How Institutional Conceptual Frameworks Influence Ethical Decision Making

We wrap things up by exploring institutions and groups designed to help ensure that hospital staff at all levels think and act ethically in caring for patients. Accrediting bodies are oversight agencies charged with performing accreditation of hospitals and helping to establish standards for health care delivery. Their aim is to keep the quality of care as high as possible and to make sure the care is delivered ethically. Ethics committees are groups of individuals within hospitals that meet regularly to advise staff on ethically difficult cases and to promote an ethical institutional culture.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 2: Apply sound ethical thinking related to a health care issue.
  • Demonstrate sound ethical thinking in applying ethical principles and moral theories to a specific case.
• Competency 3: Analyze ethical issues associated with patient care from the perspectives of various health care professionals.
  • Explain professional codes of ethics and apply them in to a specific case.
• Competency 4: Explain the conceptual framework that health care leaders use to make ethical decisions.
  • Explain organizational documents like mission and value statements and use them to analyze a case study.
  • Explain the role of accrediting bodies and applies this understanding in analyzing a case study.
• Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
  • Provides validation and support within written communications by including relevant examples and supporting evidence using APA citations.
  • Produce writing with minimal errors in grammar, usage, spelling, and mechanics.

Preparation

Complete the Case Study: Tonya Archer media activity, which is linked later in this assessment.

Before you begin creating your submission for this assessment, make sure you have worked through the Tonya Archer case study. This will provide the foundational context for the assessment, for which you will be carrying out independent research by using the Internet to complete the following:

• Identify the professional code of ethics for your professional specialty or a specialty that you are interested in.
• With a local hospital in mind (perhaps one you work for), locate the mission, vision, and values statement of that hospital.

After you identify the professional ethics code and the hospital mission, vision, and values statements relevant to your work and interests, it may be useful to complete the following:

• Identify which item in the ethical code you believe is the most important and explain why.
• Name something in the code you would like to see addressed in more depth. Why?
• Which item in the code do you think would be the most challenging to follow and why?
• Does your code make an explicit distinction between what is legal and what is ethical? That is, is the code clear that, while an action may be legal, it may not be ethical?
• Finally, how well does your professional code of ethics align with the mission and values statement of your hospital? Can you imagine a situation in which following one would make it challenging to follow the other?

Instructions

For this assessment you will apply some concepts we have learned in the course, particularly those relating to the basic principles of health care ethics, professional codes of ethics, and values of health care institutions. 

Write a paper that answers the following questions as it relates to the Tonya Archer Case Study:

• What are the most relevant end-of-life issues in health care ethics as they relate to this case?
• What should the hospital do? Should doctors simply keep Tonya on life support, as the parents want? Or, since all medical evidence indicates that Tonya’s brain damage is permanent, should life support be removed?

Support your answer with the following considerations in mind:

• Explain which principles of health care ethics and which moral theory are the best philosophical foundations for your view.
• Is your view supported by your professional code of ethics? If so, explain how. If not, explain what your code gets wrong about a case like this.
• Is your view consistent with the mission statement and values of the hospital you identified in your independent research you conducted to prepare to complete this assessment?
• Would an accrediting body, like the Joint Commission, support your choice? Why or why not?

Health Care Delivery Models and Nursing Practice 

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

Health Care Delivery Models and Nursing Practice

No of Criteria: 9 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less Than Satisfactory75.00 %Satisfactory79.00 %Good89.00 %Excellent100.00 %Content80.0     Current or Emerging Health Care Law or Federal Regulation and Effect on Nursing Practice, Role and Responsibility20.0Emerging health care law or federal regulation is omitted. The law or regulation presented is not relevant to health care.Emerging health care law or federal regulation is incomplete. Effect on nursing practice and nurse role and responsibility is partially described.Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is summarized. There are some inaccuracies.Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is described. Some information or detail is needed for clarity.Discussion on emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is well-developed.Quality Measures Pay for Performance, Patient Outcomes, and Effect on Nursing Practice20.0Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is omitted.Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is incomplete.Summary on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. There are inaccuracies or slight omissions.Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. Some information is needed for clarity.A thorough and insightful discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented.Professional Nursing Leadership and Management Roles20.0Discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is omitted.An incomplete discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is presented.A summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.A discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. Some detail or information is needed for clarity.A well-developed discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. The discussion demonstrates a thorough understanding of the nursing profession in emerging trends and patient care in a diverse health setting.Predict Change in Nursing Roles and Nursing Practice20.0Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are omitted.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are incomplete. The predictions are unrealistic or lack evidence for support.Insert Satisfactory CoA summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are summarized. The predictions are realistic, but there are inaccuracies or slight omissions. ntent 2 DescriptorPredictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are discussed. The predictions are generally supported and realistic.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are thoroughly discussed. The predictions are based on evidence and highly relevant to emerging trends.Organization, Effectiveness, and Format20.0     Thesis Development and Purpose5.0Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction5.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)2.0Template is not used appropriately, or documentation format is rarely followed correctly.Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Template is fully used; There are virtually no errors in formatting style.All format elements are correct.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)3.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  100

Read the case study presented at the end of Chapter 17 (Guido, p. 362)

