Ethical Decision

timer Asked: Oct 16th, 2018
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Question Description

Rubric and article attached. Read Betrayed Trust article ( attached) before starting

Must cite ANA Code of Ethics (There are 9 provision must cite appropriate provision number), Agency of Healthcare Research and Qualities, chapters 16 & 23 of the Marquis & Huston textbook Leadership roles and management functions in nursing (2017)

  1. Recall a situation in your clinical experiences in which an ethical decision was being made. Be sure only to discuss the situation without use of names of organizations, facilities, or persons involved.
    1. Which ethical decision-making principles came into play? (Cite Huston & Marquis textbook in your response).
    2. Which provision(s) of the American Nurses Association (ANA) Code of Ethics influenced the decision that was made? (Cite the ANA in your response).
  2. After speaking with a staff member or nursing leader in your clinical facility, describe a quality improvement initiative that is occurring (or had occurred) --- every facility has one.
    1. What events occurred to prompt the initiative?
    2. Which Agency of Healthcare Research and Quality (AHRQ) domain is addressed through this project? (Cite the AHRQ in your response).
  3. Refer to chapter 16 of the Marquis & Huston textbook. Reflect on what you have experienced and observed in your clinical sites and the principles of transition into practice.
    1. What do you expect will be the most difficult adjustment in your first nursing role?
    2. Describe actions and strategies you can take that will facilitate your adjustment into the workplace.

