Ode of ethics affecting your nursing decisions

SUBDOMAIN 724.7 PROFESSIONAL ROLES & VALUES
Competency 724.7.1: Ethical Leadership The graduate analyzes and demonstrates how codes of ethics affect practice, discusses specific issues in safety for quality care, recognizes the importance and role of confidentiality for security of information and professionalism, determines the appropriate standards under which nursesa work, and understands how these standards guide nursing practice.
Competency 724.7.2: Continuing Competence in Nursing The graduate identifies the federal and state regulations under which nursing is practiced, recognizes how these regulations affect the practice of nursing in a specific care setting, recognizes the professional nursing role in a changing health care delivery system, describes unprofessional conduct rules, and determines the importance of maintaining competence through recurring measurement and validation of nursing expertise.
Objectives:
724.7.1-01: Demonstrate how knowledge of a given nursing code of ethics can impact professional decisions in a given situation.
724.7.1-03: Recognize why maintaining confidentiality is an essential element of professionalism in nursing leadership.
724.7.1-05: Discuss how professional standards guide nursing practice in a given scenario.
724.7.2-01: Identify specified key regulations applicable to a state in which a given nurse is licensed to practice.
724.7.2-02: Recognize how a specified state nursing regulation impacts a nurseas practice within a specific care setting.
724.7.2-03: Compare and contrast the authority of the Board of Nursing in overseeing the practice of nursing in a specific state to how that relates to nurse autonomy in practice.
724.7.2-04: Describe the role of nurse autonomy in professional practice.
724.7.2-05: Define the extent of a nurseas obligation to report a specified type of conduct in a given situation.
724.7.2-07: Describe the nature of nurse accountability for patient outcomes, patient advocacy, and coordinated care in practice across multiple settings.
Introduction:
Professional nurses need to be able to recognize the regulations and scope under which they practice and apply ethical principles in decision making.

Case Study:
You are the head nurse in an intensive care unit. You accompany Dr. G to assess the condition of a patient, Mr. E. The nursing home where Mr. E resides has brought him to the hospital because of lung congestion. The medical notes indicate that Mr. E is a 67-year-old white male with diabetes, high blood pressure, poor vision, hearing difficulties, and a mild mental retardation condition.
After assessing Mr. Eas condition, Dr. G determines that Mr. E has no control over his esophagus. He also notes that when Mr. E swallows, food and water are going into his lungs, which has caused an infection and has led to the development of pneumonia. Mr. E is also running a fever and has low oxygen levels in his blood.
Dr. G determines that Mr. E needs to be put on a ventilator and a feeding tube. When Dr. G explains to Mr. E the required procedure and operation he has to undergo, Mr. E shakes his
head and says, a?Go away! No tubes! No tubes!a? Knowing Mr. Eas medical history and situation, Dr. G is concerned about how much Mr. E actually understands.
Dr. G asks you to look at Mr. Eas file to determine whether there is anyone else who might have responsibility for Mr. E. The charts indicate that seven years ago Mr. E checked himself into the local nursing home. When he entered the nursing home, and again three years ago, a patient advocate helped him fill out an advance directive, which stated Mr. Eas medical wishes. Mr. E clearly indicated that he did not want a ventilator, a feeding tube, or drastic cardiopulmonary measures such as CPR.
Dr. G wants to put Mr. E on a ventilator and feeding tube, but it is clear Mr. E does not want one. However, without the feeding tube and ventilator Mr. E will die within a short period of time. Dr. G checks Mr. Eas records again and finds that Mr. E has also filled out a durable power of attorney, which states Mr. E wants his younger brother Mr. B to make medical decisions for him in the event he is no longer able to do so.
Dr. G is convinced that Mr. B should be called and asks you to call him and explain the entire situation. You call Mr. B and tell him his brother is in the hospital with pneumonia complicated by an esophageal defect. You also explain to him that if Mr. E is not treated soon, he will most likely die within a few days. You tell him that Mr. E is against being on a ventilator and that he has requested to not have the use of a ventilator, feeding tube, or CPR measures on his advance directive form; however, you do not think that his medical condition is allowing him to think clearly. After asking Mr. B for his consent to perform the operation, Mr. B asks if he can think about it and let you know the following day. Because Dr. G feels it is an urgent situation and that the decision needs to be made right away, you tell Mr. B that it cannot wait.
Finally Mr. B agrees to drive into the hospital, see Mr. E, and make a decision. Immediately after hanging up the phone, Mr. B decides to call his nephew Mr. H, hoping that he might know what to do. His nephew is not at home when he calls, so he leaves a message stating that Mr. E is in the hospital and that he would like Mr. Has advice on what to do.
Later that evening, Mr. H receives the phone message. He immediately calls Mr. B, but Mr. B is no longer home. Mr. H drives to the hospital to find out what is happening. When he gets there, he doesnat find Mr. B, but he is directed to the ICU unit, where you are still on duty.
You are relieved Mr. H has shown up. Mr. H seems to be someone Dr. G can talk to, who will understand the situation, and help Mr. B realize that Mr. E should get treatment. However, you realize that HIPAA regulations do not allow you to give patient information to Mr. H. Just then Dr. G walks into the unit. On hearing who Mr. H is, Dr. G explains Mr. Eas condition and the need for someone to provide consent for the ventilator. Mr. H provides consent and tells Dr. G he will talk with his uncle Mr. B to have him sign the proper paperwork. Because he determines that Mr. Eas condition is deteriorating, Dr. G proceeds with the intubation while Mr. H goes to find Mr. B.
Note: Case study adapted from a?Treating Ed: A Medical Ethics Case Studya? by Eric Ribbens. Copyright held by the National Center for Case Study Teaching in Science, State University of New York at Buffalo. Used with permission.
Task:

Review the case study and write an essay (suggested length of 2a 3 pages) in which you do
the following:
A. Identify one of your stateas regulations and nursing standards on practice that applies to your role in this case study.
B. Identify a nursing code of ethics that applies to this case study.
1. Explain how this code would impact your professional decision in this situation.
2. Discuss whether it would be ethical for the doctor to put the patient on a ventilator.
3. Discuss whether it would be ethical for the patientas brother to authorize a ventilator.
C. Describe the role of nurse autonomy in professional practice.
1. Discuss how your autonomy to practice is affected by Board of Nursing regulations when there is a question of ethics and a patientas right to choose.
D. Explain your obligation to report the incident in which the doctor provided information to the nephew without written permission.
1. Explain to what extent it is a nurseas obligation to report a specified type of conduct in a given situation.
Note: Think about these two questions: If Dr. G tells Mr. H about Mr. Eas medical situation, what should Mr. H do? Can Mr. H authorize Dr. G to use the ventilator?
E. Discuss your accountability for this patientas outcome and advocacy for the quality and safety of his care.
F. If you choose to use outside sources, include all in-text citations and references in APA format.
Note: Please