Introduction
Nurse leaders are faced with difficult decisions every day; many involve ethical, moral and legal considerations. The purpose of this paper is to discuss the frameworks leaders use to guide them in decision-making processes that affect patients and staff. One situation is outlined that illustrates the use of ethical principles to formulate a decision to meet the needs of a patient. The influence of this writer’s leadership style and the implication this style had in the decision-making process is described.
Ethical Frameworks and Principles
Ethical frameworks assist managers during the decision-making process. Complex decisions can create moral distress. Moral distress occurs when an individual encounters a situation which
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requires a decision that may be in contrast to that person’s moral compass. The issue may go unresolved or is resolved in such a way as to cause a feeling of disquiet or unease (Woods, 2014). The utilization of an ethical framework can help the leader separate personal beliefs and values to formulate a decision that is legal, moral, ethical, and decreases the risk of moral distress. According to Marquis and Huston (2015), there are four basic ethical frameworks.
The frameworks are (a) utilitarian, (b) rights-based reasoning, (c) duty-based reasoning, and (d) intuitionist. The utilitarian framework infers that decisions should be for the greater good. In other words, the decision made should take into consideration the needs of a group versus that of an individual. Conversely, rights-based reasoning is more concerned with one person's rights. Duty-based reasoning focuses on the rights of the people and a caregiver’s duty to maintain these rights. Lastly, the intuitionist framework is based on the decision maker's feelings and instincts about a situation. It is the individual’s intuition that drives the decision. In addition to frameworks, there are ethical principles. The nursing profession is based on a group of ethical principles. As nurses, we strive to promote good (beneficence) and to do no harm (non-maleficence). Nurses support patient autonomy and self-determination. Society expects that nurses will be trustworthy, respectful and act with integrity (fidelity and veracity). Nurses have an obligation to tell the truth and treat patients fairly and equally; and, deal with them with respect and dignity (justice). These ethical principles, in addition to the ethical frameworks, help us, as leaders, to make the right decisions at the right time in all situations. The situations may be patient or staff-centered; ultimately, all healthcare …show more content…
decisions effect patients. Dilemma Nurse leaders are responsibility for ensuring that subordinates follow organizational values and expectations. Additionally, a nurse leader is indirectly responsible for the care provided to patients by subordinates. Frequently subordinates look to the leader to assist with decisions that involve ethics, policies, and legislation. The dilemma this writer has chosen to outline includes a vulnerable adult with a complex medical, social and psychological history. The patient has been at the hospital for many weeks. She has made poor choices in her life that have created a life-limiting, health condition for her. Her significant other reportedly provided the patient with illicit narcotics before admission to the hospital, and he has a history of illegal drug activity. Unfortunately, the patient is unable to go home due to the unstable home situation and limited support system. The healthcare team, along with the patient, decided that it would be in her best interest to transition to a long-term care facility. Unfortunately, she was declined by all facilities in the state of Vermont. The reason she was not offered admission was her significant other's involvement and his history of providing her with illicit substances before admission. The facilities feared he would continue to provide substances to her in their facility. The patient’s care team approached me asking for advice on how to deal with the situation. Utilizing rights-based reasoning the patient has the same right as all other patients to receive the right care in the right location. The individual’s past should not be a deciding factor, nor should the activities of the significant other be taken into consideration by the extended care facilities. The ethical principle involved with this decision is justice. Ultimately, the healthcare team and this writer felt the need to advocate for the patient to ensure her right to long-term care was met. It was apparent that this writer needed to meet with the local facilities to support the patient and advocate for her right to receive care. According to Disch (2014), the purpose of advocacy is to obtain a goal by employing strategies positively to influence others in the support of a cause. An additional component of this situation involved the legalities of a potential discriminatory action by the external facilities. According to Newson (2011), discrimination involves unfavorable actions taken by others, due to a perceived difference as a result of an individual's cultural, psychological or medical circumstances. In the previously mentioned situation, it could be inferred that the patient was being discriminated against because of her past behaviors and the reported actions of her significant other. This writer met with the external facilities to advocate for the patient and to determine if the facilities had the correct information. The ultimate goal was to encourage the facilities to reconsider their decision. One facility was willing to engage in a conversation with me. The facility stated that they were concerned about the welfare of the other patients in the facility, and they needed assurance that the significant other had not created any problems at the hospital. The leader of the facility had made the original decision by using a utilitarian framework. After a long conversation, the facility agreed to review and accept the patient, if the hospital would ensure the patient had long-term financial coverage in place. The social work and case management team have worked diligently to make this happen. Hopefully, the patient will be transferred to this external care facility in a few days. Personal Leadership Style An additional component that leaders must take into consideration during the decision-making process is the leader’s personal leadership style.
