NSG/426 Integrity In Practice: Ethic And Legal Considerations
NSG/426 Integrity In Practice: Ethic And Legal Considerations. Post 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to classmates or your faculty member. Substantive responses offer new info and add to the conversation. *Responses are substantive by incorporating literature to support statements. Use one literature resource for your weekly response and in your replies to a classmate or faculty. You can use the exact source of literature each time or different sources. Check the NSG/426 Integrity In Practice: Ethic And Legal Considerations rubric for more details.
Due Thursday
Read the “ethical drift” section in Chapter 47 of Essentials of Nursing Law and Ethics.
Respond to the following in a minimum of 175 words:
- Describe an example of ethical drift that you have witnessed in your nursing practice. How was the situation addressed? Or was it?
- After taking this course, what will you do if and/or when you encounter an ethical drift in the future?
Due Monday
Post 2 replies to classmates or your faculty member. Be constructive and professional.
Integrity In Practice: Ethic And Legal Considerations NSG/426
Kathleen Lozano MSN, RN, CPHRM
Week 5
1
You must remember that some things legally right are not morally right.
– Abraham lincoln
Course Description
This course addresses legal and ethical aspects of the professional nurse’s role in health care delivery and management. Topics include ethical and legal principles, ethical decision-making, standards of care, scope of practice, state Nurse Practice Acts, and Code of Ethics.
Course Objectives
Explain legal issues and regulations that affect nursing practice.
Explain ethical considerations that affect nursing practice.
Analyze legal and ethical responsibilities in nursing practice.
4
Week 5 Topic
This week focuses on exploring legal and ethical considerations in nursing practice.
Discussion of current legal and ethical issues is the week’s primary focus.
Discussion Question
Read the section on “ethical drift” in Chapter 47 in the textbook.
Describe an example of ethical drift that you have witnessed in your nursing practice. How was the situation addressed? Or was it?
After taking this course, what will you do if and/or when you encounter an ethical drift in the future?
Health care – a right or a privilege?
4 health care system fundamental goals
Quality health care
Freedom of choice
Affordable health care
Citizens to share in costs and benefits of health care
Health care is a universal right
(see article by Sorrell, “Ethics: The Patient Protection and Affordable Care Act: Ethical Perspectives in 21st Century Health Care” from the University library)
4 health care system fundamental goals
Quality health care
Freedom of choice
Affordable health care
Citizens to share in costs and benefits of health care
Health care is a universal right (see Provision 8 of ANA Code of Ethics)
Sorrell (2012, para 3)
“Provisions in the act are designed to expand insurance coverage, control costs, and target prevention (Gable, 2011).
One of the primary targets is adults aged 19-64, since their access to health care and use of health services deteriorated between 2000 and 2010, particularly among those who were uninsured (Kenney, McMorrow, Zuckerman, & Goin, 2012).
The PPACA includes reforms such as prohibiting insurers from denying coverage for pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, and providing incentives for businesses to provide health care benefits.
Insurance companies will no longer be able to drop clients when they become ill.
The act has the potential to improve health outcomes across all income and age groups at a reduced cost. It may end up saving thousands of lives, as suggested by a recent study in which researchers found a 6 % drop in the adult death rate in three states that expanded coverage for low-income residents along the general lines of the PPACA, preventing one death per year for every 176 adults covered under expanded Medicaid (Sommers, Baicker, & Epstein, 2012).
But in spite of these positive anticipated outcomes, the June 2012 Court decision that paved the way for implementation of the law has left the American public still sharply divided on the issue.”
7
Discussion question
Why is healthcare not everyone’s right, or is it?
Poor people
Children
Pregnant women seeking abortion services
Older but not yet 65 (Medicare age)
Working poor (ages 26-?)
Changing jobs
Recently unemployed
Mental Health
Gender dysphoria
Sorrell (2012, para 13)
Efforts to reform the U.S. health care system have largely avoided the language of human rights (Gable, 2011).
When access to quality health care is perceived as a right, and not just an option or privilege, health care reform embodies greater moral gravity.
The PPACA changes the social contract, establishing a new norm that moves toward universal health insurance with a subtext that everyone deserves access to basic health care (Gable, 2011).
It is interesting to note that this same mandate for “the right to adequate medical care and the opportunity to achieve and enjoy good health” was articulated already by Franklin Roosevelt in the “Second Bill of Rights” outlined in his 1944 State of the Union address (USHistory.org, 1944/2012).
8
Break
Always schedule breaks!
