Assessment 2, 3. and 4

ApplyingEthicalPrinciples_NURsFPX4000Assesment3.docx

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Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

Access the Ethical Case Studies media piece to review the case studies you will be using for this assessment.

Select the case most closely related to your area of interest and use it to complete the assessment.

Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.

Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APA section of the Writing Center for guidance.

Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.

Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.

Identify who is involved or affected by the ethical problem or issue.

Access the Ethical Decision-Making Model media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.

Apply the three components outlined in the Ethical Decision-Making Model media.

Analyze the factors that contributed to the ethical problem or issue identified in the case study.

Describe the factors that contributed to the problem or issue and explain how they contributed.

Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.

In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The NHS-FPX4000: Developing a Health Care Perspective Library Guide will help you locate appropriate references.

Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.

Review the Think Critically About Source Quality resource.

Assess the credibility of the information source.

Assess the relevance of the information source.

Discuss the effectiveness of the communication approaches present in a case study.

Describe how the health care professional in the case study communicated with others.

Assess instances where the professional communicated effectively or ineffectively.

Explain which communication approaches should be used and which ones should be avoided.

Describe the consequences of using effective and non-effective communication approaches.

Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

Describe the actions taken in response to the ethical dilemma or issue presented in the case study.

Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.

Discuss the key lessons this case provides for health care professionals.

Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.

Describe the proposed solution.

Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.

Discuss how likely it is the proposed solution will foster professional collaboration.

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

Apply the principles of effective composition.

Determine the proper application of the rules of grammar and mechanics.

Write using APA style for in-text citations, quotes, and references.

Determine the proper application of APA formatting requirements and scholarly writing standards.

Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Ethical Case Studies

Consider the ethical dilemma the health care professional is faced with in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).

Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.

Incident 2: Emergency Department Repeat Admissions — A Question of Resource Use

Matt Losinski finished reading an article that provided grim details of a study of the overuse of emergency services in hospitals in central Texas. He smiled that sardonic half smile that meant there was a strong possibility that County General Hospital (CGH) might have the same problem. As chief executive office (CEO), Losinski always saw the problems of other hospitals as potential problems at CGH, a 300–bed, acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was established as a county–owned hospital; however, 10 years ago the county wanted to get out of the hospital business and the assets were donated to a not–for–profit hospital system. The new owner has continued a strong public service orientation, even though CGH no longer receives the tax subsidy it did when it was county owned; it must look to itself for fiscal health.

The study data showed that nine residents of a central Texas community had been seen in emergency departments (EDs) a total of 2,678 times over 6 years. One resident had been seen in an ED 100 times each year for the past 4 years. Given that an ED visit can cost $1,000 or more, the nine residents had consumed $2.7 million in resources. These high users of ED services were middle age, spoke English, and were split between male and female. To Losinski, the problem seemed like a manifestation of Wilfredo Pareto's classic 80/20 rule.

Losinski forwarded the article on a priority basis to Mary Scott, his chief financial officer (CFO), and asked her to see him after she read it. Scott stopped by Losinski's office late the next day and began the conversation by asking him why he thought the article was a priority. Scott reminded Losinski that Medicaid paid 75% of costs for eligible ED users and that the cross subsidy from privately insured and self–pay ED admissions covered most of the unpaid additional costs. Losinski had a good working relationship with Scott, but he was a bit annoyed by her rather indifferent response.

Losinksi wanted details on use of the ED at CGH. He asked the administrative resident, Aniysha Patel, to gather data to identify use rates for persons repeatedly admitted to the ED. The findings that Patel gave to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few persons were repeatedly admitted to the ED and accounted for hundreds of visits in the past year. The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.

Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.

Losinski asked his senior management team for recommendations to address the problem of ED overuse.

Assessment 3 Example [PDF] Download Assessment 3 Example [PDF].

Applying Ethical Principles

Health care professionals often face ethical problems during their practice that require

them to use their moral values and principles when making decisions. The four fundamental

principles of health care ethics—autonomy, beneficence, nonmaleficence, and justice—act as

yardsticks for fair and ethical decision-making. These ethical principles are widely accepted in

the field of health care. Medical practitioners and health care administrators often use these

principles to make decisions when faced with complex situations involving patients.

