Ethical Considerations in Emergency Nursing | Nursing
However, the effect of these and other ethical issues on NPs and their As we rely more heavily on NPs and PAs to fill the primary care . Relationships between variables were assessed using Kendall's .. Public Law. Ethical and legal practice, nursing code of ethics, the language of bioethics, ethics and problems created by the practice of medicine, ethical issues in neuroscience, . Hippocrates related ethical principles to the individual relationship between the . The primary function of a decision is to commit to some sort of action: a. Medical ethics is a practical application of moral an understanding of the legal implication for both The primary goal of this course is to teach you, as The federal form of government is one in which power is divided between a central.
The use of computers and communication technologies will impact more lives in the 21st century than any other technology, including stem cells, transplants, and nanomedicine Goodman, As indicated in the case scenario and the study findings, the use of the EHR can result in a unique set of ethical and legal challenges.
Nurses must be prepared to face these challenges and recognize the requirements of state and federal law, workplace policies, and obligations of the profession. A study in revealed that nurses spent a majority of indirect nursing time documenting in the EHR, demonstrating the critical necessity of proper usage to satisfy quality of patient care Kim, Documentation must be clear and accurate to provide a basis for the contribution of nurses to patient outcomes and the viability of healthcare organizations ANA, Documentation that fails to meet these principles can result in undesirable outcomes for the nurse, patients and families, or for the healthcare organization ANA, Nursing documentation, electronic or handwritten, are legal documents that can, under some circumstances, be used in legal proceedings.
Nurses maintain competence regarding the legal significance of documentation and therefore must demonstrate legible and comprehensive reporting Larsen, Once documentation has been electronically recorded and signed by the nurse, the liability of that acknowledgement is not clear. The copy and paste functionality includes copying, pasting, cloning, auto-filling, carrying forward, replicating data and reusing content from one section to another within the EHR Scruth, The copy and paste phenomenon has caused significant debate from those who argue its necessity for time efficiency weighed against the significant risk of inaccuracy and patient safety errors Harrington, These practices can result in timeliness issues or time-related accuracy of documentation in any EHR.
EHRs are designed to facilitate easier provider order entry and have been shown to reduce prescription errors Scruth, They have tremendous potential to improve efficiency of healthcare delivery and improvement of quality patient care. However, healthcare providers have experienced notable challenges to balance necessary time for patient care with computer entry McBride et al. Historically, it was assumed that all standards of care were met unless documented otherwise.
However, with the introduction of the EHR, complete documentation requires charting of all clinical assessments, care plans, interventions, and outcomes requiring more time for documentation de Ruiter et al. Additionally, alert fatigue and clinical information overrides must be addressed within the organization.
Overriding content in what is often an undesirable system design can result in misinformation in charting that can have detrimental effects on the nurse, patient, and healthcare organization. For example, a false entry into an EHR can follow a patient for years. The patient is likely unaware of the false entry, but subsequently applies for health or life insurance.
The patient may be denied insurance coverage based on a one-time false entry that was replicated over time. Recommendations and Call to Action We conclude with a call to action for interprofessional teams, associations, industry, and others to collaboratively address these issues on behalf of the health and safety of the nation, and equally as important, the health and well-being of the healthcare workforce.
To do that, the authors suggest the following recommendations to address challenges with EHRs. These recommendations may help mitigate ethical and legal issues arising as a result of the massive uptake of technology that has resulted in the digital age of healthcare delivery. Support Nurses must have a seamless mechanism for reporting EHR challenges Nurses face time constraints, overstaffing, and unfamiliarity with EHR systems on a daily basis.
Healthcare organizations must have structures in place at the unit, management, and administrative levels to facilitate effective use of EHRs in nursing practice.
Nurses must have a seamless mechanism for reporting EHR challenges e. This type of support could potentially mitigate the moral distress noted in the case scenario.
Culture of Safety Nurse managers and executives have a particular obligation to ensure that direct care nurses are empowered to identify and engage in ethical situations associated with EHRs. Nurse managers and executives have a particular obligation to ensure that direct care nurses are empowered to identify and engage in ethical situations associated with EHRs.
