Analyze the moral, ethical, and legal implications utilized in this situation.

Assignment: Application: Taking a Stand

 Write a 4 to 5 page paper (page count does not include title and reference page) that addresses the following: APA style and 5-6 academic references that are led than 5 years old

• Introduce the conceptual frameworks of the ethical constructs of ethics, moral, or legal standards and the purpose of the paper.
• Consider  an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it.
• Analyze the moral, ethical, and legal implications utilized in this situation. Describe your role as a moral agent or advocate for this specific issue.
• Consider your leadership styles identified by your self-assessment and determine if they act as a barrier or facilitation during this dilemma.

The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references

• Introduction
• Ethical Framework for Decision Making – four ethical frameworks: utilitarianism, duty-based reasoning, right-based reasoning, intuitionism
• Dilemma at the Workplace –a nursing example and my role as the moral agent or advocate
• Self-Assessment – Keirsey Temperament Sorter questionnaire

SAMPLE WORK

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Taking a Stand

Walden University

Interprofessional Organizational and Systems Leadership

NURS 6053 N-37

May 6, 2017

1

Taking a Stand

Like many other healthcare professionals, nurses must practice in accordance with federal and state guidelines. Moreover, they need to make ethically responsible decisions on a daily basis. Nurses must also make sure that their actions serve the best interests of their patients and do not result in harm. Ostensibly these are straightforward tasks, and yet very often situations are not very well-defined and in such circumstances there arise blurry distinctions between what is legal to do and what is right to do. Nursing leaders are frequently involved in ethical decision-making, therefore, self-awareness with respect to one’s personal values, moral obligations, and beliefs must be recognized as part of the responsible ethical decision-making processes (Marquis & Huston, 2015). The purpose of this paper is to introduce the ethical framework for decision-making, analyzing the moral, ethical, and legal implications in particular situations, and describing the leadership role based on self-assessment.

Ethical Framework for Decision Making

There are many systems of ethics, and many possible ways to think about right and wrong actions. Ethical frameworks do not solve the dilemmas, but assist in helping to clarify personal values and beliefs when make a decision (Marquis & Huston, 2015). There are four ethical frameworks in common use, including (1) utilitarianism, which is based on providing “the greatest good for the greatest number of people” (Marquis & Huston, 2015 p.75); (2) duty-based reasoning, where decisions need to be made based on the basis of, for example, a “duty to do something or refrain from doing something” (Marquis & Huston, 2015, p.75); (3) right-based reasoning, wherein individuals have rights that should not be interfered with (Marquis & Huston, 2015, p.75); and (4) intuitionism, in which ethical problems are reviewed on a case-by-case basis (Marquis & Huston, 2015).

Moral and ethical frameworks are protected by professional codes of ethics. The accepted guidelines for ethical nursing practice in the United States are listed and published by the American Nurses Association (ANA).  Essential ethical principles of the nursing profession are embedded in basic elements of nursing care, and include: attentiveness, responsibility, competence, and patient responsiveness (Ulrich et al., 2010).

Dilemma at the Workplace

Every day nurses make decisions that affect their patients and have a direct impact on people’s lives. They are obligated to contemplate all the possible consequences of their actions. Many times the only option a nurse might have to influence patient care in situations of concern, however, is to bring a problem to the attention of the physician.

Here is an example of one such case: a ninety-two-year-old patient is admitted to an Oncology Floor with a diagnosis of metastatic colon cancer for the pain and fluid management. Patient has an Advance Directives with DNR orders. In the middle of night shift, the nurse observes this non-verbal patient with the classic symptoms of pain and distress: moaning, crying and grimacing, and with elevated rates of heart rate and blood pressure. The pain medication orders state: “Acetaminophen 650 mg, Rectal, Fentanyl 50 mg topical.” RN calls physician and asks him to order additional pain medications, specifically for opioid narcotics. Doctor refuses to put the order in, stating that Morphine will slow the patient’s respiratory rate and accelerate the process of dying. The nurse is facing an ethical and moral dilemma: using her critical thinking skills, knowledge, and compassion, she wants to ease the patient’s pain; yet, from the legal point of view, she simply cannot expedite the patient’s death. Moreover, she cannot force the doctor to act—her hands are tied.

Nurses are ethically obligated to be loyal, fair, and truthful with their patients. Considering the patient’s suffering, and based on the nurse’s knowledge and skills, this nurse decides to advocate for her patient. In the middle of the night she calls the patient’s oncologist and also the nursing hospital supervisor. She also calls the patient’s family and decides to respect their wishes and provide the best possible comfort, care, and dignity to her suffering patient. She insists that physician come and reassess the patient on the floor. Finally, the medications are prescribed and the patient passes away, peacefully, that same night.

Fifteen years ago I was that nurse. I still remember my frustration and feelings of helplessness. But the decision was made, and that experience made me stronger. Relieving and managing patients of their suffering—whether it be physical, emotional or psychological suffering—constitutes the most important aspect of care (Bernhofer, 2011). The ANA states the importance of advocacy in its Code of Ethics, including Provision 3: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (ANA, 2015). Advocating for this patient was my moral and ethical obligation.

Self-Assessment

The self-assessment was done using Keirsey Temperament Sorter questionnaire, and revealed the following characteristics. According the test, I am an “Artisan (Promoter)”—in the category of persons who speak mostly about what they see right in front of them, about how they can act right away; they will do whatever works and whatever gives them a quick, effective results (Keirsey Temperament Sorter, n.d.). Professionally, the combination of being realistic and also incorporating strategic risk-taking makes these people effective as troubleshooting leaders. Their highly-persuasive communication skills and abilities can help motivate and lead people, as well as to attract and keep followers. Strong and supportive leadership would guarantee nursing staff to be actively involved in these crucial decision-making process. Recognizing personal strengths and weaknesses helps leaders to make quality ethical decisions and taking an assessed risk of the possible negative outcomes (Marquis & Huston, 2015).

Conclusion

The patient is at the core of professional nursing practices. Nurses are facing legal, ethical and moral dilemmas on a daily basis. Beneficence— “doing good”—is our basic ethical obligation to our patients. Our basic ethical obligation is often not easy to implement in practice, however, and so knowing our personal strengths and weaknesses can help nursing practitioners in evaluating problematic circumstances and in making the best possible decisions for the patients in our care.

References

America Nurses Association (ANA). Code of Ethics for Nurses with Interpretive Statements 1

Provision 3, 2015

Bernhofer, E., (2011) Ethics and Pain Management in Hospitalized Patients. OJIN: The Online

Journal of Issues in Nursing Vol. 17 No. 1.

Keirsey Temperament Sorter (KTS -II). (n.d.) Retrieved from

http://keirsey.com/4temps/artisan_overview.asp

Laureate Education (Producer). (2012a). Ethical, moral, and legal leadership. Baltimore, MD:

Author.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing:

Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010).

Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced

Nursing, 66(11), 2510-2519. doi:10.1111/j.1365-2648.2010.05425.x