According to the Keirsey Temperament Sorter (n.d.), my personality type is that of a guardian. The guardian is someone who likes structure, order, and rules. The personality type guardian was conducive to the previously mentioned scenario. To fulfill the role as patient advocate one must know what rights patients have and which rules society should follow. The patient has the right to receive care in the correct location and has the right not to be judged by past behaviors, nor the behaviors of her significant other. It is imperative that hospitals and facilities abide by societal and governmental rules and laws that require us to protect individuals. Justice is one of the fundamental ethical principles, implemented as a guideline for ethical reasoning, by the individuals utilizing either a utilitarian or a rights-based ethical framework (Marquis & Huston, 2015). It 's hard to state whether someone with a differing personality type would have had the same outcome. In this situation it was the rights, rules, advocacy and justice that swayed the decision of the external care facility; thereby, ensuring the patient was receiving equal
consideration. Values, knowledge, skills and personal leadership style assist leaders in ensuring patients receive the best care (Laureate, 2012). We, leaders, are servants to patients, staff, and organizations, and have a responsibility to ensure our decisions are non-judgmental, ethical, moral and legal to all populations at all times. Conclusion Nurse leaders have the responsibility to ensure the best care is provided to patients at all times. Through the use of ethical frameworks and principles, leaders can uphold their responsibility to patients and staff. When a leader is involved in ethical decision-making practices, it is critical that the leader has self-awareness of their leadership style and have the ability to separate personal beliefs and values from the situation at hand, to prevent moral distress and maintain the authenticity of the decision made. We are faced with difficult decisions every day. It is imperative that we utilize the tools available to us to ensure we continue to preserve the integrity of the nursing profession and sustain society’s faith and trust in nurses to do the right thing at the right time.
During week 4, we became familiar with the application of ethics in the nursing practice settings. We learned about ethical theories and principles, which are crucial when practicing in any clinical settings during ethical decision-making and while facing one or multiple ethical dilemmas. Also, we were introduced to the MORAL model used in ethical decision – making progress. The MORAL model is the easiest model to use in the everyday clinical practice, for instance at bedside nursing. This model can be applyed in any clinical settings and its acronyms assist
Planning included reaching out to other health organizations, objectives, and goals of health fair were established. The implementation includes getting volunteers, set up for the health fair. The evaluation of the process occurred throughout the implementation and changes were made as needed. The evaluation will be completed by gathering information from health booth to determine the number of participants. Review vendor and participant evaluations about the health fair including how they heard about the health fair, ratings of booths and suggestions for improvements. Record everything to determine changes. Reflection on past experiences and what worked and did not work.
Since you examined the number of moral issues you will face in this profession, look through the code of ethics that you chose for this assignment and explain
In the medical profession, doctors and nurses run into ethical dilemmas every day whether it be a mother who wants to abort her baby or a patient who has decided they want to stop cancer treatment. It is important for the nurse to know where they stand with their own moral code, but to make sure they are not being biased when educating the patient. Nurses are patient advocates, it is in the job description, so although the nurse may not agree with the patient on their decisions, the nurse to needs to advocate for the patient regardless.
Nurses everywhere face problems and challenges in practice. Most of the challenges occur due to a struggle with the use of ethical principles in patient care. Ethical principles are “basic and obvious moral truths that guide deliberation and action,” (Burkhardt, Nathaniel, 2014). Ethical principles that are used in nursing practice include autonomy, beneficence, non-maleficence, veracity, confidentiality, justice, and fidelity. These challenges not only affect them, but the quality of care they provide as well. According to the article, some of the most frequently occurring and most stressful ethical issues were protecting patient rights, autonomy and informed consent to treatment, staffing problems, advanced care planning, and surrogate decision making (Ulrich et. al, 2013). The ethical issue of inadequate staffing conflicts with the principle of non-maleficence.
This paper will focus on two BNUR leaner outcomes (University of Calgary, 2013) relevant to my learned understanding of nurses as ethical decision makers. I will outline the ways that I have seen ethics used and not used in practice, what I learned about ethics and its use in my theory courses and throughout my practicums, and I will reflect on how this understanding will translate into my professional practice moving forward.
