Nursing Leadership paper

Instructions: Nurse Leader APA Assignment

 

The student will interview either their practicum nurse leader that has been assigned for the practicum experience or a nurse leader of their choice and discuss the following: 

*Practicum nurse leader or nurse leader of choice - Background - to include name, education, current and previous employment, previous careers, leadership qualities, leadership style (Based on * Leadership Quiz and Information from Cherry & Jacobs), effectiveness of leadership style on the assigned unit, interdisciplinary approach to patient care, credentials/licensure/certifications.

* Complete the Leadership Quiz on both yourself and your practicum nurse leader or nurse leader of your choice. Use as a discussion point for leadership style when discussing your practicum nurse leader or nurse leader of your choices style and leadership attributes. The Leadership Quiz is located in the assignment section for the Nurse Leader APA Assignment. You do not have to attach the Leadership Quiz to this assignment.

Name of the hospital or other place of employment where the practicum nurse leader or nurse leader of your choice is employed. Include a description of the unit and a description of the patient focus of the unit (e.g. ICU or ED).

Sample Leadership Essay

Nursing Leadership Assignment- Ethical and Legal Issues in the ICU Unit 

Introduction 

Intensive Care Units (ICUs) have been present in the United States healthcare industry for over 50 years now (Park et al., 2015).  During this time, there have been many patients that benefited from the medical and mechanical interventions that are provided by these units. However, these treatments have not always been a hundred percent effective. According to studies,  there is around one-fifth of Americans reported to die after being admitted in the intensive care units mostly after the terminal hospital admission (Park et al., 2015). Whether these people will live or they will die, it is also a fact that most of them will continue to experience prolonged suffering and pain, and this is where the ethical and legal issues come in.  When nurses are caring for ICU patients, it is usually evident that ethical issues are going to come in since patients will depict medical conditions, various providers, and various treatment plans or prognosis differently. This leads to moral distress and conflict among the patient, the healthcare providers, the patient family, and support staff (Park et al., 2015).  This report discusses ethical and legal issues related to working in the intensive care unit by looking at a proactive approach to which nursing leadership in the hospital can deal with ethical and legal issues by adapting measures that can help in reducing conflict and liability within the medical practice (Moon & Kim, 2015). 

In an ICU environment  where nurses and physicians observe the ethical and legal aspects in treatment and care, it means that they can be in a position to provide the right patient care, build trust with the patient, connect with the patient family through empathy and provide an understanding of what they are going through during the provision of optimal care. 

Ethical and Legal issues

When it comes to nursing leadership practice, Ethical and legal issues will look at the moral behavior that will analyze the theories regarding moral thinking as a way of finding out the rights and wrongs (Via-Clavero et al., 2020). In the ICU section, medical-legal and ethical issues will look at the application of moral reasoning to the practice of medicine, for which it is supposed to govern the practice of intensive care. It is important that in the ICU section, medical and legal issues are considered due to factors involved in healthcare such as high healthcare costs, restrictive governments, medical advances, and more knowledgeable and demanding public. In a medical situation, nursing leaders are required to make important decisions regarding patient care, they are also required to apply these issues to behavior and conduct including the business aspect of medical practice (Moon & Kim, 2015).  Any nurse working in the intensive care unit is bound to encounter ethical and legal dilemmas in pursuing their goal to maintain the required standards of teaching, practice, and patient welfare. At times this goal will encounter conflict with individual thoughts, the behavior of the patient, workload pressure, expediency, financial interest of the hospital, and other ethical principles.

Often it is important to also have some guideline that provides a framework for analysis and reasoning. In this regard, ethical issues in medical practice are also intertwined with legal requirements. Among the legal issues related to nursing leadership practice often vary between different states and the level of practice. It is however important that as a nursing leader one needs to be aware of the universal ethical requirements are relates to professional laws and professional bodies that apply in each particular state (Via-Clavero et al., 2020).  It is also important to note that state laws are going to take precedence over some principles and practice guidelines.  At times it may also require that as a nursing practice one seeks opinion regarding decisions made with the patient in the intensive care unit. Among the legal and ethical issues that will come by include confidentiality, consent, and end of life decisions.

 One of the most common legal issues when it comes to patient care at the ICU is the consent of the patient to treatment will often underpin the relationship between the patient and the nurse. Patient consent is considered in both ethical and legal grounds when delivering medical care.  Among the principle required inpatient consent are also established where the ICU staff need to have a legal and ethical duty to ensure that the patient confidentiality and the principles related to confidentiality are also applied in the process (Falcó-Pegueroles et al., 2016).  It is important to ensure that the ICU staff record only patient information that is important when it comes to patient care, this requires that consent is applied especially when it comes to quality assurance, information research, and other stated purposes unless there is the application of anonymity.  The consent of patients is also needed regarding disclosure of information to third parties and other healthcare providers which is obtained whenever consent is required in medical care (Park et al., 2015).   When it comes to incompetent adult patients and minors, it is important to ensure that consent is given to any authorized third party. It is also important that patient information is only shared when it serves the purpose it was collected to do.  Some of the challenges that nurses and other healthcare faces are reporting or documenting inaccurate information when the patient is in the ICU.

