MN506M1-1: Apply theoretical frameworks and concepts to ethical dilemmas in the advanced practice role

Based on your specialization, use the options below to create an ethical and legal decision-making dilemma involving an advanced practice nurse in the field of administration, education, or a nurse practitioner. 

  • Administration dilemma – Healthcare needs versus resource allocation
  • Education dilemma – Nursing student’s religious beliefs versus provision of care
  • Practice dilemma – Honesty versus withholding information 

Apply relevant codes of conduct that apply to nursing and the chosen field of the APN.

Describe one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts. 

Construct a decision that demonstrates integrity, and that would prevent violation of the ethical principle and prevent the law from being violated. 

List three recommendations that will resolve advanced practice nurses’ moral distress in the dilemma you have presented. Support your paper with a minimum of three scholarly references. 

Answer

Applying theoretical frameworks and concepts to ethical dilemmas

Ethical dilemmas are common in healthcare settings. Advanced practice nurses use their advanced nursing knowledge, skill, and judgement to solve ethical dilemmas and provide quality and safe care in primary care settings. Nursing codes of conduct and ethical principles guide nursing practice. Breaking some of these codes and principles may amount to criminal charges; thus, nurses pay hefty fines, lose licenses or serve some time in jail. This essay analyzes an ethical dilemma, nursing code of conduct, ethical decision-making, and recommendations to avoid moral distress.

Ethical Care Dilemma

Ms. Terry, a 16-year-old Hispanic American, comes to the outpatient department accompanied by her furious and fuming mother. She presents complains of lower abdominal pains, and the mother interjects care and claims that she suspects that her daughter is pregnant. The nurse requests Terry’s mother to go to the waiting room, to which she agrees after making demands that she should know all details about her condition. Inside the nurse’s room, Terry confirms that she has been involved in unsafe sex lately but uses a long-term family planning method, hormonal implants, which her mother does not know. She also asks the nurse not to share the information with the mother. She also adds that she feels pain in micturition has vagina discharge with a foul odor. On comprehensive assessment, the doctor diagnoses her with chlamydia and confides with the nurse to provide the best care to the patient. The nurse is torn between sharing this information with the parent because she is a minor or withholding it.

Nursing codes of conduct

There are several codes of conduct that guide nursing practice. Some of the relevant codes of conduct are a) Nurses maintain public confidence in the nursing profession, b) Nurses act with integrity to maintain patients’ trust, and c) Nurses maintain patients’ trust by providing safe and competent care (Cowin et al., 2019). Nurses use their knowledge, skills, and judgment in assessing patient needs. They are also responsible for upholding relevant laws and regulations regarding patient care. Maintaining patient privacy and confidentiality is paramount. Failure to fulfill these requirements have criminal/law implications. Nurses act promptly to protect and prevent patient harm. These actions include failure to share patients’ information inappropriately. Nurses should understand that they are responsible for their actions. They are also responsible for their health and should take corrective measures when they perceive that the health problems will affect their ability to provide safe and quality patient care (Gágyor et al., 2019). Lastly, nurses should communicate clearly and detail the care interventions and discuss them with their patients.

Ethical Principle

Confidentiality is an ethical principle that could be violated in this situation. The patient confided in the nurse and doctor. Being a minor, her mother demanded to know everything about her care. Confidentiality breaches can be acceptable in some instances, especially when withholding that information can cause severe harm to patients and others (Pathak & Chou, 2019). However, confidentiality is considered a criminal offense when it causes adverse effects on a patient’s health or safety. Minors have a right to confidentiality (though limited by their dependence on and the involvement of their parents in their care) (Pathak & Chou, 2019).

On the contrary, hospitals, in some instances, can be sued in courts of law for concealing information to prevent disclosure of the information under the Data Protection Act of 2018 section 173 (Price & Cohen, 2019). Healthcare institutions can also be sued for disclosing information that jeopardizes patient safety under the same act. However, care providers should ensure they provide data that does not jeopardize the client’s or institution’s safety.

Ethical Decision

Most states, including this state, say that when adolescents are old enough and give instructions regarding sharing their information, it is regarded as confidential. In this situation, the best decision is to determine the administrative laws and policies if they conform to the state provisions and make a judgment based on those policies (Rainer et al., 2018). This situation involves severe risk to the nurses’ job and their licenses. Thus, there is a need to ensure the institutional and state laws allow confining of the health information.

Recommendations to resolve APNs Moral Distress

The national association of clinical nurse specialists (NACNS) recognizes that nurse specialists face many ethical dilemmas in ethical dilemmas. These recommendations for moral distress are derived from the 4Rs moral distress strategy. The first recommendation is for the nurse to determine the severity, possible consequences of various actions, and attitudes of everyone (Shukla et al., 2019). This step helps the APN to make the right decision and avoid distress. The next recommendation is detaching personal feelings, views, and experiences from the situation. This step helps prevent stress bias in decision-making. The last recommendation is staying open to other people’s opinions and approaches and accepting their perceptions (Shukla et al., 2019). The FNP can include the interprofessional team in decision-making to ensure they make the best decision to minimize moral distress associated with ethical dilemmas.

Conclusion

Adolescents in the US are not protected by the laws in the confidentiality of their information. However, some state laws protect their information, as seen above. FNPs should understand laws and regulations that regulate nursing practice and certain ethical dilemmas. These laws help avoid law violations that could jeopardize their practice. They should also intentionally enhance their psychological health to ensure moral distress does not affect their practice.

References

 

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review, 66(3), 320-328. https://doi.org/10.1111/inr.12534

Gágyor, I., Heßling, A., Heim, S., Frewer, A., Nauck, F., & Himmel, W. (2019). Ethical challenges in primary care: a focus group study with general practitioners, nurses and informal caregivers. Family Practice, 36(2), 225-230. https://dx.doi.org/10.1093/fampra/cmy060

Pathak, P. R., & Chou, A. (2019). Confidential care for adolescents in the US Health Care System. Journal Of Patient-Centered Research And Reviews, 6(1), 46. https://dx.doi.org/10.17294/2330-0698.1656

Price, W. N., & Cohen, I. G. (2019). Privacy in the age of medical big data. Nature Medicine, 25(1), 37-43. https://doi.org/10.1038/s41591-018-0272-7

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461. https://doi.org/10.1111/jocn.14542

Shukla, R., Baker, R., Moody, K., & Allen, J. (2019). Improving Moral Distress and Provider Perceptions with an Integrated Palliative Care Conference in the Neonatal Intensive Care Unit (NICU)(TH370B). Journal of Pain and Symptom Management, 57(2), 394-395. https://doi.org/10.1016/j.jpainsymman.2018.12.092

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