NURS 8002 ETHICS AND THE DNP-PREPARED NURSE
NURS 8002 ETHICS AND THE DNP-PREPARED NURSE
NURS 8002 ETHICS AND THE DNP-PREPARED NURSE
The ethical issues relevant to the DNP-prepared nurse include informed consent and fidelity. Informed consent is based on a patient’s right to decide for themselves. The DNP prepared nurse must respect patients’ right to decide and protect those patients who are unable to decide for themselves (Varkey, 2021). Informed consent stems from the ethical principle of autonomy. The principle of autonomy entails a person’s right to choose and the ability to act on that choice. DNP prepared nurse has a responsibility of respecting patients’ right to autonomy. Autonomy reflects the belief that every competent individual has the right to determine their course of action (Vikas et al., 2021). DNP prepared nurse should be aware that the right to free choice rests on the patient’s competency to decide.
Fidelity means faithfulness and keeping promises and is the ethical foundation of nurse-client relationships. Patients have an ethical right to expect nurses to act in their best interests. As the DNP prepared nurse function in the role of patient advocate, they are upholding the principle of fidelity. The DNP nurse demonstrates fidelity when they represent the patient’s viewpoint to other members of the healthcare team (Graf et al., 2020). Fidelity is also demonstrated when the DNP prepared nurse avoids letting their own values influence their advocacy for clients. Thus, the DNP prepared nurse should support the patient’s decision even when it conflicts with the nurse’s preferences or choices.
The above issues compare to the ethical issues I have encountered in my practice since providers often encounter challenges when patients or their guardians fail to give consent. We have experienced lawsuits after providers failed to obtain consent from patients, and the interventions provided led to adverse effects. We have also had lawsuits when providers failed to keep the promises they made to patients, and the patients prosecuted them for failing to act in their best interest.
References
Graf, W. D., Epstein, L. G., & Pearl, P. L. (2020). Practical Bioethics during the Exceptional Circumstances of a Pandemic. Pediatric neurology, 108, 3–4. https://doi.org/10.1016/j.pediatrneurol.2020.04.011
Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119
Vikas, H., Kini, A., Sharma, N., Gowda, N. R., & Gupta, A. (2021). How informed is the informed consent?. Journal of family medicine and primary care, 10(6), 2299–2303. https://doi.org/10.4103/jfmpc.jfmpc_2393_20
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Reading through your post was educative. I agree with you on the aspect that Informed consent is based on a patient’s right to decide for themselves. As we all know Informed consent is an important ethical notion in healthcare delivery, ensuring that patients have the right to know the benefits, risks, and alternatives to any medical procedure (Gossman et al., 2022). When working with vulnerable groups like children, the elderly, and those with cognitive disabilities, DNP-prepared nurses may face ethical problems involving informed consent. They must therefore ensure that patients or their carers understand the information presented to them and can make informed decisions about their care. Informed consent requires that the information presented to patients be understandable, and nurses must use clear and concise language to ensure that patients comprehend (Bartrum, & Karp, 2022).
Furthermore, when caring for a patient with poor English ability, I confronted an ethical difficulty in terms of informed consent. The patient was scheduled for surgery and needed information regarding the procedure, risks, advantages, and alternatives.
However, due to the language barrier, the patient had trouble understanding the information. As a nurse, I was responsible for ensuring that the patient comprehended the information given to them, and I collaborated with a professional translator to explain the procedure in a way that the patient could understand. Despite the language barrier, this method guaranteed that the patient’s right to make informed decisions regarding their care was respected.
