Ethical Decision-Making

Let’s return to the ethical scenario presented within Page 2 of the Explore section of Week 4 to consider it further. 

* [clinical scenario. You are the Chief Nursing Officer of a regional acute care facility in the Midwest. You have just been notified that one of your senior nurses with 16 years of experience provided a 2-year-old with the incorrect medication causing the child’s death. The parents of the child are non-English speaking immigrants unfamiliar with American law.]

Upon learning that a medication error occurred resulting in a child’s death, the Chief Nursing Officer (CNO) of a regional acute care facility held a press conference to announce the mistake. The conference centered on reporter questions about why the nurse was not fired. The CNO explained that the nurse was highly regarded and that the problem was a “system” problem, not simply a problem of an incompetent nurse. The CNO also explained that an examination of the medication administration procedures was ordered and that an electronic medication error avoidance system would be implemented to ensure that such an error would not happen again. Consider this scenario to address the following:

• As the CNO in the scenario, defend your decision to disclose the incident to the media. How does this decision influence value-based healthcare? What risks might you encounter? What impact might this decision have on you personally and professionally?
• At a regional health consortium, fellow CNOs remark that they would not disclose such an incident to the media. Provide two justifications for withholding disclosure of the error to the public. How does this decision influence value-based healthcare?
• Imagine you are the patient’s family. How would you want the issue to be handled by the CNO? Explain your rationale. 

Instructions:

Use an APA 7 style and a minimum of 200 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA7 style standards apply. 

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used.

Attached is the week lecture relate to the subject.

Week lecture

Ethical Theories and Practice

Ethical principles inform our sense of moral obligation and responses to ethical dilemmas. These include principles of (a) autonomy, (b) beneficence, (c) confidentiality, (d) fidelity, (e) nonmaleficence, and (f) veracity. In addition, two competing leadership paradigms of ethical comportment that have emerged in recent healthcare are the Ethic of Care versus the Ethic of Justice (Sorbello, 2008). It is typically the competing values, both of which may be morally correct, that result in an ethical dilemma or conflict. Barbara Sorbello (2008) synthesized this ethical foundation for nurse leaders in her landmark discussion of Ray’s theory about these dichotomous Ethics.

Thus far in your DNP studies, you have learned the scientific foundations of epistemology (what is true), ontology (what is real), and axiology (what is good). As a DNP-prepared nursing leader and practice scholar, you must exercise the knowledge, skills, attitudes, and integrative abilities that will drive transformational change in healthcare. Your role will be one of promoting high-quality and cost-effective care in order to facilitate the health and well-being of your population of interest, whether it be individuals, families, or other aggregate groups.

To further understand the DNP role in axiology (what is good), it is necessary to consider one’s values and their impact on the moral dimension of advanced nursing practice (Russell, 2014). Unfortunately, nurses may mean well, but still be found at fault when it comes to ethical dilemmas (Sorbello, 2008; Zaccagnini & White, 2014). While the DNP-prepared nurse must function in a conscientious manner, attention to ethical codes of conduct and standards of care must be upheld (Chism, 2016). Most discussions of ethical theory have their roots in deontology (formalism) and utilitarianism (Flip et al., 2016).

Transcript

Deontology has its beginnings in the writings of Immanuel Kant (1724-1804) and refers to a moral duty to do what is right. This is a different perspective from utilitarianism, which has its roots in the writings of John Stuart Mill (1806-1873), and refers to doing the greater good in that what is right may be viewed as a means to an end. More recently, virtue ethics, or virtue-based ethics, approaches ethical decision-making through the individual’s character, which is shaped by learning and experience (Filip et al., 2016). This philosophical framework is one through which civility is often taught, especially in schools of nursing (Russell, 2014).

Ethic of Care versus Ethic of Justice

Ethical principles inform our sense of moral obligation and responses to ethical dilemmas. These include principles of (a) autonomy, (b) beneficence, (c) confidentiality, (d) fidelity, (e) nonmaleficence, and (f) veracity. In addition, two competing leadership paradigms of ethical comportment that have emerged in recent healthcare are the Ethic of Care versus the Ethic of Justice (Sorbello, 2008). It is typically the competing values, both of which may be morally correct, that result in an ethical dilemma or conflict. Sorbello (2008) synthesized this ethical foundation for nurse leaders in her landmark discussion of Ray’s theory about these dichotomous Ethics.

