NSG 517 Week 5 Discussion Board

After reviewing the content from this week, I think it is important to note the barriers to the ethical approach and from there look at the possible solutions to that barrier. It is my hope that when I become a practicing APRN that the education provided in this weeks resources aids me in my decision-making as stated in NSG 517 Week 5 Discussion Board. This week pointed out different ethical approaches such as principle-based and care-based ethics. The principle-based is care based on policies and principles set by the hospital, whereas the care-based focuses on the “issues surrounding intrinsic needs and the responsibilities that occur in relationships” (Tracey & O’Grady, 2019). The specific example I can give is, due to the overwhelming overcrowding in hospitals and understaffing, it has been difficult transferring out patients who need a higher level of care. One night, I remember calling over 22 hospitals in New England looking for a hospital to except an upper GI bleed in a 56yr old female. The only hospital that had bed availability was in Albany, NY. Legally, we as providers, must treat the patients that come to our facility. Ethically, I would side with the patients decision in not wanting to go over 4 hours to a hospital in an unknown area. The patient decided to leave AMA and have her husband drive her to Dartmouth to be treated in their ER.

According to NSG 517 Week 5 Discussion Board and the NCBI article, “As a general rule, it seems that learners value feedback more when it is given by someone they respect as a role model” (Hardavella, G., Aamli-Gaagnat A., et al, 2017). I think that my strength lies in the fact that I can take constructive feedback, without allowing emotions to interfere with my learning. I appreciate feedback from all my peers in the hospital setting. In the emergency room setting, we use more informal feedback when discussing a particular case or situation. I find that I respond better with the verbal feedback from my peers rather than a formal, written down example. Something I need to work on in this situation is not feeling down when formal feedback is needed.

Resources

Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., Sreter, K. B. (2017, December). How to give and receive feedback effectively. Breathe (Sheffield, England). Retrieved September 22, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709796/.

Tracy, M. F., O’Grady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.

Hi Meghan,

Thank you for sharing your specific ethical example. I think many of us can understand the unfortunate current prevalence of situations like the one you described, given the present shortage of beds and healthcare resources all around. I have recently heard about providers recommending that patients sign out AMA and presenting to another emergency department in order to get care or a second opinion. This allows the patient to get into an institution that can’t accept a hospital transfer due to bed shortages. This obviously puts the patient in some danger if they are currently requiring hospital level care and leave to transport themselves to another institution, but in some cases, also appears to be the only way a patient can get into another, and perhaps more suited, institution after presenting at an alternate facility. There are many ethical principles presenting themselves in the example you gave, including the principles of respect for autonomy, nonmaleficence, formal justice, and veracity (Tracy & O’Grady, 2018). The respect for autonomy addresses the providers’ duty to let the patient make their own decisions for their care to an extent. The principle of nonmaleficence obligates the provider to not inflict harm on the patient by having them stay in a facility that may not be able to manage their condition, but also not advising the patient to leave the facility if doing so could lead to significant harm while the patient is unattended. As stated in NSG 517 Week 5 Discussion Board the principle of formal justice provides that the physician must treat individuals equally and according to their needs. Lastly, the principle of veracity is the duty of the physician to tell the truth to the patient about what they can provide and what options the patient has in terms of staying, signing out AMA, etc. Thank you for your discussion of this unfortunately all too common issue we are seeing in our hospitals.

Thank you for what you do in your emergency department, and I hope you are staying safe and well!

Kristin

References

Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s Advanced Practice Nursing – E-Book (6th Edition). Elsevier Health Sciences (US).

Meghan, thank you for highlighting this aspect of ethical practice. I too struggle with balancing the principle-based and care-based ethics. Working in the emergency department psych zone I see this clash frequently. People who can get no response from the system come to the emergency department, basically to force the system into helping. Perhaps my biggest struggle relates to those who have to board for any length of time. We have multiple policies to keep patient and staff safe. Unfortunately, our patients are being held in rooms with no windows and little to do. So balancing following policy- not letting patients hang out in the hallway- with inhumanely requiring people to stay in their room with no windows for days on end is a challenge. And every patient is different- some can hang out in the hallway without being intrusive and moving back into their rooms when the situation needs it and other patients cannot. I am learning to live in the grey area. Just last week I had an employee of the hospital brought in by police after she made a comment to a co-worker (mandatory reporter) about wanting to harm herself. She was embarrassed and upset. I chose not to make her change into our safety gown as a way to help her maintain her dignity. Fortunately, she was able to be released later that day so I didn’t have to pass on my “nursing judgment” decision to the next nurse. NSG 517 Week 5 Discussion Board states that it is often the difficulty- my decisions impact the nurses who follow me, and sometimes what I allow to slide in terms of policy creates a mess for someone else. It is a constant battle!

I appreciate your insights and calling attention to this very real and difficult balance!