NHS FPX 4000  Applying Ethical Principles

Applying Ethical Principles

NHS FPX 4000 Applying Ethical Principles

Everyone will be confronted with an ethical dilemma at some time in their lives that will force them to question or test their moral principles or code of ethics. Healthcare workers confront ethical issues in a wide range of settings. As a result of numerous variables, healthcare workers can fulfill their obligations to their patients by using the four basic ethical principles of autonomy, beneficence, maleficence, and justice. (Vermont Ethics Network, 2011).

NHS FPX 4000 Applying Ethical Principles

Overview of the Case Study

As a response to an Ethical Case Study: Old School or Out of Touch at Capella University report, Crosby Community Hospital has just hired Corey Davidson as the Emergency Department (ED) director (2018b). She has been practicing medicine longer than the hospital has been in existence. However, some who have worked with him say that his age and deteriorating health are hurting his ability to perform medicine. He has a strong reputation in the community.

 After being called by the Director of Nursing, Margaret Truman, to explore Corey’s worries, Corey meets with Margaret Truman. Patients who arrive at the emergency department (ED) with breathlessness are treated using evidence-based recommendations that have a clear strategy (SOB). Patients with SOB should wait until they have a definitive diagnosis of acute heart failure (AHF) verified by chest x-ray and lab testing before using Lasix. When it comes to treating patients with SOB, Dr. Lacey is referred to as “Dr. Lasix” by many nurses. Lasix is contraindicated in individuals with dehydration and pneumonia, which worries her. The fact that Dr. Lacy has previously refused to use the electronic health record raises Margaret’s suspicions. He won’t work with the nursing staff, according to her, and his abilities are diminishing. An ER patient with disorientation and SOB just came, and Dr. Lacy’s nurse suspected sepsis as a result of a pressure sore. However, the nurse was able to persuade him to follow the rules after first ordering Lasix and chest radiographs. In his new role, one of his duties will be to create an evaluation procedure for physicians who are applying for clinical privileges and reappointment to the medical staff. As soon as Margaret informs Corey that Dr. Lacy’s inability to follow hospital guidelines nearly resulted in a patient’s death, Corey is faced with the ethical dilemma of whether or not to revoke Dr. Lacy’s ED privileges or to respect the clinical judgment of the community’s most experienced physician.

NHS FPX 4000 Applying Ethical Principles

Analysis of Ethical Issues in the Case Study

Dr. Lacy’s unwillingness to adjust to new hospital rules is the primary factor in Corey’s ethical dilemma in the case study. To make matters worse, Dr. Lacy refuses to follow evidence-based protocols that have been put in place to improve patient outcomes. Marge understands that Dr. Lacy’s behaviour is not only harming his ability to work with the nursing staff, but it might also be damaging to patients in the future. Sob patients are being prescribed Lasix by her doctor, she says, and he is giving it to everyone who comes to the emergency room with SOB. The American Heart Association’s recommendations say that diuretics are the primary line of therapy for AHF; nevertheless, diuretics should be used with caution and good judgment due to their detrimental effect on renal function. (Long et al., 2018). As another example of providing Lasix before appropriate diagnosis, when the patient has acute pulmonary edema, might result in damage to the patient. Patients with APE, however, have a shift of fluid towards the lungs from volume distribution, rather than a general volume overload, as is the case with AHF. Long explains that a patient with APE who receives Lasix first might suffer from reduced left ventricular “function, higher ventricular filling pressures, and increased systemic vascular resistance” (2018). Diuresis can be further slowed by a reduction in GFR (Long et al., 2018).

NHS FPX 4000 Applying Ethical Principles

Using the Ethical Decision-making Model to Analyse the Case Study

As part of the ethical decision-making paradigm, moral awareness, moral judgement, and ethical behaviour are three phases that might help one comprehend the road to making an ethical decision. (Cappella, 2018a). An ethical decision begins with moral consciousness. Moral awareness occurs when a person is aware that an ethical code is being broken. Then they are ready to face the situations that will impact their moral judgment, which is trying to determine between good and evil. Finally, the last phase of the decision-making paradigm has been reached: ethical behaviour. Case study: Corey becomes ethically aware of Dr. Lacy’s bad performance when Margaret brings it up to his notice. When Corey is faced with the possibility of having to revoke Dr. Lacy’s ED credentials, his moral judgement is clear. This will influence his moral judgments, which in turn will influence his ethical action.

