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Ethics, Biases and Responsibilities of Nursing

Written by kimmel52 on January 8, 2013 – 9:59 pm

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Ethics, Biases and Responsibilities of Nursing
nancy kimmel
October 7, 2014

Ethics, Biases and Responsibilities of Nursing
On any given day, the nurse will be faced with ethical challenges. The consequences of the nurses action in doing the “right thing” creates a dislocation point within their peer and management group.(Huston, 2014, p. 256) From my personal experience I know of one ethical dilemma that I faced. It was the morning shift. I had just made rounds. As I sorted out the medications I was going to pass, I noticed that one of my patient’s medications consisted of Depakote®(“Valproic Acid and Pregnancy,” 2014), Zyprexa®(“What special precautions should I follow?,” 2014) and Tetracycline®(“What special precautions should I follow?,” 2014). This would not have been a problem except the nurses from the midnight shift stated that the patient was only three months pregnant and had stated she was going to have an abortion. I looked through the chart to see if there was a consent signed for a D &C. There was none. I also proceeded to check if the psychiatric medication consent form was signed. This form needed to be signed prior to administering any anti-psychotic medications. The Physician was responsible for explaining to the patient the side effects. Next, I noticed that the attending Physician wrote the order for the Tetracycline and that the Psychiatrist wrote the order for the anti-psychotic meds. After reading this, I went to the patient and explained to her that there could be very teterogenic side effects to her unborn fetus if she were to take these medications either together or individually. She stated that she didn’t care because she was planning to have an abortion. I graciously bowed out and went to my head nurse. I explained to my head nurse that without documentation of a procedure for a D & C or any signature from the patient indicating that they understood the side effects of the combined medications, I could not in good faith pass these meds. In fact, I added that she could change her mind in a few hours. My head nurse just looked at me and asked me if I was defying a Physicians order. I said, “Yes”. She then proceeded to call the nursing supervisor who also asked me if I was refusing to pass the meds. I told her that I would not pass the meds citing documentation via the Micro-Medex®(“Truven Health Analytics,” 2014) drug compatibility table and my nursing code of ethics, to do no harm.(“Code of Ethics for Nurses,” 2010) After a brief discussion with my head nurse, they relieved me of this patient and gave me someone else. The nurse who took over the care of my patient followed the Dr.’s orders and passed the meds. I was told to write an incident report.
Impact of Legal Responsibilities
My first and foremost responsibility is too my patient. That has and will always be how I practice nursing. However my stance, the actions that I took obviously affected the care of the patient and not for the better. Could I have done it differently? It is important that the nurse has a scope of practice. This is what guides us to know what we can and cannot do. As nurses we must be very careful what lines we cross. Physicians are notorious for asking us to perform skills not within the scope of our practice.
Strategies to Address Conflict
There is no easy answer but as a group voice we can be heard. Which is why being part of the legislative due process of lobbying, helps to have laws passed that protect the nurse and patient.(Mason, Leavitt, & Chaffee, 2014, p. 669) Joining a nursing association also helps bring a unique camaraderie for nurse in their field so specialty, where they can also find peer group support for their cause.

References
Code of Ethics for Nurses with interpretive statements. (2010). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Huston, C. J. (2014). Legal and Ethical Issues. In Professional Issues in Nursing Challenges & Opportunities (3rd Edition ed., pp. 256-262-262). Baltimore, MD: Lippincott Williams & Wilkins a Wolters Kluwer business.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2014). Policy and Politics in the Community. In M. Iannuzzi (Ed.), Policy & Politics in Nursing and Health Care (6th ed., pp. 668-669-669). St. Louis, MO: Elsevier Saunders.
Micromedex Solutions. (2014). Retrieved from http://micromedex.com/
Olanzapine. (2014). Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601213.html
Tetracycline. (2014). Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682098.html
Valproic Acid and Pregnanacy. (2014). Retrieved from http://www.mothertobaby.org/files/Valproic_Acid.pdf


