Category: Ethics

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Disaster Nursing

Nurses play a valuable role in health care but they can also play an important role when disaster strikes. There are various tasks that a nurse can do to help any disaster situation, whether it is natural or man-made. A key job that a nurse can do is assessing patients. This can be done to determine how severe patients are from the disaster. Assessing patient’s helps doctors organize who they need to treat first. Things can get pretty hectic when a disaster occurs. It is important that the nurse remains calm and collected when assessing patients. Nurses also can’t hold be afraid to tell it like it is. If a patient is near death and has a low probability of survival, the nurse needs to make the decision to provide comfort and let the patient live out the remainder of their life. Nurses can also contribute by providing patients with first aid and medications. If people are in need of help but their injuries aren’t as extensive as others, a nurse can jump in and provide first aid. This could mean stabilizing a patient with a suspected spinal cord injury or tying off a gushing wound by providing pressure. These tasks can help save patient’s lives. Medication administration is also valuable in providing comfort to patients. Pain medications can be used to help alleviate immediate pain. When dealing with all of this commotion, a nurse needs to be able to step back and think about their own safety before jumping into something that can danger themselves.

The ANA Code of Ethics can present conflicting Provisions as a nurse has a duty to care for a patient yet, care for themselves. These two Provisions can conflict each other in times of disaster. In these types of situations, a nurse has to think about themselves and the issue at hand. If saving someone’s life is going to cost your own life, then that is not worth it. A nurse can only do some much in certain circumstances. It can be challenging for a nurse to make this decision. When a nurse spends their whole career helping people in need, these decisions do not get any easier. Sometimes, a nurse may need someone else to explain to them that helping someone in a certain situation can lead to harming themselves. The judgement is left up to the nurse as they should do what they feel comfortable doing. It would not be considered a breach in one code over another when they involve endangering yourself or the patient. 

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Death With Dignity

Death with dignity is a very important topic as it can provide patients with a sense of comfort and give respect during their late stages of life. End of life can be challenging for patient as they experience a roller coaster of emotions including pain. Personally, I agree with physician assisted death as it gives the patient the control over their care. Instead of suffering from a terminal illness and waiting for themselves to die, it gives the patient the choice and terms on when they would like to no longer exist. I had a family member who was suffering from cancer and it was very challenging to watch them suffer knowing there is nothing that can be done. This topic can be challenging for some to discuss as they can have personal experiences that influence their viewpoint. Further research can be beneficial as it can provide more information on the topic and how it can affect patient care.

After viewing various literature, I have learned a great deal of information on death with dignity. I was surprised with how many states in the US have this process for patients. I assumed, with it being a very controversial topic, that there would be only one or two jurisdictions that allowed assisted death. With this, I also learned about some of the criteria that accompanies it. The patient must be of a certain age, be diagnosed with a terminal illness, and have decision making capacity. This process can challenge the first ethical principle of nonmaleficence as it directly causes the patient to die. This can a difficult concept as it is counteracting on what nurses and health care providers pride themselves on. Yet, the great picture should be looked at in these scenarios. If the patient can make decisions and a terminally ill diagnosis is made, then the decision should be in the hands of the patient. Death with dignity should be a “treatment” option that of which a patient can elect to go proceed with. This “treatment” option would be accompanied with consent and all other required documents for procedures. Healthcare workers look to help the quality of life in patients and with death with dignity, this can be accommodated. When dealing with terminally ill patient, health care workers are only providing comforting measure and prolonging the patient’s life, yet it may not be improving quality at all. Looking at the big picture can shed light into how a patient is feeling and can ultimately lead to providing the best care that health care workers can.

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Electronic Health Records

The use of electronic health records can be very important in when it comes to patient care. The patient’s information is uploaded in real-time so that all people holding the capability can look when needed. Having the records held online allows for easy access and control over their own records. The health records can include diagnosis, medications, immunizations, allergies, lab results, and so on. The implementation of HIE and electronic health records is a huge jump the medical field. These records can be accessed on smart phones, tablets, and anywhere internet access iv available. This can allow physicians and the health care team to access this data when needed.

