Weekly Resources - NUR 313 - Nurse as Decision Maker - Subject/Research Guides at Wilmington University Library

Supplemental Weekly Reading

Healthcare practitioners’ personal and professional values. (2016) Personal and professional values of healthcare practitioners influence their clinical decisions. Understanding these values for individuals and across healthcare professions can help improve patient-centred decision-making by individual practitioners and interprofessional teams, respectively. We aimed to identify these values and integrate them into a single framework using Schwartz’s values model. We searched Medline, Embase, PsycINFO, CINAHL and ERIC databases for articles on personal and professional values of healthcare practitioners and students. We extracted values from included papers and synthesized them into a single framework using Schwartz’s values model. We summarised the framework within the context of healthcare practice. We identified 128 values from 50 included articles from doctors, nurses and allied health professionals. A new framework for the identified values established the following broad healthcare practitioner values, corresponding to Schwartz values (in parentheses): authority (power); capability (achievement); pleasure (hedonism); intellectual stimulation (stimulation); critical-thinking (self-direction); equality (universalism); altruism (benevolence); morality (tradition); professionalism (conformity); safety (security) and spirituality (spirituality). The most prominent values identified were altruism, equality and capability. This review identified a comprehensive set of personal and professional values of healthcare practitioners. We integrated these into a single framework derived from Schwartz’s values model. This framework can be used to assess personal and professional values of healthcare practitioners across professional groups, and can help improve practitioners’ awareness of their values so they can negotiate more patient-centred decisions. A common values framework across professional groups can support shared education strategies on values and help improve interprofessional teamwork and decision-making.
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M., G., W., R., & S. (2016). Healthcare practitioners' personal and professional values. Advances in Health Sciences Education : Theory and Practice,21(2), 257-86. doi:10.1007/s10459-015-9626-9
Ethical Issues in Nursing Practice (2009) Nursing is a discipline that is critical to the health and welfare of all nations and the backbone of any health care system. Without a sufficient supply of nurses to care for the public’s needs, the public’s health is at risk. Unfortunately, the United States is currently experiencing a nationwide nursing shortage and it is estimated that 500,000 additional nurses will be needed by the year 2025 (United Press International, 2008). This represents a potential public health crisis; at a time when we are facing an unprecedented nursing shortage and a need for qualified nurse providers, recruitment and retention efforts should focus on long-term solutions, not simply quick fixes. Regrettably, ethics dialogue is not generally part of this solution, as nurses leave the profession, in part, because of unresolved ethical issues. In the past, nurses were more subordinate than they are today, and changes in the profession continue to address the legitimate role of nursing in society.
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Ulrich, C. M., & Zeitzer, M. B. (2009). Ethical issues in nursing practice. In V. Ravitsky, The Penn Center Guide to Bioethics. New York, NY: Springer Publishing Company. Retrieved from http://mylibrary.wilmu.edu/login?url=https://search.credoreference.com/content/topic/nursing_ethics?institutionId=6215
Key Concepts in Nursing - Ethics (2008) Professional practice is conducted within a framework of rules (such as The Nursing and Midwifery Council Code of Professional Conduct: Standards for Conduct, Performance and Ethics, 2004) and principles that underpin those rules. Nurses have a legal and professional duty to work within those rules; however, a rule does not always provide us with an answer when we are faced with a difficult question. We often only think of ethics in terms of high-profile cases, such as should a baby live or who should get an intensive care bed. However, all practice is guided by ethics. The underpinning principles of practice are normally based on ethical theories. Ethical theories have been developed over many years from moral philosophy and have been adapted to form the basis of healthcare ethics. There are a number of different ethical theories:Deontology, Consequentialism, Principalism, Virtue ethics All aim to systemise and generalise decision making, but fail. However, each theory has its own strengths and weaknesses. KEY POINTS: Practice is bound by legal and professional duties.Professional duties are underpinned by moral philosophy.There are a number of different ethical principles that can be used to guide our decision making.
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Hobden, A. (2008). Ethics. In A. Bryan, E. Mason-Whitehead, A. McIntosh, & et. al. (Eds.), Key concepts in nursing. London, UK: Sage UK. Retrieved from http://mylibrary.wilmu.edu/login?url=https://search.credoreference.com/content/entry/sageuknurs/ethics/0?institutionId=6215

