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- QUESTION
Ethical Case Scenario Discussions - Module 4 3
Discussion Assignment
Direction:
After reading the assigned scenario, answer the scenario discussion questions individually and post your response in the discussion board. You will find the case questions at the end of the DISCUSSION section that follows the case scenario Refer to the ethical decision-making model by Burkhardt and Nathaniel (2008) that is discussed in Chism Ch 7 to guide you when answering the questions.
Burkhardt and nathiel model:
Burkhardt and Nathaniel (2008) developed an ethical decision-making model that may be useful for DNP graduates when an ethical scenario is presented. This model is based on the premise that ethical decision making is “a process that overlays other dynamic biological, psychological, and social processes—layer upon layer” (p. 128). The process of ethical decision making requires ongoing evaluation and assimilation of information, making way for an evolving perspective that may change over time. This model allows for evolving perspectives as one moves toward a resolution or decision.
Step 1: Articulate the Problem
The first step of Burkhardt and Nathaniel’s (2008) model involves clearly describing the ethical problem that has been identified. This is followed by identifying desired goals, which will allow movement toward step 3 of the model, developing strategies. Burkhardt and Nathaniel (2008) relate that because strategies are often dramatic, identifying goals at this time will reduce conflict later in the process. Clearly identifying the problem allows it to be defined as an ethical or practical dilemma.
Step 2: Gather Data and Identify Conflicting Moral Claims
After the ethical problem is clearly identified, one should gather the necessary information or facts to provide clarification of the issues involved. Burkhardt and Nathaniel (2008) relate that throughout this process, attention should be paid to the societal, religious, and cultural values and beliefs of those involved. In addition, one should identify the participants’ ethical perspectives. This is when an understanding of basic ethical content, theories, principles, and perspectives is imperative.
Step 3: Explore Strategies
Identifying the problem and gathering data is followed by identifying possible strategies. Burkhardt and Nathaniel (2008) state that “various options begin to emerge throughout the assessment process” (p. 130). In an effort to eliminate unacceptable alternatives, the proposed alternatives should be evaluated for how they best fit the identified goals, beliefs, lifestyles, and values (Burkhardt & Nathaniel, 2008). This step of the ethical decision-making process may take time because of developing acceptable strategies and eliminating unacceptable strategies. When a strategy is adopted, one must be ready and willing to act on it (Burkhardt & Nathaniel, 2008).
Step 4: Implement the Strategy
When a strategy is adopted, it is implemented. However, Burkhardt and Nathaniel (2008) relate that this may be the most difficult step. Those involved in the process must feel empowered to make a difficult decision. The emotions that are surely stirred by implementing the strategy should be acknowledged by those involved, and they should be accepted as part of this difficult process (Burkhardt & Nathaniel, 2008).
Step 5: Evaluate Outcomes
Burkhardt and Nathaniel (2008) state that upon acting on the decision, “reflective evaluation sheds light on the effectiveness and validity of the process” (p. 132). The effects of the strategy on those involved in the process should be evaluated. This step of the model may involve ongoing evaluation of additional ethical problems that may arise as the situation changes and new data are gathered (Burkhardt & Nathaniel, 2008).
Case Scenario 3
Dr. C. is a vice president of nursing at a large tertiary care hospital. She has been having trouble recruiting and keeping nursing staff; as a result, some units are short-staffed. She is faced with making a choice regarding allocation of resources. She may spread the nurses around the hospital, with few nurses on each unit, or close certain units and staff the open units adequately. If she closes units, the patients who were already admitted would be cared for, but this decision would limit how many patients could be admitted in the future (Davis, 2010).
Discussion
Evaluating this ethical scenario requires reflection on the principles of justice, nonmaleficence, and beneficence. The principle of justice must be considered when resources are limited or managed (Davis, 2010). Distributive justice refers to “the sharing of burdens and benefits in the allocation of resources, sometimes, but not always, under conditions of scarcity or rationing” (Davis, 2010, p. 17). Dr. C. should consider what solution would promote the most good while inflicting the least harm. Dr. C. is faced with scarce resources, and she must evaluate what option promotes care of the patients in her institution.
Questions:
1.Would you close some units and provide better staffing for the patients who are currently admitted? What would you do regarding the lack of open beds for new admissions? What ethical principles would you rely on to evaluate this scenario?(600words)
- Watch this video featuring Carolyn Buppert, a well-respected author and healthcare attorney who speaks about scope of practice issues. After watching the video, complete the reflection assignment below. (or URL: https://www.ncsbn.org/10579.htm)
Video - The Misaligned APRN (Links to an external site.)