References
Gossman, W., Thornton, I., & Hipskind, J. E. (2022, June 11). Informed Consent. National
Library of Medicine; StatPearls Publishing. Retrieved from
Bartrum, A., and Karp, B., (2022). Informed Consent – an overview. Retrieved from
Informed consent is a complex process of communication that includes three elements: disclosure, competence in making decisions, and voluntariness (Cheng & Lin, 2017). This process ensures that patients have a clear understanding of their condition, the proposed treatment, potential risks and benefits, alternatives, and the right to make decisions about their own care. For DNP-prepared nurses, there are several ethical considerations related to informed consent. Respecting the autonomy of patients is central to the principle of informed consent. DNP-prepared nurses must ensure that patients are provided with all relevant information in a comprehensible manner, allowing them to make informed choices about their healthcare. Some patients, such as those with cognitive impairments, language barriers, or limited health literacy, might struggle to fully comprehend complex medical information. DNP-prepared nurses must take extra measures to ensure these patients can provide genuine informed consent or involve legally authorized representatives. Informed consent isn’t just about providing information; it’s also about engaging patients in shared decision-making. DNP-prepared nurses should facilitate open discussions, address patient concerns, and involve patients in the decision-making process. Fidelity, also known as veracity, refers to the ethical principle of being truthful and honest in all professional interactions. DNP-prepared nurses are expected to uphold this principle in various ways. Nurses with a DNP preparation often have advanced roles in healthcare management and leadership. Being truthful and transparent in their communications with patients, families, colleagues, and other healthcare professionals is essential to maintain trust and integrity. DNP-prepared nurses must navigate the balance between respecting patient autonomy through informed consent and maintaining fidelity through honest communication. In summary, the ethical issues of informed consent and fidelity are paramount for DNP-prepared nurses. Upholding patient autonomy, engaging in shared decision-making, being truthful in communication, and advocating for patients’ rights all contribute to the ethical foundation of nursing practice at the DNP level.
References
Cheng, C.-T., & Lin, C.-C. (2017). [The Use of Informed Consent in Clinical Nursing Practice]. Hu Li Za Zhi The Journal of Nursing, 64(1), 98–104. https://doi.org/10.6224/JN.64.1.98
Expressing respect for patient’s autonomy means acknowledging that patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their clinicians’ recommendations (Sedig, 2016). As human, we have our own beliefs, but as health care providers, we must learn to respect the belief of others, even if it does not coincide with our own. According to Sedig (2016), when taking care of patients as a DNP-prepared nurse, you must respect patient’s autonomy by giving them the information needed to understand the risk and benefits of a proposed intervention, as well as the reasonable alternatives, so they can make independent decisions.
Fidelity as an ethical principle, is about ensuring that you’ve done everything possible to make sure your actions align with high standards and values. For health care professional the only thing guiding their choices in patients care is strong morals and a nursing code of ethics (Team, 2022). As healthcare providers, our clients will normally trust us, it is important that we keep up those values. As you stated above, while working, as a risk manager, I have seen many cases where patient’s autonomy or fidelity were not valued. Most of the time when we make an encounter with these patients, they are at a vulnerable period and the last thing they need is not to trust the people that are taking care of them.
Reference
Sedig, L. (2016). What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree? AMA Journal of Ethics, 18(1), 12–17. https://doi.org/10.1001/journalofethics.2017.18.1.ecas2-1601
Team, S. E. (2022, October 18). Fidelity in Nursing: Nursing Ethical Principles – SimpleNursing. Simple Nursing. https://simplenursing.com/fidelity-in-nursing/#:~:text=Fidelity%2C%20as%20an%20ethical%20principle
Thanks for your beautiful posting and discussion. You have talked about the ethical issues of informed consent and Fidelity and the DNP-prepared nurse. According to the American Nurses Association (2015), the Code of Ethics for Nurses provides the framework for ethical decision-making and guiding practice. As future doctor of nursing practice (DNP) degrees, we are on the frontline of patient care as ethical leaders and advocates. Nurse practitioners frequently encounter ethical dilemmas, and their identification is essential to effective resolution. An innovative approach involving collaboration between a doctor of nursing practice (DNP) and doctor of philosophy (Ph.D.) faculty was used to address this need in a graduate nursing program. The results included a broader understanding of the synergy of the two educational backgrounds in translating and delivering evidence-based practices. The development and use of realistic case studies was a teaching strategy for ethics education. The unique backgrounds of each faculty member promote ethical practice among DNP students, which is essential to the profession. Having ethical standards and knowing what is ethically acceptable in the healthcare field is necessary for all healthcare workers to care for their patients. I agree fidelity can be significant in the healthcare field and the lack of fidelity can result in a notable lack of ethical standards within a system. Fidelity can determine how well a DNP, RN, or, NP can fulfill their roles successfully as an advocate for their patients. This can be seen in the workforce today and can be expected after becoming a DNP. The education and skills that we learn as DNP students can help to minimize this in the healthcare system that we are in or we may be leaders in.
