Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Reference:

Skloot, R. (2010). The immortal life of Henrietta Lacks. New York, NY: Crown Publishing Group.

                                                                      MAIN POST

                                          Ethical Dimensions of Research Studies

       Nursing research and research studies can offer many gains in the healthcare field and offer clear, conscience evidenced-based practices (EBP). Before diving into conducting a research study it is essential to understand ethical issues and ethical dilemmas. Research ethics demand necessity on daily work, the protection of test subject’s and the publicizing of information from the research (Fouka & Mantzorou, 2011). Ethical dilemmas are situations where the test subject’s rights are in conflict with the studies requirements (Polit & Beck, 2017). Nursing researcher need to be aware of any ethical issues and develop a research plan to help alleviate any problems or ethical dilemmas.

Transfusion of Prematures

       Transfusion of Prematures (TOP) Trial was an open, parallel-group multicenter randomized controlled trial (RCT) analyzed by the intention to treat (Kirpalani et al., 2012). The main point of the TOP trial was to determine whether higher hemoglobin levels for giving transfusions to extremely low birth weight infants could result in higher hemoglobin levels leading to the improvements in neurodevelopmental impairment at 22-26 months of age and the primary outcome to be survival (ClinicalTrials, 2019). The trial explained that by avoiding a breach the current practice boundaries of the hemoglobin levels that would require an infusion by using a transfusion algorithm. This would avoid dilemmas and minimize risks to the test subject’s. There are no real results of this trial. The test subject’s will be seen for follow-up visits at around six years old to assess neurological and functional outcomes based on the transfusion threshold (Kirpaplani et al., 2012).

Ethical Principles

       Three principles that standards of ethical conduct in research are based on are beneficence, respect for human dignity and justice (Polit & Beck, 2017). Beneficence can be explained as a duty to promote good and eliminate harm to the test subjects. The TOP trial was seen by the Institutional Review Board (IRB) as harmful by veering away from usual care and harmful risks were posed by the deviations (National Public Radio, 2013). The researcher could have maintained usual care and not deviate from routine care on the test subjects. The second ethical principle is respect for human dignity which is the right to know what will take place or full disclosure (Polit & Beck, 2017). The TOPS trial had defects and faced criticism for not telling all this risks that the subjects would face. In this trial the consent forms did not elaborate on previous studies about when to transfuse. The studies suggested that premature infants that had transfusions later had a higher chance of death, brain injury and emergency care for transfusions (National Public Radio, 2013). The researchers should have been honest to the test subject’s parents regarding the previous studies and the risks of participation in the study. The third principle is justice which allows for fair treatment and the right to have privacy (Polit & Beck, 2017). In the TOPS trial it was suggested that the subject’s parents were not aware of what was being asked. Parents were giving up their rights to a physician to make decisions on what they feel was in the best interest of the infant. This would impede on the right to fair treatment. The researchers need to make sure that the parents of the test subjects understand every aspect of the trial and have the rights to make decisions on what they feel is in the best interest of their child. The parent should have the say so in what is being done to their child and not a physician. Research can be done on sensitive issues while protecting the rights of the research subjects by following the ethical principles. Adopting the ethical principles will help avoid ethical dilemmas in research.

Conclusion

       Nursing research has many benefits to the practice and can produce evidence- based practices to help provide the best care to our patients. Ethical dilemmas can be avoided by conducting a study that poses minimal conflicts with patient rights. Making patient safety the main goal is essential in the success of a research study. Keeping ethical principles of beneficence, respect for human dignity, and justice intertwined in the development or framework of the study is the only way to ensure that participants are being protected.

 

  

References

ClinicalTrials. (2019). Transfusion of Prematures (TOP). Retrieved March 18, 2019, from http://www.clinicaltrials.gov/ct2/show/NCT01702805.

 

Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3-14. Retrieved from the Walden Library databases.

