2. Read the case study entitled You be the Ethicist, presented at the end of Chapter 3 (Guido textbook). What are the compelling rights that this case addresses? Whose rights should take precedence? Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? How would you have decided the outcome if his disease state had not intervened? Now, examine the scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy?
Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
YOU BE THE ETHICIST Until recently, Tyrell Dueck was a normal eighth-grader in Canada, hoping that his favorite team would win the Stanley Cup for the third time. Then, early in the school year, he slipped climbing out of the shower and discovered a lump on his leg. He was then diagnosed with bone cancer. After receiving two rounds of chemotherapy and being told that further therapy would mean the amputation of his leg, he announced that he wanted therapy stopped. He and his parents, devout fundamentalist Christians, decided to leave his health in God’s hands and seek alternative therapy. The decision sparked a court battle between his parents, who supported Tyrell’s decision, and the health care team, who sought to compel continued medical treatment and the planned amputation. The battle ultimately ended when doctors said that his cancer had spread to his lungs and that there was little more that could be done for Tyrell.
ETHICAL QUESTIONS 1. What are the compelling rights that this case addresses? 2. Whose rights should take precedence? 3. Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? 4. How would you have decided the outcome if his disease state have not intervened?
Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues in Nursing (Legal Issues in Nursing ( Guido)) (p. 41). Pearson Education. Kindle Edition.
Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
• What is the problem? • Where is the process? • How many are affected? • What possible solutions could be proposed? • What are the ethical arguments involved? • At what level is the problem most effectively addressed? • Who is in a position to make policy decisions? • What are the obstacles to policy interventions? • What resources are ava ...
2.Ethical issues in pediatric nursing .pptxMohamedKheder7
The document outlines the objectives and content of a lecture on ethics in pediatrics nursing. The lecture will cover recognizing ethics in pediatrics, common ethical theories, the development of nursing ethics, applying ethical principles, discussing ethical issues in caring for children, examining parental authority, and landmark cases. It will also define key terms, explore ethical dilemmas, and examine the nursing ethical decision-making process.
This document discusses ethics in nursing. It notes that nurses are to provide compassionate and ethical care according to their professional codes and guidelines. However, unfavorable working conditions can negatively impact patient safety. The document then discusses a specific case involving a patient named Mr. Gurt and argues that the nurse's failure to weigh the patient put him at risk for infection and was a form of negligence. It notes that nurses are responsible for following the standard of care and outlines some of their ethical responsibilities according to the College of Nurses.
Analyzing An Ethical Decision Assignment 3.pdfbkbk37
This document discusses ethical dilemmas that advanced practice nurses may encounter. It notes that nurses will face situations requiring sound judgments to ensure patient safety and well-being, even when there are no clear answers. Nurses must provide unbiased care to all patients regardless of attributes and critically analyze ethical situations. The document then outlines an assignment where students will review literature on ethical issues faced by advanced practice nurses and analyze a specific issue in relation to their state's laws.
Nursing accountability is guided by standards of practice, legal requirements, and ethical principles which hold nurses responsible for their decisions, actions, and consequences. Accountability is important in healthcare as it focuses on patient interests, improves trust between providers and patients, and enhances quality of care. Ethical issues commonly arise in complex healthcare systems and the nursing code of ethics provides guidance, though legal, moral, and ethical concerns sometimes overlap like whether family can be present during resuscitation of a loved one. In such dilemmas, prioritizing patient rights, safety, and health ensures accountability in decision making.
Leadership in Nursing discussion part 1 and part minimum of.docxwrite4
This document discusses ethics and leadership in nursing management. It examines how ethics provides the foundation for decision making in nursing. Nursing managers face complex ethical decisions due to balancing responsibilities to patients, staff, and organizations. They must use systematic decision making processes and consider legal and professional standards. The document also discusses various types of moral issues nurses may encounter, such as moral distress when knowing the right action but organizational constraints prevent it. Overall, the document emphasizes the importance of ethics for nursing leadership and management.
Psychiatric-mental health nurse practitioner Student Nam.docxsimonlbentley59018
Psychiatric-mental health nurse practitioner
Student Name
Institution Affiliation
1
Introduction
The primary role of a psychiatric-mental health nurse practitioner is providing psychotherapy and educating patients and families.
One of the problems that has been experienced in psychiatry is stigma, discrimination and prejudice.
This issue has presented certain effects like delay in seeking help, burnout among health care providers and poor services.
One of the theories that is relevant to the specialty is the modelling and role modelling theory.
Psychiatric-mental health nurse practitioners usually play a key role in promoting health care. Their primary role is providing psychotherapy and educating patients and families. However, patients and health care providers are facing various issues particularly stigma, discrimination and prejudice which has negatively affected the provision of health care services. The modelling and role modelling theory is one of the theories that is relevant and can greatly help to deal with the problem and may be used as a framework to guide evidence-based practice.
2
Modelling and Role Modelling Theory
It was developed by Helen Erickson, Evelyn Tomlin and Mary Anne and was published in 1983.
This theory helps health care providers to care for and nurture every patient based on their needs.
Commonalities in the theory include attachment and loss, basic needs, holism and cognitive stages.
Differences in the theory include self-care, stress, adaptation, model of the world and inherent endowment.
The modelling and role modelling theory was developed by Helen Erickson, Evelyn Tomlin and Mary Anne and was published in 1983. This is a crucial theory in nursing because it helps health care providers to care and nurture patients while upholding the awareness and respect of every patient’s uniqueness (Smith, 2019). Due to that, this theory is considered to support clinical practices that concentrate on the needs of patients. The theory looks at certain elements like attachment and loss, holism, basic needs and cognitive stages. It focuses on certain differences amongst people including stress, self-care, adaptation, model of the world and inherent endowment.
3
Relevance of the Theory
Modelling involves health care providers seeking to know and understand patients’ personal model of their world.
Health care providers learn to appreciate the value of patients’ personal model of the world and its importance.
This theory acknowledges that all human beings have unique perspectives about their world.
Health care providers are able to develop an image and understanding of patients’ perspective and personal model of the world.
The modelling and role modelling theory is relevant to my nurse practitioner specialty since it entails crucial aspects that promote the well-being of patients. During the modelling process, nurses are able to find out and comprehend the personal model of patients and learn how t.
Pender's health promotion model from 1982 explains factors that influence healthy behaviors. The model identifies individual characteristics, cognitions regarding behaviors, and interpersonal/situational influences as impacting behavioral outcomes. It draws from expectancy value theory and social cognitive theory. Research has applied the model to areas like cancer screening, HIV care, smoking cessation, and health behaviors in homeless women. The model provides a framework for nurses to assess factors impacting patients' health behaviors and design interventions accordingly.
This document provides guidance on effective patient interviewing skills for physicians. It discusses the importance of professionalism, ethics, using a biopsychosocial model, and patient-centered care. The four core ethical principles are autonomy, beneficence, non-maleficence, and justice. Effective communication involves actively listening, establishing rapport, asking open-ended questions to understand the patient's perspective, and using closed-ended questions to obtain specific details. The goal is to collaborate with patients to understand their health issues and concerns in a holistic manner.
2.Ethical issues in pediatric nursing .pptxMohamedKheder7
The document outlines the objectives and content of a lecture on ethics in pediatrics nursing. The lecture will cover recognizing ethics in pediatrics, common ethical theories, the development of nursing ethics, applying ethical principles, discussing ethical issues in caring for children, examining parental authority, and landmark cases. It will also define key terms, explore ethical dilemmas, and examine the nursing ethical decision-making process.
This document discusses ethics in nursing. It notes that nurses are to provide compassionate and ethical care according to their professional codes and guidelines. However, unfavorable working conditions can negatively impact patient safety. The document then discusses a specific case involving a patient named Mr. Gurt and argues that the nurse's failure to weigh the patient put him at risk for infection and was a form of negligence. It notes that nurses are responsible for following the standard of care and outlines some of their ethical responsibilities according to the College of Nurses.
Analyzing An Ethical Decision Assignment 3.pdfbkbk37
This document discusses ethical dilemmas that advanced practice nurses may encounter. It notes that nurses will face situations requiring sound judgments to ensure patient safety and well-being, even when there are no clear answers. Nurses must provide unbiased care to all patients regardless of attributes and critically analyze ethical situations. The document then outlines an assignment where students will review literature on ethical issues faced by advanced practice nurses and analyze a specific issue in relation to their state's laws.
Nursing accountability is guided by standards of practice, legal requirements, and ethical principles which hold nurses responsible for their decisions, actions, and consequences. Accountability is important in healthcare as it focuses on patient interests, improves trust between providers and patients, and enhances quality of care. Ethical issues commonly arise in complex healthcare systems and the nursing code of ethics provides guidance, though legal, moral, and ethical concerns sometimes overlap like whether family can be present during resuscitation of a loved one. In such dilemmas, prioritizing patient rights, safety, and health ensures accountability in decision making.
Leadership in Nursing discussion part 1 and part minimum of.docxwrite4
This document discusses ethics and leadership in nursing management. It examines how ethics provides the foundation for decision making in nursing. Nursing managers face complex ethical decisions due to balancing responsibilities to patients, staff, and organizations. They must use systematic decision making processes and consider legal and professional standards. The document also discusses various types of moral issues nurses may encounter, such as moral distress when knowing the right action but organizational constraints prevent it. Overall, the document emphasizes the importance of ethics for nursing leadership and management.
Psychiatric-mental health nurse practitioner Student Nam.docxsimonlbentley59018
Psychiatric-mental health nurse practitioner
Student Name
Institution Affiliation
1
Introduction
The primary role of a psychiatric-mental health nurse practitioner is providing psychotherapy and educating patients and families.
One of the problems that has been experienced in psychiatry is stigma, discrimination and prejudice.
This issue has presented certain effects like delay in seeking help, burnout among health care providers and poor services.
One of the theories that is relevant to the specialty is the modelling and role modelling theory.
Psychiatric-mental health nurse practitioners usually play a key role in promoting health care. Their primary role is providing psychotherapy and educating patients and families. However, patients and health care providers are facing various issues particularly stigma, discrimination and prejudice which has negatively affected the provision of health care services. The modelling and role modelling theory is one of the theories that is relevant and can greatly help to deal with the problem and may be used as a framework to guide evidence-based practice.
2
Modelling and Role Modelling Theory
It was developed by Helen Erickson, Evelyn Tomlin and Mary Anne and was published in 1983.
This theory helps health care providers to care for and nurture every patient based on their needs.
Commonalities in the theory include attachment and loss, basic needs, holism and cognitive stages.
Differences in the theory include self-care, stress, adaptation, model of the world and inherent endowment.
The modelling and role modelling theory was developed by Helen Erickson, Evelyn Tomlin and Mary Anne and was published in 1983. This is a crucial theory in nursing because it helps health care providers to care and nurture patients while upholding the awareness and respect of every patient’s uniqueness (Smith, 2019). Due to that, this theory is considered to support clinical practices that concentrate on the needs of patients. The theory looks at certain elements like attachment and loss, holism, basic needs and cognitive stages. It focuses on certain differences amongst people including stress, self-care, adaptation, model of the world and inherent endowment.
3
Relevance of the Theory
Modelling involves health care providers seeking to know and understand patients’ personal model of their world.
Health care providers learn to appreciate the value of patients’ personal model of the world and its importance.
This theory acknowledges that all human beings have unique perspectives about their world.
Health care providers are able to develop an image and understanding of patients’ perspective and personal model of the world.
The modelling and role modelling theory is relevant to my nurse practitioner specialty since it entails crucial aspects that promote the well-being of patients. During the modelling process, nurses are able to find out and comprehend the personal model of patients and learn how t.
Pender's health promotion model from 1982 explains factors that influence healthy behaviors. The model identifies individual characteristics, cognitions regarding behaviors, and interpersonal/situational influences as impacting behavioral outcomes. It draws from expectancy value theory and social cognitive theory. Research has applied the model to areas like cancer screening, HIV care, smoking cessation, and health behaviors in homeless women. The model provides a framework for nurses to assess factors impacting patients' health behaviors and design interventions accordingly.
This document provides guidance on effective patient interviewing skills for physicians. It discusses the importance of professionalism, ethics, using a biopsychosocial model, and patient-centered care. The four core ethical principles are autonomy, beneficence, non-maleficence, and justice. Effective communication involves actively listening, establishing rapport, asking open-ended questions to understand the patient's perspective, and using closed-ended questions to obtain specific details. The goal is to collaborate with patients to understand their health issues and concerns in a holistic manner.
1. The document discusses key concepts in nursing including person, environment, health, and nursing. It emphasizes that these concepts must work together to achieve quality healthcare and improved patient outcomes.
2. The response discusses that there can be multiple right answers to healthcare situations that achieve the same goal but at different rates. It also stresses the importance of valuing the whole individual by addressing their spiritual, emotional, and physical needs.
3. Barriers like financial challenges, lack of transportation, and lack of health education can prevent responding to patients' contextual needs but these barriers can be reduced through combined efforts of different stakeholders.
