Interprofessional Organizational and Systems Leadership

Interprofessional Organizational and Systems Leadership

Doody and Noonan (2016) define ethics as a system of principles that can considerably
change previous thoughts, actions, and decisions of people. Ethics is an essential measure to
protect society and guide a person’s actions in regard to right and wrong in regard to oneself and
society at large (Marquis and Huston, 2015). To make appropriate ethical decisions, the
manager/leader must have knowledge of ethical principles and frameworks (Marquis and
Huston, 2015). They must also perform with a style of leadership that excludes trial and error
and places emphasis on decision-making models (Marquis and Huston, 2015). The purpose of
this assignment is to introduce the conceptual frameworks and the ethical constructs of ethics and
to display an ethical dilemma that has been encountered during my nursing practice.
Conceptual Frameworks of Ethics
Often nurses are faced with ethical dilemmas more than they would like. The nurses are
then charged to make difficult decisions. The ethical decisions made daily by nurses are apparent
in the outcomes of the people they care for (ETHICS IN NURSING, 2015). The daily decisions
made when providing end-of-life care become more burdensome depending on the age,
competence and abilities of the patient. According to Karlsson, Karlsson, Barbosa da Silva,
Berggren, and Soderlund (2013) community nurses are more responsible for sophisticated tasks
and face difficult decisions when caring for dying people at home. They require both skills and
knowledge when facing ethical issues that may prevent them from providing the best end-of-life
care (Karlsson et al., 2013).
According to Marquis and Huston (2015) ethical frameworks guide individuals in solving
ethical dilemmas. These frameworks provide the assistance needed for managers to be able to
clarify personal values and beliefs to solve ethical problems. The most commonly used ethical TAKING A STAND 3 frameworks are utilitarianism, duty-based reasoning, rights-based reasoning, and intuitionism
(Marquis and Huston, 2015).
Utilitarianism uses an ethical framework that supports decision making based on what
provides the greatest good for the greatest number of people (Marquis and Huston, 2015). When
this is done, the needs and wants of the people are taken away (Marquis and Huston, 2015). It is
proposed in utilitarianism, that the end can justify the means (Marquis and Huston, 2015).
Duty-based reasoning is the framework based on the belief that some decisions must be
made because there is a duty to do something or the duty to shun doing something (Marquis and
Huston, 2015). An example provided by Marquis and Huston (2015) is the hiring of the most
qualified person for the job even if it costs more money. Rights-based reasoning is based on the
belief that some things are a person’s just due (Marquis and Huston, 2015). The example given in
the literature is two applicants have the right to fair and impartial consideration of their
applications (Marquis and Huston, 2015).
The intuitionist framework allows the manager or leader to view each issue individually
and compare the relative weights of goals, duties and rights for each ethical dilemma (Marquis
and Huston, 2015). The weighing is determined by the intuition of the leader/manager.
Principles of Ethical Reasoning
The principles of ethical reasoning further explore and define what beliefs or values form
the basis for decision making (Marquis and Huston, 2015). According to Marquis and Huston
(2015) respect is the most basic and universal ethical principle for the people.
Autonomy is when one accepts responsibility for the decision that has been made
(Marquis and Huston, 2015). Self-determination supports this moral principle. The literature
states that an employee has the choice to meet the standards of an organization and if they don’t TAKING A STAND 4 disciplinary action can be taken. Autonomy allows patients to make decisions for themselves
concerning their care. The decision takes away a one’s right to self-determination is serious but it
is the responsibility of the leader/manager to know when this is needed.
Beneficence is described as the actions one takes should be done in an effort to promote
good (Marquis and Huston, 2015). If one cannot do good, then no harm should be done. This is
defined as nonmaleficence (Marquis and Huston, 2015). Other principles included in beneficence
are paternalism, utility, justice, veracity, fidelity and confidentiality (Marquis and Huston, 2015).
Paternalism is related to beneficence in that one person takes the authority to make
decisions for another (Marquis and Huston, 2015). Paternalism limits freedom of choice but is
believed to protect a person from harm (Marquis and Huston, 2015). Leaders/managers
demonstrate this principle when they believe they know the short and long-term goals of the
employee better than the actual employee (Marquis and Huston, 2015).
The principle of utility perceives that what is best for the common good outweighs what
is best for the individual (Marquis and Huston, 2015). Managers utilizing this principle have to
be careful not to become less humanistic (Marquis and Huston, 2015).
According to the principle justice, people that are equal should be treated equally and
those that are not should be treated as such (Marquis and Huston, 2015). The leader or manager
using this principle will apply pay raises and incentives according to the work performance of
the individual.
Veracity explains how people feel about the need to tell the truth (Marquis and Huston,
2015). This principle is perceived as it’s ok to tell a “small white lie”. The literature uses the
example; multiple job applicants were received for a particular position and only one applicant TAKING A STAND 5 was hired, the others were told by the leader that they were highly considered for the job whether
they had been or not (Marquis and Huston, 2015).
