulations are applied in specific care settings and the professional role of nursing in the ever changing health care delivery system.
State regulation or standard of nurse practice The contemporary definition of nursing according to the Scope and Standards of Practice (2010) is: “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. ” (p. 66).
According to the Standards of professional Nursing Practice, this scenario violates nursing Standard 7 – Ethics which states: “The registered Nurse: Delivers care in a manner that preserves and protects healthcare consumers’ autonomy, dignity, rights, values, and beliefs. ” (The Standard of professional Performance, 2010, p. 47). The nurse does not follow the standards of practices leading to the several implications. When asked by Dr K. to look in the chart to determine if anyone was responsible for Mr.
E’s medical decision making, the nurse failed to inform Dr K that the patient had an Advance Directive (AD) that specified he not be placed on a ventilator or have cardiopulmonary resuscitation. By not bringing forward this information the nurse did not fulfill her duty of protecting the patient’s autonomy. She ignored the AD that Mr. E, despite being a mildly developmentally delayed, had put into place before this hospital admission. Mr. E accomplished this task with the help of the nursing home patient advocate thus providing documentation about his medical wishes.
Seven years prior, Mr. E had shown the ability to make his own health care decisions. He chose the pathway of his care by checking himself into a nursing home. The nurse assumed, because the provider had stated that the patient was hypoxic (88% room air is hypoxic), that Mr. E could not make his own medical decision. Mr. E verbalized understanding of what his progression of care would be by stating to Dr. K, shaking his head and saying “Go away! No! No! Take me home. ” In this instance, the nurse did not act as a patient advocate.
The nurse should have relayed this information to Dr. K. If Dr. K had insisted that the patient was in an impaired hypoxic state, the nurse should have reported the situation to her immediate nursing supervisor who could have intervened as a patient advocate, working to insure that the patient’s wishes be granted. The nurse’s failure to act as a patient advocate and respect Mr. E’s right to self-determination resulted in the patient being intubated and placed on a ventilator against his wishes. The nurse also failed to uphold a patient right to confidentiality.
She violated the Federal Health Insurance Portability and Accountability Act (HIPAA) confidentiality laws. The nurse did not speak up and question the provider when the patient’s wishes were being questioned, leading to the patient’s rights, values and beliefs being disregarded. Nursing Code of Ethics by ANA The nurse violated more than one provision from the Nursing Code of Ethics. One of the provisions that apply to this case study is provision 3, which states: “The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient. (Code of Ethics for Nurses, 2010, p. 16). The impact on a professional decision, according to provision 3, would be that the nurse should have provided a private place for the doctor to discuss the case with the family member. Furthermore, the nurse cannot breach the fiduciary duty of confidentiality by allowing the provider to speak with a family member that was not part of the power of attorney. As well, the nurse has to remember that it is a breach of confidentiality and trust when she speaks with others, such as colleagues in a cafeteria that are not involved with the patient’s care.
The ethical implications caused by placing Mr. E on a respirator were that the patient’s right of deciding his own path of treatment was violated. The patient Bill of Rights (Roux & Halstead, 2009) allows the patient to refuse medical treatment. Like every individual, Mr. E. has the power of controlling the type of care given to him, along with having control to make decisions that influence self without interference of others. Mr. E, through narrative ethics, had set his healthcare decision precedents. He had made his wishes known by signing an AD. Once Mr.
E was intubated further ethical considerations will surface because he may be ventilator dependent or he may die from ventilator induced complications. These possibilities would be avoided by adhering to his original AD. In order to give ethical consideration to this decision, before agreeing with his brother’s intubation and placement on the ventilator, Mr. Y should have requested that all the facts be made available to him. Through the manner in which the case scenario is presented, Mr. Y is not involved in Mr. E’s life decisions even though he is entrusted with Mr. E’s final life decisions.
Any hospitalization is a stressful situation for all parties, the patient and family. In this scenario it is even more stressful because it is a life and death decision. Mr. Y’s brother is diabetic with a history of high blood pressure. Mr. Y has to face the ethical issues of quality of life versus quantity of life in deciding to follow his brother’s wishes or not. Mr. Y most likely did not understand a lot of what was happening and may have felt that it was too heavy a decision to let his brother die if no heroic measures were taken. Mt. Y asked for his niece’s opinion, indicating Mr.
Y’s inability to make a decision. As a patient advocate, the nurse should engage in multidisciplinary support to help family understand the legal aspects and obligation of the power of attorney in making life end decisions and the legal obligations of the Advance Directives. Nurse must be firm in stressing these considerations to family so they may realize the full legal and ethical implications of their decisions. The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities.
More attention is being placed on these specific decisions to ensure that the patient’s quality of life is considered and maintained even when death may be eminent. It is necessary to keep in mind that Mr. E may have been hypoxic, but he had not shown any signs of not being able to make decisions. The scenario does not describe Mr. E exhibiting any signs of advance hypoxia, such as an altered metal state, cyanosis, tachypnea, cardiac arrhythmias or coma. Mr. E verbalized his disagreement to the procedure by saying “Go away! No! No! Take me home. ” Factors that complicate Mr. E’s advance directives
The validity of Mr. E’s AD is not in question. The State of California has a specific form for AD that describes the necessary steps for the AD to be valid. (Form: PS-X-MHS-842 Rev. 2-04). The AD may be questioned in California if the nursing home did not follow the guidelines printed on the form. It requires that a nursing home patient advocate or ombudsman, as designated by the State Department of Aging, is present to witness the completion and signing of the AD. The AD does not require the presence of a notary, but requires the presence of two witnesses who sign the AD on the same day as the person making the AD.