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Evidenced Based Practice as a Change Agent

Written by kimmel52 on January 8, 2012 – 10:03 pm

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Evidenced based practice as a change agent
nancy kimmel
November 4, 2014

Evidenced based practice as a change agent
Researching as a Team
Change begins with acknowledging a common problem and having the curiosity to research that problem in hopes of finding documented solutions(Schmidt & Brown, 2012). The BSN nurse is trained to be the agent of change(Video Laureate Education, Inc., 2009). The change agent should encourage nursing staff to participate in research regarding the problem at hand. This helps with building the teamwork ethic among staff. Assessing the literature requires a keen eye for gaps. Gaps, are what is known about a problem or if that problem has not been thoroughly tested(Schmidt & Brown, 2012, p. 69). Gaps also occur when there is only one or two case studies regarding a problem, insufficient information or lack of proven results(Schmidt & Brown, 2012, p. 69). For instance, a single study that only incorporates 50 test subjects, regardless of the strength of the statistical results is not sufficient evidence for evidenced based practice to be implemented. On the other hand, 20 or more similar case studies with strong statistical evidence to support the research question, would allow one to generalize the findings to a wider population(Schmidt & Brown, 2012, p. 69).
Practical Transition
Finding a solution to a problem as a group is a euphoric experience. However, taking that solution and putting into practice is a different matter. There are many pitfalls to the implementation of any new ideas or practice theories. Suppose the change that will take place requires a special device. This device costs money. The question is, will the hospital provide the financing for such equipment or supplies? All new protocol must be documented on the floors policy and procedure manual which utilization review must first approve. Hence, the red tape.
The Iowa Model for EBP (Evidenced Based Practice) is a systematic method for organizational change(Schmidt & Brown, 2012, p. 390) The Iowa Model diagrams the necessary steps to incorporate EBP in promoting better health care(Schmidt & Brown, 2012). The model provides a series of logical steps that assist the change agent in the decision making process.
Common Errors and Pitfalls
Not everyone is on the same page. The change agent should be sensitive to the fact that some nurses have no desire to engage in research, nor implement new care skills(Schmidt & Brown, 2012). Complex statistical evaluation and knowledge diffusion poses barriers to most practical nurses(Schmidt & Brown, 2012, p. 396). Change is a process that creates an alteration in a person or the environment(Schmidt & Brown, 2012, p. 397). While there is no exact answer how to implement change, theorists have suggested that preparation should be the first step(Schmidt & Brown, 2012). Beginning a journal club helps to engage others and encourages participation(Schmidt & Brown, 2012). The disciplined clinical inquiry model is helpful in structuring the journal club, by empowering nurses in clinical practice to consider the patient, clinical setting and resources(Schmidt & Brown, 2012, p. 399). Kotter’s eight change phases model is simple in design and begins with establishing a sense of urgency(Schmidt & Brown, 2012, p. 407).
Summary
While there is no one model fits all, the change agent should be aware of the important role they play in advocating change. Finding solutions to promoting better health care and positive patient outcomes is a responsibility of every nurse. Some nurses find that this is too much of a burden to bear in the context of their daily routines. Therefore the change agent needs to help with facilitating the process through preparation, empowerment of their staff nurses, encouragement and communication. Identification in the gaps of patient care is a team effort and all teams need a leader.

References
Huston, C. J. (2014). Collective Bargaining and the Professional Nurse. In Profesional issues in nursing challenges & opportunities (3rd ed., pp. 19-23. Baltimore, MD: Lippincott Williams & Wilkins, a Wolters Kluwer business.
Schmidt, N. A., & Brown, J. M. (2012). Evidence-based practice for Nurses appraisal and application of research (2nd ed.). Sudbury, MA: Jones & Bartlett Learning .
Video Laureate Education, Inc. (2009, ). Research and scholarship for evidence-based practice: Introduction to evidence-based practice and research [Video file]. Retrieved from


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