This document discusses the advantages of learning comfort care. It states that comfort care is fulfilling for both patients and nurses as it delivers an overall feeling of comfort through addressing multiple contexts of comfort. Comfort care is considered natural for nurses as it is based on understanding a patient's experience of comfort. For nurses, comfort care involves applying nursing knowledge and skills to address individual patient needs. Comfort care is also efficient as interventions can be implemented immediately to reassure patients and meet physical needs. Outcomes such as enhanced patient comfort are practical for nurses to measure. Overall, the document presents comfort care as a patient-centered approach that is fulfilling and efficient.
Resources for Week 2 HLTH440 from M.U.S.E. My Unique Student Expe.docxronak56
Resources for Week 2 HLTH440 from: M.U.S.E. My Unique Student Experience Registered Trademark CEC 2013. All Rights Reserved.
The Basis for Health Care Ethics
What is Ethics?Ethics is what you believe is right or wrong. It is a moral philosophy that seeks to help the individual distinguish between good and bad as defined by one's culture. Ethics guides individuals and groups in their decisions about health care and other matters. Ethics helps the individual and group set boundaries.
Health care ethics is based on the law, professional codes of ethics, standards of care, and institutional policies and practices (corporate law).
Codes of EthicsCodes of ethics or codes of conduct are lists of standards or guides that provide an ethical framework for practice within a profession. Physicians are bound by the Hippocratic oath, but nursing has its own code of ethics. All health professions have a code of ethics.
It is axiomatic that the practice of health care presents moral and ethical dilemmas, because it deals with human beings and life-altering circumstances.
Health care financing presents broader moral dilemmas in the allocation of scarce resources. The conflict exists between the inherent values, duties, and obligations in caring for patients and the availability of resources to treat them.
The depth or content of a code of ethics is dependent on the type of contact that the health care professional has with a patient.
Ethical Theories
A number of ethical frameworks or theories are used to make decisions in health care and, in general, to set boundaries for expected behavior. The theories are used to determine what is fair or unfair. The following are several ethical frameworks:
Normative ethics: The ethical theory that describes how things ought to be.
Teleological theory: Also known as consequentialist theory, which believes that the best action in any situation is the one that promotes the greatest happiness for the largest number of people. In health care financing, this would fall under the rubric of cost containment by calculating the net benefits verses the consequences.
Utilitarianism: This is Mill’s definition of morality, which is the practical ethics of judgment: What is the greatest good that will benefit the greatest number of people? Medicare falls under this rubric.
Deontological theory: What one should or must do based on the obligations and duties of one’s life. This theory focuses on means, whereas teleological theory focuses on ends.
Virtue ethics: This is the ethics of care as a part of virtue ethics; virtue ethics is a form of normative ethics, which emphasizes the character of the interaction between the health care provider and the patient. This is the opposite of the emphasis on rules or consequences in other moral theories. Health care virtues include compassion, conscientiousness, cooperativeness, discernment, honesty, trustworthiness, truth telling, integrity, kindness, respect, and commitment.
Situational ...
Module 4.1 - Discussion
Applying Nursing Theory
Instructions:
Select one (1) of the following scenarios related to a specific nursing. Think about what you would do in the scenario presented and post your ideas.
Post two (2) discussion questions based on the readings along with your answers.
TheoristScenarioFlorence
Nightengale
Using Nightengale’s concepts of
ventilation
,
light
,
noise
, and
cleanliness
, analyze the setting in which you are practicing nursing (working as an employee or student).
Using Nightengale’s theory, evaluate the nursing interventions you have identified for an individual patient in your facility or practice.
OR
Your hospital patient is an 82 year-old woman. She does not have immediate family and has been living alone in her own home. Her hospitalization was unanticipated; it followed a visit to the emergency room for a burn on her lower leg. The patient has been hospitalized for 14 days. She pleads with you to allow her friend to bring her dog, a 16-year-old Scotty Terrier, to the hospital. She tells you that none of the other nurses have listened to her when she asked them about such a visit. Based on Nightingale’s model, and 13 cannon,
what actions would you take for this patient?
Betty Neuman
Martina is a middle-aged Hispanic woman who brings her family to a local free clinic to obtain medical care. She works part time in a restaurant for minimum wage. She lives in a small apartment with her daughter and four preschool children; her daughter speaks only very broken English. Martina’s medical diagnoses are hypertension, arthritis, and depression.
Use the Neuman System Model as a
conceptual framework
to respond to the following:
Describe the family as a system.
How does the dominant Anglo culture impact on the family’s stability as a system?
What stressors (actual and potential) threaten the family?
What additional assessment data are needed related to Martina’s medical diagnoses?
What additional assessment data are needed related to the family’s health status?
How will cultural differences influence planning for prevention as intervention at primary, secondary, and tertiary levels?
OR
Using the Neuman System Model, organize a patient care conference in your workplace to deal with a patient situation that has been difficult to manage. Involve caregivers from nursing and at least one other disicpline to discuss each of the following:
What factors comprise the patient's normal and flexible lines of defense and lines of resistance?
What stressors are causing the problems with this patitent? What is the patient's reaction to the stressor? What is each discipline's perspective on the problem or isssues that are involved?
How is the situation influenced by the patient's family system? By the patient's environment?
What would be the ideal coutocme in this situation from each discipline's perspective? From the patient's perspective?
What goals would be appropariat.
BBabcock - Research Summary - Coaching and Chronic Conditions - May 2013 v3Barbara Babcock, ACC
This document provides a summary of a research dissertation on the impact of coaching on the wellness and wellbeing of adults with Transverse Myelitis (TM) and their primary caregivers. The research found that a systemic coaching approach enhanced clients' wellness and reduced stress by addressing issues like control, uncertainty, loss, and family relationships. Limitations included a small sample size and focusing more narrowly may have provided clearer results. Practical implications suggest coaching can increase quality of life for those with chronic conditions, and family-based interventions are recommended.
1. The document discusses an ethical dilemma in nursing regarding end-of-life care for COVID patients where families refused to withdraw care for brain dead patients, exposing nurses to risk.
2. It defines an ethical dilemma as a situation where a person must make a decision that will affect someone else's well-being, and both choices can be argued as good or uncertain. What is an ethical dilemma for one nurse may not be for another due to individual principles and morals.
3. It emphasizes the importance of reflection, considering different perspectives, and acting in the patient's best interest when facing ethical dilemmas in nursing practice. Limitations to choices are sometimes necessary for order and safety, but should not prevent providing quality
Florida National University Nursing Leadership Discussion.pdfsdfghj21
This document discusses several topics related to nursing ethics including:
1. It provides examples of behaviors that may be considered ethical but illegal, legal but unethical, illegal and unethical, or legal and ethical.
2. It differentiates between deontological theories, utilitarianism, and principlism as ethical frameworks.
3. It asks questions about disclosing a poor prognosis or private health information to clients against their or their family's wishes.
Using Nightingale's theory, the student would evaluate the nursing interventions for an 82-year-old hospitalized woman who wanted her pet dog to visit. Based on Nightingale's 13 canons, the student would consider the patient's request in light of ensuring ventilation, cleanliness, and comfort.
Using Neuman's systems model, the student would assess a Hispanic family seeking care at a free clinic. This would include describing the family as an interconnected system, identifying stressors like low income and language barriers, and developing a culturally-sensitive plan to strengthen the family's flexibility in managing health issues.
Considering King's theory of goals, roles, and perception, the student finds similarities in their
Jan 15 Communication Bridges And Barriers Oxfordlibrary
The document discusses empowering clients in healthcare. It defines empowerment as helping clients take a primary role in their healthcare by providing knowledge and skills. Five key features of empowerment are discussed: acceptance, affect, autonomy, alliance, and active participation. Three studies on empowerment are summarized showing benefits like improved compliance, treatment satisfaction, and emotional well-being when clients feel more empowered. Barriers to therapeutic relationships like stereotyping and anxiety are also covered.
Technical And Business Of EntrepreneurshipDiane Allen
The document discusses technical and business undergraduate students' self-efficacy in entrepreneurship. It finds that business undergraduates may have higher self-efficacy in entrepreneurial endeavors than non-business students, as business students had more opportunities to be involved in business activities. Preliminary analyses were conducted to ensure assumptions of normality, linearity and homoscedasticity were not violated.
Source for ArticleMilliken, A. (2018). Ethical awareness What .docxwilliame8
Source for Article:
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Article:
Ethical Awareness: What It Is and Why It Matters
^ m d
Aimee Milliken, PhD, RN
Abstract
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Though dilemmas and challenging situations create the most obvious, dramatic risks to patients, routine nursing actions have implications for patients as well. Ethical awareness involves recognizing the ethical implications of all nursing actions. Developing ethical awareness is one way to empower nurses to act as moral agents in order to provide patients with safe and ethical care. The aim of this article is to provide an overview of the concept of ethical awareness and the role it plays in patient care. Background information is provided; three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice; followed by additional discussion; and strategies for heightening ethical awareness are suggested.
Citation: Milliken, A., (January 31, 2018) "Ethical Awareness: What It Is and Why It Matters" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
DOI: 10.3912/OJIN.Vol23No01Man01
Key Words: ethical awareness, nursing ethics, ethical sensitivity, moral sensitivity, critical care
Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action.
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action (Milliken & Grace, 2015). This means that nurses must first recognize the potential ethical repercussions of their actions in order to effectively resolve problems and address patient needs. The aim of this article is to provide an overview of ethical awareness and its important role in ethical nursing care. Three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice. Finally, strategies for heightening ethical awareness in the clinical setting are suggested.
Background
...nurses do not often recognize daily activities... as having ethical implications.
Many scholars have addressed the ethical nature of nursing practice (Austin, 2007; Erlen, 1997; Milliken & Grace, 2015; Truog et al., 2015; Ulrich et al., 2010). Though nursing ethics education often focuses on dilemmas and challenging situations (Truog et al., 2015; Zizzo, Bell, & Racine, 2016), ethical awareness involves recognizing .
Source for ArticleMilliken, A. (2018). Ethical awareness What .docxrosemariebrayshaw
Source for Article:
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Article:
Ethical Awareness: What It Is and Why It Matters
^ m d
Aimee Milliken, PhD, RN
Abstract
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Though dilemmas and challenging situations create the most obvious, dramatic risks to patients, routine nursing actions have implications for patients as well. Ethical awareness involves recognizing the ethical implications of all nursing actions. Developing ethical awareness is one way to empower nurses to act as moral agents in order to provide patients with safe and ethical care. The aim of this article is to provide an overview of the concept of ethical awareness and the role it plays in patient care. Background information is provided; three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice; followed by additional discussion; and strategies for heightening ethical awareness are suggested.
Citation: Milliken, A., (January 31, 2018) "Ethical Awareness: What It Is and Why It Matters" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
DOI: 10.3912/OJIN.Vol23No01Man01
Key Words: ethical awareness, nursing ethics, ethical sensitivity, moral sensitivity, critical care
Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action.
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action (Milliken & Grace, 2015). This means that nurses must first recognize the potential ethical repercussions of their actions in order to effectively resolve problems and address patient needs. The aim of this article is to provide an overview of ethical awareness and its important role in ethical nursing care. Three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice. Finally, strategies for heightening ethical awareness in the clinical setting are suggested.
Background
...nurses do not often recognize daily activities... as having ethical implications.
Many scholars have addressed the ethical nature of nursing practice (Austin, 2007; Erlen, 1997; Milliken & Grace, 2015; Truog et al., 2015; Ulrich et al., 2010). Though nursing ethics education often focuses on dilemmas and challenging situations (Truog et al., 2015; Zizzo, Bell, & Racine, 2016), ethical awareness involves recognizing .
READINGSIntroductionUnit II examines ethical, legal, and .docxsedgar5
READINGS:
Introduction
Unit II
examines ethical, legal, and legislative issues affecting leadership and management as well as professional advocacy. This chapter focuses on applied ethical decision making as a critical leadership role for managers.
Chapter 5
examines the impact of legislation and the law on leadership and management, and
Chapter 6
focuses on advocacy for patients and subordinates and for the nursing profession in general.
Ethics
is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are. Ethics is a system of moral conduct and principles that guide a person’s actions in regard to right and wrong and in regard to oneself and society at large.
Ethics is concerned with doing the right thing, although it is not always clear what that is.
Applied ethics
requires application of normative ethical theory to everyday problems. The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, therefore, provide the foundation and filter from which ethical decisions are made. The nurse-manager, however, has a different ethical responsibility than the clinical nurse and does not have as clearly defined a foundation to use as a base for ethical reasoning.
In addition, because management is a discipline and not a profession, its purpose is not as clearly defined as medicine or law; therefore, the norms that guide ethical decision making are less clear. Instead, the organization reflects norms and values to the manager, and the personal values of managers are reflected through the organization. The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions.
Society helps define the purposes of various institutions, and the purposes, in turn, help ensure that the institution fulfills specific functions. However, the specific values and norms in any institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. In reviewing this set of complex interactions, it becomes evident that arriving at appropriate ethical management decisions can be a difficult task.
In addition,
nursing management ethics
are distinct from
clinical nursing ethics
. Although significant research exists regarding ethical dilemmas and moral distress experienced by staff nurses in clinical roles, less research exists regarding the ethical distress experienced by nursing managers.
Nursing management ethics are also distinct from other areas of m.