9
Civility/harassment
Sexual harassment
Suspected violence against a patient
Health care practitioner violence against patient
Lateral Violence
Violence against health care workers
Sexual harassment (text chapter 41)
Definition and types have changed over time, especially after the “MeToo” movement began
Quid pro quo
Hostile work environment
Flirting can be misconstrued
Employer liability- extends to harassment by employees or contractors
Suspected violence against a patient (text chapter 42)
Mandatory reporting
Duty to protect patient
Health care practitioner violence against patient- criminal behavior
Physical/verbal abuse
Rough handling
Forcing patient to take medications
Lateral Violence AKA horizontal violence
Physical/verbal abuse
Bullying, intimidation, threatening behaviors
Reportable to leadership who is required to intervene
Violence against health care workers by patients/families is on the rise
Physical/verbal abuse
Mental health component to consider
Protect yourself from unforeseen violent behavior
Take threats seriously
Call security early and as often as needed
10
Impact of technology
Genetics/genomics
Social media
Genetics/genomics
Social media (text chapter 48)
Consequence of using social media
RNs held to high standards, even as nursing students
Be aware of how your posts may be viewed by employers or colleagues
PCA test for your posts: pause/process, choices, accountability
11
New uses for recreational drugs
Marijuana: medical and recreational use
MDMA (Ecstasy/Molly) use in PTSD treatment
Impaired RNs in the workplace
Marijuana: medical and recreational use my not apply to RNs
Determining how should use by health care providers be regulated or even allowed?
Impact on ability to practice/professional licensure- your employer and/or state may have special rules for drug use for healthcare workers which may be stricter than state laws for general public
MDMA (Ecstasy/Molly) use in PTSD treatment
Impaired nurses (text chapter 40)
An average of 10% of healthcare workers abuse substances (maybe 1-2 students in this class may have problems with alcohol or drugs)
This includes typical opioids and other types of drugs, but can include prescription drugs and alcohol
Common causes of addiction include: low self-esteem, job stress, chronic pain from the job, sense of powerlessness, and others
Boards of Nursing have diversion programs for treating impaired nurses which may be an option if RNs request
CA has a 3-year program for those that self-report to BRN.
Adverse patient outcomes while an RN is under the influence will not be covered by malpractice insurance, will be reported to Board of Nursing, and often become legal cases where nurses are charged for the patient injury.
Stealing medications from your workplace will include other criminal charges and result in stiff penalties to the facility and very close oversight.
12
Moral courage and advocacy
Definitions related to moral responsibility
Ethical drift
Patient advocacy legal and ethical framework
Strategies to promote moral courage
CODE
Ethical culture
Whistle-blower protection
Moral resilience
Definitions related to moral responsibility (see figure 47-1 on page 310 of textbook chapter 47)
Ethical drift
Unethical behavior becomes justified over time, often without your awareness
Undermines moral and ethical principles
Compromises high quality and safe patient care
Fosters a culture of acceptance of bad principles
Patient advocacy legal and ethical framework
Strategies to promote moral courage: CODE
Courage
Obligation to honor
Danger management
Expression (beliefs and action)
Ethical culture
Whistle-blower protection
Moral resilience or courage
Standing up for what is right every time will be easier as time goes on
Always considering the ethical principles even in the face of personal risk
Understanding that moral dilemmas occur, but that using ethical decision-making model is a validated standard to follow.
Apathy or certain organization cultures may prohibit the appropriate care and treatment
Always consider your license and being able to defend your actions to the Board of Nursing, patient/family, or in court of law.
13
Review weeks 1-5
Week 1: Legal Concepts in Nursing
Week 2: Regulatory Drivers of Nursing Practice
Week 3: Ethical Principles for Nurses
Week 4: Legal and Ethical Responsibilities and Accountability
Week 5: Current Legal and Ethical Issues in Health Care
Week 1 Topic: Legal Concepts in Nursing
Week 2 Topic: Regulatory Drivers of Nursing Practice
Week 3 Topic: Ethical Principles for Nurses
Week 4 Topic: Legal and Ethical Responsibilities and Accountability
Week 5 Topic: Current Legal and Ethical Issues in Health Care
14
What’s next?
HSN/476
HEALTHCARE POLICY AND FINANCIAL MANAGEMENT
Healthcare is a business of providing care to the community. Where does the money come from and where does it go? What is the profit margin at the end of the fiscal year that your facility has to use for raises, improved technology, construction, and other business expenses?