Nurses in administrative roles should promote a culture of safety in their settings that include reducing the risk of harm arising from inadequate EHR design, and usability ANA, This emphasizes the need for continuing education for novice and expert nurses in EHR management and documentation.
Informatics specialty nurses and advanced practice nurses can serve as leaders to assess and research documentation for timeliness and accuracy, along with providing continuing education on a frequent basis Scruth, Education about principles of documentation and competence in specific EHR system usage is needed to foster nurse mastery and development to successfully improve health outcomes Goodman, The American Health Information Management Association AHIMA, Code of Ethics has 11 principles with interpretive statements, referred to as guidelines, that seem to underscore the importance of practices that stand in stark contrast to the experiences of nurse participants in the Texas nursing research McBride et al.
This computational capacity may establish EHR information as authoritative, potentially displacing work processes critical to nurse-patient interaction. Systems and technologies such as EHRs that assist in clinical practice are adjunct to, not replacements for, nurse knowledge and skill ANA, Most importantly, the EHR must not substitute for a current and accurate clinical assessment, and appropriate intervention.
Finally, as reflected in the Texas study and clinical scenario, current technology in the healthcare industry often presents challenges with usability, design, implementation, and failure to adequately support clinical teams.Concepts Unwrapped - Legal Rights & Ethical Responsibilities
This results in ethical situations often associated with feelings of moral distress. Application of the FCM can assist clinical teams to explore and potentially resolve these issues.
Legal, ethical and professional aspects of duty of care for nurses
Additionally, the authors recommend further research into the moral distress noted in emerging evidence, including the TNA-TONE statewide study and the case scenario presented. As such, the healthcare industry has an imperative to identify and address ethical issues with use of EHRs. From the beginning in when the TNA Board of Directors resolution was passed, the two organizations created the partnership that provided cumulative guidance, funding, and dissemination efforts throughout the years.
Specifically, we would like to acknowledge the staff of these organizations, the dozens of volunteer committee members who have served, and the report writing sub-committee of Susan McBride, Mary Anne Hanley, Cindy Zolnierek, Laura Thomas, Mari Tietze, and Huaxin Song. Finally, we acknowledge the many subject-matter experts who, through numerous focus groups, helped yield the final surveys. McBride is a Professor at the Texas Tech University Health Sciences Center School of Nursing whose research focus is on methods development for implementing, evaluating and utilizing health information technology to address patient safety, quality and population health.
She is a professor with teaching responsibilities supporting graduate courses in statistics, informatics, and epidemiology.
Research focus is telehealth with a telemedicine, remote management and mobile health component. She has taught ethics at the undergraduate and graduate levels and conducted research on moral distress and ethical climate among other issues. She worked for several years as a critical care nurse and later received her law degree. She worked as a consultant for the D. Board of Nursing interpreting professional ethics provisions and recently completed her masters in bioethics.
Her leadership is demonstrated through various charitable roles. Weber is a nurse attorney and Clinical Assistant Professor at the University of Minnesota School of Nursing, where she teaches ethics, leadership, and public policy in the context of a continuum of interprofessional healthcare.
Identifying and Addressing Ethical Issues with Use of Electronic Health Records
Factors associated with the timeliness of electronic nursing documentation. Healthcare Informatics Research, 22 4 Scope and standards of practice 3rd ed. Code of ethics for nurses with interpretive statements 2nd ed. Addressing the safety of electronic health records: What are the most important barriers? Rethinking the role of clinical practice guidelines in pharmacy education. American Journal of Pharmaceutical Education, 79 10 Nurses and electronic health records in a Canadian hospital: Examining the social organisation and programmed use of digitised nursing knowledge.
Using email communication with your patients: Canadian Medical Protective Association, May Problems with the electronic health record. Nursing Philosophy, 17 1 Ethics, medicine, and information technology: Intelligent machines and the transformation of health care 2nd ed.
Nursing ethics and professional responsibility in advanced practice 2nd ed. Clinical ethics residency for nurses: An education model to decrease moral distress and strengthen nurse retention in acute care.