Overview of the Case Study

Betsy is a dedicated pediatric nurse known for the care and concern she shows her

patients. Her neighbor and friend, Alice, lives with her husband and 4-year-old daughter, Shirley.

Alice and her husband are followers of Christian Science, a belief that advocates spiritual healing

and discourages most types of medical intervention. One day, when visiting Alice and Shirley,

Betsy sees Shirley experience what seems like a seizure. The child suddenly becomes

unresponsive and has a brief staring spell, with her eyes rolling upward. The episode lasts for 20

seconds, during which she seems completely unaware of her surroundings. While Shirley is

having the seizure, Alice sits by her side and prays but takes no other action. Betsy is concerned

about the little girl’s condition and probes her friend for details. Alice tells Betsy that Shirley

used to have around 15–20 such episodes a day until a few months ago; this has now reduced to

about 12. Alice attributes the improvement in Shirley’s health to her prayers and faith. However,

this does not help Betsy feel comfortable about Shirley’s condition. She is almost certain that

Shirley has epilepsy, which, if not treated on time, could have profound health implications. At

the very least, she thinks Alice should have Shirley’s symptoms accurately diagnosed.

Understanding the gravity of the situation, Betsy sets up a meeting with Shirley’s parents

and Dr. Campbell, director of the neurology department at her hospital. She treats this meeting as

an intervention, and both she and Dr. Campbell express their concern for Shirley’s health. They

stress on the fact that the improvement in Shirley’s symptoms does not necessarily mean she will

be cured. They empathize with Alice and her husband’s reluctance on account of their religious

faith but reiterate the importance of getting Shirley’s symptoms diagnosed. To prove their point,

they present studies that describe how seizures can be indicative of illnesses such as epilepsy,

which could negatively affect her cognition and behavior. Shirley’s parents are grateful that

Betsy and Dr. Campbell are concerned about their daughter’s health but remain resolute about

going against their faith. They believe that prayer will cure her. Betsy is faced with an ethical

dilemma of whether she should respect the parents’ religious beliefs and not intervene in the

matter or perform her moral obligation as a health care professional.

Analysis of Ethical Issues in the Case Study

In the case study, the main factor that led to Betsy’s ethical dilemma is Shirley’s parents’

refusal of medical assistance for their daughter owing to their Christian Science beliefs. When

Betsy notices Shirley’s seizures, she thinks it is her duty to make sure Shirley receives medical

attention. As she respects the religious faith and belief of Shirley’s parents, she decides to

explain the risks that seizures could involve. She also includes Dr. Campbell in the conversation

so that he could provide an objective opinion to make them understand the need for medical

intervention. However, Shirley’s parents are certain that prayer will cure her seizures.

Considering that their attitude could result in serious health implication for Shirley, Betsy is

concerned about the little girl receiving appropriate medical attention (Baumrucker, et al., 2017).

Using the Ethical Decision-Making Model to Analyze the Case Study

The three components of the ethical decision-making model—moral awareness, moral

judgment, and ethical behavior—can help analyze the ethical issue outlined in the case study.

Whereas moral awareness is knowledge of the existence of an ethical dilemma, moral judgment

involves choosing between the right and wrong actions when posed with such a dilemma. Both

moral awareness and moral judgment lead to ethical behavior. Ethical behavior is taking the right

action to resolve a dilemma. Betsy’s moral awareness is reflected by the fact that she recognizes

the circumstances surrounding Shirley’s condition. Her moral judgment is reflected by her

decision to try to convince Shirley’s parents to get Shirley medical help because she believed

that it was the right thing to do. Betsy’s ethical behavior constitutes the action she takes to

resolve the dilemma. This, in turn, depends on her personal judgment and the four principles of

health care ethics (autonomy, beneficence, nonmaleficence, and justice) she should abide by as a

health care professional.

Effectiveness of Communication Approaches in the Case Study

Listening plays an important role in patient–physician communication. By listening to

Alice, Betsy learns of the frequency of Shirley’s seizures and the reduction in their occurrence.

