Week 4 Responses 2021

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Instructions: Reply to 2 of your peers below.  Must be 250 words or more with 1 Reference

Review your classmates’ threads, and respond through considering:

1. Do you agree/disagree with your classmates’ application of QSEN, NSI, and the Code? Explain.

2. Discuss one other ethical breach in research (another study that broke with the ethical standards of research) or in patient care (care that did not fall in alignment with the QSEN, NSI, or the Code).

3. In your personal worldview, how would you respond to an ethical breach in research? An ethical breach in practice?

Classmates’ Tread 1.

Research is something all nurses have the opportunity be involved in, nor obtain proper education on. Healthcare research is constantly in the forefront of patient care with the goal of searching for new treatment, finding a new outcome, or development of a new process and structure. As a nurse this author has not been involved in healthcare research up to this point.

Research in healthcare often is completed to solve a problem, look for a treatment, or seek a different outcome. A nurse’s involvement in research falls under the seventh provision of the ANA’s Code of Ethics for Nurses. “The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy “(American Nurses Association Code of Ethics for Nurses). All healthcare workers have a responsibility to practice based on research advances and be involved in research when the opportunity presents. Nurses play an interesting role in research due to their level of patient care and the bond they can develop with patients. In a recent article by Elizabeth Peter she described that this bond developed between a nurse and a patient can lead to better understanding of the entire patient during research; taking into account obviously the physical but also the emotional and social implications research may produce (Peter, 2017).

Quality and Safety Education for Nurses is a resource necessary for nurses and to be used in nursing to improve patient care and safety. The QSEN was developed to transform our current health care and as a result identified themes to focus on. The themes were stated in a recent article as follows, “patient-centered care, teamwork and collaboration, use of evidence-based practice, quality improvement skills, and the integrated use of informatics in the care provided for patients” (Altmiller and Hopkins-Pepe, 2019). These new values created focus for nursing and how to direct nursing care. Nurse Sensitive Indicators are a way to outline and place value to nursing care or contributions from a nurse or nursing staff. They can be used to help guide improved performance or patient outcomes. NSIs can be utilized to lead new research projects and identify problems or places for improvement especially at the bedside.

In review of the Tuskegee Syphilis Study there were many downfalls and misrepresentations that violate ethical standards. Nursing ethics were not upheld in this study. From the initiation this study was founded on unethical terms by never obtaining informed consent. The patients enrolled in the study were promised free healthcare, among other things, and a goal of treatment for their disease. The goal of this study seemed to be more related to the education and learning about the disease, disease process, and ultimate death from disease progression as opposed to learning about potential treatment. This study was not clearly explained to the participants. The study design was flawed by not having a control and an experiment group; all patients with syphilis received a placebo. The study was also flawed, skewed, in that it only had one population represented, black men. Not only did this study focus on black men, but they were share-croppers, leaving a vulnerable population even more vulnerable as they were being lied to and inappropriately studied.

The end goal of learning about the disease process and the death of this disease may have been beneficial for the future population, but the way this study was conducted was unethical on all aspects. The development, implantation, and assessment of this study was done in a secular worldview. This revolved around man and what was the best for man. There was no common good to come from this without knowingly sacrificing the participants, ethics, and morals of these healthcare providers.

Classmates’ Tread 2.

 All nurses should strive to provide high quality patient care. The Quality and Safety Education for Nurses (QSEN) is a movement that was established to improve the quality and safety of our healthcare systems (QSEN.org 2021). Dr. Mary Dolansky states that “attitudes drive behavior” and for that reason the QSEN movement not only works to ensure nursing students are competent in their knowledge and skills, but also have the right attitude to work as a nurse (online seminar 2021). The movement has impacted quality and safety of healthcare systems as stated in their mission. (QSEN.org 2021) 

     Nursing service indicators which are developed by the American Nurses Association (ANA) are designed to be a sign of the structure, process, and outcomes of nursing care (Nikitas et al.,2020). The results of these assessments are compiled in the National Database of Nursing Quality Indicators (NDNQI) which has recently worked with the Joint Commission and National Quality Forum to better nursing care. (Nikitas et al., 2020). The role of a nurse doing healthcare research would be to study the data that has been compiled to conclude the current state of whatever is being researched. This conclusion could be a great starting point to move forward in the direction of improvement based on the results compiled. Research nurses working directly with patients should also abide by the nursing code of ethics. 

     According to the ANA, the nursing code of ethics is a guide for “carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession." (Online,2021) The nursing code of ethics is a reference that could assist a nurse if he/she is facing a situation at work where there may be uncertainty as to how to proceed. There are many resources available to help nurses navigate ethical dilemmas to include coworkers and management on site. "The code is an important document that can provide effective guidance as the nurse negotiates the complexities inherent to many situations” (Epstein et al., 2015). A nurse also behaves in a way that reflects his/her own ethics and how he/she was raised. Doing the right thing when no one is watching is a great character trait to have as a nurse that would contribute to high quality patient care.  

     The Tuskegee Study was conducted by the United States Public Health Service (USPHS) from 1932 to 1972 and involved 600 African American men, 400 of which had syphilis, who were told they were receiving treatment for “bad blood”, which included syphilis, when in fact they were not receiving any treatment at all (McVean, 2019). The study was conducted to monitor effects of syphilis as the disease progressed. These men in the study were vulnerable in that they trusted their government and healthcare system to treat them as they were being told they were treated. The study took place in Macon, Alabama where a nurse named Ms. Rivers was hired to assist in running the study. By 1942, Penicillin was the known treatment for Syphilis, however the nurse and those conducting the study did everything they could to keep their participants from being treated. Looking back this would have been an ethical dilemma for the nurse involved. Nurse Rivers actions did not follow the code of ethics in that she was not promoting health for her patient participants, but we do not know all the factors that contributed to her decision-making process such as the need to keep her hard to come by job and pressures from those that hired her. The QSEN goal of ensuring that nurses have the right attitude to promote a better health care system would have been a great tool if it had been in place while Nurse Rivers was in nursing school. The Nursing service indicators would be hard to assess as the patients were not informed of the truth therefore may have been satisfied until they discovered what happened to them. It is hard to look back and know what things were considered and what a person was thinking, especially that far back in time. However, there was a class action lawsuit filed and won by the participants and their family members years later. The benefits in this study did not outweigh the risk as there were many men, spouses, and children that suffered and died needlessly.   

     The bible states, “Whoever brings blessing will be enriched, and one who waters will himself be watered.” (Focus on the Family, 2021/Proverbs 11,25) Today, a nurse following the bible and nursing code of ethics as well as having had knowledge, skills, and attitude assessed in nursing school, it seems this ethical dilemma would be much less likely to occur.