HIE allows the health care team to be more efficient and provide better quality when it comes to patient care. Instead of forcing the medical staff to hold records in filing cabinets or in boxes, it is all virtual and at the providers fingertips. Having information such as vital signs submitted in real-time, it can reduce the readmission risk, reduce medication errors, decrease duplication of testing, and improve how physicians diagnose patients. HIE also provides safe and confidential information so that each patient knows who is viewing their information and when they view the information. This tracking system that is apart of HIE is used to prevent any breaches in HIPAA and ensures only the allowed people to view the records. Electronic health records can enhance how care is provided to all patients.

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Trauma Informed Care

Trauma can have a significant impact on psychological, physical, spiritual, environmental, and social well-being. It can be life changing for a person to experience a traumatic event as it can stay with them for the rest of their lives. Traumatic experiences can be very damaging to a person’s mental health. The event or events that have occurred can trigger future negative reactions to things that resemble their traumatic event. Symptoms such as depression and anxiety can be directly correlated to trauma as a secondary diagnosis. A person’s physical well-being is also affected as well. Eating habits can diminish or escalate, sleep schedule can be derailed, and activity levels can plummet. These actions present as a person tries to cope with their traumatic experience or be a lasting effect of going through a traumatic experience. Socially, a person can become reserved and isolate themselves from others. Traumatic events can impact a person in ways that could be crippling. It is important to understand what happened during the event and try to work through the issues that present.

                 Adverse childhood experiences can develop into serious complications. Chronic illnesses, mental illness, and substance abuse are just a few examples of what can happen to an individual later in life due to ACEs. These events can cause things such as heart disease, diabetes, and respiratory illnesses. The stress that is induced from ACEs can cause physical damage to and individual. It can also cause mental inadequacies that can be life changing. It is important to recognize and establish early interventions to reduce further complications and reduce the occurrences of ACEs. Having programs available so that children can feel comfortable and safe when talking about their experiences. Promoting a healthy lifestyle is also very important in reducing the complications of ACE’s. Healthy eating, regular exercise, mindful thinking, and proper sleep can all help to reduce stress and promote well-being. This information is vital when practicing as a nurse.

               The Trauma-Informed Care principles are a key tool to use when handling a traumatic related situation. The principles look at understanding how trauma can impact a person in all facets of life and how that can be incorporated when giving care. The goal of patient care looks at the over all well-being rather than just the individual symptoms. When practicing, it is important to maintain patient safety. Providing the needed respect to allow a patient to feel safe both physically and mentally is key. Developing a trusting therapeutic relationship provokes a more safe and transparent care plan. This is important as a nurse because the patient will be more likely to express themselves which can help with diagnoses and maintaining their well-being. As a nurse, collaboration with peers and other health care professions will ultimately provide an enhanced care plan for all patients. This group work allows for sharing information between professions as well as with the patient. This entitles the patient to participate in their care and develop the course of treatment. Trauma informed care is very important in the healthcare role. It can drastically change the course of the patient’s health in a positive way.

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Public Health and Vulnerable Populations

The health or vulnerable and marginalized populations is widely underestimated which is a public health crisis. Many factors contribute and influence these populations. The individual, the environment, and the societal factors have a strong impact on their health The individual may have religious obligations that require them to not follow through with certain procedures. In the eyes of a health care worker this could be devastating, but it is important to recognize the different beliefs that people live by and how that can affect their health. An individual’s environment may not be able to support their needs. They could not have the needed facilities to treat what is needed resulting in a decreased health status. Society also plays a strong role in how well a person can maintain good health. Someone could live in a region where racial injustice is predominant. That person would not be able to go take care of themselves in the same sense that someone of different color could. All these factors contribute and influence the health of an individual and community. Money plays a huge role when it comes to and individual’s health as well. One may not be able to afford medical insurance and may have to pay out of pocket for procedures and appointments. One may have to choose between going to the doctor and putting food on their table. Individuals are likely to put aside medical conditions to afford more important things. This public health crisis needs to be rethought and changed in a way so that it is fair to everyone.

