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ethical issues faced by nurse practitioners ethical issues faced by nurse practitioners

Ethical and Legal Problems Faced by Nurse Practitioners Every medical professional has or will face some ethical and legal issues in the Medical Field, the Nurse Practitioners (NP) are no different. DOI: 10.3912/OJIN.Vol19No02Man02Key words: Nurse Practitioner, Nurse Practitioner Education, Nurse Practitioner PracticeIn the 1970’s NP education moved from a certificate program to programs that offered bachelors or masters degrees. Utilitarianism, perhaps the most well known of the consequentialist theories, identifies the principle of utility as the fundamental and only principle of ethics (Beauchamp & Childress, 2009). APRNs are confronted with a variety of everyday ethical conflicts, including: 1. The following are several common ethical dilemmas that nurses face while on the job. Ethical and Legal Role of an Advanced Nurse Practitioner Ethical and Legal Role of an Advanced Nurse Practitioner Advanced nurse practitioners welcome the dynamic developments in the nursing practice that assist them in the delivery of quality care mainly focusing on the patient (Kjervik & Brous, 2010). Moral/ethical issues encountered by a PMHNP essay example. “Some nurses feel it is ‘starving the person to death.’ This is even worse in the pediatric setting when the parents have made the decision to discontinue life-sustaining treatments and focus on comfort. Ethical issues experienced by community based nurse practitioners addressing health disparities among vulnerable populations. Graduates are prepared to sit for the Acute Care Nurse Practitioner certification exam administered by the American Nurses Credentialing Center (ANCC). To prepare: • Review literature for moral/ethical issues encountered by a PMHNP. More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). Master’s, post-master’s or doctoral preparation is required for entry-level practice (AANP, 2006). The application of bioethical theories to clinical situations originated when acute care medical technology advances made it possible to preserve life without consideration to the quality of the life preserved (Dierckx de Casterle, Roelens, & Gastmans, 1998; Dubler, 2011). However, very little is known about the ethical conflicts and causes of these conflicts experienced by these clinicians in their daily practice. Legal and ethical issues are prevalent in the health care industry, and in particular for the nursing practice, where nurses have daily individual contact with patients. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain integrity of the profession, and integrate principles of social justice into nursing and health policy. Fant stated that in an ethical dilemma there are no right answers or solutions; however, in these dilemmas there are no wrong answers either. PMHNPs face ethical dilemmas just like other nurse practitioner specialties. Bio-ethicists implemented ethical theories with a principlist approach as a way to examine ethical conflicts. Access to electronic health records is granted and monitored. accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). Fant stated that in an ethical dilemma there are no right answers or solutions; however, in these dilemmas there are no wrong answers either. Nurse practitioners (NPs) are licensed, independent practitioners who provide primary and/or specialty nursing and medical care in ambulatory, acute and long-term care settings. Ethical concerns about autonomy versus beneficence often become a heated debate when addressing childhood immunizations. Nurses who follow this theory would take the action that produces the greatest good for the greatest number. One ethical dilemma that can occur in healthcare facilities is when nurses themselves are not properly equipped to complete their duties. Consequentialist theories identify an action as right or wrong based on the outcome or consequences of that action (Beauchamp & Childress, 2009). Struggles with pain management and opiate prescribing practices for patients in chronic pain (Fontana, 2008). Before a medical procedure takes place, it is the nurse’s responsibility to obtain informed consent. According to the American Nurses Association code of ethics, “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.” As nurses, we have the privilege of protecting the health of the community and the individual, … Nurses in all settings and roles are bound by the ANA’s nursing code of ethics, which deals with various areas of patient care and provides guidance in handling the top ethical issues in nursing today, such as the five discussed below. Depending on the state, FNPs could face legal implications for prescribing to family and friends. Examples of Ethical Dilemmas that Nurses Deal with on a Regular Basis •Dealing with the pro-life and pro-choice debate. Master’s, post-master’s or doctoral preparation is required for entry-level practice (AANP, 2006). “I tell my nurses to always ask themselves, 'What are the goals of the patient and/or family?' Ethical issues are wide-ranging, from organ donation, genetic engineering, assisted suicide, withholding treatment in end-of-life care, or simple procedures requiring consent. Ethical and Legal Problems Faced by Nurse Practitioners Every medical professional has or will face some ethical and legal issues in the Medical Field, the Nurse Practitioners (NP) are no different. Nurses in all settings and roles are bound by the ANA’s nursing code of ethics, which deals with various areas of patient care and provides guidance in handling the top ethical issues in nursing today, such as the five discussed below. A common barrier to noncompliance