References
1. Vermeesch, A., Cox, P. H., Baca, S., & Simmons, D. (2018). Strategies for Strengthening Ethics Education in a DNP Program. Nursing Education Perspectives, 39(5), 309-311. https://doi.org/10.1097/01.NEP.0000000000000383Links to an external site.
2. Hall, S., Lee, V., & Haase, K. (2020). Exploring the challenges of ethical conduct in quality improvement projects. Canadian oncology nursing journal = Revue canadienne de nursing oncologique, 30(1), 64–68.
Well done, i entirely agree with you!! Ethical dilemmas manifest themselves in almost all healthcare environments. The Doctor of Nursing Practice (DNP) demonstrates proficiency in the essential competencies of evidence-based practice, patient safety, advocacy, and the promotion of favorable patient outcomes. When moral and ethical dilemmas arise within an organization, the Doctor of Nursing Practice (DNP) must use discernment to establish appropriate boundaries for oneself and other staff members. The involvement of nurses who have received medical training in healthcare transformation might be impeded by ethical dilemmas, leading to challenges in the decision-making process (Pierce et al., 2008). The attainment of a DNP degree in nursing carries with it heightened responsibilities in applying ethical principles within the realm of nursing practice. The achievement of a Doctor of Nursing Practice (DNP) degree empowers a nurse to assume a prominent role within healthcare organizations, taking leadership responsibilities and advocating for the well-being of patients and communities. Upon attaining a Doctor of Nursing Practice (DNP) degree, advanced practice nurses may encounter difficulties aligning ethical actions and attitudes among their fellow nurses with the organization’s overarching objectives. The code of ethics established by the American Nurses Association (ANA) serves as a comprehensive framework that provides nurses with a set of norms to govern their professional conduct. Two noteworthy ethical concerns pertinent to the nurse with a Doctor of Nursing Practice (DNP) qualification may revolve around challenges related to healthcare accessibility and safeguarding patient privacy.
Peirce, A. G., & Smith, J. A. (2008). The ethics curriculum for Doctor of Nursing Practice programs. Journal of Professional Nursing, 24(5), 270–274.https://doi.org/10.1016/j.profnurs.2007.06.008 Links to an external site.
Wilson Steck, M. B., & Rice, J. G. (2018). How the ANA’s Code of Ethics applies to South Carolina Nurses in Clinical Practice. South Carolina Nurse, 25(4), 8–9.
Ethics is an important aspect of nursing practice. A code of ethics can help to ensure that patients receive high-quality care. Doctor of Nursing Practice (DNP) prepared nurses faces new ethical challenges on a regular basis. Many of the ethical dilemmas relate around enhanced decision making, patient protection, and providing high-quality care. Unfortunately, with a high number of nurses being recruited into the nursing industry to address the nurse shortage, several ethical difficulties are foreseen (Vermeesch et al., 2018). As a result, the knowledge of DNPs is in high demand in the healthcare business to handle ethical concerns. Low-quality care and an unfavorable work atmosphere might be expected if DNPs do not address the ethical issues of moral suffering. DNPs serve as role models for healthcare providers. There is a need for collaboration to guarantee that ethical concerns are resolved effectively while keeping patients’ interests in mind.
The first ethical issue to be addressed is informed consent. This ethical precept might become a struggle in nursing practice at times. A problem may occur when patients are not involved in the treatment plan (Torkaman et al., 2020). Every patient and caregivers have the right to be informed about the treatment plan and to have the opportunity to choose what is best for them. When the patient’s caregivers, family, and guardians are not involved in the treatment plan, a problem arises. Patients should be told about the effects of the treatment before making an informed decision (Torkaman et al., 2020). They should pay attention and have their questions answered. To achieve better healthcare outcomes, informed consent guarantees that patients are fully involved in the treatment plan (Torkaman et al., 2020). To improve compliance, DNPs should ensure that patients understand all aspects of the therapy procedure. DNPs should take whatever steps are necessary to keep patients aware.
