18 Nov Demonstrate ability to summarize legal mandates and ethical principles

Demonstrate ability to summarize legal mandates and ethical principles to address complex challenges, manage risk, and advance organizational integrity. Healthcare consists of individuals with health problems and the professionals who care for them. These combinations require at least two levels of expertise. One area concerns the medical treatments that may lead to positive outcomes. The other level of expertise concerns the decision-making process and communication with patients and families. This consists of five separate sections that work together to illustrate the judgements involved in patient care, which often includes ethical issues concerning patients, families, and quality care.

Part 1 Principles of autonomy and nonmalieficence

• An 83-year-old diabetic male, Mr. Jones, is brought into the emergency department because of respiratory distress by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle. Mr. Jones’ daughter reports that her father has been diagnosed with Alzheimer’s disease. A preliminary capacity assessment is consistent with mild dementia but one of the nurses suggests that Mr. Jones’ confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department. The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact.
• Does the father have autonomy to make this decision? Why or why not? Response includes three definitions and examples that demonstrate an understanding ofhow the principles of respect for autonomy and nonmaleficence can conflict.
• Discuss the principle of nonmaleficence as it relates to actions of the providers. (1–2 pages) Response provides at least three relevant examples of information the hospital would use to determine whether to prioritize respect for autonomy or nonmaleficence.

Part 2 Clinical ethics

Clinical ethics requires grasping ethical issues, such as informed consent, truth-telling, confidentiality, end-of-life care, treatment futility, pain relief, and patients’ rights to self-determination. For each hypothetical situation described below, identify the conflicting ethical principles involved, and select at least one appropriate action to resolve conflicting ethical principles in each case. (2–3 paragraphs for each topic)

• An elderly patient suffers cardiac arrest and enters the intensive care unit. Her son insists that “everything possible” be done for her, and yet, she slips into a coma and is nonresponsive for months. As a healthcare administrator who oversees the organization, what steps would you recommend to address the son’s concerns? Response accurately identifies at least two conflicting ethical principles in each scenario and justifies the importance of each of the principles in conflict.
• You are a healthcare administrator reviewing statistics on lab tests ordered and realize that a few physicians account for the majority of orders of a certain very expensive lab test. You do a bit of research and realize that these physicians have relationships with the manufacturers of this testing equipment. What are your next steps?   Please write a brief policy statement about conflicts of interest in the organization.  Response is written substantively and thoroughly related to these topics

Part 3 Risk assessment framework

A hospital finds that hypodermic needle-stick injuries have increased over the last year and, when they conduct an audit, they find evidence that there is wide variation in practice from unit to unit. Some rooms have sharps boxes and others do not, the sharps boxes are of different sizes, and there is variation in how often they are emptied.

• Using the seven-step risk assessment framework described by the Joint Commission (available at 7 Steps to Comply with Joint Commission) outline each of the steps to illustrate how a hospital might use a risk assessment framework to manage the risk of needle-stick injuries. (2 pages) Response is written substantively and thoroughly related to these topics.
• Note: Registration is required to access the link referenced above.
• Once the seven steps have been outlined, write an email to the Director of Nursing about your concerns and recommendations. Response is written substantively and thoroughly related to these topics.

Part 4 Impact of regulatory guidelines on the delivery of care

You are a nursing supervisor in a small rural healthcare facility. Explain how each of the following scenarios will challenge your ability to deliver quality care and manage risks; discuss specific regulatory guidelines that may apply and explain your approach to mitigating each. Write out the following information as a report you will present to the administrative leadership about the negative implications of these issues.

• A shortage of three certified nursing assistants (CNAs) due to influenza and one registered nurse (RN) scheduled leave for a family wedding (2–3 paragraphs) Response provides two appropriate explanation of how to mitigate the impact of shortages of healthcare workers on the delivery of quality care and the management of risk for each scenario presented
• Changing reimbursement rules have a negative impact on revenue that will potentially eliminate the budget for planned renovation to the patient rooms equipped with a winch to lift patients over 200 lbs. (2–3 paragraphs) Response provides two appropriate explanation regarding how to mitigate the potential impact of changing reimbursement rules for Medicare on the delivery of quality care and the management of risk for each scenario presented.

Part 5 Is healthcare a right or privilege?

Provide your opinion about whether healthcare in the U.S. should be is a right or a privilege. Apply ethical standards and state and federal laws to support your position.  Write your position as though you are sharing it through a blog post or letter to the editor of a local paper.  (1–2 pages). Response is written substantively and thoroughly related to these topics.