At times healthcare providers are found to have misdiagnosed the patient or extended their stay at the ICU ward for financial gains. At his, the patient and his or her family will continue to experience social, financial, and psychological torture when the healthcare provider safeguards the financial interests of the hospital.  One of the ethical aspects of being abused comes during the end of life (Falcó-Pegueroles et al., 2016).  There are situations where the patient could be prolonged in life support when in reality the doctor or the physician knows that the patient is eventually going to die.  It is ethically important that in such a situation the doctor advises the patient and the patient family appropriately to ensure that they make informed decisions regarding the future of their health.  Prolonging the patient through life support will eventually lead to the accumulation of bills that might provide a lot of gain for the hospital and massive losses for the patient and the family (Park et al., 2015).  The issues are at times a big challenge even to the patient family, especially when it comes to the aspect of who makes decisions about individual lives. 

Approaches to Ethical and Legal issues

One of the best approaches to ethical and legal issues at the ICU is the proactive approach which ensures the minimizing of moral distress or conflict among the patients and staff.  In the ICU, staff and patient conflict is often common and can be very dangerous or harmful to the patient or lead to legal implications for the medical practitioner.  However, with the right approach, such conflicts can be prevented.  Among the common types of conflict are disagreements about the clinical decisions which are based on poor communication, personal tension, mistrusts, and challenges regarding the end of life care (Falcó-Pegueroles et al., 2016).  The implications of unreconciled conflict are usually high and will lead to moral distress, misguided treatment, and high job turnover and staff burnout.  With the application of the right proactive measures, such conflicts are preventable. 

There is also a common approach when it comes to organ systems, monitoring, and computer-based documentation, and maintaining the human aspect in ICU experience for the staff, patient, and family.   Due to burnout experienced by medical practitioners, there is likely to be unreconciled conflict in this situation which will lead to a detached attitude including the lack of concern for others (Via-Clavero et al., 2020).  The medical practitioner must learn to engage each other through a patient-focused attitude and concern for other nursing staff working in the ICU. Such measures are important in avoiding burnout can promote a level of personalized care and support. 

Another proactive approach to legal and ethical issues is coming up with signs, policies, and standards of practice charter which are placed in strategic areas at the ICU ward and walkways. The information in the poster is usually important as it will provide the patient, nursing staff, and family to the patient the chance to understand the procedures for treating the patient in a moral and legally acceptable manner (Via-Clavero et al., 2020).  Such an approach is also important as it will connect the patient, the nurse, and the family by developing a rapport. In any case, a family with an ICU patient are often under a great deal of stress, they will try to maintain their home responsibilities and roles while they also adjust their experience having to stand with their patient at the ICU. These families will find themselves engaging in different roles in the ICU like the protector, providing active presence and encouragement, historian, caregiver, and coach (Park et al., 2015).  In this way, working with the family also provides a great opportunity to consent and making medical decisions as they can closely related to the patient whenever it comes to any medical or treatment procedure.  

It should be remembered that informed consent is a preserve for patient autonomy and the physician or nurse has the ethical responsibility to ensure this is established.  The process of informed consent will require a dialogue between the healthcare provider and the patient where the benefits and risks of a particular medical intervention are discussed in addition to pertinent alternative options for treatment.  Informed consent must be obtained for most therapies, surgical procedures including amputations and research or organ donation (Park et al., 2015).   However, the legal aspects provide the medical practitioner to waive informed consent when it comes to certain situations like emergency surgeries and situations where the patient or the state waiver is accepted or situations that the patient may not have the capacity to consent.

Conclusion

When it comes to legal and ethical issues, the main focus should be on providing the right treatment, ensuring the patient stay at the ICU is minimized depending on how he responds and that he is as comfortable as possible. All the clinical orders must be examined regarding ICU treatment and care especially given that the patient will continue to need palliative care after the ICU operation.  It is also important to reassess the medical support equipment in the patient’s room and ensure that unnecessary distractions are taken away.  Also provide the patient with the right information regarding progress, discharge, and options for the end of life.  

References

Falcó-Pegueroles, A., Lluch-Canut, M. T., Martínez-Estalella, G., Zabalegui-Yarnoz, A., Delgado-Hito, P., Via-Clavero, G., & Guàrdia-Olmos, J. (2016). Levels of exposure to ethical conflict in the ICU: Correlation between sociodemographic variables and the clinical environment. Intensive and Critical Care Nursing, 33, 12-20. doi:10.1016/j.iccn.2015.10.004

Moon, J. Y., & Kim, J. (2015). Ethics in the intensive care unit. Tuberculosis and Respiratory Diseases, 78(3), 175. doi:10.4046/trd.2015.78.3.175

Park, D. W., Moon, J. Y., Ku, E. Y., Kim, S. J., Koo, Y., Kim, O., … Koh, Y. (2015). Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. Journal of Korean Medical Science, 30(4), 495. doi:10.3346/jkms.2015.30.4.495

Via-Clavero, G., Guàrdia-Olmos, J., Falcó-Pegueroles, A., Gil-Castillejos, D., Lobo-Cívico, A., De La Cueva-Ariza, L., … Delgado-Hito, P. (2020). Factors influencing critical care nurses' intentions to use physical restraints adopting the theory of planned behavior: A cross-sectional multicentre study. Australian Critical Care. doi:10.1016/j.aucc.2019.09.003