Dr. Y misdiagnosed and overprescribed medication to Patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. Patient X's family could sue Dr. Y for negligence, having to prove that Dr. Y deviated from the standard of care by misreading the medication instructions and that this caused Patient X's death. Healthcare ethics principles of autonomy, beneficence and non-maleficence were violated. Providers must respect patient autonomy, act in their best interest, and do no harm. Ongoing training in healthcare ethics is important to avoid such violations and ensure principles of justice, respect and fairness are followed.
4.1 EXPLORING INCENTIVE PAY4-1 Explore the incentive pay a.docxlorainedeserre
4.1 EXPLORING INCENTIVE PAY
4-1 Explore the incentive pay approach.
Incentive pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss212) or
variable pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss462)
rewards employees for partially or completely attaining a predetermined work objective.
Incentive or variable pay is defined as compensation, other than base wages or salaries that
fluctuate according to employees’ attainment of some standard, such as a preestablished
formula, individual or group goals, or company earnings.
Effective incentive pay systems are based on three assumptions:
Individual employees and work teams differ in how much they contribute to the
company, both in what they do as well as in how well they do it.
The company’s overall performance depends to a large degree on the performance of
individuals and groups within the company.
To attract, retain, and motivate high performers and to be fair to all employees, a
company needs to reward employees on the basis of their relative performance.
Much like seniority and merit pay approaches, incentive pay augments employees’ base pay,
but incentive pay appears as a one-time payment. Employees usually receive a combination
of recurring base pay and incentive pay, with base pay representing the greater portion of
core compensation. More employees are presently eligible for incentive pay than ever before,
as companies seek to control costs and motivate personnel continually to strive for exemplary
performance. Companies increasingly recognize the importance of applying incentive pay
programs to various kinds of employees as well, including production workers, technical
employees, and service workers.
Some companies use incentive pay extensively. Lincoln Electric Company, a manufacturer of
welding machines and motors, is renowned for its use of incentive pay plans. At Lincoln
Electric, production employees receive recurring base pay as well as incentive pay. The
company determines incentive pay awards according to five performance criteria: quality,
output, dependability, cooperation, and ideas. The company has awarded incentive payments
every year since 1934, through prosperous and poor economic times. In 2014, the average
profit sharing payment per employee was $33,984.
Coupled with average base
pay, total core compensation for Lincoln employees was $82,903. Over the past 10 years,
Lincoln’s profit-sharing payments averaged approximately 40 percent of annual salary.
1
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end1)
2
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end2)
3
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end3)
4
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end4)
4.1 Exploring Incentive Pay
4/15/20, 8:49 PM
Page 1 ...
38 u December 2017 January 2018The authorities beli.docxlorainedeserre
38 u December 2017 / January 2018
T
he authorities believe he slipped across the United States-Mexico
border sometime during the summer of 2016, likely deep in the
night. He carried no papers. The crossing happened in the rugged
backcountry of southeastern Arizona, where the main deterrent to
trespassers is the challenging nature of the terrain—not the metal
walls, checkpoints, and aerial surveillance that dominate much of the border.
But the border crosser was des-
ert-hardy and something of an expert
at camouflage. No one knows for cer-
tain how long he’d been in the United
States before a motion-activated cam-
era caught him walking a trail in the
Dos Cabezas Mountains on the night
of November 16. When a government
agency retrieved the photo in late Feb-
ruary, the image was plastered across
Arizona newspapers, causing an imme-
diate sensation.
The border crosser was a jaguar.
Jaguars once roamed throughout
the southwestern United States, but
are now quite rare. A core population
resides in the mountains of northern
Mexico, and occasionally an adventur-
ous jaguar will venture north of the bor-
der. When one of these elusive, graceful
cats makes an appearance stateside,
Mrill Ingram is The Progressive’s online media editor.
‘The Border Is
a Beautiful Place’
For Many, Both Sides of the
Arizona-Mexico Border Are Home
B
O
R
D
ER
A
R
TS
C
O
R
R
ID
O
R
By Mrill Ingram
Artists Ana Teresa Fernández in Agua Prieta, Mexico, and Jenea Sanchez in Douglas, Arizona, worked with dozens of community members to paint sections
of the border fence sky blue, “erasing” it as a symbolic act of resistance against increasing violence and oppression of human rights along the border.
https://apnews.com/79c83219af724016b8cfa2c505018ac4/agency-reports-rare-jaguar-sighting-mountains-arizona
The Progressive u 39
usually via a motion-triggered camera,
it may get celebrity status.
“We’ve had positive identifications
of seven cats, alive and well, in the last
twenty years in the United States,” says
Diana Hadley of the Mexico-based
Northern Jaguar Project, which works
with people in both countries to pro-
tect the big cat. One of those cats be-
came known as El Jefe, after he took
up residence in 2011 in the Santa Rita
Mountains south of Tucson, Arizona.
His presence was proof that the United
States still had enough wild habitat to
support a jaguar.
The new cat was especially excit-
ing because, based on size and shape,
observers initially thought it might
be female. “A lot of people in Arizona
would be very happy to have jaguars
from Mexico breeding in Arizona,” re-
marks Hadley.
In September 2017, the Arizo-
na-based Center for Biological Di-
versity released new video of the cat,
apparently a male, caught on a mo-
tion-triggered camera ambling through
the oak scrub forest in the Chiricahua
Mountains. He’s been named Sombra,
or Shadow, by schoolkids in Tucson.
Such things will no longer ...
3Prototypes of Ethical ProblemsObjectivesThe reader shou.docxlorainedeserre
This document outlines key concepts related to recognizing and analyzing ethical problems. It discusses how to distinguish ethical questions from clinical or legal ones, and introduces the common features of ethical problems - a moral agent, a course of action, and an outcome. It uses the story of a veteran, Bill, missing therapy appointments as an example, with his therapist Kate feeling uncertain about what to do.
4-5 Annotations and Writing Plan - Thu Jan 30 2111Claire Knaus.docxlorainedeserre
4-5 Annotations and Writing Plan - Thu Jan 30 21:11
Claire Knaus
Annotations:
Bekalu, M. A., McCloud, R. F., & Viswanath, K. (2019). Association of Social Media Use With Social Well-Being, Positive Mental Health, and Self-Rated Health: Disentangling Routine Use From Emotional Connection to Use. Health Education & Behavior, 46(2_suppl), 69S-80S. https://doi.org/10.1177/1090198119863768
It seems that this source is arguing the effect of social media on mental health. This source uses this evidence to support the argument: Provided studies focusing on why individuals use social media, types of social network platforms, and the value of social capital. A counterargument for this source is: Studies that focus more on statistical usage rather than emotion connection. Personally, I believe the source is doing a good job of supporting its arguments because it provides an abundance of study references and clearly portrays the information and intent. I think this source will be very helpful in supporting my argument because of the focus on emotional connection to social media and its effects on mental health.
Matsakis, L. (2019). How Pro-Eating Disorder Posts Evade Filters on Social Media. In Gale Opposing Viewpoints Online Collection. Farmington Hills, MI: Gale. (Reprinted from How Pro-Eating Disorder Posts Evade Filters on Social Media, Wired, 2018, June 13) Retrieved from https://link-gale-com.ezproxy.snhu.edu/apps/doc/UAZKKH366290962/OVIC?u=nhc_main&sid=OVIC&xid=2c90b7b5
It seems that this source is arguing that social media platforms are not doing enough to eliminate harmful pro-ED posts. This source uses this evidence to support the argument: Information about specific platforms and what they have done to moderate content, links for more information, and what constitutes as harmful content. A counterargument for this source is that it is too difficult for platforms to remove the content and to even find it. In addition, it is believed there may be harmful effects on vulnerable people posting this type of content. Personally, I believe the source is doing a good job of supporting its arguments because it provides opposing viewpoints as well as raising awareness of some of the dangers of social media posts. I think this source will be very helpful in supporting my argument because it provides information on specifically what is being done to moderate this type of content on social media, and what some of the difficulties in moderating are.
Investigators at University of Leeds Describe Findings in Eating Disorders (Pro-ana versus Pro-recovery: A Content Analytic Comparison of Social Media Users' Communication about Eating Disorders on Twitter and Tumblr). (2017, September 4). Mental Health Weekly Digest, 38. Retrieved from https://link-gale-com.ezproxy.snhu.edu/apps/doc/A502914419/OVIC?u=nhc_main&sid=OVIC&xid=5e60152f
It seems that this source is arguing that there are more positive, anti-anorexia posts on social media than harmful, pro-ED content. ...
3Moral Identity Codes of Ethics and Institutional Ethics .docxlorainedeserre
This document discusses codes of ethics and institutional ethics structures in healthcare organizations. It begins by outlining the key learning objectives which focus on understanding the importance of codes of ethics and how they reflect an organization's values. It then discusses the role of codes of ethics in shaping an organization's moral identity and standards of conduct. The document provides examples of codes from the American Medical Association and Trinity Health. It emphasizes that codes of ethics should apply to all healthcare workers and cover areas like cultural competence, privacy, and nondiscrimination. Institutional ethics committees and review boards also help address ethical issues.
3NIMH Opinion or FactThe National Institute of Mental Healt.docxlorainedeserre
3
NIMH: Opinion or Fact
The National Institute of Mental Health (NIMH) was formed in 1946 and is one of 27 institutes that form the National Institute of Health (NIH) (NIMH, 2019). The mission of the NIMH is “To transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.” (NIMH, 2019). There are many different mental illnesses discussed on the NIMH website to include Attention-Deficit/Hyperactivity Disorder (ADHD). The NIMH website about ADHD is effective at providing the public general information and meets the criteria of authority, objectivity, and currency.
The NIMH website about ADHD provides an overview of ADHD, discusses signs and symptoms, and risk factors. The NIMH continues with information about treatment and therapies. Information provided by the NIMH is intended for both children and adults. The NIMH concludes on the page with studies the public can join and more resources for the public such as booklets, brochures, research and clinical trials.
As described by Jim Kapoun authority can be identified by who or what institution/organization published the document and if the information in the document is cited correctly (Cornell, 2020). The information on the website is published by the NIMH which is the lead research institute related to mental health for the last 70 plus years (NIMH, 2019). On the page related to ADHD the NIMH references the program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) and provides a hyperlink to access the resources available with the agency (NIMH,2019). This link can be found under the support groups section in the treatment and therapies. On the website to the right of the area describing inattention the NIMH has a section on research. In this block there is a link to “PubMed: Journal Articles about Attention Deficit Hyperactivity Disorder (ADHD)” which will take you to a search of the National Center for Biotechnology Information (NCBI) published by PubMed on ADHD (NIMH, 2019). Throughout the entire page the NIMH provides sources and hyperlinks to the sources as citations. Based on the reputation of the NIMH and the citations to the source material the website meets the criteria of authority.
According to Kapoun objectivity can be identified looking for areas where the author expresses his or her opinion (Cornell, 2020). Information provided on the NIMH page about ADHD does not express the opinion of the author. The author produces only factual information based on research. The NIMH makes it a point not to mention the names of medications when discussing treatments and only explains the medications fall in two categories stimulants and non-stimulants (NIMH, 2019). In this same area the NIMH provides hyperlinks to the NIMH Mental Health Medication and FDA website for information about medication. The extent at which the NIMH goes to not provide an opinion on the website meet ...
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Similar to 2. Read the case study entitled You be the Ethicist, presented at .docx
1. The document discusses key concepts in nursing including person, environment, health, and nursing. It emphasizes that these concepts must work together to achieve quality healthcare and improved patient outcomes.
2. The response discusses that there can be multiple right answers to healthcare situations that achieve the same goal but at different rates. It also stresses the importance of valuing the whole individual by addressing their spiritual, emotional, and physical needs.
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Resources for Week 2 HLTH440 from M.U.S.E. My Unique Student Expe.docxronak56
Resources for Week 2 HLTH440 from: M.U.S.E. My Unique Student Experience Registered Trademark CEC 2013. All Rights Reserved.
The Basis for Health Care Ethics
What is Ethics?Ethics is what you believe is right or wrong. It is a moral philosophy that seeks to help the individual distinguish between good and bad as defined by one's culture. Ethics guides individuals and groups in their decisions about health care and other matters. Ethics helps the individual and group set boundaries.
Health care ethics is based on the law, professional codes of ethics, standards of care, and institutional policies and practices (corporate law).
Codes of EthicsCodes of ethics or codes of conduct are lists of standards or guides that provide an ethical framework for practice within a profession. Physicians are bound by the Hippocratic oath, but nursing has its own code of ethics. All health professions have a code of ethics.
It is axiomatic that the practice of health care presents moral and ethical dilemmas, because it deals with human beings and life-altering circumstances.
Health care financing presents broader moral dilemmas in the allocation of scarce resources. The conflict exists between the inherent values, duties, and obligations in caring for patients and the availability of resources to treat them.
The depth or content of a code of ethics is dependent on the type of contact that the health care professional has with a patient.
Ethical Theories
A number of ethical frameworks or theories are used to make decisions in health care and, in general, to set boundaries for expected behavior. The theories are used to determine what is fair or unfair. The following are several ethical frameworks:
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Teleological theory: Also known as consequentialist theory, which believes that the best action in any situation is the one that promotes the greatest happiness for the largest number of people. In health care financing, this would fall under the rubric of cost containment by calculating the net benefits verses the consequences.
