INSTRUCTIONS DUE IN 6 HOURS:

• Describe two or more significant ethical issues relevant to the PhD-prepared nurse.
• Explain how these issues might compare to the types of issues you have already encountered in your practice.

As referenced in Week 2, Discussion 2, nurses are perceived as having very high ethical standards (Gallup, 2013). Doctorally prepared nurses should be able to consider ethical issues from multiple viewpoints. In this week’s media presentation, the experts discuss ethical challenges encountered by nurses as they assume leadership positions and as they engage in research.

To prepare:

• Reflect on ethical challenges that you have encountered in your nursing practice.
• Think about the information the experts shared in this week’s media presentation, focusing on the ethical challenges they have encountered as nurse leaders or scientists, as well as information presented in other Learning Resources.
• With this information in mind, consider what new ethical challenges you may face once you obtain your doctoral degree.

By Day 3

Post a cohesive response that addresses the following:

• Describe two or more significant ethical issues relevant to the DNP- or PhD-prepared nurse.
• Explain how these issues might compare to the types of issues you have already encountered in your practice.

DUE IN 2 DAYS BY FRIDAY 6/30/2020

response 1

Ruth Eby and Colleagues in 2017 discussed how nursing faculty can encounter different perspectives from students on ethical integrity and how it is the role of the instructor to develop and model a strong ethical foundation in students and novice educators. As Ph.D. prepared nurses we will often become leaders in nursing education, moving from the novice educator to the expert nurse educator. In this role, we can encounter ethical dilemmas with the students that we are instructing. We can also note ethical issues found with fellow instructors. Eby and colleagues in 2017 found 4 areas that influenced ethical integrity. They found that the learning environment, behaviors, ethical principles, and strategies to influence ethics were the major themes. They noted that ethical integrity can be improved by modeling it effectively, effective communication, clear and appropriate grading, faculty interactions, and faculty peer mentoring.

I have been very blessed in my current role to have great ethical role models in nursing education. We have a healthy work environment. However, I have heard from other programs about nursing instructors playing mind games and making it very difficult for novice instructors to fit in. In the role of a nursing instructor, it is also important that we are consistent in our grading and feedback to our students. The nursing program I am involved with now does have issues with this from time to time. However, as a Ph.D. prepared nurse, modeling ethical integrity becomes of the foremost importance. We must ensure that we create and foster a consistent ethical learning environment.

References

Eby, R. A., Hartley, P. L., Hodges, P. J., & Hoffpauir, R. B. (2017). Fostering Ethical Integrity in Nursing Education. Journal of Christian Nursing : A Quarterly Publication of Nurses Christian Fellowship, 34(4), 250–255. https://doi-org.ezp.waldenulibrary.org/10.1097/CNJ…

Response 2

Ethical Issues relevant to the DNP or PhD Prepared Nurses.

Doctoral trained nurses are now increasingly occupying more positions that deal with not only legal but ethical decision-making in their clinical practice. They are no longer responding to ethical decisions made by others, today they are involved in making these decisions. According to Peirce & Smith (2008), the traditional master’s trained APN curriculum lacks training on the extended expertise and decision-making skills that are needed by the DNP practitioners while they face these new evolving type of ethical dilemmas. It further communicated the need for an expanded view of required contents of ethics in the curriculum of DNP programs worldwide (P. 271). Therefore, the DNP trained nurses at their clinical level must be equipped with specialized skills and knowledge in all aspects of medical, legal, research, and business ethics relevant to evidence-based practice and research in all population (P. 271). Having said that, this report aims in discussing the ethical issues that the DNP trained nurses’ face in their health care practice.

Significant Ethical Issues Relevant to the DNP or PhD-Prepared Nurses.

Professional code of ethics guide nurses in making health care decisions (American Nurses Association, 2012). A code of ethics is a tool or set of principles, established by a profession to guide individual practitioner, and when ethical considerations are not given adequate attention, nurses may make serious decision-making mistake. Advanced nurse practitioners especially the DNP trained face ethical issues and challenges as they take the new professional role in their practice (Laureate Education [Producer], 2011a). One of the ethical issues or challenges the DNP trained nurse face in their clinical profession is “who gets health resources first”. These include vaccination, drugs, organ transplant, preventative, and high end health care. These type of ethical decision-making have often been made by others while nurses respond to them. Today, with the changing doctoral nursing educational curriculum and the evolving expansion of DNP scope of practice, the DNP trained nurses are now involved in making these ethical decisions in their practice (Peirce & Smith, 2008), With the 2019-2020 occurrence of pandemic virus known as Corvid-19, it has been publicly debated who should receive its vaccine first. Majority of the decision-making authorities and experts are stating that people in the health care system who are on the forefront should receive Copvid-19 vaccination firs before others. The fundamental change requiring a curriculum that reflects an advanced level of ethics knowledge that follows the 2015 mandate to transit nurse practitioner education from master’s to doctoral level has put the doctoral nurses on the position to make these ethical decisions (P. 272).

