DNP 815 Based on your response to Topic 4 DQ 1, provide a decision tree of how you came to the decision of ethical theory application

Nurses have a responsibility as advocates for patients’ rights; as a consequence, nurses confront ethical quandaries daily (Johnstone ,2021). As the healthcare system becomes more complex and demands for high-quality nursing care increase, nurses struggle to solve multi-faceted ethical challenges. Early nurse theorists positioned the principles and practice of nursing as having their origins in ‘universal human needs. Ethical issue addressed was on justice and the principle of non-maleficence among mental health patients in seclusion. Justice was one of the fundamental rights of mankind, patients with the mental disability still had their inherent rights to be treated equally, their integrity and dignity should also be respected.

Ethical decision-making is a vital aspect to working within the mental health professions. There are benefits in the use of an EDM model to work through ethical dilemmas in mental health professions (Johnson, et al 2022). Ethical decision-making (EDM) models are designed to guide professionals in a systematic and standardized manner to provide a framework for helping someone determine an acceptable and defensible outcome when confronted with an ethical dilemma. According to Johnson 2021, the decisions in ethical dilemmas can be resolved by (a) evaluate whether training on the use of EDM models improves decision quality, (b) compare the acceptability of EDM models as rated by participants, and (c) demonstrate that EDM model use, training practices, or similar decision-making strategies, are associated with feelings of preparedness or improved decision-making.

The use of ethical decision-making models has its setbacks s, such as social influences, culture, ethical mindset, and biases in decision-making, but understanding these limitations also allows practitioners to consider supplementing existing models with steps that take into account checks for biases. The principle of deriving nursing care from human needs was thought to provide a guide not only for promoting health, but for preventing disease and illness. The nursing profession has had a longstanding commitment to social justice as a core professional value and ideal, obligating nurses to address the social conditions that undermine people’s health (Lee, et al 2020).

References

Johnstone M. J. (2011). Nursing and justice as a basic human need. Nursing philosophy : an international journal for healthcare professionals, 12(1), 34–44. https://doi.org/10.1111/j.1466-769X.2010.00459.x

Johsons, M.K., Weeks, S.N., Peacock, G.g., Rodriquez, M.M. (2022). Ethical decision-making models: a taxonomy of models and review of issues, Ethics & Behavior, 32:3, 195-209, DOI: 10.1080/10508422.2021.1913593

Lee, W., Choi, S., Kim, S., & Min, A. (2020). A Case-Centered Approach to Nursing Ethics Education: A Qualitative Study. International journal of environmental research and public health, 17(21), 7748. https://doi.org/10.3

Nine Checkpoints for Ethical Decision Making

· Determine the moral issue.- the moral issue discussed in the previous discussion about is the moral outage or frustration directed towards others who refused to be vaccinated with the Covid vaccine, which can probably limit their capacity for empathy affecting patient care.

· Determine the actor- Nurses providing patient care

· Get the facts.- The right to refuse a vaccine may be considered an exercise of individual liberty or resistance against mandates of the government.

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· Determine if the moral issue is right versus wrong- Attitude towards possible disparate levels of care to unvaccinated patients may be guided to the nursing-related policies and codes, such as the statement outlined in the American Nurses Association (ANA) Social Policy Statement wherein obligation of the nursing profession is not only to optimize, promote and protect the health, to alleviate suffering, to prevent illness and injury but also to advocate for individuals, communities and patient population (Milken & Uveges, 2022).

DNP 815 Based on your response to Topic 4 DQ 1, provide a decision tree of how you came to the decision of ethical theory application

· Test for right versus right by assigning one of the four dilemma paradigms. The dilemma paradigm of justice vs. mercy indicates fairness, equality, understanding, and compassion. As nurses, we are expected to use theory and evidence-based knowledge to carry out nursing interventions with the goal of promoting quality outcomes (Milken & Uveges, 2022).

· Apply resolution principles: Rules-based, known as duty or obligation, dictates the behavior without consequences, whereas care-based principles guide the nurse to determine the most compassionate course. Delivery of care, as outlined in the ANA Social Policy Statement relies on nurses who are guided by an established professional code of ethics that defines what beneficial or good care looks like (Milken & Uveges, 2022). The first provision of the ANA Code of Ethics calls on nurses to practice with respect and compassion to all individuals, whether vaccinated or not.

