NSG 517 Identify an example of how you can uphold and improve the ethical practice of your profession
NSG 517 Identify an example of how you can uphold and improve the ethical practice of your profession
After reviewing this weeks content, I will uphold and improve the ethical practice of my profession by striving to maintain an ethical environment for everyone involved. According to Tracy and O’Grady (2019), “thoughtful ethical decision making arises from an environment that supports and values the critical exchange of ideas and promotes collaboration among members of the health care team, patients, and families” (p.331). I think this inclusive understanding of an ethical environment is crucial. I also feel that preventive ethics is optimal because it is preventing the problem before it arises. I will be sure to always use reflection and to seek opinions that are different from my own. Furthermore, I will be sure to take moral action when needed, in order to address ethical issues that may come up.
After reading this week’s article, I feel that my strengths are being a good listener and being a good sport and showing appreciation. I feel that I could use work on learning from my mistakes and being motivated. When it comes to myself, I can be brutal. I feel that I am much harder on myself than anyone else. I easily can accept feedback, however I do beat myself up afterward. To strengthen this skill, I will try to remember some of the concepts that we have learned in this course. For example, one that really resonated with me was that it’s ok to make mistakes. While we all know this, I feel that it is easily forgotten and that we demand perfection of ourselves. I will try next time to take a brief pause and a deep breath and remind myself of this. What I also found interesting was reading that, “differing interpretations or uptakes of feedback may be based on a number of factors that include: personality, fear, confidence, context and individual reasoning processes” (Hardevella et al., 2017). After reading this, I thought that perhaps I could benefit from working on my confidence.
Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., & Sreter, K. B. (2017). How to give and receive
feedback effectively. Breathe (Sheffield, England), 13(4), 327–333. https://doi.org/10.1183/20734735.009917 (Links to an external site.)
Tracy, M.F., & O’Grady, E.T. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. Elsevier.
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I appreciated your discussion about maintaining an ethical environment, and specifically, your focus on preventive ethics. According to Tracy and O’Grady (2018), preventive ethics are important in both promoting ethical environments and preventing avoidable ethical dilemmas from occurring. Exercising preventive ethics includes that “all important values should be reviewed and examined prior to the conflict so that situations in which values may conflict can be anticipated” (Tracy & O’Grady, 2018, p. 332). When doing our reading for this week, I was particularly struck by the topic of preventive ethics in light of the Covid pandemic and the frequent absence of advance directives in our society. When I took the evidence based research course, I researched health care proxies and advance directives and was stunned by the number of people in our country without advance directives or designated health care proxies. A preventive ethics approach would prioritize determining a patient’s wishes early in the establishment of care. Although this approach would not remove all possible dilemmas, it would certainly help to prevent some conflicts in the event of a medical emergency or change in status. One can see how important this is after living through the height of the pandemic, where families had to make end of life decisions for loved ones, seeing them only through a Facetime video. I imagine there are many nurses and patients’ family members still dealing with the moral distress that resulted from some of these specific situations. It is sad to think that some of this distress may have been prevented with a preventive ethics approach.
I had a similar answer regarding my ability to take constructive feedback. I also tend to be very hard on myself and demand perfection in my performance. I found the learning resources this week to be preparative for becoming a new nurse practitioner, and was grateful for the advice given. Not that I would ever call myself a true expert at anything, but according to Benner’s model, I am at the expert level in my current career as a nurse, as I have worked in my current position for 11 years, and am now able to apply both an intuitive and holistic approach in my care of patients (Nutt et al., n.d.). Given this, going back to the level of a novice when I am a new nurse practitioner will be a major change for me. I tend to find that expectation is everything. Having my expectations reframed and knowing that I will be a novice in this next step in my career helped me to lower my anxiety and expectations on myself. Tracy and O’Grady (2018) gave good advice for handling this role change, recommending role rehearsal, skill development, and maintaining an adequate support network. I will be sure to focus on these things as I move forward toward my goal of becoming a nurse practitioner.
Nutt, L., Savage, J. & Scanlon, A. (n. d.) From novice to expert, Patricia Benner [PowerPoint slides]. Retrieved from Rivier University Canvas course page.
Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s Advanced Practice Nursing – E-Book (6th Edition). Elsevier Health Sciences (US). https://bookshelf.vitalsource.com/books/9780323447706 (Links to an external site.)
I agree with you that preventative ethics is optional because it is preventing the problem before it arises. It is imperative to seek opinions that are different from yours to gain an insight into why someone made an ethical decision. Great job!
Our text narrated that the principle-based approach is guided by the “principle of respect for persons, autonomy, beneficence, and justice is commonly applied in the analysis issues in nursing” (Tracy& O’ Grady 2018). A challenge to this principle is that there is a trivial understanding of autonomy. To honor someone’s autonomy, does not imply that the person will get everything they want (Tracy& O’ Grady 2018). Furthermore, it is important to understand how to balance what a person wants with the responsibility to avoid harm and promote the safety of a person’s well-being (Tracy& O’ Grady 2018).