is science versus spirituality. Nursing ethics require you to inform your patients of the necessity for medical treatment, but you can’t force them to accept it. Nurses must adhere to ethical guidelines surrounding the opioid epidemic as they struggle with the dilemma of the best treatment approach for their patients. The action considered morally right is the action that produces the best overall result. Research exploring nursing ethics for APRNs has also addressed areas such as respect for human dignity (Kalb & O'Connor-Von, 2007; Ulrich et al., 2010) and the ethical problems encountered by APRNs related to client care and organizational-industrial issues (Hannigan, 2006; Laabs, 2005, 2007; Ulrich & Hamric, 2008; Ulrich & Soeken, 2005). “According to co-author Catherine Hiler, RN, DNP, CCRN-CMC, the intensive care unit is a practice environment where life-sustaining care intersects with end-of-life care. Ulrich indicated that end-of-life issues arise as concerns but ethical dilemmas also extend to the day-to-day issues of caring for patients. 3. Fant stated that in an ethical dilemma there are no right answers or solutions; however, in these dilemmas there are no wrong answers either. those of nurses who share [patient] oversight with other health-care professionals” (Grace, 2004b, pp. This chapter reviews basic ethics definitions, discusses keys to application of ethical guidelines for APRN challenges, and briefly defines and critiques the current ethical decisional frameworks. Patient or family conflicts when the prognosis or goals of care are unclear (Dubler, 2011; Laabs, 2005; Ulrich et al., 2010; Wiegand, 2003), 2. Background: More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). Nurses are highly accountable to patients, the public, employers, and the entire profession. 2, Manuscript 2. Conclusions A proposal for a code of ethics for NPs is presented. Citation: Hain, D., Fleck, L., (May 31, 2014) \"Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign\" OJIN: The Online Journal of Issues in Nursing Vol. “Artificial hydration and nutrition is the most difficult conversation to have with patients, family and staff,” says Helen Staples-Evans, DNP, RN, NE-BC and Chief Nursing Officer at Loma Linda University Children’s Hospital. Citation: Hain, D., Fleck, L., (May 31, 2014) \"Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign\" OJIN: The Online Journal of Issues in Nursing Vol. 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique of attributes of every person. For example, a client may refuse to follow up by getting a necessary diagnostic test (autonomy) even though obtaining an accurate diagnosis and appropriate treatment for a recurring problem may benefit the client's health (beneficence) (Dubler, 2011; Fiester, 2007). To make matters even trickier for nurses, the same ethical dilemma on two different occasions may require a different solution each time. 2, Manuscript 2. Just give us a call or check out our helpful FAQs. The American Nurses Association (ANA) Code of Ethics (ANA, 2015) is a good example of incorporating virtue ethics into the ethical and legal obligations of the nursing profession (Exhibit 12.1). Unfortunately, you can try to administer care and dispense prescribed medications, but the patient has every right to refuse all medical treatment, even if it means they may not survive. Ethical legal decision-making dilemma for the nurse practitioner In creating an ethical and legal decision-making dilemma involving an advanced practice nurse in the field of a family nurse practitioner (FNP) I will be choosing the practice dilemma of honesty versus withholding information. Ethical issues in nursing also emerge from the opioid crisis. Participating in the dual degree program will enable Family Nurse Practitioners to be better prepared for these challenges. The fact that the patient is incarcerated is only a circumstance of his or her situation and does not, and should not, change how the nurse practices or how the nurse views the patient. There has to be mutual trusting relationship between the therapist and the Unethical practices of health care colleagues or demands by employers for coding or billing practices that may be questionable or fraudulent (Peirce & Smith, 2008; Laabs, 2005; Hannigan, 2006: Ulrich et al., 2010), 7. Family Nurse Practitioner. Nurse practitioners face ethical dilemmas in the healthcare system everyday, including issues surrounding treatment options, insurance coverage, institutional policies, patient confidentiality, cultural and religious beliefs, end of life care, and more. They are registered nurses with specialized, advanced education and clinical competency to provide health and medical care for diverse populations in a variety of primary care, acute and long-term care settings. The correctional nurse makes ethical decisions about care delivery, caring and patient advocacy in planning and providing safe patient care. Primary care nurse practitioners (NPs), working in nursing centers, frequently care for vulnerable patients who are at increased risk for poor health outcomes and diminished quality of life. However, other ethical problems were encountered in the areas of privacy, beneficence, non-maleficence, and justice. She says the number one resource accessed on the AACN website in 2018 was related to ethics: a study published in the American Journal of Critical Care about Predictors of Moral Distress in a US Sample of Critical Care Nurses. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. The term ethics is used broadly to understand and examine the moral life, and the norms, social customs, and rules that define society's conceptions of right and wrong. The primary care gap has surfaced over the past decade from events including the Affordable Care Act, new education requirements for health care providers, and increasing clinical complexity in patient populations. Conclusion: Based on study results, serious ethical problems were ob- Bioethicists encourage specific decisional strategies to apply this principlist theory to clinical situations (Fiester, 2007). Today, bullying has become a serious issue, and nurses are not immune to these challenges in nursing. 8. These providers are likely to be confronted with a variety of ethical issues as they balance quality care with their patients' rising cost concerns. (Frankena, 1988). Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. 6. This rule-based deontologic approach to ethical problem solving uses the specific bioethical principles of autonomy, beneficence, nonmaleficence, justice, and rules of veracity, confidentiality, and fidelity (Beauchamp & Childress, 2009). The American Nurses Association (ANA) defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient.” The American Nurses Association developed the Code of Ethics for Nurses to establish the ethical standard for nurses and the ethical obligations and duties of everyone in the nursing profession. Nurses eating their young isn’t an entirely new thing. Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. Ethical and Legal Problems Faced by Nurse Practitioners Every medical professional has or will face some ethical and legal issues in the Medical Field, the Nurse Practitioners (NP) are no different. Access to electronic health records is granted and monitored. HIPAA laws protect healthcare consumers from having their personal health information shared inappropriately. iThese d… The sudden onset of acute illness raises a host of ethical challenges for both the patient/family and the nurse practitioner, including questions about care plans and decision-making. Understanding the application of ethical constructs and theories is essential for APRNs as they address complex health issues and manage ethical conflicts in research and business arenas (Peirce & Smith, 2008). Loma Linda University Children’s Hospital, Ethical dilemmas for emergency room nurses. In addition to understanding the legal implications of prescribing medications, FNPs must also understand their ethical obligations, particularly in light of the ongoing … Futile care or aggressive interventions. Ethical Issues in Psychiatric Nursing In mental health care, the epistemological distinctions be- tween what are considered as ‘illness’ and ‘health’ or ‘normal’ and ‘abnormal’ is often not as clear as in somatic health care. Respect for persons (autonomy and self-determination) 2. Healthcare technology is set up to protect privacy as well. those of nurses who share [patient] oversight with other health-care professionals” (Grace, 2004b, pp. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of work setting and conditions of employment that are conducive to safe, quality health care. Before a medical procedure takes place, it is the nurse’s responsibility to obtain informed consent. Examples of Ethical Dilemmas that Nurses Deal with on a Regular Basis •Dealing with the pro-life and pro-choice debate. Respectfulness and integrity are identified in this code and have been examined as an important part of ethics education for APRNs (Kalb & O'Connor-Von, 2007; Peirce & Smith, 2008). Ethical theories organize concepts or principles into a framework that can be used to approach ethical conflicts. Protect confidentiality. Privacy screens help reduce the visibility of patient charts, and passwords are required t… The nurse practitioner saw the patient several more times, and the patient s condition improved. Virtue ethics offers a framework that provides a warmer interpersonal view of ethical decisions compared with the calculated reasoning that Kantian principles require. These providers are likely to be confronted with a variety of ethical issues as they balance quality care with their patients' rising cost concerns. There are other ethical theories that may be relevant and helpful guides to health care practitioners. 2. APRNs soon discover that ethical principles can conflict and compete and become the basis for ethical dilemmas in clinical situations. In the course, Philosophical, Theoretical, & Ethical Basis of Advanced Practice Nursing, students are asked to debate an ethical issue in front of our peers and instructors with the goal of developing practical knowledge and skills to address ethical issues commonly faced in nursing. Risk and marginalization compound vulnerability and create the context for a variety of ethical issues. accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). Source: American Nurses Association (ANA; 2015). Challenges in Nursing: Bullying and Harassment. Causation of psychiatric diseases and response to psychiat- … Laabs (2007) describes a theory of maintaining moral integrity in the face of moral conflict as the key process that NPs use to manage the ethical issues encountered in primary care practices. The American Nurses Association (ANA) defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient.”. known about the ethical conflicts and causes of these conflicts experienced by these clinicians in their daily practice. This case study involves a nurse practitioner in an in-patient alcohol/drug treatment setting. The APRN would be morally conflicted when a family requests that he or she hide the truth from the patient because of the family concern for that patient's emotional status. Concerns about privacy and confidentiality of information in the era of human genomics and protected health information in the electronic medical record (Badzek, Henaghan, Turner, & Monsen, 2013; Demiris, Oliver, & Courtney, 2006; Peirce & Smith, 2008; Ulrich et al, 2010), 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. If the answer is yes, then the treatment should be continued; if not, the treatment shouldn’t be done.”