Utilitarianism: This is Mill’s definition of morality, which is the practical ethics of judgment: What is the greatest good that will benefit the greatest number of people? Medicare falls under this rubric.
Deontological theory: What one should or must do based on the obligations and duties of one’s life. This theory focuses on means, whereas teleological theory focuses on ends.
Virtue ethics: This is the ethics of care as a part of virtue ethics; virtue ethics is a form of normative ethics, which emphasizes the character of the interaction between the health care provider and the patient. This is the opposite of the emphasis on rules or consequences in other moral theories. Health care virtues include compassion, conscientiousness, cooperativeness, discernment, honesty, trustworthiness, truth telling, integrity, kindness, respect, and commitment.
Situational ...
Module 4.1 - Discussion
Applying Nursing Theory
Instructions:
Select one (1) of the following scenarios related to a specific nursing. Think about what you would do in the scenario presented and post your ideas.
Post two (2) discussion questions based on the readings along with your answers.
TheoristScenarioFlorence
Nightengale
Using Nightengale’s concepts of
ventilation
,
light
,
noise
, and
cleanliness
, analyze the setting in which you are practicing nursing (working as an employee or student).
Using Nightengale’s theory, evaluate the nursing interventions you have identified for an individual patient in your facility or practice.
OR
Your hospital patient is an 82 year-old woman. She does not have immediate family and has been living alone in her own home. Her hospitalization was unanticipated; it followed a visit to the emergency room for a burn on her lower leg. The patient has been hospitalized for 14 days. She pleads with you to allow her friend to bring her dog, a 16-year-old Scotty Terrier, to the hospital. She tells you that none of the other nurses have listened to her when she asked them about such a visit. Based on Nightingale’s model, and 13 cannon,
what actions would you take for this patient?
Betty Neuman
Martina is a middle-aged Hispanic woman who brings her family to a local free clinic to obtain medical care. She works part time in a restaurant for minimum wage. She lives in a small apartment with her daughter and four preschool children; her daughter speaks only very broken English. Martina’s medical diagnoses are hypertension, arthritis, and depression.
Use the Neuman System Model as a
conceptual framework
to respond to the following:
Describe the family as a system.
How does the dominant Anglo culture impact on the family’s stability as a system?
What stressors (actual and potential) threaten the family?
What additional assessment data are needed related to Martina’s medical diagnoses?
What additional assessment data are needed related to the family’s health status?
How will cultural differences influence planning for prevention as intervention at primary, secondary, and tertiary levels?
OR
Using the Neuman System Model, organize a patient care conference in your workplace to deal with a patient situation that has been difficult to manage. Involve caregivers from nursing and at least one other disicpline to discuss each of the following:
What factors comprise the patient's normal and flexible lines of defense and lines of resistance?
What stressors are causing the problems with this patitent? What is the patient's reaction to the stressor? What is each discipline's perspective on the problem or isssues that are involved?
How is the situation influenced by the patient's family system? By the patient's environment?
What would be the ideal coutocme in this situation from each discipline's perspective? From the patient's perspective?
What goals would be appropariat.
BBabcock - Research Summary - Coaching and Chronic Conditions - May 2013 v3Barbara Babcock, ACC
This document provides a summary of a research dissertation on the impact of coaching on the wellness and wellbeing of adults with Transverse Myelitis (TM) and their primary caregivers. The research found that a systemic coaching approach enhanced clients' wellness and reduced stress by addressing issues like control, uncertainty, loss, and family relationships. Limitations included a small sample size and focusing more narrowly may have provided clearer results. Practical implications suggest coaching can increase quality of life for those with chronic conditions, and family-based interventions are recommended.
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3. It emphasizes the importance of reflection, considering different perspectives, and acting in the patient's best interest when facing ethical dilemmas in nursing practice. Limitations to choices are sometimes necessary for order and safety, but should not prevent providing quality
Florida National University Nursing Leadership Discussion.pdfsdfghj21
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1. It provides examples of behaviors that may be considered ethical but illegal, legal but unethical, illegal and unethical, or legal and ethical.
2. It differentiates between deontological theories, utilitarianism, and principlism as ethical frameworks.
3. It asks questions about disclosing a poor prognosis or private health information to clients against their or their family's wishes.
Using Nightingale's theory, the student would evaluate the nursing interventions for an 82-year-old hospitalized woman who wanted her pet dog to visit. Based on Nightingale's 13 canons, the student would consider the patient's request in light of ensuring ventilation, cleanliness, and comfort.
Using Neuman's systems model, the student would assess a Hispanic family seeking care at a free clinic. This would include describing the family as an interconnected system, identifying stressors like low income and language barriers, and developing a culturally-sensitive plan to strengthen the family's flexibility in managing health issues.
Considering King's theory of goals, roles, and perception, the student finds similarities in their
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Source for ArticleMilliken, A. (2018). Ethical awareness What .docxwilliame8
Source for Article:
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Article:
Ethical Awareness: What It Is and Why It Matters
^ m d
Aimee Milliken, PhD, RN
Abstract
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Though dilemmas and challenging situations create the most obvious, dramatic risks to patients, routine nursing actions have implications for patients as well. Ethical awareness involves recognizing the ethical implications of all nursing actions. Developing ethical awareness is one way to empower nurses to act as moral agents in order to provide patients with safe and ethical care. The aim of this article is to provide an overview of the concept of ethical awareness and the role it plays in patient care. Background information is provided; three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice; followed by additional discussion; and strategies for heightening ethical awareness are suggested.
Citation: Milliken, A., (January 31, 2018) "Ethical Awareness: What It Is and Why It Matters" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
DOI: 10.3912/OJIN.Vol23No01Man01
Key Words: ethical awareness, nursing ethics, ethical sensitivity, moral sensitivity, critical care
Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action.
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action (Milliken & Grace, 2015). This means that nurses must first recognize the potential ethical repercussions of their actions in order to effectively resolve problems and address patient needs. The aim of this article is to provide an overview of ethical awareness and its important role in ethical nursing care. Three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice. Finally, strategies for heightening ethical awareness in the clinical setting are suggested.
Background
...nurses do not often recognize daily activities... as having ethical implications.
Many scholars have addressed the ethical nature of nursing practice (Austin, 2007; Erlen, 1997; Milliken & Grace, 2015; Truog et al., 2015; Ulrich et al., 2010). Though nursing ethics education often focuses on dilemmas and challenging situations (Truog et al., 2015; Zizzo, Bell, & Racine, 2016), ethical awareness involves recognizing .
Source for ArticleMilliken, A. (2018). Ethical awareness What .docxrosemariebrayshaw
Source for Article:
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html
Article:
Ethical Awareness: What It Is and Why It Matters
^ m d
Aimee Milliken, PhD, RN
Abstract
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Though dilemmas and challenging situations create the most obvious, dramatic risks to patients, routine nursing actions have implications for patients as well. Ethical awareness involves recognizing the ethical implications of all nursing actions. Developing ethical awareness is one way to empower nurses to act as moral agents in order to provide patients with safe and ethical care. The aim of this article is to provide an overview of the concept of ethical awareness and the role it plays in patient care. Background information is provided; three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice; followed by additional discussion; and strategies for heightening ethical awareness are suggested.
Citation: Milliken, A., (January 31, 2018) "Ethical Awareness: What It Is and Why It Matters" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
DOI: 10.3912/OJIN.Vol23No01Man01
Key Words: ethical awareness, nursing ethics, ethical sensitivity, moral sensitivity, critical care
Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action.
Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action (Milliken & Grace, 2015). This means that nurses must first recognize the potential ethical repercussions of their actions in order to effectively resolve problems and address patient needs. The aim of this article is to provide an overview of ethical awareness and its important role in ethical nursing care. Three everyday scenarios highlight the importance of ethical awareness in everyday nursing practice. Finally, strategies for heightening ethical awareness in the clinical setting are suggested.
Background
...nurses do not often recognize daily activities... as having ethical implications.
Many scholars have addressed the ethical nature of nursing practice (Austin, 2007; Erlen, 1997; Milliken & Grace, 2015; Truog et al., 2015; Ulrich et al., 2010). Though nursing ethics education often focuses on dilemmas and challenging situations (Truog et al., 2015; Zizzo, Bell, & Racine, 2016), ethical awareness involves recognizing .
READINGSIntroductionUnit II examines ethical, legal, and .docxsedgar5
READINGS:
Introduction
Unit II
examines ethical, legal, and legislative issues affecting leadership and management as well as professional advocacy. This chapter focuses on applied ethical decision making as a critical leadership role for managers.
Chapter 5
examines the impact of legislation and the law on leadership and management, and
Chapter 6
focuses on advocacy for patients and subordinates and for the nursing profession in general.
Ethics
is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are. Ethics is a system of moral conduct and principles that guide a person’s actions in regard to right and wrong and in regard to oneself and society at large.
Ethics is concerned with doing the right thing, although it is not always clear what that is.
Applied ethics
requires application of normative ethical theory to everyday problems. The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, therefore, provide the foundation and filter from which ethical decisions are made. The nurse-manager, however, has a different ethical responsibility than the clinical nurse and does not have as clearly defined a foundation to use as a base for ethical reasoning.
In addition, because management is a discipline and not a profession, its purpose is not as clearly defined as medicine or law; therefore, the norms that guide ethical decision making are less clear. Instead, the organization reflects norms and values to the manager, and the personal values of managers are reflected through the organization. The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions.
Society helps define the purposes of various institutions, and the purposes, in turn, help ensure that the institution fulfills specific functions. However, the specific values and norms in any institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. In reviewing this set of complex interactions, it becomes evident that arriving at appropriate ethical management decisions can be a difficult task.
In addition,
nursing management ethics
are distinct from
clinical nursing ethics
. Although significant research exists regarding ethical dilemmas and moral distress experienced by staff nurses in clinical roles, less research exists regarding the ethical distress experienced by nursing managers.
Nursing management ethics are also distinct from other areas of m.
Dr. Y misdiagnosed and overprescribed medication to Patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. Patient X's family could sue Dr. Y for negligence, having to prove that Dr. Y deviated from the standard of care by misreading the medication instructions and that this caused Patient X's death. Healthcare ethics principles of autonomy, beneficence and non-maleficence were violated. Providers must respect patient autonomy, act in their best interest, and do no harm. Ongoing training in healthcare ethics is important to avoid such violations and ensure principles of justice, respect and fairness are followed.
Similar to 2. Read the case study entitled You be the Ethicist, presented at .docx (15)
4.1 EXPLORING INCENTIVE PAY4-1 Explore the incentive pay a.docxlorainedeserre
4.1 EXPLORING INCENTIVE PAY
4-1 Explore the incentive pay approach.
Incentive pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss212) or
variable pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss462)
rewards employees for partially or completely attaining a predetermined work objective.
Incentive or variable pay is defined as compensation, other than base wages or salaries that
fluctuate according to employees’ attainment of some standard, such as a preestablished
formula, individual or group goals, or company earnings.
Effective incentive pay systems are based on three assumptions:
Individual employees and work teams differ in how much they contribute to the
company, both in what they do as well as in how well they do it.
The company’s overall performance depends to a large degree on the performance of
individuals and groups within the company.
To attract, retain, and motivate high performers and to be fair to all employees, a
company needs to reward employees on the basis of their relative performance.
Much like seniority and merit pay approaches, incentive pay augments employees’ base pay,
but incentive pay appears as a one-time payment. Employees usually receive a combination
of recurring base pay and incentive pay, with base pay representing the greater portion of
core compensation. More employees are presently eligible for incentive pay than ever before,
as companies seek to control costs and motivate personnel continually to strive for exemplary
performance. Companies increasingly recognize the importance of applying incentive pay
programs to various kinds of employees as well, including production workers, technical
employees, and service workers.
Some companies use incentive pay extensively. Lincoln Electric Company, a manufacturer of
welding machines and motors, is renowned for its use of incentive pay plans. At Lincoln
Electric, production employees receive recurring base pay as well as incentive pay. The
company determines incentive pay awards according to five performance criteria: quality,
output, dependability, cooperation, and ideas. The company has awarded incentive payments
every year since 1934, through prosperous and poor economic times. In 2014, the average
profit sharing payment per employee was $33,984.
Coupled with average base
pay, total core compensation for Lincoln employees was $82,903. Over the past 10 years,
Lincoln’s profit-sharing payments averaged approximately 40 percent of annual salary.
1
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end1)
2
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end2)
3
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end3)
4
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end4)
4.1 Exploring Incentive Pay
4/15/20, 8:49 PM
Page 1 ...
38 u December 2017 January 2018The authorities beli.docxlorainedeserre
38 u December 2017 / January 2018
T
he authorities believe he slipped across the United States-Mexico
border sometime during the summer of 2016, likely deep in the
night. He carried no papers. The crossing happened in the rugged
backcountry of southeastern Arizona, where the main deterrent to
trespassers is the challenging nature of the terrain—not the metal
walls, checkpoints, and aerial surveillance that dominate much of the border.
But the border crosser was des-
ert-hardy and something of an expert
at camouflage. No one knows for cer-
tain how long he’d been in the United
States before a motion-activated cam-
era caught him walking a trail in the
Dos Cabezas Mountains on the night
of November 16. When a government
agency retrieved the photo in late Feb-
ruary, the image was plastered across
Arizona newspapers, causing an imme-
diate sensation.