Fidelity is the principle that holds individuals to their word and commitment to others
(Marquis and Huston, 2015). If a promise is made, it should be kept.
Confidentiality is a basic and ethical principle of the nursing and medical profession. As
nurses it is our duty to maintain the confidentiality of patient information. However, there are
times when this is overridden by nurse managers or leaders in cases legally required by law such
as abuse (Marquis and Huston, 2015).
The Ethical Dilemma
Working in community healthcare and caring for terminally ill patients, I am often faced
with ethical dilemmas concerning patients’ right to refuse treatment. Recently there was a patient
that was mentally competent to make his own decisions but he was disable physically. The
patient was nineteen years of age and had a diagnosis of stomach cancer. The patient had taken
several rounds of chemotherapy but had decided he was tired of treatments and opted to stop.
Although the oncologist recommended the treatments and thought it to be helpful with a positive
outcome, the patient continued to refuse. The family was irate with the patient’s decision and was
constantly wanting myself and my coworkers to discuss this matter with the patient.
On behalf of the patient I arranged a family meeting that involved the social worker,
patient and family. The family found it difficult to agree with the patient’s decision because of
what they had been told by the physician. They were attempting to find ways to ignore the rights
and wishes of the patient to satisfy their wants. With the help of the social worker, the patient’s
rights were explained and preserved. At the end of the meeting everyone was supportive of the
patient’s decision because it was what he wanted. In this situation, autonomy and beneficence TAKING A STAND 6 were observed. Even though the patients right to refuse further treatment may not prolong his
life, he will have a better quality of life in the days he has left.
The Role of Advocate
According to Flemming (2015) the challenges in healthcare are constant and intense. The
support and guidance of the American Nurses Association (ANA) have been made evident by the
establishment of policies and standards that guide nursing practice. Thacker (2008) writes that
nursing professionals are in key positions to support end-of-life decisions and to advocate for
patients and families across all health care settings. Advocacy has been identified as the common
thread of quality end-of-life nursing care (Thacker, 2008). Dilemmas such as those associated
with the refusal of treatment can be viewed as not upholding the patient’s rights. Advocacy is
embedded in nursing practice and is therefore the nurses’ responsibility to protect the health and
well-being of the patient receiving the care (Thacker, 2008).
Nurses have legal and ethical obligations to uphold the rights of those in their care.
Patients have the right to receive or deny treatment if they choose. As a nurse advocate for my
patients, it is my responsibility to be aware and knowledgeable of the laws that protect my
patients. If our patients are unable to make decisions for themselves, as nurses we may have to
help them at times. Nurses are legally and ethically bound by their oaths to preserve the rights of
the patients in their care.
Leadership Style
According to the Keirsey Temperament Sorter II (KTS-II) (2015) my personality type is
that of the guardian. The KTS-II (2015) describes the guardian as the cornerstone of society and
are the temperament given to serving and preserving the most important social institutions. They
are also described as having a natural ability to keep things running smoothly in their families, TAKING A STAND 7 communities, schools, churches, hospitals, and businesses (KTS-II, 2015). I feel that becoming a
nurse was my calling and I’m fulfilling my life long purpose.
Guardians also know how to have fun but are quite serious about their duties and
responsibilities. The guardian is also described as dependable and trustworthy. This is a very true
description of myself. I take pride in being dependable and knowing that my friends, coworkers,
and family can count on me. My role in the ethical dilemma described above illustrates these
traits.
Summary
In my years as a nurse, I have always found it to be an honor to serve my patients.
Upholding their rights is an ultimate obligation of mine and is for every nurse to understand and
be knowledgeable of the rules and laws of ethics. As a leader/manager I find comfort in the
ability to make difficult decisions with the knowledge that I have obtained through my studies
and my experiences during my career. Ethical dilemmas can be challenging and difficult to solve
but with the application of the principles of autonomy and beneficence, these decisions are made
easier. My personality as a guardian has made me realize that I am definitely what I am supposed
to be in life, a nurse. TAKING A STAND 8 References
Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance and application in practice.
British Journal Of Nursing, 25(14), 803-807
ETHICS IN NURSING. (2015). Queensland Nurse, 34(3), 28-31.
Fleming, D. A. (2015). The Moral Agency of Physician Organizations: Meeting Obligations to
Advocate for Patients and the Public. Annals Of Internal Medicine, 163(12), 918-921.
doi:10.7326/M15-2527
http://www.keirsey.com/sorter/register.aspx
Karlsson, M., Karlsson, C., Barbosa da Silva, A., Berggren, I., & Söderlund, M. (2013).
Community nurses’ experiences of ethical problems in end-of-life care in the patient’s
own home. Scandinavian Journal Of Caring Sciences, 27(4), 831-838.
doi:10.1111/j.1471-6712.2012.01087.x
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing:
Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Thacker, K. (2008). Nurse’s advocacy behaviors in end-of-life nursing care. Nursing Ethics,
15(2), 174-185. Doi:10.1177/0969733007086015

 

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