Another ethical concern is the protection of patient privacy and confidentiality. These are important ethical considerations for DNPs. They can complicate the therapy procedure if they are not followed. Patient privacy and confidentiality refer to a patient’s ability to make smart decisions on their own. DNPs must respect cultural or personal belief systems that influence their customers’ decisions. With respect to patient privacy and confidentiality, patients have the freedom to refuse medications, treatment plans, or processes (Rejno et al., 2020). Their decisions should be respected, and potential alternatives that meet their preference should be preferred.
DNPs face ethical dilemmas daily. DNPs face ethical dilemmas regarding medical treatment and must make decisions on the spot. The ethical difficulties raised are comparable to circumstances I’ve faced in my practice. The first issue I encountered in practice is providing care to a critically ill child who was found outside the hospital gate trembling in pain without a caregiver or parent. The child was admitted to the facility, and care was required to save her life (Torkaman et al., 2020). The ethical problem was whether to save the child’s life or follow the ethical principle of informed consent. Children under the age of 18 are unable to make treatment decisions without the assistance of a caregiver, parent, or guardian (Torkaman et al., 2020). We violated the concept of informed consent by administering care to the child after consultation. Ethical difficulties are difficult for DNPs to face (Phelan, 2020).
To address ethical concerns, practitioners should consult the American Nursing Codes of Ethics and develop a solution that meets the needs of each particular patient.
References
Phelan, P. S. (2020). Organizational Ethics for US Health Care Today. AMA Journal of Ethics.
Mar2020, Vol. 22 Issue 3, p183-186. 4p. DOI: 10.1001/amajethics.2020.183
Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the
relationship between professional ethics and organizational commitment in healthcare
organizations. Journal of MedicalEthics and History of Medicine, Vol 13 (2020). DOI:
10.18502/jmehm.v13i17.4658
Vermeesch, A., Cox, P. H., Baca, S., & Simmons, D. (2018). Strategies for strengthening.
ethics education in a DNP program. Nursing Education Perspectives. Sep 01, 2018
39(5):309-311. DOI: 10.1097/01.NEP.0000000000000383
You identified confidentiality and privacy. These are mandatory for the healthcare provider to be aware of and adhere to not just as principles but as a legal obligation. These are often violated due to negligence (Deshefy-Longhi et al., 2004). Despite the reason, not adhering to these ethical principles have stiff consequences in all organizations. This usually results in termination which has occurred when nurses access information for patients when they have no need to retrieve this information (The HIPAA Journal, 2022). This is under “need to know” which essentially comes under the Health Insurance Portability and Accountability Act (HIPAA) Minimum Necessary Standard (The HIPAA Guide, 2023). This standard requires that entities and business associates restrict information use and disclosure to the minimum amount required to achieve a specific purpose. The American Nurses Association Center for Ethics and Human Rights (2015) revised their position statement to address privacy and confidentiality in light of social media. They stated:
“The patient’s right to privacy of individually identifiable health information, including genetic information, is established statutorily with specific exceptions. Individuals retain the right to decide to whom, and under what circumstances, their individually identifiable health information will be disclosed. Confidentiality protections should extend not only to health records, but also to other individually identifiable health information, including clinical research records, oral reporting, images and mental health therapy notes. This protection should be maintained in the treatment setting and in all other venues”.
It is imperative that nurses know all standards to which they are held when it comes to ethical components for patient care. Thanks for your post. Dr. M. Revell
References
American Nurses Association Center for Ethics and Human Rights. (2015). Privacy and Confidentiality. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/privacy-and-confidentiality/Links to an external site.
Deshefy-Longhi, T., Dixon, J.K., Olsen, D., Grey, M. (2004). Privacy and confidentiality issues in primary care: Views of advanced practice nurses and their patients. Nursing Ethics, 11(4), 378-393. https://journals.sagepub.com/doi/10.1191/0969733004ne710oaLinks to an external site.
The HIPAA Guide. (2023, January 1). What is the HIPAA “Minimum Necessary” standard? https://www.hipaaguide.net/hipaa-minimum-necessary-standard/Links to an external site.Links to an external site.
The HIPAA Journal. (2022, November 20). Nurse fired for HIPAA violation. https://www.hipaajournal.com/nurse-fired-hipaa-violation/Links to an external site.