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This competency assessment assesses the following Outcome(s):
MN506M1-1: Apply theoretical frameworks and concepts to ethical dilemmas in the advanced practice role.
Assessment Guidelines:
Based on your specialization, use the options below to create an ethical and legal decision-making dilemma involving an advanced practice nurse in the field of administration, education, or a nurse practitioner.
Apply relevant codes of conduct that apply to nursing and the chosen field of the APN.
Describe one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts.
Construct a decision that demonstrates integrity, and that would prevent violation of the ethical principle and prevent the law from being violated.
List three recommendations that will resolve advanced practice nurses’ moral distress in the dilemma you have presented. Support your paper with a minimum of three scholarly references.
Minimum Submission Requirements
All competency criteria must be met to earn a B grade and pass this Course Outcome.
A predefined number of mastery criteria must be met to earn an A grade, indicating mastery of the Course Outcome. See the CLA and Grade Criteria Chart below.
METNOT YET METEthical-Legal Dilemma Competency Creates an ethical legal decision-making dilemma involving an advanced practice nurse. Mastery Ethical Legal decision-making dilemma has sufficient details, addresses the relevant field of the APN, and demonstrates critical thinking. Codes of Conduct Competency Applies relevant codes of conduct that apply to the practice of nursing and your chosen field. Mastery All codes of conduct are identified, all codes of conduct identified are relevant to the chosen APN field. Ethical Principles and Laws Competency Describes one ethical principle and one law that could be violated and whether the violation would constitute a civil or criminal act based on facts. Mastery Describes one ethical principle and one law that could be violated. Identifies correctly if the violation would constitute a civil or criminal act based on facts. Decision Integrity Competency Constructs a decision that demonstrates integrity and that would prevent violation of the ethical principle, and prevent the law from being violated. Lists three recommendations that will resolve advanced practice nurses’ moral distress in the proposed dilemma. Mastery Describes three or more recommendations that will resolve advanced practice nurses’ moral distress in the dilemma presented. All recommendations are pertinent to the APN specialty area. Total Competency Criteria: Total Mastery Criteria:*Not Yet Competent grades convert to an F at term end
*If work submitted for this competency assessment does not meet the minimum submission requirements, it will be returned for revision without being scored. If the work submitted does not meet the minimum submission requirements by the end of the term you will receive a failing score.
Ethical dilemmas are common in healthcare settings. Advanced practice nurses use their advanced nursing knowledge, skill, and judgement to solve ethical dilemmas and provide quality and safe care in primary care settings. Nursing codes of conduct and ethical principles guide nursing practice. Breaking some of these codes and principles may amount to criminal charges; thus, nurses pay hefty fines, lose licenses or serve some time in jail. This essay analyzes an ethical dilemma, nursing code of conduct, ethical decision-making, and recommendations to avoid moral distress.
Ms. Terry, a 16-year-old Hispanic American, comes to the outpatient department accompanied by her furious and fuming mother. She presents complains of lower abdominal pains, and the mother interjects care and claims that she suspects that her daughter is pregnant. The nurse requests Terry’s mother to go to the waiting room, to which she agrees after making demands that she should know all details about her condition. Inside the nurse’s room, Terry confirms that she has been involved in unsafe sex lately but uses a long-term family planning method, hormonal implants, which her mother does not know. She also asks the nurse not to share the information with the mother. She also adds that she feels pain in micturition has vagina discharge with a foul odor. On comprehensive assessment, the doctor diagnoses her with chlamydia and confides with the nurse to provide the best care to the patient. The nurse is torn between sharing this information with the parent because she is a minor or withholding it.
There are several codes of conduct that guide nursing practice. Some of the relevant codes of conduct are a) Nurses maintain public confidence in the nursing profession, b) Nurses act with integrity to maintain patients’ trust, and c) Nurses maintain patients’ trust by providing safe and competent care (Cowin et al., 2019). Nurses use their knowledge, skills, and judgment in assessing patient needs. They are also responsible for upholding relevant laws and regulations regarding patient care. Maintaining patient privacy and confidentiality is paramount. Failure to fulfill these requirements have criminal/law implications. Nurses act promptly to protect and prevent patient harm. These actions include failure to share patients’ information inappropriately. Nurses should understand that they are responsible for their actions. They are also responsible for their health and should take corrective measures when they perceive that the health problems will affect their ability to provide safe and quality patient care (Gágyor et al., 2019). Lastly, nurses should communicate clearly and detail the care interventions and discuss them with their patients.