The border crosser was a jaguar.
Jaguars once roamed throughout
the southwestern United States, but
are now quite rare. A core population
resides in the mountains of northern
Mexico, and occasionally an adventur-
ous jaguar will venture north of the bor-
der. When one of these elusive, graceful
cats makes an appearance stateside,
Mrill Ingram is The Progressive’s online media editor.
‘The Border Is
a Beautiful Place’
For Many, Both Sides of the
Arizona-Mexico Border Are Home
B
O
R
D
ER
A
R
TS
C
O
R
R
ID
O
R
By Mrill Ingram
Artists Ana Teresa Fernández in Agua Prieta, Mexico, and Jenea Sanchez in Douglas, Arizona, worked with dozens of community members to paint sections
of the border fence sky blue, “erasing” it as a symbolic act of resistance against increasing violence and oppression of human rights along the border.
https://apnews.com/79c83219af724016b8cfa2c505018ac4/agency-reports-rare-jaguar-sighting-mountains-arizona
The Progressive u 39
usually via a motion-triggered camera,
it may get celebrity status.
“We’ve had positive identifications
of seven cats, alive and well, in the last
twenty years in the United States,” says
Diana Hadley of the Mexico-based
Northern Jaguar Project, which works
with people in both countries to pro-
tect the big cat. One of those cats be-
came known as El Jefe, after he took
up residence in 2011 in the Santa Rita
Mountains south of Tucson, Arizona.
His presence was proof that the United
States still had enough wild habitat to
support a jaguar.
The new cat was especially excit-
ing because, based on size and shape,
observers initially thought it might
be female. “A lot of people in Arizona
would be very happy to have jaguars
from Mexico breeding in Arizona,” re-
marks Hadley.
In September 2017, the Arizo-
na-based Center for Biological Di-
versity released new video of the cat,
apparently a male, caught on a mo-
tion-triggered camera ambling through
the oak scrub forest in the Chiricahua
Mountains. He’s been named Sombra,
or Shadow, by schoolkids in Tucson.
Such things will no longer ...
3Prototypes of Ethical ProblemsObjectivesThe reader shou.docxlorainedeserre
This document outlines key concepts related to recognizing and analyzing ethical problems. It discusses how to distinguish ethical questions from clinical or legal ones, and introduces the common features of ethical problems - a moral agent, a course of action, and an outcome. It uses the story of a veteran, Bill, missing therapy appointments as an example, with his therapist Kate feeling uncertain about what to do.
4-5 Annotations and Writing Plan - Thu Jan 30 2111Claire Knaus.docxlorainedeserre
4-5 Annotations and Writing Plan - Thu Jan 30 21:11
Claire Knaus
Annotations:
Bekalu, M. A., McCloud, R. F., & Viswanath, K. (2019). Association of Social Media Use With Social Well-Being, Positive Mental Health, and Self-Rated Health: Disentangling Routine Use From Emotional Connection to Use. Health Education & Behavior, 46(2_suppl), 69S-80S. https://doi.org/10.1177/1090198119863768
It seems that this source is arguing the effect of social media on mental health. This source uses this evidence to support the argument: Provided studies focusing on why individuals use social media, types of social network platforms, and the value of social capital. A counterargument for this source is: Studies that focus more on statistical usage rather than emotion connection. Personally, I believe the source is doing a good job of supporting its arguments because it provides an abundance of study references and clearly portrays the information and intent. I think this source will be very helpful in supporting my argument because of the focus on emotional connection to social media and its effects on mental health.
Matsakis, L. (2019). How Pro-Eating Disorder Posts Evade Filters on Social Media. In Gale Opposing Viewpoints Online Collection. Farmington Hills, MI: Gale. (Reprinted from How Pro-Eating Disorder Posts Evade Filters on Social Media, Wired, 2018, June 13) Retrieved from https://link-gale-com.ezproxy.snhu.edu/apps/doc/UAZKKH366290962/OVIC?u=nhc_main&sid=OVIC&xid=2c90b7b5
It seems that this source is arguing that social media platforms are not doing enough to eliminate harmful pro-ED posts. This source uses this evidence to support the argument: Information about specific platforms and what they have done to moderate content, links for more information, and what constitutes as harmful content. A counterargument for this source is that it is too difficult for platforms to remove the content and to even find it. In addition, it is believed there may be harmful effects on vulnerable people posting this type of content. Personally, I believe the source is doing a good job of supporting its arguments because it provides opposing viewpoints as well as raising awareness of some of the dangers of social media posts. I think this source will be very helpful in supporting my argument because it provides information on specifically what is being done to moderate this type of content on social media, and what some of the difficulties in moderating are.
Investigators at University of Leeds Describe Findings in Eating Disorders (Pro-ana versus Pro-recovery: A Content Analytic Comparison of Social Media Users' Communication about Eating Disorders on Twitter and Tumblr). (2017, September 4). Mental Health Weekly Digest, 38. Retrieved from https://link-gale-com.ezproxy.snhu.edu/apps/doc/A502914419/OVIC?u=nhc_main&sid=OVIC&xid=5e60152f
It seems that this source is arguing that there are more positive, anti-anorexia posts on social media than harmful, pro-ED content. ...
3Moral Identity Codes of Ethics and Institutional Ethics .docxlorainedeserre
This document discusses codes of ethics and institutional ethics structures in healthcare organizations. It begins by outlining the key learning objectives which focus on understanding the importance of codes of ethics and how they reflect an organization's values. It then discusses the role of codes of ethics in shaping an organization's moral identity and standards of conduct. The document provides examples of codes from the American Medical Association and Trinity Health. It emphasizes that codes of ethics should apply to all healthcare workers and cover areas like cultural competence, privacy, and nondiscrimination. Institutional ethics committees and review boards also help address ethical issues.
3NIMH Opinion or FactThe National Institute of Mental Healt.docxlorainedeserre
3
NIMH: Opinion or Fact
The National Institute of Mental Health (NIMH) was formed in 1946 and is one of 27 institutes that form the National Institute of Health (NIH) (NIMH, 2019). The mission of the NIMH is “To transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.” (NIMH, 2019). There are many different mental illnesses discussed on the NIMH website to include Attention-Deficit/Hyperactivity Disorder (ADHD). The NIMH website about ADHD is effective at providing the public general information and meets the criteria of authority, objectivity, and currency.
The NIMH website about ADHD provides an overview of ADHD, discusses signs and symptoms, and risk factors. The NIMH continues with information about treatment and therapies. Information provided by the NIMH is intended for both children and adults. The NIMH concludes on the page with studies the public can join and more resources for the public such as booklets, brochures, research and clinical trials.
As described by Jim Kapoun authority can be identified by who or what institution/organization published the document and if the information in the document is cited correctly (Cornell, 2020). The information on the website is published by the NIMH which is the lead research institute related to mental health for the last 70 plus years (NIMH, 2019). On the page related to ADHD the NIMH references the program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) and provides a hyperlink to access the resources available with the agency (NIMH,2019). This link can be found under the support groups section in the treatment and therapies. On the website to the right of the area describing inattention the NIMH has a section on research. In this block there is a link to “PubMed: Journal Articles about Attention Deficit Hyperactivity Disorder (ADHD)” which will take you to a search of the National Center for Biotechnology Information (NCBI) published by PubMed on ADHD (NIMH, 2019). Throughout the entire page the NIMH provides sources and hyperlinks to the sources as citations. Based on the reputation of the NIMH and the citations to the source material the website meets the criteria of authority.
According to Kapoun objectivity can be identified looking for areas where the author expresses his or her opinion (Cornell, 2020). Information provided on the NIMH page about ADHD does not express the opinion of the author. The author produces only factual information based on research. The NIMH makes it a point not to mention the names of medications when discussing treatments and only explains the medications fall in two categories stimulants and non-stimulants (NIMH, 2019). In this same area the NIMH provides hyperlinks to the NIMH Mental Health Medication and FDA website for information about medication. The extent at which the NIMH goes to not provide an opinion on the website meet ...
4.1
Updated April-09
Lecture Notes
Chapter 4
Enterprise Excellence
Implementation
ENTERPRISE EXCELLENCE
4.2
Updated April-09
Learning Objectives
• Management & Operations Plans
• Enterprise Excellence Projects
• Enterprise Excellence Project decision Process
• Planning the Enterprise Excellence Project
• Tollgate Reviews
• Project Notebook
4.3
Updated April-09
MANAGEMENT AND OPERATIONS PLANS
• The scope and complexity of the
implementation projects will vary from the
executive level, to the management level, to
the operational level
• Each plan, as it is developed and deployed,
will include projects to be accomplished
• Conflicts typically will occur amongst
requirements of quality, cost, and schedule
when executing a project
4.4
Updated April-09
ENTERPRISE EXCELLENCE PROJECTS
• An Enterprise Excellence project will be one of three
types:
1. Technology invention or innovation
2. New product, service, or process development
3. Product, service, or process improvement
• Enterprise Excellence uses the scientific method
• The scientific method is a process of organizing
empirical facts and their interrelationships in a
manner that allows a hypothesis to be developed and
tested
4.5
Updated April-09
ENTERPRISE EXCELLENCE PROJECTS
• The scientific method consists of the
following steps:
1. Observe and describe the situation
2. Formulate a hypothesis
3. Use the hypothesis to predict results
4. Perform controlled tests to confirm the hypothesis
4.6
Updated April-09
ENTERPRISE EXCELLENCE PROJECTS
• Figure 4.1 shows the project decision process
4.7
Updated April-09
ENTERPRISE EXCELLENCE PROJECT
DECISION PROCESS
• Inventing/Innovating Technology:
Technology development is accomplished using
system engineering
This system approach enables critical functional
parameters and responses to be quickly transferred
into now products, services, and processes
The process is a four-phase process (I2DOV):
Invention & Innovation – Develop – Optimize – Verify
4.8
Updated April-09
ENTERPRISE EXCELLENCE PROJECT
DECISION PROCESS
• Development of Products, Services, and
Processes
The Enterprise Excellence approach for developing
products, services, and processes is the Design for
Lean Six Sigma strategy.
This strategy helps to incorporate customer
requirements and expectations into the product
and/or service.
Concept – Design – Optimize - Verify (CDOV) is a
specific sequential design & development process
used to execute the design strategy.
4.9
Updated April-09
ENTERPRISE EXCELLENCE PROJECT
DECISION PROCESS
• Improving Products, Services, and Processes:
Improving products, services and processes usually
involves the effectiveness and efficiency of operations.
A product or service is said to be effective when it meets
all of its customer requirements.
Effectiveness can be simply expressed as "doing the
right things the first time ...
3Type your name hereType your three-letter and -number cours.docxlorainedeserre
3
Type your name here
Type your three-letter and -number course code here
The date goes here
Type instructor’s name here
Your Title Goes Here
This is an electronic template for papers written in GCU style. The purpose of the template is to help you follow the basic writing expectations for beginning your coursework at GCU. Margins are set at 1 inch for top, bottom, left, and right. The first line of each paragraph is indented a half inch (0.5"). The line spacing is double throughout the paper, even on the reference page. One space after punctuation is used at the end of a sentence. The font style used in this template is Times New Roman. The font size is 12 point. When you are ready to write, and after having read these instructions completely, you can delete these directions and start typing. The formatting should stay the same. If you have any questions, please consult with your instructor.
Citations are used to reference material from another source. When paraphrasing material from another source (such as a book, journal, website), include the author’s last name and the publication year in parentheses.When directly quoting material word-for-word from another source, use quotation marks and include the page number after the author’s last name and year.
Using citations to give credit to others whose ideas or words you have used is an essential requirement to avoid issues of plagiarism. Just as you would never steal someone else’s car, you should not steal his or her words either. To avoid potential problems, always be sure to cite your sources. Cite by referring to the author’s last name, the year of publication in parentheses at the end of the sentence, such as (George & Mallery, 2016), and page numbers if you are using word-for-word materials. For example, “The developments of the World War II years firmly established the probability sample survey as a tool for describing population characteristics, beliefs, and attitudes” (Heeringa, West, & Berglund, 2017, p. 3).
The reference list should appear at the end of a paper (see the next page). It provides the information necessary for a reader to locate and retrieve any source you cite in the body of the paper. Each source you cite in the paper must appear in your reference list; likewise, each entry in the reference list must be cited in your text. A sample reference page is included below; this page includes examples (George & Mallery, 2016; Heeringa et al., 2017; Smith et al., 2018; “USA swimming,” 2018; Yu, Johnson, Deutsch, & Varga, 2018) of how to format different reference types (e.g., books, journal articles, and a website). For additional examples, see the GCU Style Guide.
References
George, D., & Mallery, P. (2016). IBM SPSS statistics 23 step by step: A simple guide and reference. New York, NY: Routledge.
Heeringa, S. G., West, B. T., & Berglund, P. A. (2017). Applied survey data analysis (2nd ed.). New York, NY: Chapman & Hall/CRC Press.
Smith, P. D., Martin, B., Chewning, B., ...
3Welcome to Writing at Work! After you have completed.docxlorainedeserre
3
Welcome to Writing at Work! After you have completed the reading for the week, write an email to introduce yourself to your peers. The name of your thread should be what you would include in the subject of the email.