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LWW/NAQ NAQ200179 December 5, 2011 23:18 Nurs Admin Q Vol. 36, No. 1, pp. 63–80 c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright  Betrayed Trust Healing a Broken Hospital Through Servant Leadership Deborah A. Yancer, MSN, RN An investigative reporter with The Washington Post broke the news of a no-confidence vote by the medical staff of a hospital in the suburbs of Washington, District of Columbia. The chaos that followed created a perfect storm for needed change and offered the rare opportunity for unbridled deep and creative collaboration. Issues the hospital faced as a result of this crisis and subsequent events that tested the authenticity of change are summarized. This article focuses on the approach used by the registered nurse chief executive officer (RN-CEO) to humanize the hospital, viewing it as though it were a patient and leading a clinical approach to organizational recovery and health. The relationship that developed between the medical staff leaders and the RN-CEO was pivotal to the hospital’s recovery and evolved as a hybrid of servant leadership. Outcomes achieved over a 7-year period and attributable to this relational model are summarized. Finally, the RN-CEO shares lessons learned through experience and reflection and advice for nurses interested in pursuing executive leadership roles. Key words: no-confidence vote, recovery, servant leadership, trust M IRACLES HAPPEN, as clinical professionals we know that. We have been blessed to see patients recover when healing was not thought possible and our efforts inadequate to the challenge. Miracles can also happen in the health and recovery of a hospital. When a hospital falls from grace in the eyes of the community it serves, people look for someone to place their trust and confidence in. A building does not engender confidence. But people can. And so when we hold up a leader, confidence in the hospital can be nurtured. But the path to recovery can be long and unpredictable. When trust is betrayed, it is more difficult for people to invest in new Author Affiliation: Independent Consultant, Lincoln, Nebraska. The author thanks the past presidents and other medical staff leaders of Shady Grove Adventist Hospital for their leadership and sage advice as they, along with the author, laid down the path to the future. The author declares no conflict of interest. Correspondence: Deborah A. Yancer, MSN, RN ( DOI: 10.1097/NAQ.0b013e31823b458b relationships and risk disappointment again. This is true for each of us and so, too, for people bound together by a common work. A HOSPITAL IN CRITICAL CONDITION In 1999, Shady Grove Adventist Hospital (SGAH), a 268-bed acute care hospital serving a rapidly growing community in the suburbs of Washington, District of Columbia, was the subject of a breaking investigative story in The Washington Post, a reputable national news source. The premise of the article, and the series that followed it, was that patients were dying at SGAH because of poor leadership and the medical staff had issued a noconfidence vote (NCV). Although the source was not named, it was attributed to medical staff speaking on behalf of hospital nurses and staff. Perhaps, more damaging was the slow decline in personal confidence that physicians and staff shared with family and close friends. When the story went public, all those comments added credibility to the concerns. Confidence was lost from the inside of the hospital out to the community. All venues of 63 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. LWW/NAQ 64 NAQ200179 December 5, 2011 23:18 NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2012 local media carried the story over the intervening months. In fact, for several years, any news about the hospital was prefaced by reference to the troubled time. The good intention of medical staff leaders to herald the need for change spiraled out of control and caused many unintended consequences. Public scrutiny placed an additional burden on all engaged in delivering or supporting care at the already faltering hospital. Everywhere hospital staff and physicians went in the community they were questioned and subjected to name-calling. The hospital’s staff and physicians were battered in the cross fire of accusations and suspicion. It was a fearful time, with great uncertainty about the future of the hospital. Patients continued to come to the hospital, with newspapers in hand, and challenged even the most basic care processes. Regulatory agencies (The Joint Commission and the Maryland Department of Health) also arrived immediately and conducted concurrent reviews. Temporary management was put in place at the hospital and the parent health system, Adventist HealthCare, Inc, whereas the system board (there was no hospital board at the time) worked to respond to the immediate situation. Conflicts between board members and medical staff were aired in the media. The hospital was subsequently placed on conditional accreditation by The Joint Commission, and its deemed status with the Centers for Medicare & Medicaid Services (CMS) was threatened. Conditional accreditation was a designation that had not been previously used, and its meaning and path to resolution were unclear. Many people in the community misunderstood the designation and believed the hospital had lost its accreditation. Since the hospital had recently achieved the highest Joint Commission rating, the health system formally appealed the decision. Meanwhile, the health system board considered potential management options including affiliation, contract management, or recruitment of new leadership. Interim leadership, with assistance from consultants, worked to stabilize the hospital and set priorities. Ef- forts during the interim period, while well intended, were in some cases off point, bringing focus and energy to change initiatives inappropriate for a hospital in crisis. For example, work began on the development of a clinical ladder for nursing. Although nurses were interested in the development of a system to recognize their clinical expertise, this work would have no value unless the hospital’s performance and reputation were first restored. The medical staff leadership, to their credit, took seriously their involvement in selection of the next hospital leader. They articulated what they wanted in a leader and what they believed the hospital needed. The medical staff president and president-elect participated in the selection interviews and pledged their support moving forward. No formal methods for medical staff engagement had existed prior to the NCV. Contact with hospital and health system leadership had been predominately transactional. Meetings were held on an as-needed basis with individual physicians or groups. Distrust had grown as people had different accounts of commitments made, and many described an absence of relationship with administration. The medical staff desired relevant involvement in shaping the future of the hospital. Many barriers existed in the hospital that would need to be overcome, including but not limited to the following: • Significant findings from regulatory agencies with tight timelines for improvement. • Frequent unannounced surveys by discipline-specific and hospital accrediting and regulatory bodies. • Damaged credibility with the community. • Weariness of hospital staff and physicians before the NCV worsened under intense public scrutiny and suspicion of coverup. • Broken trust; people described feelings of deep disappointment and betrayal. • Vacant, consolidated, and eliminated executive and management roles. Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. LWW/NAQ NAQ200179 December 5, 2011 23:18 Betrayed Trust • Acting or inexperienced leaders; some had experience only at SGAH and lacked requisite formal education. • No hospital board and limited connection between the community, the hospital, and the health system board. • Communication had been messy, with conflicts and disagreements reported in the media; “no comment” responses to inquiries deepened community distrust. • Hospital financial performance had declined to a loss position; expenses for consultants and interim leadership were unbudgeted. • An entrenched view of the prior leadership, like a mantle, would be inherited by the new hospital leader. • People interpreted responses and actions through the filter of prior experience. • People were reluctant to try again since their prior efforts had gone unheeded. • The uncertain future of the hospital made retention and recruitment of qualified and experienced leaders and staff difficult. Over the next several years, significant internal and external events provided additional challenges to the hospital and tested forward progress (given next). Media coverage of selected (*) events and investigations produced a layering type of impact on the hospital and its people. Keeping hope for recovery alive was perhaps the most important and daunting leadership challenge. • The community was growing rapidly and with it, needs for health care services • Service-line competition was increasing with 4 other hospitals in the service area • Patient boarding and ambulance diversions among county hospitals reached a crisis point* • Significant near misses and sentinel events were self-reported, and the error rate in the hospital appeared to increase as a result of increased reporting* • Members of the community notified The Joint Commission and the State Board of Health of their concerns about care delivery, resulting in additional inquiries and on-site reviews* 65 • An intensive care unit nurse was suspected of hastening the deaths of patients at SGAH; investigations were conducted concurrently by the hospital, the police, and the Maryland State Board of Nursing* • A disgruntled former employee was arrested and sentenced to prison after bringing a concealed shotgun to the hospital in search of his supervisors* • Various threats to the community required hospital attention or response, including: • The Pentagon attack* • Anthrax exposure threat at the Shady Grove post office* • Reports that hospitals were targeted for dirty bombs • Random DC sniper attacks, gunmen arrested in hospital service area* At the time, living the experience, each day was filled with urgent issues and more work to be done than we had staff to satisfy. The environment was dynamic both in the hospital and in the broader community. It was easier to see what was working against, rather than for, the hospital’s recovery. The hospital continued to serve the community and experienced growth in volume and services while doing the difficult work of making changes rapidly and in full public view. For the purposes of this article, we will focus on the collaboration between the hospital president (registered nurse chief executive officer [RN-CEO]) and the medical staff officers (past president, president, presidentelect, secretary, and treasurer). Certainly, contributions from the health system leadership, board members, medical staff, hospital leaders and managers, employees, and volunteers were all critical to the recovery of the hospital and are recognized. RN-CEO, THE NEW HOSPITAL LEADER During the selection process, it had become clear that the next hospital leader would need a broad base of health care experience and an ability and interest in providing Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. LWW/NAQ 66 NAQ200179 December 5, 2011 23:18 NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2012 hands-on, just-in-time leadership. Turning the clinical and financial performance of the hospital would require expert communication skills, a strong personal presence, a sense of urgency, and the ability to inspire confidence. The new leader would become the face of the hospital and would need to be comfortable dealing with adversity and conflict. Motivation for success must be deeply ingrained, and the leader must be mission driven. In June 2000, the newly appointed CEO for Adventist HealthCare, Inc, announced the selection of a new hospital leader (RN-CEO) for SGAH. I had been selected to fill the role. I was living in Tennessee at the time and would make the move to Maryland to assume my duties. I had 25 years of experience as a nurse, with 20 years in progressively responsible hospital executive positions including experience in both chief nursing officer (CNO) and chief operating officer (COO) roles. While most of my experience was in mid-size, private, not-for-profit, faith-based hospitals and health systems, I had served as COO in a large teaching hospital and carried interim responsibilities during organizational transitions. My experience included working at every level within the hospital hierarchy, leading department and division turnarounds, and collaborating with other health system executives during hospital reorganizations, consolidations, and mergers. My leadership perspective had been built upon a systems theory framework, beginning with my education in a baccalaureate nursing program and continuing in my first role as a primary nurse in the intensive care setting. It was in that first role as a nurse that I discovered that work conditions matter and that patients care depends on the effective integration of effort across departments and disciplines. I quickly discovered that clear accountability and the existence of healthy relationships are requisite to good patient outcomes. As a staff nurse, I witnessed horrific patient care as the result of fragmented care processes and the divorce of responsibility