Confidentiality is an ethical principle that could be violated in this situation. The patient confided in the nurse and doctor. Being a minor, her mother demanded to know everything about her care. Confidentiality breaches can be acceptable in some instances, especially when withholding that information can cause severe harm to patients and others (Pathak & Chou, 2019). However, confidentiality is considered a criminal offense when it causes adverse effects on a patient’s health or safety. Minors have a right to confidentiality (though limited by their dependence on and the involvement of their parents in their care) (Pathak & Chou, 2019).
On the contrary, hospitals, in some instances, can be sued in courts of law for concealing information to prevent disclosure of the information under the Data Protection Act of 2018 section 173 (Price & Cohen, 2019). Healthcare institutions can also be sued for disclosing information that jeopardizes patient safety under the same act. However, care providers should ensure they provide data that does not jeopardize the client’s or institution’s safety.
Most states, including this state, say that when adolescents are old enough and give instructions regarding sharing their information, it is regarded as confidential. In this situation, the best decision is to determine the administrative laws and policies if they conform to the state provisions and make a judgment based on those policies (Rainer et al., 2018). This situation involves severe risk to the nurses’ job and their licenses. Thus, there is a need to ensure the institutional and state laws allow confining of the health information.
The national association of clinical nurse specialists (NACNS) recognizes that nurse specialists face many ethical dilemmas in ethical dilemmas. These recommendations for moral distress are derived from the 4Rs moral distress strategy. The first recommendation is for the nurse to determine the severity, possible consequences of various actions, and attitudes of everyone (Shukla et al., 2019). This step helps the APN to make the right decision and avoid distress. The next recommendation is detaching personal feelings, views, and experiences from the situation. This step helps prevent stress bias in decision-making. The last recommendation is staying open to other people’s opinions and approaches and accepting their perceptions (Shukla et al., 2019). The FNP can include the interprofessional team in decision-making to ensure they make the best decision to minimize moral distress associated with ethical dilemmas.
Adolescents in the US are not protected by the laws in the confidentiality of their information. However, some state laws protect their information, as seen above. FNPs should understand laws and regulations that regulate nursing practice and certain ethical dilemmas. These laws help avoid law violations that could jeopardize their practice. They should also intentionally enhance their psychological health to ensure moral distress does not affect their practice.
Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review, 66(3), 320-328. https://doi.org/10.1111/inr.12534
Gágyor, I., Heßling, A., Heim, S., Frewer, A., Nauck, F., & Himmel, W. (2019). Ethical challenges in primary care: a focus group study with general practitioners, nurses and informal caregivers. Family Practice, 36(2), 225-230. https://dx.doi.org/10.1093/fampra/cmy060
Pathak, P. R., & Chou, A. (2019). Confidential care for adolescents in the US Health Care System. Journal Of Patient-Centered Research And Reviews, 6(1), 46. https://dx.doi.org/10.17294/2330-0698.1656
Price, W. N., & Cohen, I. G. (2019). Privacy in the age of medical big data. Nature Medicine, 25(1), 37-43. https://doi.org/10.1038/s41591-018-0272-7
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461. https://doi.org/10.1111/jocn.14542
Shukla, R., Baker, R., Moody, K., & Allen, J. (2019). Improving Moral Distress and Provider Perceptions with an Integrated Palliative Care Conference in the Neonatal Intensive Care Unit (NICU)(TH370B). Journal of Pain and Symptom Management, 57(2), 394-395. https://doi.org/10.1016/j.jpainsymman.2018.12.092
This competency assessment assesses the following Outcome(s):
MN506M2-2: Analyze ethical-legal principles and dilemmas related to health care.
Using the information from the case study (below), discuss the following issues from the perspective of an APN role:
Standards of care — Which standards of care were violated and who was responsible?
In your role as an educator, administrator, or practitioner, what risk management steps should be taken before or after the incident to alleviate the issue?
Case Study: Malpractice Action Brought by Yolanda Pinellas
Yolanda Pinellas is a 21-year-old female student studying to be a music conductor. She was admitted for chemotherapy. The medication Mitomycin was administered by intravenous infusion through an infusion pump.
During the evening shift, the infusion pump began to beep. The RN found that the IV was dislodged, discontinued the infusion, notified the physician, and provided care to the infusion site. The patient testified that a nurse came in and pressed some buttons, and the pump stopped beeping. She was groggy and not sure who the nurse was or what was done. The documentation in the medical record indicates that there was an IV infiltration.