. Particularly, many advanced practitioner nurses struggle with legal and ethical issues that are highly associated with their roles. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems … Nursing students most often identified inequality between the nurse educator and nursing student as the ethical issue faced by the nurse educator. When choices need to be made concerning ethical issues, but the “best” course of action isn’t clear and the treatment options aren’t ideal, nurses are often faced with an ethical dilemma. “Not giving artificial feeds and hydration to a dying person is very difficult for the families and staff,” Staples-Evans continued. The APRN’s Role and Responsibility in Ethical Prescribing. There are six ethical principles that arise frequently for the nurse who works in the correctional setting. Academic library - free online college e textbooks - info{at}ebrary.net - © 2014 - 2020. Writing for DailyNurse, Christina Morgan pointed out, “In the face of a primary care gap, much focus has been placed on nurses, especially nurse practitioners, as the solution. In today’s healthcare environment, ethical issues in nursing are becoming increasingly complex. Kantian ethics require the test of universalizability in all ethical decisions. In 1965, to meet the demands of underserved populations, Lorett… Legal & Ethical Issues that Health Care Professionals Face. To prepare: • Review literature for moral/ethical issues encountered by a PMHNP. These providers are likely to be confronted with a variety of ethical issues … Health care professionals continually face ethical and legal issues in the workplace, putting them at risk for burnout. The ANA Code of Ethics provides a standard by which nurse managers can assess ethical issues in nursing. Primary care nurse practitioners (NPs), working in nursing centers, frequently care for vulnerable patients who are at increased risk for poor health outcomes and diminished quality of life. Nurses are trained to protect private health information in nursing school and throughout their career by their employer. Artificial hydration and nutrition We found high levels of moral distress frequency when nurses deemed that the care being provided was futile, and the highest level of moral distress frequency occurred when the wishes of the patient’s family to continue life support were followed even though the nurse believed that doing so was not in the best interest of the patient.”. According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s … More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). • Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment. 321–322). Conflicts between insurer/payer system guidelines and the perceived most appropriate care (Laabs, 2005; Ulrich et al, 2006; Ulrich & Soeken, 2005), 6. A parent’s autonomy gives them the right to refuse to immunize their children, but not vaccinating potentially poses a public health hazard and could cause previously eradicated diseases to reappear. These providers are likely to be confronted with a variety of ethical issues … The primary care gap has surfaced over the past decade from events including the Affordable Care Act, new education requirements for health care providers, and increasing clinical complexity in patient populations. EXHIBIT 12.1 ANA Code of Ethics. Australia With the enactment of the 2009 Health Practitioner Regulation National Law Act in July 2010, Australia’s six states and two territory boards of nursing became one unified national board and with it a national nurse practitioner endorsement process. Like all jobs, it does present challenges. Today, bullying has become a serious issue, and nurses are not immune to these challenges in nursing. Risk and marginalization compound vulnerability and create the context for a variety of ethical issues. The following are several common ethical dilemmas that nurses face while on the job. That is, although the ethical substance of situations may not differ from that faced by nurses In fact, this disgusting practice … In 1965, to meet the demands of underserved populations, Lorett… There are three primary duties for nurses, among many others, which are the duty of autonomy, confidentiality, and duty of care to all patients. Advanced practice registered nurses (APRNs) are active in a variety of clinical, educational, and executive roles, with varying degrees of involvement in and influence over clinical practice. However, the way it addresses ethical dilemmas can vary in different situations. • Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment. The new doctorate of nursing practice (DNP) requirement will expand the knowledge required and the role of APRNs in a variety of settings. “There is an ethical problem in that the close relationship could cloud the practitioner’s judgment,” Buppert said in the Legal and Professional Issues for Nurses section of Medscape Nurse. As the Duquesne University School of Nursing explains on its blog, some religions restrict medical interventions, so patients or their family members with strong religious convictions may feel that science-based health care infringes on their religious beliefs and refuse much-needed treatment. Broader ethical issues. The discomfort among nurses grows the longer the child is alive and not being fed.”, 2. 321–322). The nurse, in roles and settings advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

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