I had a similar answer regarding my ability to take constructive feedback. I beat myself up and demand perfection in my performance especially making errors in areas I know I should have mastered well. I am learning to receive positive and negative feedback as a way of growth. I assure myself that everyone learns at a different pace; give myself time to learn ( Hardavella et. al 2018).
Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., & Sreter, K. B. (2017). How to give and receive feedback effectively. Breathe (Sheffield, England), 13(4), 327–333. https://doi.org/10.1183/20734735.009917
Tracy, M.F., & O’ Grady, E. T., ( 2019). Hamric and Hanson’s Advanced Practice Nursing. An Integrative Approach. St Louis, MO: Elsevier.
“The ANAs Code of Ethics for Nurses describes the profession’s philosophy and general ethical obligations of the professional nurse” (Tracy & O’Grady, 2019). Understanding these code of ethics in tandem with an organization’s mission, vision and nursing professional practice model is one strategy to identify if a healthcare organization aligns with your own belief values related to patient care delivery. A particular ethical scenario which occurred in my practice involved a case in which power dynamics between healthcare teams and the patient’s wife may have prevented her from participating effectively in a “family meeting.” The patient was admitted for a cardiac issue which deteriorated into acute tubular necrosis, ATN, and initiation of dialysis was necessary. His baseline dementia worsened, and he became increasingly anxious and uncooperative with care, frequently yelling at staff as they tried to administer dialysis and impulsively walking away while connected to the equipment. On several occasions, the dialysis catheter became dislodged and bleeding occurred. Despite ongoing, efforts by the healthcare team to keep the patient calm and comfortable, these behaviors proved difficult to manage. The care team decided to hold a family meeting to consider whether dialysis could be safely continued for this patient and, if not, to discuss goals of care. A multidisciplinary team of clinical staff was developed, including representation from our ethics committee.
The patient wife advocated for her husband’s wishes and confirmed he would want to continue with treatment. Discussion dense in medical terminology was used and the patient’s wife remained quiet the remainder of the meeting. A decision was ultimately made that the harm of continuing dialysis outweighed the benefits. The patient was recommended for hospice care. Patient wife was very upset and although did not say anything at the meeting, sought a second opinion and had her husband transferred where he was able to receive the care that aligned with his wishes. Many of us left the meeting feeling like there was much unfinished business, but the decision was made. Our unit practice council decided to reach out to our ethics department and perform a case review. The case review was presented by our medical and nursing team at our Schwartz rounds. The case review revealed gaps which included not allowing the patient wife to be an active participant in conversation including active listening, less taking and uninterrupted silence to allow for processing of information. Simple language should have been used and validation that her and the patient’s wishes were heard and valued should have taken place.
Our ethics team further reviewed the cased and the decision was made that the asymmetrical relationship between the patient wife and healthcare team contributed to the outcome. Nimmon et al., 2016 discussed how, “The very nature of the relationship between clinicians and patients/surrogates is asymmetrical. This unequal dynamic is a product of clinicians possessing professional status and expertise, and patients/surrogates being reliant on them to provide needed care.” In advanced practice, being aware of the existing “…power differential and how this can affect communication in a family meeting, can help create an “emotionally safe” space in which patients/surrogates feel supported and empowered to engage in shared decision-making” (Peek et al. 2009). Although the patient and family member did not receive the best outcome from our team, the reflections made were beneficial to our healthcare team.
I had never heard the term “power dynamics” and thought that it was incredibly helpful in how I communicated with patients thereafter. In advanced practice, understanding ethical approaches to patient’s decision making will foster growing my ethical competencies. Evoking both casuistry and care based approaches to scenarios such as the one described above may have offered an opportunity to focus on the patient, wife and caregiver relationships further.
Earlier in my career, receiving feedback was very difficult. I would see it as punitive and/or embarrassing. Often the feedback would be presented in the presence of other colleagues and I would just want to sink into myself. As time has progressed, I proactively seek feedback, especially from my peers. I recently started a new role in electrophysiology outpatient services. Reading internal electrograms are starkly different than surface electrocardiograms. Reaching out to the providers and industry for support has been incredibly helpful. The providers message me with corrections and offer rationales. It has truly served to be a tremendously advantageous experience. Concerted work on defusing my own negative criticisms in regards to feedback is an ongoing skill set I hope to foster in advanced practice.
Nimmon, L., & Stenfors-Hayes, T. (2016). The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians. BMC Medical Education, 16, 114. https://doi-org.rivier.idm.oclc.org/10.1186/s12909-016-0634-0 (Links to an external site.)
Peek, M. E., Lopez, F. Y., Williams, H. S., Xu, L. J., McNulty, M. C., Acree, M. E., & Schneider, J. A. (2016). Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians. Journal of General Internal Medicine, 31(6), 677–687. https://doi-org.rivier.idm.oclc.org/10.1007/s11606-016-3616-3
Tracy, M. F., O’Grady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.