Ethical principles are judgments that serve as a basic justification for the ethical evaluation of one’s action. They are the viewpoints from which guidance can be obtained along the pathway to a decision. According to the Journal of the American Nurse Association, ethical principles are the general goals that each theory tries to achieve in order to be successful. The widely accepted prima facie ethical principles are; Autonomy, duty to respect one’s right. Beneficence, the desire to do good. Non-maleficence refers to avoidance of harm or hurt. Justice, duty to treat one fairly. (Beauchamp, 2004). While some of the ethical dilemmas includes: ensuring informed consent, determining decision-making capacity, promoting advance care planning, surrogate decision-making, withdrawing and withholdi...
Since ethical dilemmas are not always easily answered through the use of The Code of Ethics, ethical decision-making models are effective tools that can assist nurses in dealing with ethical issues. Ethical decision-making models provide a framework for working through difficult choices. They seek to define the limits of what is morally acceptable and help clarify the guidelines for making those difficult decisions. Ethical decision making models assist nurses in analyzing situations by focusing on understanding the patient needs, need for responsiveness to circumstantial considerations, and recognizing the uniqueness of each situation.
Providing the steps to ethically sound excellent care, healthcare providers must acknowledge first the legal and ethical matters involved with proper investigation and then devise a plan for best possible action recognizing the rights of the patient and its benefits followed by the application of the chosen intervention with positive outcome in mind (Wells, 2007). Delivery of excellent and quality of care at a constant level (NMC, 2008) must be marked in any responsibilities and duties of the care provider to promote exceptional nursing practice. Codes of nursing ethics and legal legislation have addressed almost all the necessary actions in making decisions in consideration to the best interest of the patient. Nurses must make sure that they are all guided by the set standard to lead their action and produce desirable and ethically sound outcomes.
Deontology is an ethical theory concerned with duties and rights. The founder of deontological ethics was a German philosopher named Immanuel Kant. Kant’s deontological perspective implies people are sensitive to moral duties that require or prohibit certain behaviors, irrespective of the consequences (Tanner, Medin, & Iliev, 2008). The main focus of deontology is duty: deontology is derived from the Greek word deon, meaning duty. A duty is morally mandated action, for instance, the duty never to lie and always to keep your word. Based on Kant, even when individuals do not want to act on duty they are ethically obligated to do so (Rich, 2008).
The word ethics is derived from the Greek word ethos, which means character (1). Being moral always fills a nurse with morals respects, guidelines of good judgment and expert lead. There are three essential obligations for nurses, among many other which are the duty of autonomy, confidentiality, and obligation of care to all patients (2). There are professional duties with becoming distinctly legitimate obligations if any law and policies are ruptured in between professional practice. In 2001, a review found that there was an apparent requirement for more guidance on moral predicaments inside the medical professionals, subsequent to expanding legal cases and open request (3). Medical attendants ought to withstand to regulatory law and statutory law while managing the nursing practice.
Before Nightingale, nurses were lower class citizens that were alcoholics or prostitutes with no to a little education. Florence Nightingale realized that nurses ought to have some education in caring for others and be of a higher class. In 1860, she opened the first nursing school in London that did not accept prostitutes and alcoholics. To signify Nightingale’s view of nursing, Lystra Gretter composed a Hippocratic Oath for nurses called the Nightingale pledge.
The American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
In every nurse's career, he or she will face with legal and ethical dilemmas. One of the professional competencies for nursing states that nurses should "integrate knowledge of ethical and legal aspects of health care and professional values into nursing practice". It is important to know what types of dilemmas nurses may face
Another huge ethical topic is the patient’s right to choose autonomy in the refusal of life-saving medicine or treatment. This issue affects a nurse’s standards of care and code of ethics. “The nurse owes the patient a duty of care and must act in accordance with this duty at all times, by respecting and supporting the patient’s right to accept or decline treatment” (Volinsky). In order for a patient to be able make these types of decisions they must first be deemed competent. While the choice of patient’s to refuse life-saving treatment may go against nursing ethical codes and beliefs to attempt and coerce them to get treatment is trespass and would conclude in legal action. “….then refusal of these interventions may be regarded as inappropriate, but in the case of a patient with capacity, the patient must have the ultimate authority to decide” (Volinsky). While my values of the worth of life and importance of action may be different than others, as a nurse I have to learn to set that aside and follow all codes of ethics whether I have a dilemma with them or not. Sometimes with ethics there is no right or wrong, but as a nurse we have to figure out where to draw the line in some cases.