Having examined health information technology, it is important to also be thinking about the related ethical implications of these innovations.  

To begin this discussion, let’s first make a distinction between morality and ethics.

When we talk about morality, we are talking about our beliefs in right and wrong. So for example, most of us believe it is morally right to give everyone a fair chance and it is wrong to discriminate based on race, ethnicity, or gender.

But while ethics also deals in the realm of right and wrong, it doesn’t really come up until I am asked precisely WHY I think it is morally right to be fair.

In other words, whereas morality is all about right and wrong, ethics is all about the underlying logical reasons why we should act in a certain way.

Or:  Ethics is the thinking behind our morality that gives us the solid REASONS for believing our behavior is morally right.  

So, with that distinction in mind, this week’s discussion is asking us to do more than simply state our feelings about the rights and wrongs of healthcare technology. Rather – We need to be looking at the underlying ethical reasons for WHY we think that way.

As an example, consider the whole issue of personal privacy and then ask whether the Government has the right to collect health-related information about each of us through a special ID number issued at birth?

Off the top of your head, what do you think:  Yes or no?

Your answer to that question reflects your moral sense about the rights of the individual versus the rights of the government as a representative of the larger society.  

But now, let’s look at the “ethics” of your answer. To do that, you must explain WHY you have come to your particular judgment about the relative rights of the individual, the government, and the society as a whole.

Saying such things as “Because I think so,” or “Because it’s obvious,” and “Because I don’t like the government mucking around with my personal information” are all insufficient answers. We need to dig much deeper to actually explain WHY we think that the centralized collection of health data by the government is an ethically good or bad idea.

So how do we do that?

To start, we need to develop some basic rules of ethical thinking.

The good news is that a lot of really thoughtful people have already done a lot of work on developing these rules AND they had the good graces to write them down for us to read.

The most general rules for ethical thinking in health are called “Clinical Ethics.” There are four basic principles or pillars of clinical ethics that you can learn about here: Clinical Ethics.

A more specific set of ethical principles designed just for healthcare managers has been developed by the American College of Healthcare Executives (ACHE). You can read about the specific ethics governing our profession here: ACHE Ethics.

After reading both sets of ethical principles, let’s now revisit the question about government collection of health information by identifying why we think it is right or wrong BASED ON CLINCIAL ETHICS AND THE ETHICAL CODE OF OUR PROFESSION. In other words, why do we think it is right or wrong based on the application of clinical and ACHE ethics to this situation?

So that’s what this week’s discussion is all about – an ethical discussion about health information technology.

Let’s discuss two ethical questions.

First, let’s continue our thinking about the government’s right to healthcare information. More specifically, does the government have the right to assign each person born in the US a unique health identifier and then collect and store all your personal health information in a centralized data base? To help your thinking, consider how useful such a data base could be in determining the effectiveness of different clinical techniques, controlling epidemics, and strategic planning to best meet a community’s healthcare needs. On the other hand, are such benefits outweighed by the risk that such personal information might be misused to discriminate against people who might have cancer, HIV/AIDS, or a genetic disposition towards extremely high cost illnesses?

After that, let’s shake the government out of our heads, and think about a very different type of ethical issue – Mobile apps.

Apple has included a health app with its most recent iPhone and operating system update. This means that in the not too distant future, anyone with an iPhone will have the ability to monitor basic vital signs like blood pressure and heart rate.

What if someone buys an iPhone in Nepal or Sierra Leone, finds out they have dangerously high blood pressure, but does not have access to medical treatment? Does Apple have an ethical responsibility to help arrange treatment to that person? And further – since we now know about such a person, do we also have an ethical responsibility to help provide treatment ourselves? Or – are we are on ethically sound ground to stand back and just let that person die? 

 

 

The Lab Assignment

• Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

• Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.

 

Discussion 2: Can Technology + Behavior Be Diffused?

The biological understanding of health and disease has evolved from miasmas (vaporous exhalation formerly believed to cause disease) to germs to individual risk factors tied to specific diseases. Now you are challenged by the knowledge that many people get chronic illnesses without having the known critical risk factors (e.g., smoking) that some may try to avoid in an effort to be healthy. The scientific revolution in health creates an even bigger challenge.