· Identify if a trilemma or third option exists- Provisions call on the nurses to take the lead on issues of public health and to collaborate with other healthcare clinicians by adapting the nature of social determinants.

· Make the decision- Nursing codes of ethics and other related policy statements will serve as a helpful reminder of our professional obligations.

· Reflect on the decision- Consider productive and proactive ways to address vaccine refusal.

References

Edgar, P. H. (2002). Resolving Ethical Dilemas: Applying the Institute for Global Ethics’ Ethical FitnessTM Model to Occupational and Environmental Health Practice Issues. AAOHN Journal, 50(1), 40–47. https://doi.org/10.1177/216507990205000110

Milliken, A., & Uveges, M. K. (2022). Nurses’ Ethical Obligations Toward Unvaccinated Individuals. AACN Advanced Critical Care, 33(2), 220–226.

https://doi-org.lopes.idm.oclc.org/10.4037/aacnacc2022491

In the work we do as nurses, we face ethical dilemmas. Ethics in nursing offers a framework to ensure nurses and the patient are safe. The framework also guides nurses in difficult decision-making and provides a moral compass to carry out their nursing care fairly (Yildiz, 2017). The previous discussion explored ethical issues that nurses faced during the COVID-19 pandemic. The lack of supplies led to nurses having to make difficult decisions regarding the duty to provide patient care while possibly placing them in an unsafe situation. Additionally, changes to hospital visitation caused an ethical burden on the nurse-client relationship. These ethical dilemmas caused challenges however using a decision tree such as the one suggested by Edgar (2002) can help develop optimal solutions for all involved.

The moral issue: In the examples discussed, the moral issue is the duty to do no harm and provide safe patient care while keeping yourself, as a nurse, safe. The other moral issue is autonomous decision-making to have family actively engaged in patient care by being actively present.

Determining the actor: The owner of these ethical dilemmas is the nurse and the healthcare facility that has the responsibility of providing adequate resources to deliver safe patient care.

Facts: The obvious fact is the lack of resources with the expectation that nurses still deliver quality of care. The other fact is the change in visitation rights due to the COVID-19 pandemic.

Is the moral issue right versus wrong: The nurse must first explore what would happen if they refused to provide care due to lack of resources? Additionally, the healthcare organization should consider if not providing resources, due to the scarcity, violates healthcare policy. As it relates to the visitation policy, the gut test could be applied which implies does the action feel wrong (Edgar, 2002). Not allowing patients to have their families physically present may intuitively feel wrong.

Assigning a dilemma paradigm: The two ethical paradigms applicable to these examples are justice versus mercy and individual versus community. Is it fair to not provide care to the patient in need? Should the patient/family be able to autonomously decide if they want to be at a COVID patient bedside knowing the health risk this could pose to the general society?

Apply resolution principles: The principle that aligns with the lack of resources but the duty to provide care is the care-based principle. If roles were reversed the nurse would want to receive adequate care regardless of an organizational issue of not having supplies. In the second situation, the rules-based principle applies. During COVID the rules set by healthcare organizations aimed to protect the nurse, patient, and community they serve.

Identify if a third option exists: Alternative options in this case could be using personal protective equipment that may not meet the standard regulations. The other alternative could be using technology to meet the patient needs.

Make the decision: Once all options are considered proceeding forward with providing the best care possible should be the choice. In other words, doing everything that can be done to uphold the duties of a nurse all the while respecting the patient wishes.

Reflect on the decision: As COVID is now part of our daily lives, nurses and healthcare organizations should reflect if is the best decisions were made. Furthermore, these ethical dilemmas may allow healthcare organizations to better prepare if there was a reoccurrence in the future. In my healthcare organization we are using lessons learned from COVID and applying them to operating procedures in case there are a substantial number of patients with Monkeypox admitted.