In a Word document, title this document Misaligned APRN Reflection - Your Name and submit your reflection here. This entry is limited to one paragraph or about 150 words.
Answer your choice of one of these questions/prompts:
- What is the big point you learned from this video?
2. I was surprised by...
3. The most useful thing I will take from this video is...
4. What I liked most about this video was...
5. After watching this video, I feel...
| Subject | Nursing | Pages | 5 | Style | APA |
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Answer
Ethical Discussion Paper
Question 1
Working in the healthcare sector is both rewarding and challenging, irrespective of the role an individual hold. Primarily, when in a leadership position, the challenge becomes more intense, and the demand to make decisions that align with ethical practice becomes inevitable. In most cases, doctors and nurses strive to remain within the four primary principles of justice, non-maleficence, beneficence, and autonomy when offering medical services and making decisions. Considering the case scenario provided, Dr. C. has to deal with the reality of scarcity of resources within the facility, which has prompted the need to balance between the number of operational units and staffing. Such a scenario can prove complicated and require proper application of work ethics and ethical principles to ensure the decision made remains for the benefit of the patients.
The principle of justice demands to treat all patients fairly and equally. It involves making a balanced decision on burdens and benefits such that the scarce resources within the institution are similarly distributed. Furthermore, it holds that medical practitioners should uphold the applicable legislation and laws throughout any decision-making process. Therefore, in this scenario, I would close some of the units and provide better staffing for the patients currently admitted. In essence, this decision has to come with the reality that the hospital has had a long struggle with hiring and keeping staff, which is a result of the scarce resources. This makes it necessary for the institution to operate within its means such that the health of the patients currently admitted can be cared for without fear of harming anyone (Nordhaug, 2017).
Moreover, while considering beneficence, which presumes that healthcare providers must provide services for the patients' benefit in every situation, closing down other units will be essential in offering the best of services to the patients. Besides, it will also be a relief to the staff since the workload will be equal to the number. There is no point in having several units in operation, which cannot offer the best of services to the patients since it can only result in disregarding the principle of non-maleficence. The principle of non-maleficence states that healthcare service providers should endeavor not to harm the patients (Nordhaug, 2017). Through inadequate staffing, it is easier to harm the patients because of insufficient and improper care.
Despite this decision being of significance to the patients already admitted, it will hinder new admissions, requiring health services. This calls for considering the fifth step in the Burkhardt and Nathaniel Model, outcome evaluation (Burkhardt & Nathaniel, 2008). Upon a reflection on the decision to close extra units, the hospital faces a crisis with new admissions such that as the current patients enjoy the best of services, others are languishing in pain and require the same services. However, for the good of the staff and the patients, the hospital can boost its resources before re-opening, which means that other patients can seek better services in other institutions.
While evaluating this scenario, I would rely on the concept of deontology, which requires that the end goal and the means must be ethical. In this case, the primary aim is to ensure better services for the in-patients with the right staffing. Since there are inadequate resources to improve the number of staff, the hospital's most logical approach would be to close the excess units and ensure the nurses do not strain while offering their services. Furthermore, this would also help in championing the principle of justice, both for the nurses and the patients. The end product will be an improved quality of outcome and better care services through the closing of some units.
Question 2
The most useful thing I learned from this video is the reality of numerous misalignment (Buppert, 2017). In most cases, this has proved to be a significant problem for nurse practitioners, especially in cases where things go wrong. Since employment may be so fascinating for many, they have to remain careful to avoid instances of misalignment since that can attract severe legal battles. As Carolyn alludes, the primary question in such cases would be, was the person qualified to do the work in the first place? (Buppert, 2017). It is often simple to ignore such concerns by most practitioners. However, when you get paid for services that you are unable to do, it only complicates ethical and legal issues. Where patients are misled about their service providers' qualifications, it can hinder the quality of outcome since the APRN will have no idea what jobs they can safely do. The nurses must, therefore, develop their professionalism and specialty through proper education and experience.
References
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Buppert, C. (2017). Advanced Practice Registered Nurses (APRNs), Practice, Regulation. https://www.ncsbn.org/10579.htm Burkhardt, M. A., & Nathaniel, A. (2008). The ethical decision-making model. Nordhaug, M. (2017). Partiality and justice in nursing care. Taylor & Francis.
Appendix
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