reply
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an alternative approach to the ethical issue described by your colleague. use 2 reference for each. Less than 1 page
1.Organizations use professional ethics to provide a framework for what behaviors are accepted and expected. Professional ethics can be defined as “rules of acceptable conduct that members of a given profession are expected to follow” (American Psychological Association, n.d.). As a doctorally prepared nurse, it is critical to understand the impact that an organization’s professional ethics can have on the success of an organization as well as patient outcomes. A recent study conducted by Torkaman et al. (2020) investigated the relationship between professional ethics and organizational commitment and was able to show a positive correlation between professional ethics and nurses’ commitment to their organization. A DNP-prepared nurse would be able to identify the importance of leveraging professional ethics in order to increase retention rates. The DNP-prepared nurse could offer reimbursement for staff who attend ethics-based training to highlight the organization’s emphasis on these principles, strengthening nurses’ perceptions of the value of professional ethics within their organization.
Autonomy
Autonomy in healthcare refers to the notion that patients should have the right to make their own decisions about their treatment. Ethical dilemmas may arise when patients do not have the capacity to make decisions, and others (family members, Emergency Room (ER) staff, or legal guardians) have to step in to make these critical decisions for the patient. Rejno et al. (2020) created vignettes to examine the importance of autonomy and dignity. In one of these vignettes, a patient named David was in a motor vehicle accident and had to be sedated and placed on a respirator. The ER team providing care to David has no knowledge of his wishes for care and, therefore, has to use their own judgment to provide life-saving measures. In situations like this, “healthcare professionals can find support from basic ethical values, ethical guidelines such as those provided by the ICN and from learning not to prejudge what the dignity of identity might be for David; additionally, it is essential to protect the identity of every patient, viewing each as a unique person whose life stories are acknowledged, in order to preserve their dignity” (Rejno et al, 2020). The DNP-prepared nurse should consider creating an ethics committee to help provide support and guidance to staff who need to provide care for patients who are unable to make decisions on their own.
Issues in My Own Practice
Over the years, I have worked in many different inpatient psychiatric settings, one being a consistently nationally-ranked hospital by US News and World Report. One of the main differences that I observed in this organization was a strong emphasis on professional ethics. Staff members took great pride in the fact that they were providing evidence-based best patient care in an organization that set forth professional expectations, which, for the most part, staff strived to follow. When staff are provided with clear expectations, they feel more supported, are better equipped to deliver quality care, and are more invested in the organization.
In the inpatient psychiatric setting, autonomy is an issue that we deal with quite regularly. Oftentimes, patients are so mentally ill that they do not want to take medications that would help them to stabilize. When this is the case, the Psychiatrist has to petition the court to have the patient committed and medicated against their will. Staff members have to physically restrain these patients and provide intramuscular medications to them against their will. As you can imagine, this frequently brings up ethical questions of patient autonomy. In order to provide support, ethics committees are a valuable tool to help staff process complex patient cases.
References
American Psychological Association. (n.d.) Dictionary of Psychology. https://dictionary.apa.org/professional-ethicsLinks to an external site.
Rejno, A., Ternestedt, B.-M., Nordenfelt, L., Silfverberg, G., & Godskesen, T. E. (2020). Dignity at stake: Caring for persons with impaired autonomy.Links to an external site.Links to an external site. Nursing Ethics, 27(1), 104–115. https://doi.org/10.1177/0969733019845128
Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics & History of Medicine, 13(17), 1–10.
2. Ethics are one of the main pillars of nursing care and uphold the quality and integrity of interventions delivered. Ensuring that ethical considerations are taken when constructing the framework for a healthcare organization can ensure that those involved feel connected to a deeper and valuable meaning within their work and are also meeting the ethically based qualifications to deliver said care (Torkaman et al., 2020).
Along with ensuring the providers are qualified to deliver appropriate care, the setting must also be appropriate for the level of patient acuity. Telehealth has undoubtedly increased access to care, providing resources to individuals who may not have sought psychiatric support prior to virtual appointments. An ongoing assessment by federal and state regulators has been the appropriateness of prescribing certain medications, including buprenorphine products for medication-assisted treatment (MAT) in the use of substance use disorders. Additionally, fully virtual psychiatric providers have also experienced the need to carefully screen the mental health symptoms for severity and ensure a patient is appropriate for telehealth level of care (LOC).
The Doctor of Nursing practice (DNP) is a change agent supportive of guiding these processes not only at their but as regulations change and adapt. The DNP can play an integral role in collecting new data on care outcomes and translating this data into information that can be disseminated to and understood by non-healthcare professionals. Doing so can promote the ongoing availability of telehealth measures, with focus on increasing access to care. The DNP serves as an expert reviewer to examine outcomes with particular attention to interventions that provide therapeutic outcomes and assessing for gaps in practice. This is of particular concern with telepsychiatry, as progressive steps have been implemented over time to proactively identify individuals who may be at risk for self-harm or are experiencing high-acuity symptoms out of reasonable scope of telehealth care (Fiorini et al., 2020).
Much like general psychiatry services, there are even fewer psychiatric providers providing specialty substance use disorder treatment. Throughout the pandemic, access was increased to MAT treatment and the previous requirement for a specialty waiver and training to prescribe buprenorphine was waived and consolidated by the Omnibus bill (SAMHSA, 2023). This allows all prescribers with schedule III authority to prescribe buprenorphine products to their patients with opiate use disorder, pending state law allowability. Prescribers have also been permitted to prescribe to patients via telehealth, given all other aspects of MAT treatment are completed including urine drug screening and engagement in psychotherapy per state requirements Mahmoud et al., 2022). These permissions may not continue if they are not continuously extended, and the patients utilizing the prescribers who are available in their area due only to telehealth will be without a MAT prescriber once they end. DNPs can present and advocate for ongoing advancements in safe but broadened prescribing practices for MAT, with respect for the seriousness of buprenorphine prescribing and also the management and severity of opiate use disorder in the United States.
References
Fiorini, R. A., De Giacomo, P., & L’Abate, L. (2020). Towards resilient telehealth support for clinical psychiatry and psychology: a strategic review. Studies in Health Technology and Informatics, 213, 275–278.
Mahmoud, H., Naal, H., Whaibeh, E., & Smith, A. (2022). Telehealth-based delivery of medication-assisted treatment for opioid use disorder: a critical review of recent developments. Current Psychiatry Reports, 24(9), 375–386. https://doi.org/10.1007/s11920-022-01346-z
Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Waiver elimination (MAT Act). https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act
Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics and History of Medicine, 13(17), 1–10. https://doi.org/10.18502/jmehm.v13i17.4658