Informed Consent: An Ethical Obligation or Legal Compulsion?
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Satyanarayana, R. (2008). Informed consent: An ethical obligation or legal compulsion? Journal of Cutaneous and Aesthetic Surgery, 1(1), 33-5. doi:10.4103/0974-2077.41159
Informed Consent: Essential Legal and Ethical Principles for Nurses
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Menendez, J. (2013). Informed consent: Essential legal and ethical principles for nurses. Jonaʼs Healthcare Law, Ethics, and Regulation, 15(4), 140-144. doi:10.1097/NHL.0000000000000015

Ethical Issues with Informed Consent

Identifying and Addressing Ethical Issues with Use of Electronic Health Records With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, the United States, as of 2017, has achieved 95% saturation with electronic health records as a means to document healthcare delivery in acute care hospitals and guide clinical decision making. Evidence is mounting that EHRs are resulting in unintended consequences with patient safety implications. Clinical teams confront usability challenges that can present ethical issues requiring ethical decision-making models to support clinicians in appropriate action on behalf of safe, effective clinical care. The purpose of this article is to identify and address ethical issues raised by nurses in use of electronic health records. We provide a case scenario with application of the Four Component Model and describe a study of nurse experiences with the EHR. The nursing Code of Ethics, Nursing Scope and Standards, and Legal Implications are reviewed, and we conclude with recommendations and a call to action.
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McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with use of electronic health records. Online Journal Of Issues In Nursing, 23(1), 6. doi:10.3912/OJIN.Vol23No01Man05
The Nurse as the Patient's Advocate: A Contrarian View. An important role for all health care professionals is to be an advocate for their patients, and there is no question that many patients need advocacy to reach their health care goals. The role of advocate takes many forms, but one is to speak up when one is concerned for the safety or well-being of a patient. A nurse is often the member of a health care team most likely to notice changes that might signal problems or poor responses to treatment. The duty of the nurse is to speak up in a timely and urgent manner when the nurse believes-or fears-that the patient's safety may be at risk. Yet the role of nurses as advocates for their patients has assumed near-mythic status. Rather than seeing advocate as one among many equally important and interrelated professional roles, the nurse, when asked, "Who are you?" is likely to give the heartfelt and passionate answer, "The patient's advocate!" This essay examines and critically analyzes the advocacy role adopted by the nursing profession and outlines the challenges it has created to nursing's contributions to collaborative practice, ethics, and policy in health care.
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Shannon, S. E. (2016). The nurse as the patient's advocate: A contrarian view. The Hastings Center Report, 46 Suppl 1S43-S47. doi:10.1002/hast.632
Listening to the Narratives of Our Patients as Part of Holistic Nursing Care. Nurses in all settings interact with individuals often identified as vulnerable or marginalized, and at times are frustrated by their own inability to "make a difference." By allowing oneself to listen, a fuller appreciation of the individual circumstance, or that which is unwritten, can be appreciated. Storytelling is a way to set the stage for experiences to be shared and can provide insight into lives. The narratives told by patients are often complex, affected by various influences of the environment, and personal, which in combination with nursing informs their individual healing journeys. Using a philosophy of nursing that encompasses all of the distinct influences on these narratives can allow nurses to more holistically care and advocate for their patients. As this case study shows, nursing plays a significant role in the narratives of others. Although many vulnerable populations live in a perpetual cycle of poverty and poor health, some nurses are able to assess the intricacies of a situation and facilitate understanding, as part of their support, caring, and advocacy for their patients.
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Alicea-Planas, J. (2016). Listening to the narratives of our patients as part of holistic nursing care. Journal Of Holistic Nursing: Official Journal Of The American Holistic Nurses' Association, 34(2), 162-166. doi:10.1177/0898010115591396

