January 4, 2017
As an advanced practice nurse (APN), it is important to build confidence to confront complex moral situations, as this will reduce moral injury, distress, and burnout (Lachman, 2016). According to the American Nurses Association (ANA) (2015), nurses are caught between conflicting value systems and complex moral pressures daily. Understanding the ANA code of ethics can arm nursing with the power to handle the decisions regarding a patient care. The paper aims at creating an ethical, legal decision-making dilemma involving an APN. The paper will also include ethical principles and law, as well as decision to prevent ethical and legal violations. Further, a decision will be presented to prevent such a violation according to the principles of the ANA’s code of ethics provision one which states the nurse will practice with compassion and respect for the every person (Winland-Brown, Lachman & Swanson, 2015). Finally, a nurse practitioner should consult with the ethics committee to discuss ethically troubling situations as this is proven to reduce moral distress and provide moral perspective (Kalvemark, Hoglund, Hansson, Westerholm & Bengt, 2004).
The following scenario shall be analyzed for this paper: an 80-year-old female with Alzheimer’s disease was brought to Hackley Emergency Department in Muskegon, Michigan unconscious after a fall that occurred yesterday. She was accompanied by her common-law husband who presents with a document declaring him as medical power of attorney that is a legal document giving the spouse the authority to make medical decisions in the event of incapacitation (Kronzek & Cronkright, 2016). The social worker who did not recognize the power of attorney document to be legal reaches out to the patient`s family to determine who can make legal decisions for the patient. In the meantime, the patient is admitted to the hospital with complications related to her fall, which include pneumonia and septic shock. Moreover, the patient is in need of intubation and administration of pressors via a central line. According to the spouse, the patient would not want to receive the treatment. However, her daughter is demanding the procedures take place. The attending nurse practitioner speaks to both the daughter and gentleman, who are unable to agree on the treatment plan.
Ethical Principles and Laws
Advanced nurse practitioners have the mandate to ensure that they execute their duties in ways that are in line with the established ethical principles and laws. However, nurses are faced with an ethical dilemma in the process of discharging their duties. The case presented is one that puts the nurse in a challenging position considering that the parties expected to make the decision influencing treatment of the patient are in disagreement. Nevertheless, the nurse has to exercise caution to ensure that the patient gets the best treatment service that would be influential in improving her outcome. In doing so, it is vital that the nurse employs the existing ethical principles and laws in arriving at the decision to guide on further management of the patient.
The first principle that can be applied to the scenario is that of beneficence. The principle reiterates the need for advanced nurse practitioner to prioritize safety and ensure ultimate good for the patient as relates to the treatment outcome (Judkins-Cohn, 2013). The ethical principle is applicable at the highest level of advanced nursing considering the impact it has on the outcome of treatment. In the case presented, both the sister and husband of the patient are focused on ensuring that the best treatment results for the woman are achieved. However, the final decision made by the nurse will be dependent on an agreement reached by both parties. The advanced nurse practitioner has to ensure that she demonstrates expertise as relates to the issue for the benefit of the patient.
The second ethical principle that guides the case is that of non-maleficence. The principle identifies the need for the advanced nurse practitioner to do no harm when executing her duty (Duncan, & Nelson, 2015). Regardless of the interests portrayed by both the parties, it is the responsibility of the advanced nurse practitioner to ensure that no harm comes to the patient. For example, the initial approach proposed by the nurse practitioner is the use of intubation and administration of pressors via a central line. However, the sister is against the idea despite the common-law husband agreeing to the approach. Evidently, there are repercussions to either of the approaches that would be adopted. For example, it is definite that something needs to be done to help the patient considering the prevailing circumstances. Further, the application of intubation and administration of pressors via a central line could have either positive or adverse effects. It is out of such concerns that the two parties are in disagreement on what the nurse needs to do. However, the buck stops with the nurse who has to ensure that no harm comes to the patient.