A keyway to start change is to rewire the way we think. For example, someone could decline getting a vaccine. Rather than just saying they should get the vaccine everyone is doing it; they should ask why. Many key things can influence how someone approaches health care. Not everyone is afforded the opportunity to make the best decisions possible. Does that person have health insurance? Transportation? Education? Resources? These drive the decisions we make yet some must set aside their health for a variety of reasons. As a community, we should look to help those less fortunate. Educate them, give them resources, give them the tools to help themselves. This ongoing public health crisis is important to everyone. We should all be educated and appreciate the things we have. When giving care, this information is important to know. As a nurse, I would educate patients and listen to their opinions. I would listen to what they have to say and try to help them the best I could. These populations are already at risk of decreased health it should be our job to help them.

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Ethical Considerations For EBP

Reviewing the provided resources about nursing and ethics, my opinion has not changed. I understand further that the role of a nurse will entail ethics. This is because patients have a wide view on the practices that they want to participate in. Educating the patient and informing them of recommendations should be a priority of the nurse. With this, it comes down to what the patient feels comfortable doing based on their past experiences or practices. There is a common saying by George Santayana that goes, “Those who do not learn history are doomed to repeat it.” This is the case for ethics in nursing. Understanding what practices have been preformed before will help further the knowledge of the nurse. Taking a deeper dive into these practices can help further progress studies that examine the same variable. A nurse should have a good understanding of the events that have occurred in the past and what lead up to those events. This can help prevent possible complications that could arise. This course specifically has enhanced my knowledge of the relationship between nursing and ethics. This course looks at evidence based practices and how to read, interpret, and explain these articles. It starts with understanding what you are reading. Once you have the ability to interpret results and hold the ability to explain them, the nurse will be able to communicate the results and consider them in their practices. Evidence based practice looks at problem solving in the medical profession while incorporating the patient and family. This should be done with every evidence based article that revolves around care. A nurse should have the capability to participate in these studies once they understand the key concepts of EBP. Contributing can ultimately result in a better experience for the patient by looking at what works and what does not work. This class, along with my ethics class, have delivered home the importance of ethics in nursing. I have the knowledge to examine articles and understand how they can play a role in the care I am providing. In short, the job of the nurse is to provide the most exceptional care keeping in mind the beliefs, values, and morals of the patient.

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Assumptions

Ethics in the nursing profession is prevalent every day. Nurses have to guide themselves through various ethical situations and provide the best response. They need to be well aware of the situation on use resources such as evidence based articles to help explain and implement procedures and treatment. Examining these articles can help provide the patient with a sense of comfort as the nurse holds the knowledge to the ethics as they present. Generation of evidence can be done through various ways and can entail the contribution of the nurse. A nurse can report the symptoms the patient is receiving from the treatment and help navigate the causation of the symptoms. A nurse can also tell if the treatment is working effectively by examining the physical patient and trending labs results. This is done so that the medical profession can understand how a procedure of treatment is affecting the patient. It can also open up new ways to do such tasks that will better affect the patient in a positive way. Ethics plays a major role in providing care and it is the duty of the nurse to provide the best care by doing and participating in evidence based studies.

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Mental Health Stigma

  1. There is a substantial amount of stigma that revolves around mental health. This negativity can be sourced from the lack of knowledge of the reoccurring issue. A lot of people are unaware of how prevalent mental issues are in society. It is hard for people to conceptualize that one is suffering from a mental illness when society is so focused on observations and physical appearance. Just because one cannot see the disability, does not mean that the disability does not exist. It is important for people to educate themselves on issues that are frequent in a lot of people. Self-stigmas can also be derived from societies outlook on people with mental illnesses. People are so focused on there public appearance they forget to be themselves. Society looks down upon people with these disabilities, which in turn causes self-stigma. It is important to understand your condition and work to better yourself without the negativity.
  2. Culture plays an important role in everyone’s conception of wellness and illness. It works with values and beliefs to form the basis of what you believe in. With this, it could deter people from getting screenings done or taking medications that can help a person improve their condition. If a person grows up without the knowledge or awareness about mental illnesses, then they are less likely to seek out help. Religion can also play a similar role in the influence of a person’s response to mental illness. It can give a person direction and influence decisions in their daily life. It is important to establish what values and beliefs you believe in and incorporate them into your own wellbeing.
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Empathy & Compassion Reflection