Two weeks after the event, the patient developed necrosis of the hand, required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The patient alleges that she is no longer able to perform as a musical conductor because of this.
While reviewing charts, the risk manager noted that there were short-staffing issues during the 3 months prior to this incident, and many nurses were working double shifts (evenings and nights) then coming back to work the evening shift again. The risk manager also noted a pattern of using float nurses among several units.
Assessment Requirements:
Before finalizing your work, you should:
Your writing assessment should:
Minimum Submission Requirements.
All competency criteria must be met to earn a B grade and pass this Course Outcome.
A predefined number of mastery criteria must be met to earn an A grade, indicating mastery of the Course Outcome. See the CLA and Grade Criteria Chart below.
METNOT YET METRole of the APN Competency Identifies the role of the APN, content of paper pertains to the identified role. Identifies all standards of care violations pertaining to the identified APN role (administrator, practitioner, or educator). Clearly identifies who violated the standards of care, and how the standards of care were violated. Mastery The individuals responsible for the violations were identified. Each individual’s standards of care violation is described, including how the violation happened. Risk Management Steps Before Competency Identifies risk management steps relevant to the APN role (Administrator, Practitioner, or Educator) before event to prevent such adverse events. Mastery All risk management measures described are relevant to the APN role identified. Risk Management Steps After Competency Identifies risk management steps to be taken that are relevant to the APN role (Administrator, Practitioner, or Educator) after event to prevent future adverse events. Mastery All risk management steps described are relevant to the APN role identified. Total Competency Criteria: Total Mastery Criteria:*Not Yet Competent grades convert to an F at term end
*If work submitted for this competency assessment does not meet the minimum submission requirements, it will be returned for revision without being scored. If the work submitted does not meet the minimum submission requirements by the end of the term you will receive a failing score.
his competency assessment assesses the following Outcome(s):
MN506M3-3: Analyze the effects of contemporary health policy on providers and consumers.
For this assessment, select a local or state health care policy or legislation that was enacted in the last 5 years. Then:
To view the Grading Rubric for this assessment, please visit the Grading Rubrics section of the Course Resources.
Assessment Requirements:
Before finalizing your work, you should:
Your writing Assessment should:
How to Submit:
Submit your assessment to the unit Dropbox before midnight on the last day of the unit.
Minimum Submission Requirements
All competency criteria must be met to earn a B grade and pass this Course Outcome.
A predefined number of mastery criteria must be met to earn an A grade, indicating mastery of the Course Outcome. See the CLA and Grade Criteria Chart below.
METNOT YET METPolicy Identification & Summary Competency Identifies a healthcare policy/legislation, names the policy/legislation and the date of implementation, identifies the state, county or local area pertaining to the policy. Summarizes policy/legislation, all relevant facts are included, and the role of the APN is integrated throughout the paper. Analyzes one strength and one weakness of the policy/legislation. Mastery Identifies and analyzes one strength and one weakness of the policy/legislation. The strength and weakness identified are significant and has major impact on the providers and consumers. Policy Impact on Consumer Stakeholders Competency Discusses impact of policy on all consumer stakeholders. Mastery All the consumer stakeholders are identified, positive and negative impacts are discussed. Policy Impact on Provider Stakeholders Competency Discusses impact of policy on all provider stakeholders. Mastery All the provider stakeholders are identified, positive and negative impacts are discussed. Total Competency Criteria: Total Mastery Criteria:*Not Yet Competent grades convert to an F at term end
*If work submitted for this competency assessment does not meet the minimum submission requirements, it will be returned for revision without being scored. If the work submitted does not meet the minimum submission requirements by the end of the term you will receive a failing score.
Healthcare institutions function under laws, policies, and regulations. These policies and regulations are dynamic and keep changing with changing demands to meet the consumer and provider needs. They also ensure that all individuals receive care with maximum benefit. Advanced practice nurses should be aware of these regulations to implement them in their practice. When these policies arise, they affect consumers and care providers differently. Legislations are statutory laws put in place by the governing body or bodies. This essay discusses recent local/state healthcare legislation and its implications.
Falls are unplanned events that can be prevented because the major causes of falls are environmental factors such as poor lighting, lack of handrails, slippery floors, present obstacles, and high staircases; thus, individuals are unable to climb safely (Kiel et al., 2019). Falls, especially among elderly individuals, have increased lately, provoking the state governments to develop legislation and policies t
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