Nursing Ethics Research Paper

Ethics Paper
Christina Noto
Arizona State University Ethics Paper
Nurses should be concerned about values and laws that pertain to patients. There should be concern for those patients that are homeless without insurance and not receiving the care that they should because it goes against the ethical principle beneficence, to remove and do no harm. Beneficence, is one of the primary ethical principles that guides us to do good for our patients (Epstein & Ward, 2016). Ethical principles provide the foundation for nurses and the duties that they perform (Epstein & Ward, 2016). The Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, allows patients to be treated in emergency situations regardless of their means to pay (Dunford,
Buchanon, & Jain, 2009). Nurses hold the responsibility to treat patients by not causing harm, not inflicting harm, but rather prevent or remove harm (Epstein & Ward, 2016). The ANA Code of Ethics (2016), states that it is the nurse’s obligation to focus on the needs of the patient. Nurses follow ethical values to help with decisions on giving patients the care that they need.
Ethical Principle The ethical principle, Beneficence, pertains to the scenario where a homeless man without insurance is not getting the care that he needs. Beneficence, means to do good for our patients and remove harm (Epstein & Ward, 2016). A clinical case by, Dunford, Buchanan & Jain (2009), in the American Medical Association Journal of ethics, presented a patient that was well known to the hospital who came in not feeling well. They performed numerous tests that showed no significant findings. The doctor was aware that despite the negative test results her patient was hungry, cold, and not in great health due to his living situation. She also knew that if sent back out on the street, he might come back in worse shape. The doctor asked herself, should she drain the hospital resources to provide the basic elements of survival, check out his complaints each time he comes to the hospital, and what should her treatment plan be for this particular visit. When looking at the above scenario, it presents the ethical principle, Beneficence which is to remove harm. If treatment is not given because medical staff feel that it is pointless, then beneficence is void. Some patients may not be able to take care of themselves once they leave the hospital, but that does not mean that they should get suboptimal care while in the hospital (Dunford, Buchanon, & Jain, 2009). During nursing school, we were taught that it is not about us and our needs but the patients. While some facilities do not have all the resources or funds to give a patient the care that they need, it is still a duty to do our best.
Provision
American Nurses Association [ANA] of 2015, has written that Provision 5 includes that nurse’s duty is to self and others which includes the responsibility to health and safety. Our duties as nurses are to respect others despite their living situation or their ability to pay for medical care. Nurses promote health and safety to ensure that patients leave the hospital with short term goals met and long term goals in action. The ANA (2015), in provision 5 section 5.2, wrote that as professionals we assess, intervene, evaluate, protect, promote, advocate, educate and conduct research for the health and safety of others. While the code of ethics provision 5 talks about the duties to others to promote health, safety and well-being; it can be challenging when faced with moral distress.
Moral distress, has two parts, the first happens when you know what ethical responsibilities should be done but cannot because of restrictions within the work environment (Epstein & Ward, 2016). An example of this would be when your supervisor tells you to discharge a homeless man because the tests say that he is fine, but you know overall he could use help with basic food, shelter and water. The second part to moral distress is called moral residue. Moral residue happens after a situation has passed and can last for years with vivid memories of the complex situation that can leave one frustrated and angry when they cannot provide the patient with optimal care (Epstein & Ward,
2016). Nurses have professional and personal identities that are a part of their profession that help mold their personal values. In return, being aware of their own personal values while working through tough situations at work will allow them to help the patients without being biased to the patient’s needs. Nurses should be aware of unintended influence of their own values when assisting others and provide compassionate, respectful, competent care (American Nurses Association, 2015).
Federal Statute The Emergency Medical Treatment Act is a federal law that says anyone who comes to the emergency room is to be stabilized and/or treated to a point if they need to be transferred somewhere else, regardless of the financial status.
It was originally designed to prevent hospitals from turning away patients due to their ability to pay (American College of Emergency Physicians, 2014). Emergency Medical Treatment and Labor Act (EMTALA) of 1986, states that in section (h) that there should be no delay in treatment if the patient can pay or not. The definition used for the term “emergency medical condition” includes serious dysfunction and serious impairment (EMTALA, 1986). The determination by the hospital on who will pay for the care and how will the hospital survive if they treat patients who cannot pay, should also not be a factor if they get the care that they need. Also, regardless if the patient is a frequent flyer, this should not be factor in suboptimal
care. The homeless man receiving substandard care questions the EMTALA act of 1986. Was the homeless patient stable enough to leave the hospital if they discharged him? Was the patient treated with the same care that someone with insurance would have been? Was the patient at least given help with the basic needs of life such as food, water or shelter? A provision of EMTALA is that an examination and treatment cannot be delayed to inquire if the patient can pay for services or not (ACEP, 2014).
Even when we cannot provide certain resources at the hospital, there are always ways to try and help. Most hospitals have social workers that can help direct patients to shelters, food coupons and bus passes. The EMTALA act helps to protect the patients and their rights to be treated and nurses also have the right to advocate for their patients to be treated.
Conclusion
Nurses are faced with many clinical challenges while at work. During emergency visits or routine exams, each patient should be treated with equal respect. Regardless if you are homeless or not, should not be a factor whether you get care. There are numerous individuals that come into the emergency department that spend years on the streets with untreated illnesses, mental conditions and poverty (Dunford, Buchanon, & Jain, 2009). Beneficence, to do good and prevent harm can be difficult as emergency visits only help short term and are not available for continued care such as a clinic. It may not be intentional if a nurse or doctor cannot provide optimal care, but it should be attempted. The EMTALA act of 1986, is beneficial to patients who need care but can also threaten hospitals that need payment to stay open. As stated by the ANA, provision 5 reiterates that it is a duty for medical personnel to provide health and safety. Our responsibility is to our patients and not to pass judgment.