Finally, the guiding framework for the execution of duties by an advanced nurse practitioner is the existing law. Federal and state laws guide the manner in which a particular nurse practitioner carries out their mandate (Buppert, 2014). In the case illustrated, the advanced nurse practitioner must ensure that the decision arrived at is one which is within the established framework. Healthcare practice is governed by legislation that intends to protect both the patient by ensuring no harm befalls them in the course of receiving treatment. Because of the same, it is vital that the advanced nurse practitioner equips herself with such laws as a guiding framework to help her execute her mandate. For example, the law bestows the common-law husband a power of attorney in making decisions. Because of the same, it is essential that the advanced nurse practitioner takes that into consideration while making decisions as regards to the best procedure for addressing the issue.
Preventing Ethical/Legal Violations
Advanced nurse practitioners must uphold the highest ethical standards as they execute their task. It is evident that in the case depicted there is the moral obligation of the nurse to provide the patient with the best treatment regardless of the position taken by the affected parties. An ethical violation can arise in a scenario where the nurse fails to administer treatment to the patient because both the husband and the sister have a differing opinion on what needs to be done. The advanced nurse practitioner took an oath to protect life regardless of the circumstances. It would be unethical of the nurse to relent in upholding the oath which requires her to ensure that life is protected. Because of the same, it is crucial that she stands out and makes a decision that indeed will help the patient while at the same time taking into consideration the wishes of both the sister and the common-law. Indeed, both the parties have the best interest of the patient hence the position that they have taken.
The decision reached by the patient in administering treatment should not violate the existing laws which guide practice (Malbrough, 2015). For example, a power of attorney bestows the responsibility of making decisions on behalf of the patient to the common-law. Because of the same, it becomes mandatory that the nurse observes the power of attorney that has been given to the common-law husband. Through the same, it would be an indication that she is executing her duty within the established legal guidelines.
Laws to Prevent Ethical Dilemma
Advanced nurse practitioners should at all times ensure that they have knowledge of state and federal laws that dictate their practice. It is essential to understand that the law aims at protecting nurses as they discharge their mandate (Tingle, & Cribb, 2013). Because of the same, it is vital for one to have an understanding of the laws especially in cases where an ethical dilemma arises. For example, in the case described, the ethical dilemma regards the aspect of agreeing to the demands of either the sister or the common-law husband. It is the wish of the husband that the patient undergoes intubation and administration of pressors via a central line as has been suggested by the nurse. However, the sister is opposed to the idea because of the potential repercussions associated with the same. The Ethics Code allows advanced nurse practitioners to execute their mandate for as long as they have experience in the particular area (Tingle, & Cribb, 2013). The law can be applied in the scenario to enable the nurse to make an informed decision on what should be done. For example, the nurse is of the opinion that the application of intubation and administration of pressors via a central line could be essential in dealing with the situation. She can proceed to subject the woman to the procedure provided she is qualified enough to do so. The application of the approach will help in the nurse resolving the dilemma while at the same time saving a life. Finally, the law requires that nurses do whatever they can to save a life. If the nurse decides that the application of intubation and administration of pressors via a central line will save a life, then she is protected from undergoing the procedure without facing violations of practice.
Legal Principles and Law
The federal government has instituted different laws that are essential in protecting both the patient and healthcare practitioners attending to the case. For example, there is the Emergency Medical Treatment and Active Labor Act (Terp, 2016). The law mandates that patients be given timely treatment and stabilization before proceeding to provision of other services. The woman brought to the emergency department requires immediate treatment. However, it is evident that there is disagreement between the members of the family on what should be done. However, both the parties seem to forget the fact that the life of the patient is at stake negating the need to allow for immediate medical intervention. The circumstances allow the advanced nurse practitioner to make the best judgment and subject the patient to immediate treatment.
The other legal principle that comes to play regards the aspect of the person who can give consent if the patient is unconscious. The patient has given the power of medical attorney to the common-law husband. It means that the husband is authorized to make any decision on behalf of the patient. Because of the same, it could be essential for the nurse to make arrangements and administer treatment considering the circumstances. The decision by the advanced nurse practitioner can be guided by the legal principle which one is expected to operate from.