Stress and inflammatory processes are sometimes seen to be critical factors affecting our biology. The stress response helps us get out of the path of the oncoming car or shelters us from falling debris in an earthquake. But if we turn it on while we are stuck in traffic, angry at the boss, experiencing financial difficulties, or dealing with another rejection, it does not benefit us. While some may cope better than others, those who are economically less fortunate and have to cope with issues of poverty may be less able to withstand stressful encounters. Today, health and illness tend to follow a socioeconomic gradient, in which people in lower socioeconomic groups tend to have higher mortality than those in higher socioeconomic groups. In general, those lower down the ladder of income, success, and wealth will exhibit lower health outcomes than those higher up. Societies with a bigger gap between rich and poor do worse in health outcomes overall than societies with a smaller gap because there is more unhealthy stress in unequal societies (United Health Foundation, 2013).

There are exceptions to the gradient in health that present learning opportunities. For example, Latinos or Hispanics appear to have better health outcomes in the U.S. than non-Latino whites, a concept termed the Hispanic Paradox (New America Media, 2012). Reasons for this disparity are debated. One point of view is that the social support Latinos or Hispanics offer one another can counteract some of the adverse effects of having lower socioeconomic status.

For this Discussion, you consider how cultural and economic factors influence those biologic mechanisms that can result in disease for specific segments of the population. You also propose possible policy solutions to reduce the burden of disease.

To prepare for this Discussion, review the Learning Resources. Consider how the determinants of health you have learned about in this class can improve or worsen health for individuals and populations.

Post a brief description of a population segment (by race, ethnicity, economic status, geographical location, etc.). Then, explain the relationship between health inequality/inequities and common biological or behavioral risk factors that have been linked to a particular disease in that population segment. Finally, describe the relationship between health inequality/inequities and life expectancy for that population. Expand on your insights utilizing the Learning Resources.

Zero Plagiarism

5 references

While cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) have many similarities, they are distinctly different therapeutic approaches. When assessing clients and selecting one of these therapies, you must recognize the importance of not only selecting the one that is best for the client, but also the approach that most aligns to your own skill set. For this Assignment, as you examine the similarities and differences between CBT and REBT, consider which therapeutic approach you might use with your clients.

Learning Objectives

Students will:

Compare cognitive behavioral therapy and rational emotive behavioral therapy

Recommend cognitive behavioral therapies for clients

To prepare:

Review the media in this week’s Learning Resources.

Reflect on the various forms of cognitive behavioral therapy.

The Assignment

In a 1- to 2-page paper, address the following:

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.

Explain at least three differences between CBT and REBT. Include how these differences might impact your practice as a mental health counselor.

Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature.

Write an answer to this and use at leat one reference but not the same that appear here.

Leadership in Nursing

Leadership in the nursing field entails influencing other nurse practitioners to improve patient care by offering high-quality care that significantly improves patient outcomes.  Leadership in nursing enables nurse leaders to motivate other practitioners towards better healthcare delivery approaches. Nurse leaders need to encourage other nurses to work closely together as a team in health promotion. Therefore, nursing leadership e tails creating a conducive environment that motivates nurse practitioners and supports health promotion.  

The healthcare facility where I offer patient care aims at always remaining relevant to the patient it serves through serving their care needs cost-effectively and efficiently. The facility promotes the continuous learning of the nurse practitioners and other health practitioners working in the facility. The learning ensures there is a constant improvement of healthcare services. It further ensures that we’ll inform all the healthcare staff on current and emerging trends in the healthcare sector. The practice ensures that the facility provides up to date care to its patients all times.

I work for a Private for-profit hospital that offers different types of care and health promotion approaches. The hospital has embraced information technology that it uses to improve the kind of care provided to patients while at the same time reducing the associated costs. Lowering the cost of healthcare services is one of the critical objectives of the facility; it ensures that the hospital receives an increased number of patients. 

The climate in the facility motivates nurse practitioners to offer quality care that improves patient outcomes. The nurse leaders continue to create a positive work environment for the nurse professionals, thus serves as a very robust buffer against opposing forces that have adverse effects on their work. The motivation offered to the nurse practitioners by the leaders enables the nurses to work to the best of their ability. The leaders further provide training and guidance to the nurses, which also plays a crucial role in improving patient outcomes. The facility’s structuring is divided into four crucial segments: the individual patient segment, the care team segment that includes the healthcare professionals from the doctors, the nurses, and other professionals that deliver healthcare to the patients, the patient, and their family. The third segment is the administration, which comprises the hospital leadership and the external environment that comprise the hospital’s political and economic environment.  

