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Ethics in DNP Practice

Published January 21, 2015 8:46 AM by Walton Reddish

Morrison and Furlong (2013) identify the four major ethical theories - nonmaleficence, beneficence, autonomy and justice - and apply them to healthcare. It is the ethical responsibility of the provider to ensure that these principles are upheld, regardless of the work load or stresses of the office practice.

  • Nonmaleficence: The first thought in any provider's mind has to be to prevent further harm to the patient. Even in a busy practice, the APN must take the time to listen to the patient, review the history, and make a diagnosis. Hurrying through any of these steps can result in misdiagnosis, missed drug allergies or interactions, and potential harm to the patient. It is important that the APN remains in control of the patient schedule and to never allow the schedule to build to the point that the patient is placed in jeopardy.
  • Beneficence: The concept of beneficence goes beyond prescribing the appropriate treatment. The APN must also narrow the studies and treatment to only those things that will aid in the diagnosis or treatment of the condition. In a healthcare environment where the emphasis is on maximum billing, the provider must be mindful of the orders that are written and the services that are being billed. If, for example, MRIs are being ordered because the office manager thinks that the office owned MRI is being underutilized, then the patient's best interests are not being met.
  • Autonomy:  As Morrison and Furlong (2013) point out, the ethics of healthcare go beyond doing good and not doing harm. As the provider considers the treatment options, it is imperative that the competent patient (or the surrogate for a patient unable to make decisions) is a working member of the decision making team. The APN must be careful to make sure that the patient is properly informed and that they understand that information. The good intentions of nonmaleficence and beneficence mean very little if the provider acts against the patient's wishes.
  • Justice: Finally, the busy provider must be careful to deliver the same quality of care to every patient. Every provider encounters patients who try their patience or who do not fit the provider's concepts of responsible behavior. Despite their internal conflict with the individual's personality or lifestyle, the APN must focus on the presenting problem and treat that problem as they would with any other patient. There are times when the treatment options are narrowed by the insurance coverage or the patient's ability to pay. It is the provider's responsibility to explore every option to find affordable options or to help the patient find ways to finance the care they need. It is not enough to simply write a prescription when the patient does not have the resources to fill it.

For many providers, the ethical concepts relayed by Morrison and Furlong (2013) are the tenets by which they practice. While they may not use the same words to describe what they do, the basic philosophies are the same.   

Morrison, E.E., & Furlong, B. (2013). Health care ethics: Critical issues for the 21st century (3rd ed.). Sudbury, MA: Jones & Bartlett Learning.

posted by Walton Reddish

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