Overall, it is essential that the nurse ensures that they execute their mandate in ways that are consistent with the prevailing laws. The knowledge of such laws is vital as a way of ensuring that both the nurse and the patient are protected against any unwelcoming eventualities in the course of practice.
Ethical and Legal Reasoning
Ethical and legal reasoning should guide the day to day practice activities of any given nurse. The practice environment in a hospital is defined by various ethical issues as attested in the case described. However, regardless of the prevailing scenario, it is vital that an advanced nurse practitioner upholds the highest standards of ethical and legal reasoning (Goethals, De Casterlé, & Gastmans, 2013). For example, ethically, it is expected that the ultimate objective of the nurse should be to save the life of the woman despite the differences that exist between the husband and the sister. It is vital that she strives to do what is right in the prevailing circumstances. Various ethical principles exist that she can adopt as a way of helping the advanced nurse practitioner in resolving the case. For example, there is the virtue ethics. The principle requires that one strives to do the right thing at all times. The choice to do the right thing should be the goal of the advanced nurse practitioner. For example, the focus of the advanced nurse practitioner is to see to it that the best patient outcomes are attained. The ethical reasoning will be instrumental in ensuring that the best decision is arrived at which will result in the achievement of the best outcomes for the patient (Goethals, De Casterlé, & Gastmans, 2013). The advanced nurse practitioner has to make sure that they exercise sobriety in the prevailing issue for the benefit of the patient. Further, there is the principle of beneficence which reiterates the need to ensure that the patient is protected from harm. If it is determined that the conflicting parties could put the woman’s health at risk, then it is mandatory that the nurse exercises ethical reasoning to resolve the issue in the best way possible.
Further, the legal reasoning must be adopted as a way of ensuring that any decisions arrived at do not come to affect the advanced nurse practitioner. It is essential that she acknowledges the laws that guide her practice. For example, the assignment of the power of medical attorney to the common-law husband means that he is entitled to make decisions on behalf of the patient. However, it is essential to acknowledge the fact that the sister has a right as the next of kin in making decisions on behalf of the patient. Nevertheless, it is vital to consider that the husband remains to be the one in charge of any decisions that would be made relating to the health of the patient. The advanced nurse practitioner has the duty to exercise sound legal reasoning to resolve the issue and ensure that her actions do not subject her to problems (Goethals, De Casterlé, & Gastmans, 2013). The consideration of all factors regarding who is entitled to make decisions on behalf of the affected patient is essential. Through the same, the advanced nurse practitioner will not be at risk of suffering legal confrontations from any of the affected parties.
The advanced nurse practitioner should determine the ethical values of either of the parties that is the common-law husband and the sister. The determination is essential since it enables the advanced nurse practitioner to understand the stakes that she has to deal with in the ethical dilemma. Despite the fact that both the sister and common-law husband have the best interest of the patient, it could be vital to assess the values that both possess and if indeed it can affect their judgment on the case.
Further, it is essential that the advanced nurse practitioner considers the options which can be described as being ethically sound. It is crucial that the advanced nurse practitioner considers the outcomes of her actions if she was to adhere to either of the positions held by the affected parties. For example, it would be vital that the advanced nurse practitioner determines whether the final decision made would be rational from a different perspective which has not been considered. The factors need to be considered by the advanced nurse practitioner in the circumstances.
Advanced nurse practitioner have to deal with various ethical issues that arise in the hospital environment. The inability to carefully consider the different factors related to the case at hand has significantly affected the execution of duties by the advanced nurse practitioners. Because of the same, it becomes vital that the advanced nurse practitioners exercise sound ethical and legal reasoning in any issue that arises. Further, multiple ethical theories and principles can serve as a guide for the nurse practitioners in making decisions. The adoption of such theories and principles is helpful in ensuring that the best treatment outcomes are achieved for the patients.
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