The Journal of Nursing Administration, 44 12 Copy-forward in electronic health records: Lipstick on a pig. The praxis of courage as a foundation for care. Journal of Nursing Scholarship, 46 4 Adoption of electronic health record systems among U. What moral distress in nursing history could suggest about the future of health care.
AMA Journal of Ethics 19 6 Analysis of nurse's job in general hospital using hospital information system after introduction of electronic nursing record system.
Available from Keimyung University, Deagu, Korea. Clinical documentation in the 21st century: Executive summary of a policy position paper from the American college of physicians.
Legal & Ethical Issues that Health Care Professionals Face | guiadeayuntamientos.info
Annals of Internal Medicine, 4 Strategies necessary for moral courage. Online Journal of Issues in Nursing, 15 3Manuscript 3.
Moral courage in action: Doing the right thing: Pathways to moral courage. American Nurse Today, 7 5 Casting palliative care nursing as legal relations.
Nursing Inquiry, 19 4 How electronic health records structure communication, relationships, and meaning. Journal of the Association of American Medical Colleges, 87 4 Statewide study assessing the experience of nurses with their electronic health records.
Statewide study to assess nurses' experiences with meaningful use-based electronic health records. Computers, Informatics, Nursing, 35 1 Nursing Ethics, May Understanding the nature of everyday practice.
Nursing Ethics, 24 5 The hype and the hope for improving nursing satisfaction and quality outcomes. Nursing Administration Quarterly, 39 4 Improving outcomes with CDS: Healthcare Information and Management Systems Society. Advances in Nursing Science, 36 4 Patient-centered communication in the era of electronic health records: What does the evidence say?
Refusal of Care Ethically patients have the right to refuse care. It is the responsibility of the ED nurse to ascertain if the patient has enough information to make an informed decision regarding refusal of care.
If the reasoning for the decision is irrational, the nurse is responsible for ensuring that the patient has all necessary information. It is the responsibility of the nurse to make sure the patient has more information by which they can make a better informed decision.
Surrogates and family members that are making decisions must also have enough information in order to ensure the best care for the patient.
Discharge against medical advice is a decision made by the patient to leave the ED prior to the physician recommending discharge. In such cases it is incumbent upon nurses to determine the capacity of the patient, evaluate the quality of the delivered information including risks and benefits, and a full documentation of the process.
Ethical Problems An ethical problem is one in which no clear answer exists for all. Although algorithms are available to guide care in cases of cardiac arrest and trauma, each patient and situation is unique, and deviations from protocol may be indicated.
Like clinical problems, ethical problems require action for resolution. In most clinical settings, there is adequate time to identify and discuss the relevant ethical issues before decisions are made.
However, this is often not the case in the ED, where ethical problems may require immediate resolution. To promote ethical decision making in these situations, a system to quickly analyze ethical concerns should be in place. This system can include consideration of the following issues: Who are the stakeholders? What is the chronology of events? What medical, social, and legal information is required to facilitate decision making?
What is the best communication pathway to follow? What family values must be considered? Is there any consensus that exists with any of the person involved?
Public Guardians The ED is unique from all other specialties in healthcare, and presents in a unique environment with distinct moral challenges. In order to respond appropriately to these ethical challenges, ED nurses are required to have knowledge of moral concepts and principles, and specialized moral reasoning skills.
It becomes import then to identify and promote the moral attributes of those nurses in the ED. ED nurses have a duty not only to their patients, but to the society in which they live. The nurse is responsible for informing the public, assisting in the allocation of resources in a just manner, opposing violence and promoting public health.
It then becomes the responsibility of the ED nurse to participate in helping craft legislative, regulatory, institutional and educational pursuits that promote the safety of the patient and improve the quality of care. Mission Statements and Code of Ethics.
Retrieved May 10,from http: Ethics in the Emergency Room. Retrieved June 1,from http: Some limits of informed consent. Journal of Medical Ethics, 29, University of Washington School of Medicine.
Legal & Ethical Issues that Health Care Professionals Face
The relationship between law and medical ethics. Retrieved May 11,from http: Retrieved June 1,from Ethics in Medicine Web site: Discharges Against Medical Advice.
Mayo Clinic Proceedings, 84 3 ,