Nursing is a very difficult and challenging profession. It requires long hours and hard work to routinely ensure the health and safety of their patients. Nurses hold certain qualities that allow them to effectively provide care in the most effective and efficient way. Some of the qualities include leadership, determination, and showing empathy and compassion. Empathy and compassion form part of the backbone when it comes to providing patient care. It instills that you are there for them and care about who they are, rather than just a patient with a number. Both qualities play an important role in providing care and can contrast in many ways.

Empathy directly focuses on the ability of the nurse to understand and share the feelings of the patient. This contrasts to compassion, as compassion dives deeper with the understanding of feelings by acting and holding the desire to help. Both terms have the same subject topic, but both take different directions to patient care. In terms of providing care, empathy is when a nurse would sit down with a patient and try to understand how they are feeling through a difficult situation. The nurse would be a support system for the patient. Compassion would be the nurse feeling and understanding the situation of the patient by acting and implementing interventions that would overall benefit them. They both have a specific and unique place while being a primary aspect of providing care.

Compassion and empathy can be seen in many shapes and forms. Jean Watson, a nurse theorist and professor, constructed the 10 Caritive Factors, within Watson’s Theory, that demonstrate compassion and empathy. The theory explains the framework of how nurses provide care in the most productive and efficient way. Compassion and empathy are concrete characteristics that influence the effectiveness of the framework. Watson’s 10 Caritive Factors include the following

“1.The formation of a humanistic-altruistic system of values

2.The instillation of faith-hope

3.The cultivation of sensitivity to one’s self and to others

4.The development of a helping-trust relationship

5.The promotion and acceptance of the expression of positive and negative feelings

6.The systematic use of the scientific problem-solving method for decision making

7.The promotion of interpersonal teaching-learning

8.The provision for a supportive, protective and corrective mental, physical, socio-cultural and spiritual environment

9.Assistance with the gratification of human needs

10.The allowance for existential-phenomenological forces”

The first factor includes the nurse’s ability to form relationships with the patients that is professional yet personal. This includes expressing empathy and compassion towards the patient as you care for them as they are your family. The nurse respects the patient’s values giving them a sense of identity. The second factor incorporates the beliefs of the patient by expressing empathy to allow the patient to accept the terms of their condition. The relationship formed promotes positive health during treatment. The third factor identifies differences in patient care by incorporating different methods of compassion and empathy. The nurse holds the ability to distinguish these differences and act accordingly to provide efficient and effective care. The fourth and fifth factor develops communication that is present in compassion and empathy that entitles the patient to a healthy relationship. The patient, as well as the family, is heard and feel they can trust the nurse with any issue regardless if it is positive or negative. No judgement is mad nor does the family feel guilt for the things they say and do within the practice of patient care. The sixth and seventh factor focuses on compassion by implementing problem solving strategies to promote the health of the patient. The nurse must educate, inform, guide, and explain processes to the patient. The decision-making aspect of these factor can be derived from the nursing process as nurse’s are always looking to improve their skills. The eighth factor looks at the patient’s environment and holds the nurse accountable for providing a safe mental, physical, sociocultural, and spiritual environment. Empathy and compassion play a role by establishing and implementing strategies that promote a healthy environment. The ninth factor involves a nurse’s intuition as well as communication strategies to decide the hierarchy of needs when it comes to patient care. Compassion and empathy aids in decided which needs come first. The nurse identifies what works best with the patient as well as their needs and establishes the order as to which they will be implemented. The tenth and final factor includes the spiritual needs of the patient. The nurse uses empathy and compassion to learn about what spiritual needs the patient has. The nurse sets aside their own beliefs to help aid the patient during care. These factors can be seen in every hospital, long term care facility, and even my clinical rotation.

