And ethical dilemma encountered in my practice setting was a case of a 68-year-old woman admitted with an overdose of metoprolol and some other medication she could not identify. During the intake in the emergency department, the patient admitted she did it on purpose because she is tired of taking care of her bedridden mother. The patient further stated that as she took the pills, she thought about jumping in front of a moving vehicle to kill herself. I believe in the fact every situation has a solution, one that is not expected but at that moment that is the best option.
I believe she did have the choice of asking for help from other family members or having her mother admitted to a nursing home. I was assigned to admit and plan her care, but my thinking and moral principles led me to have a moral and ethical dilemma. I was having doubts about giving her the best possible attention, and not think less of her for the decision and choices she has made, and at the same time be sympathetic, understanding and not judgmental. Clinical decision making plays a vital role in the APN practice of nursing, it has both moral and ethical component and requires the use of critical thinking (Callahan & Mannino, 2011).
As stated by Callahan and Mannino (2011), the use of critical reasoning ensures the best outcome and eliminates the use of errors, “ignorance, personal bias or strong paternalism” (pg. 310). I choose to use shared decision making (SDM) to work through the situation. SDM is described as a method where clinicians and patients use the best-presented evidence to work through the situation to formulate decisions; patients are advised and aided to deliberate on options, to choose informed preferences (Elwyn et al. , 2012).
The SDM is patient centered with guiding ethical principles, and it is based on the fundamentals of the clinician appreciating a patient’s individual self-determination and the need to support the patients to achieve this goal (Elwyn et al. , 2012). In applying this principle to my ethical dilemma as an advanced practice nurse (APN), I realized that I owe the patient the chance to work through her issues with my assistance, my role is to present options for the patient to decide which one works best for her, wherever feasible. Putting my opinions aside allowed me to be there for the patient and not neglect her in her time of need.
I needed to acknowledge the fact that the patient’s need support, which is one of the bases for SDM, recognizing the need to support independence through establishing positive relationships, respecting both individual competence and interdependence on others (Elwyn et al. , 2012). As indicated by Elwyn et al. , (2012), selfdetermination theory is related to our inherent tendencies to safeguard and preserve our well-being.
The application of the SDM for clinical practice, helps the APN to use three distant steps to work through the patient’s problem, namely: choice talk, option talk and decision talk (Elwyn et al. 2012). During the choice talk phase, the APN ensures that the patients know that there are other viable options available. Detailed information is presented during option talk, and in the decision talk phase the best choice is selected with support from the APN (Elwyn et al. , 2012). In resolving an ethical situation, it is prudent for the APN to analyze the problem by gathering data and considering the benefits for the patient, formulating a plan before making a final decision (Buppert, 2015).
Discuss the legal documents that create the framework for the nursing educator role, and competencies and nurse practice act that apply to the nurse educator’s role. The nurse educator’s role in today’s healthcare elivery system has become even more essential and crucial in training, inspiring and motivating and challenging students while upholding the integrity of the profession to a higher standard to produce nurse who is knowledgeable, skilled, critical thinkers with the sound decision-making process.
The science of nursing is health promotion, disease prevention, or disease management, the aim of the masters-prepared nurse educator there is to strengthen and impact this knowledge onto students based on a particular framework to ensure uniformity in the curriculum of the nursing education. According to Adam (2014), the National League for Nursing (NLN) mission with respects to nurse educators is to uphold excellence to create a solid foundation and eliminate disparate in the workforce to advance the health of the nation.
Nurse educators are therefore prepared to have qualities the displays integrity, diversity, and caring (Adam, 2014). The conceptual and legal framework of the nurse educator program is based on the excellence model of the National League for Nursing and describes eight core elements required to achieve and sustain this excellence as well as many of the components relevant to each of the eight core elements (National League for Nursing [NLN], 2016).
The eight elements of the excellence model include: clear program standards and hallmarks that raise expectations; well-prepared faculty; qualified students; well-prepared educational administrators; evidence-based programs and teaching/evaluation methods; quality and adequate resources, student-centered, interactive, and innovative programs and curricula; recognition of expertise (NLN, 2016).
The excellence model allows for nurse educators to address the essential components required to attain and maintain excellence in nursing education to prepare faculty members to be student-centered, interactive, innovative programs and curricula to prepare qualified students using evidence-based programs and teaching/evaluation methods to ensure the best possible outcome of producing exceptional dedicated and skilled nursing students (Adam, 2014).
Competencies for the nurse educator’s role encourage, endorses the nursing education as a specialty area of practice and designed as a means for nurse educators to ultimately demonstrate the richness and complexity of the role (NLN, 2013). The basis of the NLN Core Competencies is rooted in the Scope of Practice for Academic Nurse Educators (2013) (NLN, 2013).
The NLN aligns the nine core competencies of the nurse educator with scope of practice, these are: “facilitating learning; facilitate learner development and socialization; use assessment and evaluation strategies; participate in curriculum design and evaluation of program outcomes; function as a change agent and leader; pursue continuous quality improvements in the nurse educator role; engage in scholarship, and function within the educational environment” (NLN, 2013).
How will you apply the most important ingredient, integrity, to your practice? Integrity is one of the essential characteristics of the nursing profession regardless of the settings. Integrity can be a choice or nurture and a requirement as a core value in nursing. As a nurse educator, I plan on applying academic integrity to every aspect of the curriculum in the classroom and clinical setting. I plan to establish trust, build the ability to influence, prove to the students that I am worth to lead them (Maxwell, 2005).
As a nursing educator, my actions reflect on the conduct of the student’s behavior and the positive outcome of their education; I, therefore, must set the tone for integrity, honesty, moral and ethical principles among the students by the examples I set for them to follow. I will apply these qualities by setting the example of conducting myself in a proper manner, by incorporating honor codes that ensure open communication, about my behavior expectation and well as the students.
As a leader, I must set an example to lead by integrity and honesty, not allow myself to act in duplicity, and as stated by Maxwell (2005), a leader must be authentic to earn trust. Nursing is a profession of that integrity, honesty, trust, ethical and morally sound, respect and responsibility mean everything, it is the same qualities that I will imbue the students with, showing them the way.
The students of today will become health care providers and leaders for the future of nursing; therefore they need a sound foundation rooted deep in what makes the nursing profession the most honest among other occupations. I know I can only succeed with the student if I show them what it means to have integrity, and I will do that through my way of teaching, inspiring, role modeling, influencing and leading as an educator (Maxwell, 2005).