Another ethical issue that is relevant to the doctorate trained nurses in their profession is “improving access to healthcare” to individuals who lack the opportunity to access health care in this country. As stated by Dr Stefan (2011a), looking at what the families or the patient may need brings challenges in the healthcare system. It is a challenge to doctoral trained nurses when a patient is not able to access healthcare resources due to one reason or the other. These include lack of health insurance, lack of healthcare settings where one resides, lack of transportation, older age, poverty, immigration status, and etcetera. Working as an NP in a primary care setting, I see a lot of immigrant patients who lack health insurance and such results to noncompliance to provider’s advice/order. These individuals are considered to belonging to vulnerable group of the healthcare recipients (Campbell-Crofts, Field, & Fetherstonhaugh, 2013). Some refuse the needed test order, procedures, treatments, and drugs due to lack of insurance. This brings me to another ethical challenge that I have gone through in my profession as an NP.

How these Issues may compare to the types of issues I have Encountered in my Practice.

Upholding the ethical implications of prescription of drugs is an important responsibility of advanced nurse practitioners. An American Nurses Association (2001) states that nurses must adhere to the code of ethics including no harm to a patient (non-maleficence). Thus, care must be exercised when prescribing medications to patients. Arcangelo & Peterson (2013) indicated that one of the key elements to a good practitioner is the ability to plan for unintended consequences, as well as using critical thinking to make the right decision when such unintended consequences occur.

A friend called me and asked me to prescribe thyroid medication for her. Although, I have the autonomy to prescribe this medication, but she is not my patient and I don’t have her medical history or her last TSH and T4/T3 levels. I informed her that for this medication to be prescribed by me that I would need to see her at the clinic and that she will need to go to the lab first because the dosage of her medication will depend on her thyroid function test. She refused to take my medical advice because she didn’t want to go to the lab. “The American Nurses Association (ANA) stated that the Code for Nurses is non-negotiable and that each nurse has an obligation to uphold and adhere to the code of ethics” (ANA Code of Ethics for Nurses, 2012, par. 1). In the scenario above, considering that I do not have my friend’s health history or information, prescribing the medication may not only result to ethical but also legal problems for me, the patient, and the pharmacist who will fill the medication.

In order to appropriately prescribe a medication, the prescriber must assess the patient’s entire situation including, (a) the patient’s diagnosis (b) when the health problem started, (c) whether the patient have had the problem before or not, (d) questions regarding when the problem started, (e) medication allergies, and (f) patient’s risk factors that may contradict or affect the efficacy of the medication being prescribed. Arcangelo and Peterson (2013) stated that prior to prescribing any medication, the advanced nurse practitioner has ethical and legal obligation to obtain a full history and physical examination. The purpose of health history is to collect subjective data of a patient combined with the objective data from the physical assessment or examination, and laboratory studies to form the data base (Jarvis, 2004). A good history of non-prescription drugs including OTC medications, complementary and alternative medication use must be assessed by the clinician prior to prescribing drugs. Therefore, the code of ethics made this decision for me not to prescribe the thyroid medication for her.

References

Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28.

American Nurses Association. (2012). Code of Ethics for Nurses. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards

Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach, 298-939. (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Campbell-Crofts, S., Field, J., & Fetherstonhaugh, D. (2013). Ethical considerations for nurses undertaking research with a potentially vulnerable population with chronic kidney disease. Renal Society of Australasia Journal, 9(2), 74–79.

Jarvis, C. (2004). Physical & health assessment, 83-104. (4^th ed.). St. Louis,

MO: WB Saunders.

Laureate Education (Producer). (2011a). Ethical issues relevant to the DNP [Video file]. Retrieved from https://class.waldenu.edu

Peirce, A. G., & Smith, J. A. (2008). The ethics curriculum for Doctor of Nursing Practice programs. Journal of Professional Nursing, 24(5), 270-274.