She also learns that Alice and her husband believe that this reduction is due to their prayers and

faith in Christian Science. Therefore, active listening helps Betsy understand the situation better.

Betsy is aware that if she decides to get medical help for Shirley without the consent of

Shirley’s parents, she would be violating their right to informed consent and overstepping her

boundaries as a health care professional. So, she decides to present them with the information

they need to make an informed decision. She maintains an open communication with Shirley’s

parents while explaining the impact of seizures on their daughter’s health. She stresses the

importance of immediate diagnosis of Shirley’s seizures. Thus, by being respectful of Shirley’s

parents’ emotions and providing them with complete information about the problem, Betsy

communicates the situation to them in an effective manner.

During the discussion with Shirley’s parents, both Betsy and Dr. Campbell are

empathetic toward Alice and her husband’s reluctance to get the necessary medical help for their

daughter on account of their religious faith. Betsy seems to have involved Dr. Campbell so that

he could share his objective expert opinion based on his experience in dealing with patients who

have similar symptoms. She probably thought that Shirley’s parents would change their decision

if Dr. Campbell reiterated that Shirley could develop severe cognitive problems (such as learning

difficulties and memory deficits) or behavioral problems (such as irritability, anxiety,

hyperactivity, and mood swings) if her seizures are neglected. However, they were unable to

convince Shirley’s parents to get Shirley medically diagnosed.

Although Betsy followed a systematic approach while dealing with the issue at hand, it

seems to have been ineffective as Shirley’s parents continued to stand by their faith in prayer.

However, listening patiently to patients’ problems and showing empathy and genuine care while

communicating with them are some lessons that health care professionals can take back from this

case study.

Resolving the Ethical Dilemma by Applying Ethical Principles

The four ethical principles of autonomy, beneficence, nonmaleficence, and justice are

often employed to resolve ethical dilemmas related to health care. Autonomy refers to accepting

and understanding patients’ values, beneficence refers to acting for the welfare of patients,

nonmaleficence refers to not doing harm to the patient, and justice refers to treating patients

fairly without bias.

The ethical dilemma that Betsy faces in this case involves three of the four basic

principles of medical ethics. In the case study, the ethical dilemma is caused by the conflict

between the principles of autonomy on the one hand and beneficence and nonmaleficence on the

other. Betsy preserves the autonomy of Shirley’s parents by respecting their religious beliefs and

not coercing them to get the girl correctly diagnosed. She further ropes in Dr. Campbell to try to

explain to them the importance of getting an accurate diagnosis.

Approaching Child Protective Services—a social service agency run by the government

to counsel and support children and their families and promote child welfare—could be

considered by Betsy as an ethical means to resolve the dilemma. As Betsy is obligated to help

Shirley get medical care (beneficence) and prevent any harm that might be caused from ignoring

her seizures (nonmaleficence), she could seek intervention from Child Protective Services.

Although involving Child Protective Services could result in overriding the ethical principle of

autonomy, Betsy might have to take this decision keeping Shirley’s best interests in mind

(Baumrucker et al., 2017).

Conclusion

The four principles of health care ethics can be applied by health care professionals to

analyze and resolve ethical dilemmas. In the case study, Betsy has to decide between respecting

Shirley’s parents’ religious beliefs and performing her moral obligation as a health care

professional by helping Shirley seek medical care. The proposed solution involves upholding the

principles of autonomy, beneficence, and nonmaleficence to resolve Betsy’s ethical dilemma.

Additional Requirements

Your assessment should also meet the following requirements:

Length: 3–5 typed, double-spaced pages, not including the title page and reference page.

Font and font size: Times New Roman, 12 point.

APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance.

Written communication: Use correct spelling, grammar, and punctuation.

References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.

APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.

Competencies Measured

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

Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.

Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.

Competency 3: Apply ethical principles and academic standards to the study of health care.

Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.

Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.

Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella's writing standards.

Discuss the effectiveness of the communication approaches present in a case study.

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

Write following APA style for in-text citations, quotes, and references.