The Ethics of Human Freedom and Healthcare Policy: A Nursing Theoretical Perspective. Global healthcare and healthcare policies are evolving with change at a swift pace. Inherent in the discussions of a person's right to choose health is the notion of freedom. The author in this column compares and contrasts bioethical views of freedom and autonomy with alternative views and possibilities by examining an ethic of freedom grounded from a different paradigm, the humanbecoming nursing theoretical perspective.
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Milton, C. L. (2015). The ethics of human freedom and healthcare policy: A nursing theoreticalpPerspective. Nursing Science Quarterly, 28(3), 192-194. doi:10.1177/0894318415585630
Cultivating Synergy in Nursing, Bioethics, and Policy. Nursing and bioethics have a lot in common because they share concerns about life and death, illness and health, the rights of individuals and communities, ethical patient care, health care delivery, and public health. Nurses and bioethicists contribute to ethical practice, ethics scholarship, and health policy-making in a variety of ways. Some nurses have bioethics education or experience, some bioethicists study or collaborate closely with nurses, and some of us proudly identify as both bioethicists and as nurses. Despite certain shared and interwoven aims, bioethicists and nurses often accomplish their goals in dissimilar ways, have diverse educational and training trajectories as well as distinct roles and responsibilities, and are viewed differently within health care organizations. Yet the work of bioethics and nursing can be, and in my view should more often be, synergistic. That synergism may be especially critical in the arena of health policy and ethics. Nurses can bring extraordinary insights and real-world experiences to the policy table but are not always considered essential contributors.
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Grady, C. (2016). Cultivating synergy in nursing, bioethics, and policy. Hastings Center Report, 46S5-S8. doi:10.1002/hast.623

Ethics and Defining Cultural Competence. Global ethics calls upon the discipline of nursing to critically evaluate personal and culture-based beliefs to nurture professionalism in relationships and improve health disparities. What does it potentially mean to provide nurse services based on culture and cultural competence? This article begins a discussion of potential ethical questions that surround the concept of culture and potential implications for education and practice from a nursing theoretical perspective.
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Milton, C. L. (2016). Ethics and defining cultural competence. Nursing Science Quarterly, 29(1), 21-23. doi:10.1177/0894318415614624
Creating a Culture of Ethical Practice in Health Care Delivery Systems. Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy-makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice.
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Rushton, C. H. (2016). Creating a culture of ethical practice in health care delivery systems. Hastings Center Report, 46S28-S31. doi:10.1002/hast.628
Providing Palliative Care to LGBTQ Patients. Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care.
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Barrett, N., & Wholihan, D. (2016). Providing P\palliative care to LGBTQ patients. The Nursing Clinics Of North America, 51(3), 501-511. doi:10.1016/j.cnur.2016.05.001
Nursing care and maintaining professional boundaries. Compassion is inherent to good nursing care and is an expectation within the NHS (Nursing and Midwifery Council [NMC], 2012). This is much easier said than done however, and genuinely compassionate care is not always easy to achieve in every nursing interaction. Nurses working in the community will usually visit several patients in a day, each with their own personalities and individual circumstances spanning a range of diagnoses and prognoses.
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Mendes, A. (2017). Nursing care and maintaining professional boundaries. British Journal Of Community Nursing, 22(8), 407-408. doi:10.12968/bjcn.2017.22.8.407
Ethics, Law, and Policy. Dead Wrong! The Ethics of Culturally Competent Care. The article describes the case of a 39-year-old female with human immunodeficiency virus and acquired immunodeficiency syndrome in which her ability to exercise autonomy was influenced by her cultural beliefs. Topics covered include the need for health institutions to bridge barriers to safe and effective health care, ability to communicate a choice and understand relevant information, and difficulty of surrogate decision making when the patient refuses to disclose personal health information.
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Ortiz, J., & Casey, D. (2017). Ethics, law, and policy. Dead wrong! The ethics of culturally competent care. MEDSURG Nursing, 26(4), 279-282.
Health implications of human trafficking. Freedom is arguably the most cherished right in the United States. But each year, approximately 14,500 to 17,500 women, men and children are trafficked into the United States for the purposes of forced labor or sexual exploitation. Human trafficking has significant effects on both physical and mental health. This article describes the features of human trafficking, its physical and mental health effects and the vital role nurses can play in providing care to this vulnerable population.
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Richards, T. A. (2014). Health implications of human trafficking. Nursing For Women's Health, 18(2), 155-162. doi:10.1111/1751-486X.12112