Effectiveness of Communication and Approach in the Case Study

In order to communicate effectively, it is essential to be open with one another. Corey is always available to communicate with the staff. This allows him to be aware of concerns within the hospital, such as Margaret’s report on Dr. Lacy. Closed-loop communication is another key technique for effective communication, especially in healthcare. As a result, material is repeated in order to ensure that it’s understood. Communication may be improved by simply clarifying what needs to be said. According to Margaret, Dr. Lacey has a habit of prescribing Lasix first and not according to recommended parameters She also claims that a nurse was able to persuade Dr. Lacy to follow the rules on a particular patient who would have been injured by his directives. Margaret, on the other hand, did not indicate that Dr. Lacy was aware of the new rules, simply that they were not being followed. Corey didn’t even question Dr. Lacy if he was aware of the new rules, which is a shame. As a result, the message was miscommunicated. Clarification would have been useful in making an educated ethical judgment.

Resolving the Ethical Dilemma by Applying Ethical Principles

Cory is ethically conscious in this case study, but it’s uncertain what he’ll do about the ethical dilemma he’s facing. According to the Vermont Ethics Network (2011), Corey’s moral assessment may be influenced by four ethical principles: autonomy, beneficence, nonmaleficence, and fairness. Allowing patients to make their own healthcare decisions is known as autonomy. An act of compassion or generosity is called benevolence. As it relates to healthcare, this implies acting in a way that is beneficial to the patient’s well-being. Patients have a moral duty not to purposely injure them.

A moral answer can be found for Corey by using beneficence and nonmaleficence. Beneficence, or acting in the patient’s best interest, is Corey’s first duty. For physicians, the American Medical Association has established a set of principles. All of these principles serve as a guideline and a foundation for ethical behaviour among physicians. The AMA Code of Medical Ethics (2001) explicitly states that a physician should “be devoted to delivering competent medical treatment” and “continue to study, use, and develop scientific knowledge” by maintaining “a dedication to medical education.” Doctor Lacy would be in breach of the ethical norms of beneficence and nonmaleficence, and his ED privileges would be revoked if he did so on purpose. Corey, on the other hand, just has one person’s account of the incident and should consult a doctor. In spite of the fact that Dr. Lacy has a wealth of expertise, he may not be aware of the new standards. Dr. Lacy may be aware of the importance of chest Xray’s and laboratory investigations in the diagnosis of AHF, but he may be worried about the delay in therapy, according to the article (beneficence). As a possible remedy to Dr. Lacy’s dilemma, Corey might recommend the use of Pontificated Ultrasound (POCUS) instead of Chest Xray. When it comes to diagnosing AHF, POCUS is not only more accurate and faster, but it can also give answers that a chest X-ray cannot, such as etiology (Long et al., 2018). Afterwards, Dr. Lacy would know if it was acceptable to order Lasix or not (nonmaleficence). Additionally, this solution will improve communication and collaboration between the workforce. 

NHS FPX 4000 Applying Ethical Principles

Conclusion

Moral awareness, moral judgment, and ethical behaviour – affected by the four ethical principles – autonomy, beneficence, nonmaleficence and judgement – can assist any healthcare professional in making an ethical decision in the field of healthcare. It’s Corey’s moral issue in this case study as to whether or not to remove Dr. Lacy’s ED privileges or to follow the clinical judgment of his community’s most experienced physician. As a result of the offered remedy, Corey’s ethical problem is resolved.

References

American Medical Association. (2001). AMA principles of medical ethics. Retrieved from https://www.ama-assn.org/delivering-care/ama-principles-medical-ethics

Capella University (2018a). Ethical Decision-Making Model. Retrieved from Capella University Website: NHS-FP4000 course room.

Capella University (2018b). Old School or Out of Touch? Ethical Case Studies. Retrieved from Capella University Website: NHS-FP4000 course room. 

Long, B., Koyfman, A., & Chin, E. J. (2018). Misconceptions in acute heart failure diagnosis and Management in the Emergency Department. The American journal of emergency medicine, 36(9), 1666-1673 

Vermont Ethics Network. (2021). Medical Ethics / Health Care Ethics. https://vtethicsnetwork.org/medical-ethics

Leave a Reply