My experience at clinical was full of effective communication and hands on learning. I went through my daily tasks such as taking vital signs and performing bedside assessments while keeping in mind the necessity of empathy and compassion. One interaction caught my attention when providing care. I was preforming my bedside assessment on an older female patient who was recently admitted. She had fallen in her bedroom and was awaiting the results of her CT scan. She was very distraught and emotional about the situation as she sat in her bed. A little nervous myself, I sat down and expressed empathy through listening to her concerns. We talked about her daughters, her husband, and herself. She expressed how frightened she was that this was her third fall this year and how her health is deteriorating. I ensured the patient, as well as, educated her about some precautions that will help eliminate the risk of falling. I encouraged her to enhance her physical, mental, and spiritual responsibilities through various activities. I expressed compassion by guiding her through these difficult times. This process proved to be effective as the patient demonstrated a more relaxed demeanor.

Reflecting on this experience, it was not particularly perfect. I was timid and quite to start the conversation. As it went on, I started to gain confidence and was efficient and effective with my communication. Next time, I would look to build off this experience to help ensure other patients who are dealing with issues. I will actively listen and express empathy and compassion through my communication. In doing so, will provide comfort and acceptance of the patient. I will also keep in mind the 10 Caritive factors that are apart of Watson’s Theory. This will ensure that the patient is able to trust me with what they are telling me in a nonjudgmental and honest way. This is the standard for all nurse’s regardless of where they are located or what they are practicing.

Nurse’s everywhere are very different yet very similar. They can all come from different backgrounds but all focus on the well-being of the patient. They hold the needed qualities to provide effective and efficient patient care. Compassion and empathy are two of the most vital qualities that each nurse holds. It is these qualities that comfort, support, and give a sense of self to patients during a very critical time in their life. Patients are more than just paying customers. Patients are people who have loving families and emotions. They are citizens of our community that work for the better of others. They are the people who come to us in search of help and it is the job of the nurse to protect them.

                                                                        References

Jeffrey D. (2016). Empathy, Sympathy and Compassion in Healthcare: Is There a Problem? Is     There a Difference? Does it Matter? Journal of the Royal Society of Medicine. 109(12).     446-452. doi:10.1177/0141076816680120

Rexroth, R., & Davidhizar, R. (2003). Caring: Utilizing the Watson Theory to Transcend       Culture. Health Care Manager, 22(4), 295-304.

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How I Made a Difference

The first clinical rotation of my nursing career was more than exceptional. I reinforced procedures learned in class, learned new hands on techniques, and built communication strategies with patients. This experience will be the foundation of my nursing career and I will look to build off it. Not only did I reinforce my techniques, I also managed to help and make a difference in a patient.


I was performing my bedside assessment on this little old lady. She was the sweetest and kindest patient I had. We talked about the Portland campus and how my nursing education was going. In doing so, I cracked a couple of funny comments about nursing school, and she chuckled. I explained to her that it was my first ever clinical experience and to just bear with me through this process. I was a little nervous but also excited to take what I have learned in the lab and practice it in person. I started with the neurological exam and moved down to the rest of the
body. I auscultated her heart and lungs, palpated her abdomen, and examined her skin. Through the exam I gained confidence. I provided descriptions, education, and reasoning with each movement and analysis. I was as thorough and informative as I could be. With this, the patient gained the greatest outcome of it all. Once I finished, the patient was grateful. She said that I was the first person to tell her why they were doing these tests. She was amazed as to how complex
the human body was. She did not know about capillary refill, skin turgor, or even pedal pulses. I was the most informative person to who her as she gained knowledge and understanding of how these things work. I thanked her as I finished the exam for being supportive through my first assessment. She thanked me back for teaching her these new topics. I left the room and never saw her again.

The situation could be small or large but no matter what, it is important to make a
difference. The small conversation I had with this patient will go with her through the rest of her life. As little as it can seem to many people, it is as great as anything to the patient. Things aren’t going to be easy at times in the nursing profession, but it is important to take a step back and observe the greatness that nurses do and to reflect on the influence you have on people.

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