Foundations And Essentials For The Doctor Of Nursing Practice
DISCUSSION RESPONSE
respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an alternative approach to the ethical issue described by your colleague.
PEER #1
Ethics
Nursing, a profession at the intersection of science and humanity, is inherently bound to ethical considerations. Nursing ethics revolves around compassionate and principled care to preserve patient dignity and well-being. The advent of technology and the unprecedented challenges posed by the COVID-19 pandemic have brought forth a surge in ethical dilemmas nurses face. These complexities necessitate a rigorous exploration into the evolving ethical landscape in nursing, leading one to scrutinize issues such as informed consent, medical violence, advocacy in health policy, and the integration of artificial intelligence (AI) in healthcare. This project explores these pertinent ethical issues, reflecting on their implications and how they have been navigated in personal nursing practice.
Ethical Issues
As part of nursing practice, myriad ethical considerations consistently surface, requiring DNP-prepared nurses to navigate with competence and compassion. One such critical issue is informed consent and its intersection with medical violence. Campbell (2021) clarifies the concept of informed consent, emphasizing its paramount significance to patient autonomy. This principle is particularly imperative in obstetric cases, where Black women have been systematically subjected to medical violence and limitations in informed consent, exacerbating the disparities in maternal morbidity and mortality (Campbell, 2021; Howell, 2018). In my practice, I vividly recall encountering a case where a Black pregnant woman was not informed about the risks of a medical procedure, instigating distress and mistrust. By advocating for the patient, ensuring proper communication, and addressing the issue with the healthcare team, I sought to prevent such recurrences and uphold the ethical principles of nursing practice.
Further, the ethical landscape of nursing is characterized by the vital role of advocacy in health policy and patient care. Heck et al. (2022) provide a comprehensive overview of nursing advocacy. It outlines its significance in influencing health policy and safeguarding patient well-being. During the COVID-19 pandemic, the role of nurses in shaping health policies and addressing healthcare disparities became increasingly critical (Anders, 2020). It was evident in my practice, where I witnessed disparities in healthcare access and outcomes, particularly among minority populations. By participating in policy advocacy, collaborating with healthcare teams, and engaging in community education and outreach, I actively addressed these disparities and enhanced equitable healthcare delivery.
In addition to these traditional ethical concerns, the emergence of AI in healthcare presents a novel frontier of ethical deliberations. Morley et al. (2020) introduce the use of AI in healthcare. It shows the associated ethical challenges and the imperative for robust governance models. In one instance in my practice, I encountered a situation where an AI-based diagnostic tool demonstrated bias in predicting health outcomes, raising significant ethical concerns. By voicing these concerns, collaborating with IT specialists, and advocating for the ethical application of AI, I endeavored to ensure that technology serves as a tool for enhancing, rather than compromising, patient care (Reddy et al., 2020). Overall, the DNP-prepared nurse grapples with various ethical issues, ranging from informed consent and advocacy to the ethical application of emerging technologies. Through reflection on personal practice and adherence to ethical guidelines, nurses can effectively navigate these challenges, ensuring the delivery of compassionate, equitable, and competent care to all patients.
Conclusion
In conclusion, the ethical landscape that DNP-prepared nurses navigate is vast and varied, presenting issues from informed consent and medical violence to advocacy in health policy and the ethical implications of AI in healthcare. By exploring practical scenarios, one might discern these ethical considerations’ profound impact on patient care and outcomes. Armed with knowledge, compassion, and a commitment to advocacy, nurses are positioned at the forefront of addressing these challenges. Nurses play a pivotal role in advancing ethical healthcare practices by fostering open communication, championing patient autonomy, influencing health policy, and scrutinizing emerging technologies.
References
Anders, R. L. (2020). Engaging nurses in health policy in the era of COVID‐19. Nursing Forum, 56(1), 89–94. https://doi.org/10.1111/nuf.12514Links to an external site.
Campbell, C. (2021). Medical violence, obstetric racism, and the limits of informed consent for Black women. Michigan Journal of Race & Law, 26(1), 47–75. https://doi.org/10.36643/mjrl.26.sp.medicalLinks to an external site.