Ethical Issues in School Nursing. School nurses are a unique group. They may be responsible for hundreds of students; some may have over 1000 students in their charge. They must have a breadth of knowledge to assess, treat, or refer for common pediatric illness and injuries, as well as ability to manage health emergencies and disasters. In addition, they must navigate rules, policies, and regulations that apply to their educational setting, and adhere to their state Nurse Practice Act. Overall goals for school nurses address student health, safety, and learning. In this quest, they may encounter myriad ethical issues. Rarely does literature include specific ethical issues faced by school nurses. This article addresses this gap by offering a brief review of the literature, and discussion about ethical concepts in the context of school nursing, ethical decision-making, and other relevant concepts such as moral distress, moral courage. Also included are recommendations and resources for school nurses.
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Savage, T. A. (2017). Ethical issues in school nursing. Online Journal Of Issues In Nursing, 22(3), 1. doi:10.3912/OJIN.Vol22No03Man04
Ethics, Law, and Policy. Nurse's Role in Increasing Patient Access to Hospice Care. Three contributing factors account for the increase in hospice use: patients’ preferences for dying at home, bereaved family members’ high satisfaction with hospice care, and Medicare payment system associated with the Balanced Budget Act of 1997 (Park-Lee & Decker, 2010). Medicare is the single largest payer for hospice care. Although a significant increase in hospice use has occurred in the last 10 years, one-half of the patients enroll in the last 3 weeks of life (National Hospice and Palliative Care Organization [NHPCO], 2009). Additionally, research reveals that about one third enroll in the last week of life, and 10% enroll on the last day. The mean length of stay is 49 days, with less than 17% of patients receiving 6 months of care (Medicare Payment Advisory Commission, 2009). Also 60% of Medicare decedents were not enrolled in hospice at the time of their death.
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Lachman, V. D. (2011). Ethics, law, and policy. Nurse's role in increasing patient access to hospice care. MEDSURG Nursing, 20(4), 200-207.
Nurses in the Know: The History and Future of Advance Directives. Health crises are unpredictable. Nurses have a role in promoting advance directives that is increasingly important. The aging population is increasing and individuals are living longer and often seeking healthcare alone. Nurses must understand the history and nature of advance healthcare directives to help patients make informed decisions prior to a crisis. Major milestones in the history of advance directives have resulted from cases of healthy, young people in their twenties. This article defines advanced directives, and discusses the evolution of patient self-determination as a concept and the Patient Self-Determination Act. Federal law and varied state laws, some still evolving, and the American Nurses Association Code of Ethics together define nurses' ethical obligations to educate patients and advocate for their legal right to self-determination.
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Miller, B. (2017). Nurses in the know: The history and future of advance directives. Online Journal Of Issues In Nursing, 22(3), 1. doi:10.3912/OJIN.Vol22No03PPT57

Understanding Nursing Ethics

Course Focus Book (Limited to two concurrent users. Be sure to logout when finished reading).

Ethics and Issues in Contemporary Nursing by Margaret A. Burkhardt; Alvita Nathaniel
ISBN: 1133129161
Publication Date: 2013-06-05