 

 

 

Kirpalani, H., Bell, H., D’Angio, C., Hintz, S., Kennedy, K., Ohls, R., Poindexter, B., Schibler, K., Schmidt, B., Vohr, B., Widness, J., Das, A., Higgins, R., Zupancic, J., Roberts, R., Whyte, R., Chaudhary, A., & Johnson, K. (2012). Transfusion of Prematures (TOP) Trial: Does a Liberal Red Blood Cell Transfusion Strategy Improve Neurologically-Intact Survival of Extremely-Low-Birth-Weight Infants as Compared to a Restrictive Strategy? Neonatal Research Network. Retrieved from http://www.nichd.nih.gov/sites/default/files/about/Documents/ TOP_Protocol.pdf.

 

National Public Radio (2013). Another Study of Preemies Blasted Over Ethical Concerns. Retrieved March 18, 2019, from http://www.npr.org/sections/health-shots/2013/08/23/214800726/another-study-of-preemies-blasted-over-ethical-concerns.

 

Polit, D.F., & Beck, C.T. (2017) Nursing Research Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Based on “Case Study: Fetal Abnormality” and the required topic study materials, write a 750-1,000-word reflection that answers the following questions:

1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
3. How does the theory determine or influence each of their recommendations for action?
4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

Angela La Dow 

 

Manage Discussion Entry 

The name of the condition is Neonatal Abstinence Syndrome (NAS). The baby will be born with opioids on board and will require opioids or partial opioid receptor agonists to help the baby through withdrawl and detox. This process can be started while in utero with the mother in medication assisted treatment (MAT). The idea behind MAT is to use opioid agonists that do not fully cover the opioid receptors thereby reducing the euphoria of the full opioid (morphine, hydrocodone, fentanyl, oxycodone, & heroin). There are three treatment modalities for MAT; methadone, buprenorphine or the combo buprenorphine/naltrexone (Suboxone), and naltrexone itself (SAMHSA, 2018

 (Links to an external site.)

Links to an external site.

). Buprenorphine in combination with naltrexone completely blocks the full receptor so the effects can not be overcome by more opioids (to a certain extent) and reduces cravings. Once a patient is in MAT and dosed appropriately with a Suboxone dose that is the smallest dose to keep withdrawl away visits can be extended out if they are working therapy and group therapies such as NA and AA the psychosocial aspect of addiction. When a pregnant women starts MAT the amount of medication that crosses the placenta is the same as the mother’s and the fetus can start to slowly and safely reduce their exposure to full opioids (McQueen and Oikonen, 2016

 (Links to an external site.)

Links to an external site.

). A patient has to be off full opioids for at least 3 days before starting MAT with Suboxone. They are given Imodium, gabapentin, and clonidine to help reduce the withdrawl symptoms. If they are not they will go into full withdrawl with the initiating dose due to the naltrexone. 

Risks for the baby are low birth weight, STI infections, potential abuse and neglect, and preterm birth (McQueen & Oikonen, 2016). Opioid withdrawl for infants is more serious that opioid withdrawl for adults due to the seizures and other neurologic symptoms it can cause. Depending the type of opioid and the amount taken by the mother the severity of withdrawl will be different for each infant. There will be tremors, diarrhea, irritability, tachycardia and tachypnea, poor feeding, and possibly seizures (McQueen and Oikonen, 2016). Long-term effects of NAS are not well studied but it has been found that there can be some behavioral problems and mental health issues with these children as well as abuse and neglect by the parents (McQueen and Oikonen, 2016). 

There is a misconception that a women will automatically be placed in jail if the are using opioids while pregnant once they give birth so they do not seek prenatal care and sometimes will wait until they are in labor to be seen. There was on NAS infant in the hospital I work at who was born to the girlfriend of a MAT patient we were seeing. She left the hospital AMA because she did not tell anyone she was a heroin addict and started withdrawl. She could have been treated appropriately in the hospital and reduced her risk of hemorrhage and death and stayed with her baby. The goal for these women is to get them to bond with the baby, be able to manage their care in their home, and find supports for them over the long term (McQueen and Oikonen, 2016). 