Heck, L. O., Carrara, B. S., Mendes, I. A. C., & Arena Ventura, C. A. (2022). Nursing and advocacy in health: An integrative review. Nursing Ethics, 29(4), 1014–1034. https://doi.org/10.1177/09697330211062981Links to an external site.
Howell E. A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2), 387–399. https://doi.org/10.1097/GRF.0000000000000349Links to an external site.
Morley, J., Machado, C. C. V., Burr, C., Cowls, J., Joshi, I., Taddeo, M., & Floridi, L. (2020). The ethics of AI in health care: A mapping review. Social Science & Medicine, 260. https://www.sciencedirect.com/science/article/pii/S0277953620303919Links to an external site.
Reddy, S., Allan, S., Coghlan, S., & Cooper, P. (2020). A governance model for the application of AI in health care. Journal of the American Medical Informatics Association, 27(3), 491–497. https://doi.org/10.1093/jamia/ocz192Links to an external site.
PEER # 2
Diane Rivero
Ethical Issues
Over the past few decades, the healthcare system’s need for organizational ethics has risen due to the increase in players such as private health investors, insurance firms, and hospitals (Phelan, 2020). They allow organizations to cultivate ethics among their employees while guiding them on maintaining employee expectations and attracting public trust. Several ethical issues emerge relevant to DNP-prepared nurses, which can be compared to those I have encountered in my nursing practice experience.
For instance, one of the most common ethical challenges is related to advocacy and organizational ethics. Most DNP-prepared nurses are more likely to experience challenges in balancing their ethical responsibility to enhance and advocate for optimal care while meeting their organization’s operational and financial goals (Rejnö et al., 2020). For instance, I have experienced situations where optimal patient care was compromised by the cost-cutting policy of the hospital I used to work for a few years ago, which involved reducing costs by implementing a strict nurse-patient ratio. This policy created challenges to nurses’ ability to ethically conduct various nursing practices while at the same time respecting and adhering to the hospital’s cost-cutting measures, thus affecting their ability to provide quality care. Another issue is related to autonomy and dignity in advanced practice. Due to the complexities of impaired autonomy conditions, DNP-prepared nurses are most likely to work closely with them, thus engaging in advanced practice (Pavlish et al., 2020). As such, it is paramount for nurses to respect the patient’s autonomy and maintain their dignity. For instance, I encountered a situation where a patient’s dignity raised ethical concerns after undergoing unnecessary invasive procedures for his advanced dementia. Patients’ preferences and values should always be consistent with their care plans, and advanced practice nurses should see to it, even if their ability to do so is compromised, especially if they are working in palliative or gerontology care.
DNP-prepared nurses can address these ethical challenges since they have a broader responsibility and influence within healthcare facilities. For instance, as a DNP-prepared nurse, I should ensure that ethical standards align with my responsibility to shape and influence organizational practices and policies in the wake of challenges balancing the organization’s operational and financial goals. I would also promote ethical care by implementing practices and helping develop policies that foster respect and dignity for patients suffering from impaired autonomy (Torkaman, Heydari & Torabizadeh, 2020). Through continuous education, nurses will be better equipped with advanced leadership capabilities and ethical decision-making skills to develop strategies that uphold high ethical standards while advocating for patients to shape organizational policies and effectively address these challenges.
References
Pavlish, C. L., Henriksen, J., Brown-Saltzman, K., Robinson, E. M., Warda, U. S., Farra, C., … & Jakel, P. (2020). A team-based early action protocol to address ethical concerns in the intensive care unit. American Journal of Critical Care, 29(1), 49-61.
Phelan, P. S. (2020). Organizational Ethics for US Health Care Today. AMA Journal of Ethics, 22(3): E183-186. https://journalofethics.ama-assn.org/article/organizational-ethics-us-health-care-today/2020-03 Links to an external site.
Rejnö, Å., Ternestedt, B. M., Nordenfelt, L., Silfverberg, G., & Godskesen, T. E. (2020). Dignity at stake: Caring for persons with impaired autonomy. Nursing ethics, 27(1), 104-115.
Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics and History of Medicine, 13.