Mr. E is mildly developmentally delayed; a condition such as this is not a factor which would complicate his ability to have a valid AD. AD and Advance Care Planning for People with Intellectual and Physical Disabilities was addressed by the U. S. Department of Health and Human Services. (HSS, October, 2007). In 2003, a study that assessed the capability of people with a mild mental disability concluded that adults with mild retardation have the ability to provide adequate consent for their own medical decisions.
This led the American Association on Intellectual and Developmental Disabilities (AAIDD), in 2005 to take the following position regarding end of life: “Permissible treatment options at the end of life are the same for persons with intellectual or developmental disabilities as for everyone else. ” (U. S. Department of Health and Human Services, October 2007, p. 13). A factor that complicates the AD is the Power of Attorney given to his brother, Mr. Y. Mr. Y was asked to make an end of life decision for his brother, Mr. E, without the knowledge of the AD.
The case scenario notes that “no family member signed the advance directive and it is unclear if any family member were involved. ” Mr. Y was unaware of Mr. E’s AD, made seven years prior, that Mr. E did to avoid having heroic medical procedures performed on himself if should he be in a condition that precluded him from verbalizing his desires. Advance, meaning the wishes are written in advance, before the situations arise for which the wishes have made. Directives meaning giving, directing the actions of others that are empowered to make the decisions.
The lack of communication between Mr. E and Mr. Y created the stressful situation. The nurse’s decision to withhold her knowledge of Mr. E’s AD from other individuals involved in Mr. E’s care led to inappropriate treatment. HIPAA violations HIPAA is violated when information is given to anyone who does not have participation in the care of patient. Patient information can be shared by an entity for the purpose of TPO. TPO is described as release of information pertaining to patients own treatment, payment, and health care operations activities.
Knowing how protected health information can be used and disclosed, a HIPAA violation occurred in the following instances. Dr. K discussed Mr. E’s condition with his niece in front of her boyfriend and other patients. The nurse, during her dinner break, discussed patient’s medical issues with three nurses not involved in the patient’s care and requested their opinion. The nurse also violated the Code of Ethic Provision 3, which states that nurses have the duty to safeguard patient’s privacy and only share the pertinent information necessary for treatment with those who are participating in the care of the patient. Code of ethics, 2001). Professional conduct of the nurses The comments made by the nurses in the cafeteria were unprofessional, unethical and derogatory. These comments reflect that they were not conducting themselves in accordance with the nursing standards of professional practice. Nurses are not expected to feel warmth towards all human beings, but they cannot treat others with uncaring behavior to justify their feelings or their short comings.
Nurses are professionals, and as professionals, nurses are expected to move beyond feelings and provide the same care to every patient regardless of their background, level of intelligence, diagnosis or economic status. In the case study the nurses were not: 1) Participating in ongoing educational practices as evidenced by the lack of knowledge of the pre-existing is AD. The nurses did not consider the legal ramifications of not following the patient’s AD requests nor did they respect the patient’s rights to self-determination. ) Providing care in a cultural and sensitive way, as evidenced by calling the patient “retarded”. Oral defamation – calling patient “retarded” – is slander. 3) Respectful of the patient’s moral worth nor did they give dignity to the patient, in respect to his living situation by the statement “he is already in a nursing home” The Code of Ethics, an integral part of what professional nursing stands for, addresses the fact that nurses have a commitment to the well being of their patients.
It requires that nurses act as advocates by being vigilant and taking action when inappropriate dealings, such as unethical or questionable practices, are being carried out, and may jeopardize a patient’s care. It is the ethical responsibility of the nurse to report to administration the nurses’ practices and lack of knowledge and the cavalier attitude towards HIPAA. It is an integral part of nursing not to remain silent when substandard care is known and practices that do not align with the nursing code of ethics are being used.
The conduct that does not follow the nurse principles also will not align with place of work policies. These nurses should be reported to supervisors for counseling, education and corrective actions. Some issues are so severe that nurses are mandated to report offenses to authorities such as the Board of Registered Nursing, Nursing Organization, and HIPAA. In conclusion, the above case study identifies a case where several standards were compromised in protecting patients’ rights, privacy and protecting patient from harm.
Through knowledge and competency in following the Nursing Practice Act as well as the Code of Ethics, one can always ensure uncompromised patient care and safety in practice. References Board of Registered Nurse. The Registered Nurse as Patient Advocate [Regulations]. Sacramento, CA: (Reprint from the BRN Report – Winter 1987). Retrieved from: http://www. rn. ca. gov/pdfs/regulations/npr-i-11. pdf America Nursing Association (2010). In Scope and Standards of Practice (2nd edition). Silver Spring, Maryland: Nursesbooks. org. America Nursing Association (2001).
Code of ethics for nurses with interpretive statements (2001 edition). Silver Spring, Maryland: nursingbooks. org. Advance Directive Form. (PS-X-MHS-842 Rev. 2-04). Retrieved from: http://ag. ca. gov/consumers/pdf/AHCDS1. pdf Roux, G. ; Halstead, J. A. (2009). Issues and Trends in Nursing. Sudbury, Massachusetts: Jones and Bartlett Publishers. U. S Department of Health and Human Services. (October 2007). Advance Directives and Advance Care Planning for People with Intellectual and Physical Disabilities. Retrieved from: http://aspe. hhs. gov/daltcp/reports/2007/adacp. htm#who (Roux ; Halstead, 2009)
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