As you compose your email, keep in mind the following:
· You are addressing a group you will work with in a professional capacity for at least 15 weeks. Let us know something about you, but don't share anything you wouldn't want repeated.
· You should include what you perceive to be your relative strengths with regard to writing at work. What types of tasks would you feel most comfortable taking on?
· You should also include what aspects of writing at work make you feel least comfortable. What types of tasks would you not be as suited for?
· What do you hope to learn in the next several months?
Next, in an attachment, choose one of the following two prompts and write a letter, taking into account the purpose, audience, and appropriate style for the task.
1. Your organization has been contracted to complete a project for an important client, and you were charged with managing the project. It has unfortunately become clear that your team will not meet the deadline. Your supervisor has told you to contact the client in writing to alert them to the situation and wants to be cc'd on the message. Write a letter, which you will send via email, addressing the above.
2. After a year-long working relationship, your organization will no longer be making use of a freelancer's services due to no fault of their own. Write a letter alerting them to this fact.
Name:
HRT 4760 Assignment 01
Timeliness
First, you will choose one particular organization where you will conduct each of your 15 different observational assignments. Stick with this same organization throughout your coursework. (Do not switch around assignment locations at different organizations or locations.) The reason for continuing your observational assignments at the same organization is to give you a deeper understanding of this particular organization across the 15 different assignments. As you read on, you will get a more complete understanding as to how these 15 assignments come together.
Tip: Many students choose the organization where they are currently working. This works particularly well. If you are working there, you have much opportunity to gain access to the areas that will give you a more complete understanding of the quality of entire service package (the 15 different elements) that the organization offers to its customers.
This is one of a package of 15 different assignments that comprise the Elements of Service, which you will study this term. For this assignment, you will observe elements of service in almost any particular service establishment. A few examples of service establishments would include, but not be limited to these: Hotel, resort, private club, restaurant, airline, cruise line, grocery store, doctor’s office, coffee house, and scores of oth ...
3JWI 531 Finance II Assignment 1TemplateHOW TO USE THIS TEMP.docxlorainedeserre
3
JWI 531 Finance II Assignment 1Template
HOW TO USE THIS TEMPLATE:
This is a template and checklist corresponding to your Assignment 1 paper: Enterprise Risk Management and Moat Strength. See below for an explanation of the color-coding in this template:
· All green text includes instructions to support your writing. You should delete all green text before submitting your final paper.
· All blue text indicates areas where you need to replace text with your own information. Replace the blue text with your own words in black.
· Headings and subheadings are written in black, bold type. Keep these in your paper.
TIPS:
· Write in the third person, using “he” or “she” or “they”, or using specific names. Do not use the second person “you”.
· The body of this paper has one-inch margins and uses a professional font (size 10-12); we recommend Arial or Times New Roman fonts.
· The Assignment template is already formatted with all needed specifications like margins, appropriate font, and double spacing.
· Before submitting your paper, use Grammarly to check for punctuation and usage errors and make the required corrections. Then read aloud to edit for tone and flow.
· You should also run your paper through SafeAssign to ensure that it meets the required standards for originality.
FINALIZING YOUR PAPER
Your submission should be a maximum of 4 pages in length. The page count doesnotinclude the Cover Page at the beginning and the References page at the end. The final paper that you submit for grading should be in black text only with all remaining green text and blue text removed. Assignment 1: Enterprise Risk Analysis and Moat Strength
Author’s Name
Jack Welch Management Institute
Professor’s Name
JWI 531
Date
Introduction
An Introduction should be succinct and to the point. Start your Introduction with a general and brief observation about the paper’s topic. Write a thesis statement, which is the “road map” for your paper - it helps your reader to navigate your work. In your thesis statement, be specific about the major areas you plan to address in your paper.
The headings below should guide your introduction, since they identify the topics to be addressed in your paper. The introduction is not a graded part of your rubric but it helps your reader to understand what your assignment will be about. We recommend that you write this part of your Introduction after you complete the other sections of your paper. It only needs to be one paragraph in length.
Analysis and Recommendations
You must answer each of the following questions in your paper. Keep your responses focused on the topic. Straying off into additional areas, even if they are interesting, will not earn additional marks, and may actually detract from the clarity of your responses.
I. Where is each company in its corporate lifecycle (startup, growth, maturity or decline)? Explain.
Before writing your response to this question, make sure you understand what characterizes ea ...
3Big Data Analyst QuestionnaireWithin this document are fo.docxlorainedeserre
3
Big Data Analyst Questionnaire
Within this document are four different questions. Each question is structured in the following manner:
1) Premise
- Contains any needed background information
2) Request
- The actual question, what you are to solve
3) Notes
- A space if you feel like including notes of any kind for the given question
Please place your answer for each question in a separate file, following this naming convention:
Name_Qn.docx, where n = the question number (i.e., 1, 2 ...). So the file for the first question should be named ‘Name_Q1.docx’.
When complete, please package everything together and send email responses to the designated POCs.
Page | 1
Premise:
You have a table named “TRADES” with the following six columns:
Column Name
Data Type
Description
Date
DATE
The calendar date on which the trade took place.
Firm
VARCHAR(255)
A symbol representing the Broker/Dealer who conducted the trade.
Symbol
VARCHAR(10)
The security traded.
Side
VARCHAR(1)
Denotes whether the trade was a buy (purchase) or a sell (sale) of a security.
Quantity
BIGINT
The number of shares involved in the trade.
Price
DECIMAL(18,8)
The dollar price per share traded.
You write a query looking for all trades in the month of August 2019. The query returns the following:
DATE
FIRM
SYMBOL
SIDE
QUANTITY
PRICE
8/5/2019
ABC
123
B
200
41
8/5/2019
CDE
456
B
601
60
8/5/2019
ABC
789
S
600
70
8/5/2019
CDE
789
S
600
70
8/5/2019
FGH
456
B
200
62
8/6/2019
3CDE
456
X
300
61
8/8/2019
ABC
123
B
300
40
8/9/2019
ABC
123
S
300
30
8/9/2019
FGH
789
B
2100
71
8/10/2019
CDE
456
S
1100
63
Questions:
1) Conduct an analysis of the data set returned by your query. Write a paragraph describing your analysis. Please also note any questions or assumptions made about this data.
2) Your business user asks you to show them a table output that includes an additional column categorizing the TRADES data into volume based Tiers, with a column named ‘Tier’. Quantities between 0-250 will be considered ‘Small’, quantities greater than ‘Small’ but less than or equal to 500 will be considered ‘Medium’, quantities greater than ‘Medium’ but less than or equal to 500 will be considered ‘Large’, and quantities greater than ‘Tier 3’ will be considered ‘Very Large’ .
a. Please write the SQL query you would use to add the column to the table output.
b. Please show the exact results you expect based on your SQL query.
3) Your business user asks you to show them a table output summarizing the TRADES data (Buy and Sell) on week-by-week basis.
a. Please write the SQL query you would use to query this table.
b. Please show the exact results you expect based on your SQL query.
Notes:
1
Premise:
You need to describe in writing how to accomplish a task. Your audience has never completed this task before.
Question:
In a few paragraphs, please describe how to complete a task of your choice. You may choose a task of your own liking or one of the sample tasks below:
1) How to make a p ...
3HR StrategiesKey concepts and termsHigh commitment .docxlorainedeserre
3
HR Strategies
Key concepts and terms
High commitment management •
High performance management •
HR strategy •
High involvement management •
Horizontal fi t •
Vertical fi t •
On completing this chapter you should be able to defi ne these key concepts.
You should also understand:
Learning outcomes
T • he purpose of HR strategy
Specifi c HR strategy areas •
How HR strategy is formulated •
How the vertical integration of •
business and HR strategies is
achieved
How HR strategies can be set out •
General HR strategy areas •
The criteria for a successful HR •
strategy
The fundamental questions on •
the development of HR strategy
How horizontal fi t (bundling) is •
achieved
How HR strategies can be •
implemented
47
48 Human Resource Management
Introduction
As described in Chapter 2, strategic HRM is a mindset that leads to strategic actions and reac-
tions, either in the form of overall or specifi c HR strategies or strategic behaviour on the part
of HR professionals. This chapter focuses on HR strategies and answers the following ques-
tions: What are HR strategies? What are the main types of overall HR strategies? What are the
main areas in which specifi c HR strategies are developed? What are the criteria for an effective
HR strategy? How should HR strategies be developed? How should HR strategies be
implemented?
What are HR strategies?
HR strategies set out what the organization intends to do about its human resource manage-
ment policies and practices and how they should be integrated with the business strategy and
each other. They are described by Dyer and Reeves (1995) as ‘internally consistent bundles of
human resource practices’. Richardson and Thompson (1999) suggest that:
A strategy, whether it is an HR strategy or any other kind of management strategy must
have two key elements: there must be strategic objectives (ie things the strategy is sup-
posed to achieve), and there must be a plan of action (ie the means by which it is pro-
posed that the objectives will be met).
The purpose of HR strategies is to articulate what an organization intends to do about its
human resource management policies and practices now and in the longer term, bearing in
mind the dictum of Fombrun et al (1984) that business and managers should perform well in
the present to succeed in the future. HR strategies aim to meet both business and human needs
in the organization.
HR strategies may set out intentions and provide a sense of purpose and direction, but they are
not just long-term plans. As Gratton (2000) commented: ‘There is no great strategy, only great
execution.’
Because all organizations are different, all HR strategies are different. There is no such thing as
a standard strategy and research into HR strategy conducted by Armstrong and Long (1994)
and Armstrong and Baron (2002) revealed many variations. Some strategies are simply very
general declarations of intent. Others go into much more detail. ...
3Implementing ChangeConstruction workers on scaffolding..docxlorainedeserre
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Implementing Change
Construction workers on scaffolding.
hxdbzxy/iStock/Thinkstock
Learning Objectives
After reading this chapter, you should be able to do the following:
Summarize the nine steps in Ackerman and Anderson’s road map for change.
Analyze Cummings and Worley’s five dimensions of leading and managing change.
Describe how to align an organization with its new vision and future state.
Explain how roles/relationships and interventions are used to implement change.
Examine ways to interact with and influence stakeholders.
Change is the law of life and those who look only to the past or present are certain to miss the future.
—John F. Kennedy
Alan Mulally was selected to lead Ford in 2006 after he was bypassed as CEO at Boeing, where he had worked and was expected to become CEO. Insiders and top-level managers at Ford, some of whom had expected to become CEO, were initially suspicious and then outraged when Mulally was hired. They questioned what someone from the airplane industry would know about the car business (Kiley, 2009).
Chair William (Bill) Clay Ford, Jr.—who selected Mulally as CEO—told Ford’s officers that the company needed a fresh perspective and a shake-up, especially since it had lost $14.8 billion in 2008—the most in its 105-year history—and had burned through $21.2 billion, or 61%, of its cash (Kiley, 2009). Because Ford knew that the company’s upper echelon culture was closed, bureaucratic, and rejected outsiders and new ways of thinking, he was not surprised by his officers’ reactions. However, Ford’s managers had no idea that the company was fighting for its life. To succeed, Mulally would need Chair Ford’s full endorsement and support, and he got it.
The company’s biggest cultural challenge was to break down the silos that various executives had built. As we will discuss more in Chapter 4, silos are specific processes or departments in an organization that work independently of each other without strong communication between or among them. A lack of communication can often stifle productivity and innovation, and this was exactly what was happening at Ford.
Mulally devised a turnaround strategy and developed it into the Way Forward Plan. The plan centralized and modernized plants to handle several models at once, to be sold in several markets. The plan was designed to break up the fiefdoms of isolated cultures, in which leaders independently developed and decided where to sell cars. Mulally’s plan also kept managers in positions for longer periods of time to deepen their expertise and improve consistency of operations. The manager who ran the Mazda Motor affiliate commented, “I’m going into my fourth year in the same job. I’ve never had such consistency of purpose before” (as cited in Kiley, 2009, “Meetings About Meetings,” para. 2).
Mulally’s leadership style involved evaluating and analyzing a situation using data and facts and then earning individuals’ support with his determinatio ...
3Assignment Three Purpose of the study and Research Questions.docxlorainedeserre
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Assignment Three: Purpose of the study and Research Questions
RES 9300
Recently, Autism has become a serious health concern to parents. According to Center for Disease Control and Prevention (2018), about one in fifty nine United States children has been identified with autism spectrum disorder with one in six children developing developmental disability ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism (CDC,2018). World Health Organization (2019) estimates that 1 in 160 children globally has autism making it one of the most prevalent diseases. Despite the disease prevalence, most population has little knowledge about the disease. Many health practitioners have proposed early care as a means to control the disease effects.
Purpose Statement
The purpose of this study is to determine whether early intervention services can help improve the development of children suffering from autism. This study also aims to explore the general public awareness and perception about autism disorder.
Research Questions
(1) How should service delivery for autistic patients be improved to promote their health? (2) What impact does early intervention services have on development of children suffering from autism? (3) How can public knowledge on autism improve support and care for autistic patients? (4) What effect will early intervention have on patient’s social skills?