The health facility’s formal goals include improving the quality of care offered to patients, improving patient outcomes, and ensuring that healthcare services are provided to patients at a reduced and affordable cost. The healthcare facility’s informal goals entail ensuring the healthcare professionals serving in the facility have a good working relationship that fosters the coordination of care offered to patients. The goals play a crucial role in ensuring teamwork among the hospital staff, which is vital in improving the quality of healthcare provided to the patients (Weiss & Tappen, 2014).

The facility’s processes include detecting different health conditions patients have by carrying out a proper patient diagnosis. Another key process that the health facility engages in is carrying out the necessary treatment to the patient depending on the diagnosis given and, lastly, ensuring that the patients are provided with a good end of life. The facility aims to provide care that improves the quality of life of the patients served and ensures the patients’ healthcare needs are well addressed. 

An organization’s work climate is vital to nurse leaders and managers because it enables them to understand better the processes involved in the work and have a clear picture of their roles and responsibilities in healthcare delivery in the organization. The work climate enables nurse leaders to understand the social processes that affect the nurse professionals they lead. As nurse professionals portray, work-related attitudes enable them to develop an environment conducive to the facility’s nurse practitioners.

The health facility climate is also vital for the career growth and development of nurse professionals in the facility (Stanley & Stanley, 2018). It promotes their empowerment and also impacts their productivity and job satisfaction. The work climate further leads to increased loyalty to the nurse leaders, significantly impacting nurse retention in the facility. In advancing their expertise, nurse practitioners need to embrace technological advancement in their practice. Through this, the nurses can learn new and emerging approaches that improve patient care quality.   

Effective communication is another approach that nurse practitioners can utilize in improving their expertise in the nursing field. Through this, the nurses have more clarity and understanding of patient needs, and that the patients and nurse practitioners relate better with each other. In my health facility, nurse practitioners have continuously engaged in critical thinking to effectively promote their healthcare practices. Shared governance entails the framework of accountability, equity, partnership, and ownership. In healthcare practice, it involves the integration of crucial values and beliefs to improve patient care. Shared governance impacts the power structure of a healthcare organization by improving the structure of the health facilities. It promotes the job satisfaction of the health professionals, thus promoting job retention.

Understanding the health facility’s culture and real goals that nurse practitioners serve plays a crucial role in guiding the nurse practitioners in their duties. It offers a sense of direction and guidance to the nurse practitioners in the different activities they engage in. An organization’s culture sets expectations on the organization’s practices, how people behave within the organization, and how they work together as a team (Stanley & Stanley, 2018). Therefore, the nurse needs to understand the organizational culture and the facility’s goals they work in to achieve high-quality care. 

According to one of the staff nurses, the activities that empower the nurses include providing them with leadership development. Different ways of doing this include introducing training programs that effectively empower nurse professionals in their professional and personal attributes. Involving nurse professionals in decision making is also an effective way of empowering nurse practitioners (Backman, Sjögren, Lindkvist, Lövheim & Edvardsson, 2017). Different ways of doing this involve giving the nurses a voice in crucial decision making. It enables the nurses to develop a sense of belonging, making them feel part of the big team.

My first impression upon walking into a healthcare facility was a place where my health issues would be solved with a lot of care. I remember who the nurses welcomed me with a lot of politeness and care, and I was instantly assured that I was in the right place. The changes that would be made at a low cost include training the nurse professionals on how to win a patient’s trust. Expensive changes include increasing the number of staff to offer a better patient experience. Making a good first impression is vital in enabling a health facility to gain patient trust.   

References

Backman, A., Sjögren, K., Lindkvist, M., Lövheim, H., & Edvardsson, D. (2017). Characteristics of highly-rated leadership in nursing homes using item response theory. Journal of Advanced Nursing, 73(12), 2903–2913. https://doi.org/10.1111/jan.13353

Stanley, D., & Stanley, K. (2018). Clinical leadership and nursing explored: A literature search. Journal of Clinical Nursing, 27(9-10), 1730–1743. https://doi.org/10.1111/jocn.14145

Weiss, S., & Tappen, R. (2014). The essentials of nursing leadership and management. F.A. Davis Company; 6th Edition.