My last preceptor became certified in addiction treatment with Suboxone so I got the opportunity to work with this population and see first hand the initiation of treatment, pride in getting clean, pride in staying clean, and the disappointment of relapse. There are not a lot of providers that are certified to do this treatment and they are only allowed a certain amount of patients per provider. The certifying body that maintains it just opened certification to NPs and PAs to manage patients. Generally recreational drug use and alcohol abuse escalates to heroin use. I saw at least four patients that started with legit prescriptions for opioids and progressed to heroin use. The others started with other recreational drug use and alcohol abuse. My last preceptor stated to me that if a pregnant women seeks MAT and is on it while in labor there are better outcomes for the baby and the mother and child protective services may be willing to work with her.

References

McQueen, K., & Oikonen, J. (2016). Neonatal Abstinence Syndrome. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1600879 

 (Links to an external site.)

Links to an external site.

SAMHSA. (2018). Medication assisted treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment

 (Links to an external site.)

Links to an external site.

In developing the evidenced based project to improve/increase formal workplace violence reporting utilizing the current “RL Solutions” software, there are several aspects of implementation that will affect the impact of the delivery and success of the plan. The first aspect to consider is the financial impact that the project will have on the organization. The plan entails a unit-based educational piece detailing: What constitutes workplace violence? and how to navigate RL solutions to document violent events, Education will also include the importance and impact of formal documentation, as well as what support processes to anticipate as follow-up to incident reporting. Educational material will be nominal, including a three-fold poster board and small fliers in strategic high nursing traffic areas. It will involve several in-services 10-15 minutes in length, provided by project leader to reach all staff. The larger impact to violence in the workplace is astounding. A 2017 report prepared for the American Hospital Association estimated that workplace violence costs U.S. hospital and health systems $2.7 billion in 2016, including $280 million related to preparedness and prevention, $852 million in unreimbursed medical care for victims, $1.1 billion in security and training costs and an additional $429 million in medical care, staffing, indemnity and other costs related to violence against hospital employees. (ashclinicalnews.org)Other costly aspects associated with WPV are lost wages, legal expenses, workman’s comp claims, diminished public image and employee turn-over expenses. The U.S.Department of Labor, estimates the cost to replace an employee due to workplace violence is approximately two-thirds to twice the annual salary of the employee being replaced.( www.osha.gov)Clinically, the impact of workplace violence leads healthcare workers to commit a greater number of medical errors which correlates with poorer patient outcomes. Also. Healthcare workers who must must take time off work to manage physical or psychological impact of violence put a strain on staffing availability. “Healthcare workers who were victims of violence experienced an average of 112.8 hours her year of sick, disability” (ashclinicalnew.org) which is a little more than twice that of those who did not experience workplace violence. Poor Staffing ratios due to lost staffing availability also stand to impact patient outcomes. The aspect of quality of care is also affected by episodes of workplace violence. A study published in 2001 by Judith Arnetz and Bengt Arnetz, “suggest that the violence experienced by healthcare staff is associated with lower patient ratings of the quality of care.”Additionally, workplace violent incidents contribute to decreased job interest, productivity and confidence, which directly impact the delivery of quality service to the patient. The RL solutions system is already in place, therefor there is no added cost required to design a program from the ground up. The project simply intends to increase the utilization of the current reporting system. Increased reporting will allow the organization to collect and analyze data that can assist the employer with developing prevention and intervention strategies to ultimately reduce workplace violence against workers and the physical and psychological impact victims suffer. It will also help to reduce the deleterious financial consequences associated workplace violence.  Arnetz, J.,& Arnetz, B., (Feb. 2001). Violence Toward Healthcare Staff and Possible effects on the Quality of Patient Care. Social Science and Medicare. Vol.52 Issue 3Beck, D., (Dec. 2018). Hazardous to Your Health: Violence in the Health-Care Workplace. ASH Clinical News. Retreived on Nov. 18, 2019, from https://www.ashclinicalnews.org/features/hazardous-health-violence-health-care-workplace/Hartley, D., Ridenour, M., Craine, J., & Morrill, A. (2015). Workplace violence prevention for nurses on-line course: Program development. Work (Reading, Mass.), 51(1), 79–89. doi:10.3233/WOR-141891Nowrouzi-Kia, B., (2017). The Impact of Workplace Violence on Health Care Workers’ Quality of Life. Developmental Medicine & amp; child Neurology. Vol. 59. Issue 7