References
Center for Disease Control and Prevention. (2018). Autism Spectrum Disorder (ASD). Data & Statistics. Retrieved From https://www.cdc.gov/ncbddd/autism/data.html
World Health Organization. (2019). Autism Spectrum Disorders. Fact Sheet. Retrieved From https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders
3
Assignment Two: Theoretical Perspective and Literature Review
RES 9300
Literature Map
Parenting an Autism Child
(Dependent Variable)
9
Mothers/Father Role
Education
Religious Beliefs
Gender/Age
Financial Resources
Maternal Relationship
Region
Public Awareness
Support
Ethnicity
Independent Variables
Secondary Source I Will Be Using In My Literature Review
Mother/Father Roles
Glynn, K. A. (2015). Predictors of parenting practices in parents of children with autism spectrum disorder.
Religious Beliefs
Huang, C. Y., Yen, H. C., Tseng, M. H., Tung, L. C., Chen, Y. D., & Chen, K. L. (2014). Impacts of autistic behaviors, emotional and behavioral problems on parenting stress in caregivers of children with autism. Journal of Autism and Developmental Disorders, 44(6), 1383-1390.
Education
Brezis, R. S., Weisner, T. S., Daley, T. C., Singhal, N., Barua, M., & Chollera, S. P. (2015). Parenting a child with autism in India: Narratives before and after a parent–child intervention program. Culture, Medicine, and Psychiatry, 39(2), 277-298.
Financial Resources
Zaidm ...
380067.docxby Jamie FeryllFILET IME SUBMIT T ED 22- .docxlorainedeserre
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Interpretations of Iron Age Architecture Brochs in Society/Social Identity
Archaeology is a historical field which has advanced over the years based on more discoveries still being experienced by the archaeologists who seek them. According to Kelly and Thomas (2010; p.5), the concession that life existed in more ancient times than stipulated by biblical scholars and human culture allowed the archaeologists to dig deeper into genealogical data. Iron Age architecture and social/society identity relate to one another. For instance, the population, based on their identity and perception will construct buildings that directly reflect their beliefs. This essay will discuss these archaeological concepts of Iron Age architecture and society/social identity. Need a paragraph on brochs and how many and where they are across Scotland with patcialur focus on the atlantc region, this is not relevant for masters essay. Must define broch from its architecture and how long it would take to build and note famous ones and note the ones that will be referred to in this essay – this could be Perhaps incorpated into the next paragraph.
Iron Age architecture has over the years been dominated by differing archaeological concepts and debates. It was defined by settlements and settlement structures such as duns, brochs, wheelhouses, hillforts, stone-built round houses and timber. The social and societal identity which is identified through material remains indicates aspects of differentiation, regional patterns and segregation. According to Kelly and Thomas (2010; p.28), people who existed in Iron Age Scotland were isolated. This is demonstrated by the presence of a burial followed by an assembled chariot at Newbridge. Northern and western Scotland have been the source of the well-structured developments that have provided cultural, architectural and social data over time. Maes Howe, which is the largest Orkney burial cairn, located between Stromne ...
39Chapter 7Theories of TeachingIntroductionTheories of l.docxlorainedeserre
This document summarizes theories of teaching from several influential learning theorists. It discusses how theorists like Thorndike, Guthrie, Skinner, Hull, Tolman, and Gagné viewed the role of the teacher based on their behavioral and cognitive learning theories derived from animal and child studies. They generally saw teaching as managing external conditions to ensure specified behavioral changes in learners. The document then contrasts this with theories of teaching from adult learning theorists like Rogers, who rejected the notion that teaching is controlling learning and saw the teacher's role differently.
38 Monthly Labor Review • June 2012TelecommutingThe.docxlorainedeserre
38 Monthly Labor Review • June 2012
Telecommuting
The hard truth about telecommuting
Telecommuting has not permeated the American workplace, and
where it has become commonly used, it is not helpful in reducing
work-family conflicts; telecommuting appears, instead, to have
become instrumental in the general expansion of work hours,
facilitating workers’ needs for additional worktime beyond the
standard workweek and/or the ability of employers to increase or
intensify work demands among their salaried employees
Mary C. Noonan
and
Jennifer L. Glass
Mary C. Noonan is an Associate
Professor at the Department of
Sociology, The University of Iowa;
Jennifer L. Glass is the Barbara
Bush Regents Professor of Liberal
Arts at the Department of Sociol-
ogy and Population Research
Center, University of Texas at
Austin. Email: [email protected]
uiowa.edu or [email protected]
austin.utexas.edu.
Telecommuting, defined here as work tasks regularly performed at home, has achieved enough
traction in the American workplace to
merit intensive scrutiny, with 24 percent
of employed Americans reporting in recent
surveys that they work at least some hours
at home each week.1 The definitions of
telecommuting are quite diverse. In this ar-
ticle, we define telecommuters as employ-
ees who work regularly, but not exclusively,
at home. In our definition, at-home work
activities do not need to be technologically
mediated nor do telecommuters need a
formal arrangement with their employer to
work at home.
Telecommuting is popular with policy
makers and activists, with proponents
pointing out the multiple ways in which
telecommuting can cut commuting time
and costs,2 reduce energy consumption
and traffic congestion, and contribute to
worklife balance for those with caregiving
responsibilities.3 Changes in the structure
of jobs that enable mothers to more effec-
tively compete in the workplace, such as
telecommuting, may be needed to finally
eliminate the gender gap in earnings and
direct more earned income to children,
both important public policy goals.4
Evidence also reveals that an increasing num-
ber of jobs in the American economy could be
performed at home if employers were willing
to allow employees to do so.5 Often, employees
can perform jobs at home without supervision
in the “high-tech” sector, in the financial sector,
and many in the communication sector that are
technology dependent. The obstacles or barriers
to telecommuting seem to be more organiza-
tional, stemming from the managers’ reluctance
to give up direct supervisory control of workers
and from their fears of shirking among workers
who telecommute.6
Where the impact of telecommuting has
been empirically evaluated, it seems to boost
productivity, decrease absenteeism, and increase
retention.7 But can telecommuting live up to its
promise as an effective work-family policy that
helps employees meet their nonwork responsi-
bilities? To do so, tel ...
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
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हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
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Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
2. Read the case study entitled You be the Ethicist, presented at .docx
1. 2. Read the case study entitled You be the Ethicist, presented at
the end of Chapter 3 (Guido textbook). What are the compelling
rights that this case addresses? Whose rights should take
precedence? Does a child (specifically this competent 14-year-
old) have the right to determine what will happen to him?
Should he ethically have this right? How would you have
decided the outcome if his disease state had not intervened?
Now, examine the scenario from the perspective of health care
policy. How would you begin to evaluate the need for the policy
and the possible support or lack of support for the policy from
your peers, nursing management, and others who might be
affected by the policy?
Do the 10 framework questions outlined by Malone in chapter 4
(Guido textbook) assist in this process? Create a process
proposal for the organization with possible guidelines,
procedures, and policies to address the issues you have
identified.
YOU BE THE ETHICIST Until recently, Tyrell Dueck was a
normal eighth-grader in Canada, hoping that his favorite team
would win the Stanley Cup for the third time. Then, early in the
school year, he slipped climbing out of the shower and
discovered a lump on his leg. He was then diagnosed with bone
cancer. After receiving two rounds of chemotherapy and being
told that further therapy would mean the amputation of his leg,
he announced that he wanted therapy stopped. He and his
parents, devout fundamentalist Christians, decided to leave his
health in God’s hands and seek alternative therapy. The
decision sparked a court battle between his parents, who
supported Tyrell’s decision, and the health care team, who
sought to compel continued medical treatment and the planned
amputation. The battle ultimately ended when doctors said that
his cancer had spread to his lungs and that there was little more
that could be done for Tyrell.
ETHICAL QUESTIONS 1. What are the compelling rights that
2. this case addresses? 2. Whose rights should take precedence?
3. Does a child (specifically this competent 14-year-old) have
the right to determine what will happen to him? Should he
ethically have this right? 4. How would you have decided the
outcome if his disease state have not intervened?
Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues
in Nursing (Legal Issues in Nursing ( Guido)) (p. 41). Pearson
Education. Kindle Edition.
Do the 10 framework questions outlined by Malone in chapter 4
(Guido textbook) assist in this process? Create a process
proposal for the organization with possible guidelines,
procedures, and policies to address the issues you have
identified.
• What is the problem? • Where is the process? • How many
are affected? • What possible solutions could be proposed? •
What are the ethical arguments involved? • At what level is the
problem most effectively addressed? • Who is in a position to
make policy decisions? • What are the obstacles to policy
interventions? • What resources are available? • How can I get
involved? (Malone, 2005, p. 138)
Apply Guido's MORAL model to resolve the dilemma presented
in the case study described in EXERCISE 4–3 (Guido textbook).
How might the nurses in this scenario respond to the physician's
request? How would this scenario begin to cause moral distress
among the nursing staff, and what are the positive actions that
the nurses might begin to take to prevent moral distress?
MORAL DISTRESS Nurses experience stress in clinical
practice settings as they are confronted with situations
involving ethical dilemmas. Moral stress most often occurs
when faced with situations in which two ethical principles
compete, such as when the nurse is balancing the patient’s
3. autonomy issues with attempting to do what the nurse knows is
in the patient’s best interest. Though the dilemmas are
stressful, nurses can and do make decisions and implement
those decisions. Moral distress, first described within the
discipline of nursing by Jameton (1984), is a negative state of
painful psychological imbalance seen when nurses make moral
decisions, but are unable to implement these decisions because
of real or perceived institutional constraints. This author
acknowledged that there are three categories in this
phenomenon: moral uncertainty, moral dilemma, and moral
distress. Moral uncertainty is characterized by an uneasy
feeling wherein the individual questions the right course of
action. Generally, this uncertainty is short lived. Moral
dilemma, according to Jameton (1984), is characterized by
conflicting but morally justifiable courses of action. In such a
dilemma, the individual is uncertain about which course of
action should be enacted. Moral distress involves the individual
knowing the ethical course of action to take, but the individual
cannot implement the action because of institutional obstacles.
Seen as a major issue in nursing today, moral distress is
experienced when nurses are unable to provide what they
perceive to be best for a given patient. Examples of moral
distress include constraints caused by financial pressures,
limited patient care resources, disagreements among family
members regarding appropriate patient interventions, and/or
limitations imposed by primary health care providers. Moral
distress may also be experienced when actions nurses perform
violate their personal beliefs. A study by Zuzelo (2007)
concluded that the primary sources of moral distress included
the following: • Resenting physician reluctance to address
death and dying • Feeling frustrated in a subordinate role •
Confronting physicians • Ignoring patients’ wishes • Feeling
frustrated with family members • Treating patients as
experiments • Working with staff members perceived as
inadequate (pp. 353 – 356). These themes were present in
nurses practicing in multiple care settings who work with
4. various populations of patients across the lifespan. A later
study by Pauly and colleagues (2009) concluded that high
levels of moral distress for nurses in clinical settings involved
“nurses’ own feelings of competency and their confidence in
the competence of registered nurses” (p. 569). Corley (2002)
had found in an earlier study that lack of adequate education in
nursing ethics, specifically in being able to apply ethical
decision-making models, may also account for some of the
moral distress experienced by nurses in clinical settings. He
further noted that there is a relationship between moral distress,
nurse satisfaction, and nurse attrition. Moral distress may be
further subdivided into initial moral distress and reactive moral
distress (Jameton, 1993). Nurses who are experiencing initial
moral distress generally experience frustration, anger, and
anxiety when confronted with value conflicts and institutional
obstacles. This frustration, anger, and anxiety result from being
prevented from doing what the nurse sees as the correct course
of action. Reactive distress incorporates negative feelings when
the nurse is unable to act on his or her initial distress. Reactive
distress involves the inability to identify the ethical issues
involved or may result from a lack of knowledge regarding
possible alternative actions. Signs and symptoms of reactive
moral distress include powerlessness, guilt, loss of self-worth,
self-criticism, and low self-esteem and physiologic responses
such as crying, depression, loss of sleep, nightmares, and loss
of appetite. In extreme cases, moral distress may culminate in
moral outrage, causing burnout and inability to effectively care
for patients. The impact of moral distress among nurses can be
quite serious. There is evidence that moral distress com-
promises patient care and that moral distress may be
manifested in such behaviors as avoiding or withdrawing from
patients (McAndrew, Leske, & Garcia, 2011). Their study
noted that nurses who experienced moral distress may avoid
aspects of patient care, decreasing the nurse’s role as patient
advocate and further contributing to patient discomfort and
suffering. The study noted that there was a negative
5. relationship with all aspects of professional practice except for
foundations for quality care. The authors, though, additionally
noted that in this study the tool used for the study measures
foundations for quality care such as clinically competent care
and availability of ongoing education for nurses rather than
nurse reports about the quality of care actually delivered to
patients. Thus, they recommended that further research explore
the issue of moral distress and its influence on quality of care
provided to patients and family members. There are several
strategies for beginning to address moral distress in clinical
practice settings. Nurses who feel empowered to voice their
ethical concerns within their institutions may experience less
moral distress. Storch, Rodney, Brown, and Starzomski (2002)
concluded that nurses will continue to feel moral distress in
clinical settings. This conclusion was based on the participant
nurses’ ongoing concerns about the ethical nature of the
institution, appropriate resource utilization, and lack of time
for working directly with patients. These researchers noted,
though, that there is an important relationship between ethics
and power. When nurses have the ability to raise legitimate
ethical concerns, power is manifested in ways that affect
quality practice environments and allows the nurses to better
cope with moral distress. Additional aspects that may assist in
reducing moral distress among nurses in nursing care settings
include educating nurses about the concept and offering
opportunities to discuss moral distress in neutral settings.