Judy, age 20, was admitted to an inpatient psychiatric facility for acute depression and suicidal ideation. She had gone to the local police station the previous afternoon, stating that she was suicidal. The police transported her to the emergency center, and Judy was admitted on a 24-hour emergency mental health hold. O n admission, Judy was obviously depressed and stated that she was still tormented with thoughts about killing herself. Later that evening, the nurses heard a crash from Judy’s room and, upon investigation, found her sitting on the bed with an overturned chair next to the bed. She had torn her robe, tied the pieces together as a rope, and fell from the chair as she was attempting to tie the homemade rope to the ceiling. Judy was immediately placed on a 15-minute observation protocol. The following morning, the patient was still on observation every 15 minutes. The nurse at that point determined that Judy was more coherent and noted that Judy was disturbed by her appearance as she had not bathed in some days. The nurse unlocked the bathroom door so that Judy could shower. S oon after the bathroom door was unlocked, Judy’s psychiatrist came to speak with her. She remained with Judy for about 45 minutes, left the room, and entered a charting area next 

to the nurses’ station. The nurse caring for Judy did not see the psychiatrist leave Judy’s room, nor did the psychiatrist inform the nurse that Judy was now alone in her room. The nurse checked on Judy approximately 15 minutes later. She found Judy hanging by the belt of her bathrobe from the shower rod. Judy was in full cardiac and respiratory arrest, a code was called, and Judy now has severe and permanent anoxic brain injury. Her parents have brought this lawsuit alleging breach of the standard of nursing care.

Was the nurse negligent for unlocking the bath-room door and allowing Judy to shower by herself?

Was it below the standard of care for the nurse to leave the bathroom door unlocked when the psychiatrist came to see Judy?

How significant are the hospital policy and procedures in this instance?

How would you decide this case?

Read the case study presented at the end of Chapter 18 (Guido, p. 393)

Gonzales was admitted to a surgical center for a routine colonoscopy during which three polyps were removed. The procedure began at 11:00 a.m. and he was released at 12:30 p.m. The patient began experiencing abdominal pain the following day. He tried to phone the attending physician at 2:00 p.m. and later called the physician’s nurse at 5:00 p.m. Mr. Gonzales told the nurse he was experiencing severe abdominal pain and that he was flushed and felt he had a fever. The nurse told Mr. Gonzales that everyone had gone home for the day, and she advised him to take aspirin for the fever and call back in the morning. Mrs. Gonzales drove her husband to the hospital the following morning at 10:00 a.m. He was placed on antibiotics, which did not resolve the problem, and he had surgery on the fifth day following the original colonoscopy. At that time, it was determined that the patient’s intestine was perforated at the time of the 

polyp removal, and Mr. Gonzales now has a permanent colostomy. The patient has now filed a lawsuit against the nurse and physician for malpractice.

Was the nurse negligent in the advice she gave Mr. Gonzales concerning his condition?

Did the nurse exceed her scope of practice in the advice she gave the patient?

Should the nurse have instructed Mr. Gonzales to go immediately to the local emergency center?

How would you decide this case? Who, if anyone, is liable in this case?

Read the case study presented at the end of Chapter 20 (Guido, p. 439)

Aburu, 81, with a history of cerebral vascular accidents, was hospitalized as an outpatient for a surgical procedure to incise and drain a skin lesion on his chest. After the procedure, he returned to the long-term care facility with sterile packing in the partially sutured incision site. The packing was to remain for 3 days, then be removed, and the wound covered with a dry dressing. The risk of complications for this type of surgery was considered quite low, and both the nursing home administrator and the attending surgeon saw no reason why the patient could not be adequately cared for in the nursing home immediately after surgery. A pproximately 5 hours after Mr. Aburu returned to the nursing home, blood was observed at the incision site. He was transferred back to the acute care hospital, where he died the following day. E vidence at trial showed that for the 5 hours that Mr. Aburu was at the nursing home, several licensed and unlicensed personnel attended to him. At lunchtime, two aides escorted Mr. Aburu to the dining room; lunch was about 3 hours after his return to the 

nursing home. None of the personnel examined his dressing until an aide noticed that he was bleeding though his bed sheets. Shortly after discovering the bleeding, the patient was transferred by ambulance to the hospital. His family has filed a lawsuit for the wrongful death of their father, alleging that the care given to the patient after surgery fell below the acceptable standards of care.

What should the standards of care be for such a patient?

Even though the nursing care plan did not specify that the wound should be checked hourly, how should the prudent nurse have acted?

Should the lawsuit center primarily on the surgeon for allowing this patient to be sent back to the nursing home for post- operative care rather than insisting he be kept for 24 hours in an acute care facility post-operatively?

How would you decide this case?

Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.

Create an APA essay with 1200-1500words, complete the following questions using 4 scholarly sources to support your perspective. please an introduction and conclusion needed.

Case Study, Chapter 13, The Use of Social Media in Nursing: Pitfalls and Opportunities

Two registered professional nurses are attending a meeting where the focus is examining teaching methods that enable them to share information with newly diagnosed diabetic patients. One nurse initiates a discussion on the use of social media in teaching patients and the use of social media for all health care providers.

1. Discuss actions the nurse should take before using social media as a teaching tool.

2. What types of social media could benefit health care providers and patients?

3. What are the pitfalls to utilizing social media for both patients and health care providers?

Week 6 Assignment:

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html

By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.