References

Edgar, P. H. (2002). Resolving ethical Dilemas. AAOHN Journal, 50(1), 40–47. https://doi.org/10.1177/216507990205000110

Yıldız, E. (2017). Ethics in nursing: A systematic review of the framework of evidence perspective. Nursing Ethics, 26(4), 1128–1148. https://doi.org/10.1177/0969733017734412

The decision tree derived from the article of Bruchem-Vissera, R. (2020) is based on the methodology described in AACN nursing theory elements like asking, assessing, affirming, and acting. The first step involved designing a decision tree fit to all situations and then moving to secure the probabilities and utility of the outcome against the selected situation. The third step involved the affirmation of the particular decision following the calculation of cumulative probabilities ( Bruchem-Visser et al., 2020). The final step according to AACN’s theory is to

take action that can be analysis of the information as per the situation stated in DQ1. Following is a decision tree representing the decision taken by the nurse in response to the application of ethical theory in practice:

According to the selected article for analysis against the ethical theory, the checkpoints

that need to be considered in ethical decision making can be enlisted as follows:

Checkpoint Description

Identification of problem or dilemma:

The first step of the decision tree involves the identification of issues and need special attention. the nurse moves to examine the moral dilemma related to that issue and tries to identify the manners and social agreements while taking things into monarchy or conflicting standards which are not moral and economical and technologically aesthetic ( Bruchem-Visser et al., 2020).

Application of Global Ethics:

The nurse manager will evaluate the decision based on institutional global ethics standards like credibility, transparency, and accountability. However, taking an assessment of the decisions the nurse needs to keep a high level of patience, coordination, and determination.

Ethical Fitness :

The next checkpoint in the decision tree is to observe the ethical fitness of the decision. This feature is comprised of social circumstances like the patient has certain perceptions regarding the release of information about his disease ( Bruchem-Visser et al., 2020). These perceptions reveal the quality of the information provided to nurses and the medical care provided to them.

Model to Healthcare Practice Issue:

The feasibility of the healthcare practice model is another point in the decision tree. It helps nurses to remove the dilemma of situations and to better entertain the stakeholders. For the resolution of dilemmas, the nurses are supposed to use ethical models for the selection of appropriate practices. The nurse can adopt a model based on the concept of autonomy providing the basic rights of healthcare decisions to every patient ( Bruchem-Visser et al.,2020).

References

Bruchem-Visser, Z., Dijk, G., Beaufort,I. and Mattace-Raso,F. (2020). Ethical frameworks for

complex medical decision making in older patients: A narrative review. Archives of

Gerontology and Geriatrics, 104-160, https://doi.org/10.1016/j.archger.2020.104160.

Morrell, J., Konda, S.and Grant-Kels, M. . (2019 ). Response to a letter to the editor regarding

"The ethical issue of cherry-picking patients. J Am Acad Dermatol, e127.

Ethical decision-making involves strategies that will help organize your moral principles from standards, thus aiding in customer focused decisions. According to Edgar (2002), nurses in occupational and environmental health are faced with daily ethical considerations. To help with decision making it is encouraged that one take courses, read book and articles about ethical decision making to enhance this skill. Ethics has become a critical component to humanity due to current technology. Based on my post regarding the COVID mandate for healthcare workers, I will provide responses from the ethical decision-making model.

When using the ethical decision-making model components highlighted by Johnson (2021), component one is actions: my selected course of action would be to formulate a committee that will include key stake holders to assist in this decision for the staff. Next is Review: we need to review current state requirements and standards to issue a mandate id warranted. Intrapersonal and interpersonal is how we engage in self reflection and our consumers. I would ask that whatever decision came from the committee be done by the committee as well. Self-motivating: this involves testing the decision and the outcomes then reengaging as needed. Perspective taking this I feel is the most important and it involved considering how it will affect those involved. This will help us device a plan that will be feasible to all even those not willing to abide by the mandate. After considering all of this I do feel ethically we addressed the ethical dilemma. A little more consideration could have been given in relation to the effects of the decision such as the staffing considerations and staff religious exemptions.

Gostin LO, Salmon DA, Larson HJ. (2021). Mandating COVID-19 Vaccines. JAMA.;325(6):532–533. doi:10.1001/jama.2020.26553

DNP 815 Based on your response to Topic 4 DQ 1, provide a decision tree of how you came to the decision of ethical theory application