from accountability. Within 2 years of begin- ning practice, I felt a deep calling to directly influence care conditions and moved from a staff nurse role to a unit-level management position. My personal mission in that first management role and every role leading up to my appointment as the president of SGAH was to create conditions where good people could give great care. My motivation for moving from a direct patient care role to a management role was to change what was happening at the bedside. I explored ways of involving staff in decisions about patient care and began implementing staff engagement models. Soon after taking my first position as CNO in 1980, I heard Tim Porter O’Grady speak about Shared Governance. Over the next decade, I served as CNO in 3 different organizations in Michigan, Missouri, and Nebraska: • Introducing shared governance in each organization • Applying learning from the prior experience • Deepening my understanding of the complexity of culture change I learned that improving performance in nursing, engaging and empowering staff nurses, and strengthening effectiveness of nursing leadership contributed to improvements in patient care but in limited ways. To really impact patient care, influence across the hospital was required. During this time, I completed a clinical master’s degree in nursing, an unusual academic path for a nurse executive. A more typical path would have been a master’s in nursing administration or a master’s in health care or business administration. However, by that point in my career, I had significant executive-level experience and had learned business skills on the job. Given my passion for improving patient care, I had chosen to pursue graduate level education in clinical nursing and to further strengthen my understanding of patient care, a hospital’s core mission. I chose to specialize in women’s and children’s health, the only clinical area in which I lacked experience. In this way, I broadened my understanding of clinical specialties. Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. LWW/NAQ NAQ200179 December 5, 2011 23:18 Betrayed Trust This combination of clinical education and administrative experience offered a balance in perspective that would prove an important advantage. Although this would be my first time in a permanent CEO position, there was confidence that my deep experience in hospital operations, engagement models, success with turnarounds, as well as leadership presence and style would be a good match for the challenges the hospital faced. Many people asked me then and since, why I would be willing to take on such a responsibility and risk failure? As I visited the community and interviewed for the position, I had seen a great community that needed its hospital. This was work worth doing. My decision to accept the position came with a deep sense of calling to help ensure that the hospital would be able to continue its mission of service to the community. I had a strong faith that the outcome would not rely solely on my effort, knowledge, or skill. Like all the work we do in nursing, I believed I could make a difference by joining my efforts with that of others. As a clinical professional, my courage came from that internal well that nurses and other professionals routinely draw upon in providing clinical care. It is what we are prepared to do. THE HOSPITAL AS PATIENT But how should I lead? Where would the work begin? It was like being confronted with a critically ill patient and determining where to put your first effort. I observed that much of what was needed was the exact opposite of what had been happening. For example, the initial response to the media inquiries about care had been “no comment,” a literal fuel for the fire of public scrutiny. From the moment my appointment was announced, I made myself available and was willing to comment even if the response was “I don’t know, but I will find out.” I was responsive to the hospital’s need for permanent leadership and traveled to the hospital before my official start date to address staffing shortages. Every conversation became an opportunity to learn from people about what had happened 67 and what it meant to them. People described the disappointment and hurt they had experienced. It was important to understand the way people in different parts of the hospital had experienced the gradual breakdown of trust and how that played out, near and distant, to the patient. It was valuable to understand the meaning that individuals and groups made of their experiences and to consider how that would affect their behavior moving forward. All the hospitals problems were rooted in disconnection and broken trust. It took 6 months to begin to see an impact. It was like bailing water out of a sinking boat. There were many small changes, and how something was done, often proved more important than what was done. I looked for opportunities to be responsive in early and meaningful ways to signal a new beginning and that people would be valued and heard. For example, 2 major capital investments were made in response to physician and staff feedback, a new computed tomographic scanner for the high-volume emergency department and an additional emergency generator with wiring mapped throughout the hospital to support critical patient needs. Early on, it was difficult to get people to believe that they would be heard, as these urgent requests had been made before. It was the fragile beginning of rebuilding trust. Like priming a hand water pump for a well, there is no water unless you first pour some in. So, too, with trust, when people have been disappointed repeatedly and trust is broken or betrayed, they stop trying and give up hope of any response. Apathy is a learned response. To change this situation, the leader must gift trust, modeling consistent and continuous behaviors that deepen with repetition so that trust can be reborn one relationship at a time (Table 1) ...
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Find the attached assignment, in case you need clarification or edits kindly let me know.




Nursing Ethical Decisions






Nursing Ethical Decisions
Nurses are faced with numerous ethical challenges in their practice and have to make
critical ethical decisions that will ascertain the wellbeing of patients (Marquis & Huston, 2009).
If a nurse fails to adhere to the various ethical codes of conduct, he or she puts himself or herself
in serious legal problems. Recently within the rehabilitation center (which was my clinical
setting), an ethical situation emerged in my practice that required making critical ethical
decisions. The family of one patient with brain tumor required that the patient should not be told
about his condition...

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