Information about moral distress should be part of orientation
programs for new employees. Other means of reducing moral
distress include identifying and addressing impediments to
delivery of quality nursing care, incorporating conflict
resolution and mediation techniques so that nurses can work
through their concerns and bring them to closure, and allowing
nurses to serve on the institution ethics committees. This latter
means of working with moral distress encourages nurses not
only to identify and understand resources that are available to
them, but also to use these valuable resources. These strategies
6. may also improve working relationships with peers,
management staff, and other members of the interdisciplinary
health care team. Finally, establishing systems that value the
active participation of nurses in clinical and ethical decision
making,
encouraging and rewarding collaborative teamwork, and open
communications assist nurses in appropriately dealing with
moral distress. Individual nurses, though, have learned to
employ additional strategies in preserving their dignity and in
compensating patients for perceived wrongdoing (McCarthy &
Deady, 2008). These strategies include self-care, such as
working on a part-time basis and accepting personal
limitations; assertiveness; collective action; and reexamining
basic nursing ethical values. Lutzen and colleagues (2003)
noted that moral distress can also be an energizing factor that
results in the person having an enhanced feeling of
accomplishment of professional goals. They concluded that
moral distress may begin to make individuals more aware of
their own beliefs and strive to handle ethical issues more
effectively in future encounters. EXERCISE 4–3 Mrs. R., an
87-year-old patient, has a past history that includes coronary
artery disease, a previous stroke, and advanced Alzheimer’s
disease. Ten days ago, Mrs. R. was hospitalized for aspiration
pneumonia and has been ventilator dependent since being
admitted to the intensive care unit in a small rural hospital.
Family members visit daily and have repeatedly voiced their
concern to the nursing staff about the continued ventilator
support that Mrs. R. is receiving, most notably the fact that
Mrs. R. would never have wanted such care. They also note
that Mrs. R. has not recognized them in past months and that
they plan to visit less in future days, but can be contacted
should any change in Mrs. R.’s condition occur. Her primary
physician has practiced in this community for multiple years;
he is well-known for his reluctance to discontinue any type of
life support for any patient. When questioned, Dr. G.’s
consistent response is, if this were his frail 92-year-old mother,
7. he would prescribe the very same treatment for her. Dr. G. has
now requested that the nurses talk to the family about moving
Mrs. R. to a major medical center, where she can receive more
advanced care, including vigorous rehabilitation and physical
therapy, so that she may eventually return to a long-term
nursing care facility. How might the nurses in this scenario
respond to the physician’s request? How would this scenario
begin to cause moral distress among the nursing staff and what
are the positive actions that the nurses should begin to take to
prevent moral distress.
2. Read the case study entitled You be the Ethicist, presented at
the end of Chapter 3 (Guido textbook). What are the compelling
rights that this case addresses? Whose rights should take
precedence? Does a child (specifically this competent 14-year-
old) have the right to determine what will happen to him?
Should he ethically have this right? How would you have
decided the outcome if his disease state had not intervened?
Now, examine the scenario from the perspective of health care
policy. How would you begin to evaluate the need for the policy
and the possible support or lack of support for the policy from
your peers, nursing management, and others who might be
affected by the policy?
Do the 10 framework questions outlined by Malone in chapter 4
(Guido textbook) assist in this process? Create a process
proposal for the organization with possible guidelines,
procedures, and policies to address the issues you have
identified.
YOU BE THE ETHICIST Until recently, Tyrell Dueck was a
normal eighth-grader in Canada, hoping that his favorite team
would win the Stanley Cup for the third time. Then, early in the
school year, he slipped climbing out of the shower and
discovered a lump on his leg. He was then diagnosed with bone
cancer. After receiving two rounds of chemotherapy and being
told that further therapy would mean the amputation of his leg,
he announced that he wanted therapy stopped. He and his
parents, devout fundamentalist Christians, decided to leave his
8. health in God’s hands and seek alternative therapy. The
decision sparked a court battle between his parents, who
supported Tyrell’s decision, and the health care team, who
sought to compel continued medical treatment and the planned
amputation. The battle ultimately ended when doctors said that
his cancer had spread to his lungs and that there was little more
that could be done for Tyrell.
ETHICAL QUESTIONS 1. What are the compelling rights that
this case addresses? 2. Whose rights should take precedence?
3. Does a child (specifically this competent 14-year-old) have
the right to determine what will happen to him? Should he
ethically have this right? 4. How would you have decided the
outcome if his disease state have not intervened?
Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues
in Nursing (Legal Issues in Nursing ( Guido)) (p. 41). Pearson
Education. Kindle Edition.
Do the 10 framework questions outlined by Malone in chapter 4
(Guido textbook) assist in this process? Create a process
proposal for the organization with possible guidelines,
procedures, and policies to address the issues you have
identified.
• What is the problem? • Where is the process? • How many
are affected? • What possible solutions could be proposed? •
What are the ethical arguments involved? • At what level is the
problem most effectively addressed? • Who is in a position to
make policy decisions? • What are the obstacles to policy
interventions? • What resources are available? • How can I get
involved? (Malone, 2005, p. 138)
Apply Guido's MORAL model to resolve the dilemma presented
in the case study described in EXERCISE 4–3 (Guido textbook).
9. How might the nurses in this scenario respond to the physician's
request? How would this scenario begin to cause moral distress
among the nursing staff, and what are the positive actions that
the nurses might begin to take to prevent moral distress?
MORAL DISTRESS Nurses experience stress in clinical
practice settings as they are confronted with situations
involving ethical dilemmas. Moral stress most often occurs
when faced with situations in which two ethical principles
compete, such as when the nurse is balancing the patient’s
autonomy issues with attempting to do what the nurse knows is
in the patient’s best interest. Though the dilemmas are
stressful, nurses can and do make decisions and implement
those decisions. Moral distress, first described within the
discipline of nursing by Jameton (1984), is a negative state of
painful psychological imbalance seen when nurses make moral
decisions, but are unable to implement these decisions because
of real or perceived institutional constraints. This author
acknowledged that there are three categories in this
phenomenon: moral uncertainty, moral dilemma, and moral
distress. Moral uncertainty is characterized by an uneasy
feeling wherein the individual questions the right course of
action. Generally, this uncertainty is short lived. Moral
dilemma, according to Jameton (1984), is characterized by
conflicting but morally justifiable courses of action. In such a
dilemma, the individual is uncertain about which course of
action should be enacted. Moral distress involves the individual
knowing the ethical course of action to take, but the individual
cannot implement the action because of institutional obstacles.
Seen as a major issue in nursing today, moral distress is
experienced when nurses are unable to provide what they
perceive to be best for a given patient. Examples of moral
distress include constraints caused by financial pressures,
limited patient care resources, disagreements among family
members regarding appropriate patient interventions, and/or
limitations imposed by primary health care providers. Moral
distress may also be experienced when actions nurses perform
10. violate their personal beliefs. A study by Zuzelo (2007)
concluded that the primary sources of moral distress included
the following: • Resenting physician reluctance to address
death and dying • Feeling frustrated in a subordinate role •
Confronting physicians • Ignoring patients’ wishes • Feeling
frustrated with family members • Treating patients as
experiments • Working with staff members perceived as
inadequate (pp. 353 – 356). These themes were present in
nurses practicing in multiple care settings who work with
various populations of patients across the lifespan. A later
study by Pauly and colleagues (2009) concluded that high
levels of moral distress for nurses in clinical settings involved
“nurses’ own feelings of competency and their confidence in
the competence of registered nurses” (p. 569). Corley (2002)
had found in an earlier study that lack of adequate education in
nursing ethics, specifically in being able to apply ethical
decision-making models, may also account for some of the
moral distress experienced by nurses in clinical settings. He
further noted that there is a relationship between moral distress,
nurse satisfaction, and nurse attrition. Moral distress may be
further subdivided into initial moral distress and reactive moral
distress (Jameton, 1993). Nurses who are experiencing initial
moral distress generally experience frustration, anger, and
anxiety when confronted with value conflicts and institutional
obstacles. This frustration, anger, and anxiety result from being
prevented from doing what the nurse sees as the correct course
of action. Reactive distress incorporates negative feelings when
the nurse is unable to act on his or her initial distress. Reactive
distress involves the inability to identify the ethical issues
involved or may result from a lack of knowledge regarding
possible alternative actions. Signs and symptoms of reactive
moral distress include powerlessness, guilt, loss of self-worth,
self-criticism, and low self-esteem and physiologic responses
such as crying, depression, loss of sleep, nightmares, and loss
of appetite. In extreme cases, moral distress may culminate in
moral outrage, causing burnout and inability to effectively care
11. for patients. The impact of moral distress among nurses can be
quite serious. There is evidence that moral distress com-
promises patient care and that moral distress may be
manifested in such behaviors as avoiding or withdrawing from
patients (McAndrew, Leske, & Garcia, 2011). Their study
noted that nurses who experienced moral distress may avoid
aspects of patient care, decreasing the nurse’s role as patient
advocate and further contributing to patient discomfort and
suffering. The study noted that there was a negative
relationship with all aspects of professional practice except for
foundations for quality care. The authors, though, additionally
noted that in this study the tool used for the study measures
foundations for quality care such as clinically competent care
and availability of ongoing education for nurses rather than
nurse reports about the quality of care actually delivered to
patients. Thus, they recommended that further research explore
the issue of moral distress and its influence on quality of care
provided to patients and family members. There are several
strategies for beginning to address moral distress in clinical
practice settings. Nurses who feel empowered to voice their
ethical concerns within their institutions may experience less
moral distress. Storch, Rodney, Brown, and Starzomski (2002)
concluded that nurses will continue to feel moral distress in
clinical settings. This conclusion was based on the participant
nurses’ ongoing concerns about the ethical nature of the
institution, appropriate resource utilization, and lack of time
for working directly with patients. These researchers noted,
though, that there is an important relationship between ethics
and power. When nurses have the ability to raise legitimate
ethical concerns, power is manifested in ways that affect
quality practice environments and allows the nurses to better
cope with moral distress. Additional aspects that may assist in
reducing moral distress among nurses in nursing care settings
include educating nurses about the concept and offering
opportunities to discuss moral distress in neutral settings.
Information about moral distress should be part of orientation
12. programs for new employees. Other means of reducing moral
distress include identifying and addressing impediments to
delivery of quality nursing care, incorporating conflict
resolution and mediation techniques so that nurses can work
through their concerns and bring them to closure, and allowing
nurses to serve on the institution ethics committees. This latter
means of working with moral distress encourages nurses not
only to identify and understand resources that are available to
them, but also to use these valuable resources. These strategies
may also improve working relationships with peers,
management staff, and other members of the interdisciplinary
health care team. Finally, establishing systems that value the
active participation of nurses in clinical and ethical decision
making,
encouraging and rewarding collaborative teamwork, and open
communications assist nurses in appropriately dealing with
moral distress. Individual nurses, though, have learned to
employ additional strategies in preserving their dignity and in
compensating patients for perceived wrongdoing (McCarthy &
Deady, 2008). These strategies include self-care, such as
working on a part-time basis and accepting personal
limitations; assertiveness; collective action; and reexamining
basic nursing ethical values. Lutzen and colleagues (2003)
noted that moral distress can also be an energizing factor that
results in the person having an enhanced feeling of
accomplishment of professional goals. They concluded that
moral distress may begin to make individuals more aware of
their own beliefs and strive to handle ethical issues more
effectively in future encounters. EXERCISE 4–3 Mrs. R., an
87-year-old patient, has a past history that includes coronary
artery disease, a previous stroke, and advanced Alzheimer’s
disease. Ten days ago, Mrs. R. was hospitalized for aspiration
pneumonia and has been ventilator dependent since being
admitted to the intensive care unit in a small rural hospital.
Family members visit daily and have repeatedly voiced their
concern to the nursing staff about the continued ventilator
13. support that Mrs. R. is receiving, most notably the fact that
Mrs. R. would never have wanted such care. They also note
that Mrs. R. has not recognized them in past months and that
they plan to visit less in future days, but can be contacted
should any change in Mrs. R.’s condition occur. Her primary
physician has practiced in this community for multiple years;
he is well-known for his reluctance to discontinue any type of
life support for any patient. When questioned, Dr. G.’s
consistent response is, if this were his frail 92-year-old mother,
he would prescribe the very same treatment for her. Dr. G. has
now requested that the nurses talk to the family about moving
Mrs. R. to a major medical center, where she can receive more
advanced care, including vigorous rehabilitation and physical
therapy, so that she may eventually return to a long-term
nursing care facility. How might the nurses in this scenario
respond to the physician’s request? How would this scenario
begin to cause moral distress among the nursing staff and what
are the positive actions that the nurses should begin to take to
prevent moral distress.
Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues
in Nursing (Legal Issues in Nursing ( Guido)) (p. 48). Pearson
Education. Kindle Edition.