ANA Code of Ethics

Of course, one of the primary practice guidelines in ethics for DNP leaders is the American Nurses Association’s (ANA, 2015) Code of Ethics for Nurses with Interpretive Statements. The integrative literature review by Mallari and Tariman (2017) found it (along with the International code of nurses for ethics) the most frequently used ethical framework.

There are nine provisions of the code of ethics (ANA, 2015). Under each provision are sub-provisions of ethical beliefs for nurses. If the provisions were briefly restated for DNP leaders, they might look like the following list. Reflect on these as you complete your discussions and assignments for the remaining weeks of the course.

Provisions for DNP Leaders (Links to an external site.)

Ethical Dilemmas

By virtue of the definition, there is no clear right or wrong in an ethical dilemma, which results in the tensions that nurses face between patients and society or between patients and the organization. DNP-prepared nursing leaders may additionally face such dilemmas between coworkers and the profession. Ethics are further challenged by the constant change in healthcare. Just as change leads to the need for informed decision-making, the needs to protect patient rights and patient safety are also influenced by decision-making (Mallari & Tariman, 2017). We often see the tension among nurses who find themselves trapped between ethical decision making that leads them in one direction based on their personal values and another direction based on their senses of duty to patients and/or the profession. These are times when ethical theories provide guidelines for professional behavior and decision-making (Chism, 2016; Smith, 2018). Such ethical decision-making is described in the integrative literature review by Mallari and Tariman (2017), who found that nursing ethical codes were the basis of decisional processes around the world and that “professional nurses are expected to make clinical practice decisions within a professional ethical framework” (p. 55).

View the following activity to further your exploration of ethical principles and theories in the healthcare setting.

Ethical Dilemma Reflection

Now, reflect on this scenario. You are the Chief Nursing Officer of a regional acute care facility in the Midwest. You have just been notified that one of your senior nurses with 16 years of experience provided a 2-year-old with the incorrect medication causing the child’s death. The parents of the child are non-English speaking immigrants unfamiliar with American law. What action are you going to take?

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Publishing.

Balevre, S. M., Balevre, P. S., & Chesire, D. J. (2018). Nursing professional development anti-bullying project. Journal for Nurses in Professional Development, 34(5), 277-282. https://doi.org/10.1097/NND.0000000000000470

Chism, L. A. (2016). The Doctor of Nursing Practice: A guidebook for role development and professional issues (3rd ed.). Jones & Bartlett.

Czabanowska, K., Smith, T., Könings, K. D., Sumskas, L., Otok, R., Bjegovic-Mikanovic, V., & Brand, H. (2014). In search for a public health leadership competency framework to support leadership curriculum-a consensus study. European Journal of Public Health, 24(5), 850-856. https://doi.org/10.1093/eurpub/ckt158

Field, L. E. (2015). The effect of the implementation of relationship-based care on patient satisfaction. (Doctor of Nursing practice project). Walden University, Minneapolis, Minnesota. https://pdfs.semanticscholar.org/87b5/9269b773d805e5159f2b7bf6a8495bb5c609

Filip, I., Saheba, N., Wick, B., & Radfar, A. (2016). Morality and ethical theories in the context of human behavior. Ethics & Medicine: An International Journal of Bioethics, 32(2), 83-87.

Gallison, B., & Kester, W. T. (2018). Connecting holistic nursing practice with relationship-based care: A community hospital’s journey. Nurse Leader, 16, 181-185. https://doi.org/10.1016/j.mnl.2018.03.007

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Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12-25. https://doi.org/10.1097/NOR.0000000000000320

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Sorbello, B. (2008). The nurse administrator as caring person: A synoptic analysis applying caring philosophy, Ray’s ethical theory of existential authenticity, the ethic of justice, and the ethic of care. International Journal for Human Caring, 12(1), 44-49. https://doi.org/10.20467/1091-5710.12.1.44

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