Compare_and_Contrast_the_Operation_of_Traditional_Economic_Markets_with_Political_and_Health_Care_Markets

Assignment 4, February 11, Ethics 1. Think about your own personal and professional value system. How might they influence how you approach your involvement in politics/health policy' Values are beliefs that an individual or social group has regarding what is relevant and important to their belief system. Values generally have an emotional attachment. (Porch, 2012) I did not realize until the last two weeks how true this was for me, given my response to the new health care plan. My values have a strong root in my childhood; I suppose that is true for everyone. Growing up I was taught that the value of being honest, being accountable, moral and the importance of taking care of my health as well as the health of others was instilled in me as young child for example, my mom always took me to see my elderly great aunt at her home and then at the nursing home. This taught me to respect and help people. Porche, (2012) describes evolution of a value system to be a continuous process throughout life. My evolution has brought me here. I have spent a good part of my life helping people as a profession, and have always felt fortune to do so. The values listed in porch are all important, however too long to comment on all. In respect to how my values have influenced my involvement in politics and health policy, I guess the fact I have always felt compelled to advocate for those who could not advocate for themselves speaks for itself, for example, in my work as a hospice nurse I went to great lengths to keep my patients pain free. This meant calling doctors for more pain meds to speaking to my supervisors about how to keep patients pain free on a continuous basis. Also, I was politically active before I became a nurse representing the Democratic Party as a delegate. This experience helped me after I become a nurse to assist in making changes in various nursing jobs I have held. It facilitated my having the courage to become more outspoken about the issues I felt needed to be changed to help my patients. Another example of my involvement in politics and health policy was recently had to advocate for someone with mental health problems who had been having breaks from reality and not functioning well in her life. I called my supervisor for an intervention from her family and doctor. This was successful and this person is now doing quite well with medication adjustments. All of us in this profession will be faced with whether or not we will act on our beliefs, choices, and being happy with making those choices public in or order to make changes. 2. Use your discipline specific code of ethics. Identify the following from your review of the discipline specific code of ethics: professional values, ethical principles guiding ethical decision making, and professional ethical boundaries. The American Nurses Association’s code of ethics for nurses. Professional values: The shaping of nurses professional values began in the 19th century in England with a school founded by Florence Nightingale. By the end of the 19th century, nursing ethics with the help of Florence Nightingale was established. The International Council of Nurses (ICN) developed the code of nursing ethics in, 1899. In 1900, Isabel Hampton Robb‟s wrote the first nursing book on ethics, Nursing Ethics: For Hospital and Private Use. Although the book is stated as being more focused on the physician, it reflects the climate of the times, the period in which it was written. It was not until the 1960‟s that climate changed and nurse‟s responsibility was not to the physician but to the patient. This is the focus of nursing today. Under provision 9. Of the ANA code of ethics it states that the profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for mainintaing the integrity of the profession and its practice, and for shaping of social policy (ANA,2001 P.13). All nurses by gathering together have a stronger voice then standing alone in making changes that benefit those on all levels of the profession, policy making, and patient care. The code of ethics for nurses sustains integrity for all by requiring standards of nursing, which include: education, continued development of knowledge, and evaluation of nursing practices. In social reform the code of ethics gives nurses the ability to come together as a group to advocate about health care policy and reform for those who cannot speak for themselves. Professional nurses have a responsibility to maintain this code of ethics. Nurses through political committees and lobbying can help change policies that violate patients and nurses rights. Under provision 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems (ANA, 2001, p. 3). The nurse is expected to be kind and caring respecting patient rights no matter whom or what they are experiencing under their care. We as professionals can find it difficult to maintain objectivity in regards to the patient. We are expected under the code of ethics to keep our feelings in check in order to provide equal care. One way to stay objective is to recognize our feeling without judgment and be kind to ourselves. Another is to ask for help from our peers in the work setting. An example for this would be making sure that patient understands a test or procedure being done; this may include the doctor describing the test again to assure the patient understands what is going to happen or giving the patient information on advanced directives. Equally important is to develop positive relations with all co-workers and others in our lives. Under provision 3. The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient (ANA, 2001, p. 6). The first part of this provision states the patient„s right to privacy, the patient can show others what he or she deems necessary. Confidentiality is covered in the Health Information Portability Act (HIPPA). www.gov.confidentiality. This act helps nurses balance harm verses confidentiality. Also, under this provision is the obligation to report incompetence of a co-worker due to impairment, lack of knowledge, and any illegal practices that may pose harm to the patient or community. Under provision 2. The nurse‟s primary commitment is to the patient, whether an individual, family, group, or community (ANA, 2001, p. 5.) Some of the aspects of this provision include having the courage to speak the truth at all times, keeping promises to patients and others, and nonmaleficence (causing no harm Porch, p. 220). A conflict that may arise under this provision is when the organizations priorities cause a conflict of interest in patient care, for example in an emergency room doing triage, this represents utilitarianism (the greatest good for the greatest number Porch, p. 219). The provision also asserts the importance of nurses collaborating in the care of patients which gives us the opportunity to take part in decisions being made on behalf of the patient. The last part of the provision states the importance of maintaining professional boundaries. On a daily basis we form close relationships with the people we take care of it is only natural to cross the boundaries of professionalism. The areas of mental health would be the most difficult to maintain boundaries. However, the code of ethics reminds us that we are here to ease a patient‟s suffering, promote, protect and restore health. 3. Provide exemplars of potential, actual, apparent, objective or subjective conflicts of interest. Propose strategies to avoid each these types of conflicts of interest. Potential conflict of interest: a conflict of interest that occurs when an individual has an interest that may influence their judgment and decisions in the future (Porch, 2012). Example: A nurse practitioner who provides care for the older adult with hypertension, hypercholesteremia and osteoarthritis. This nurse is approached by a pharmaceutical company who came to her practice. She is given samples for her patients. Should she continue to meet with the representatives of this company' Strategy: By continuing to meet with the pharmaceutical company and supplying patients with free samples could create a bias towards the medication. It would be better if she did not create this bias. She would then be free to make the right decision for the patient who is under her care. Also, this does not come under the premise for evidence based practice. Actual conflict of interest: This occurs when an individual has an interest that impacts their judgment and they engaged in an activity that is directly related to the area of the conflict (Porche, 2012). Example: A nurse practitioner attends a conference where a pharmaceutical company has paid for dinner and provides free gifts. He subsequently, supports the medications that are being promoted at the conference. Strategy: This nurse needs to maintain role clarity, review code of ethics, learn to recognize potential conflicts of interest before they arise and seek out others for expert opinions (Porche, 2012). Apparent conflict of interest: this occurs when there is no actual conflict of interest but other persons looking at the situation perceive that there is an actual conflict of interest (Porche, 2012). Example: A doctor I worked with strongly encouraged a patient to use a specific medication after attending a conference about this medication. The assumption was made that he did this because he had been influenced by the pharmaceutical company. Strategy: All professionals need to act in accordance with the rules and regulations of the hospital. Speak upfront with others he or she works with to avoid the wrong perception, also realize the need for self perception (Porche, 2012). Subjective conflict of interest: this is based on emotional ties or relationship (Porche, 2012). Example: I am the assistant manager of the building I presently reside in where everyone here knows I am a nurse. Recently, one of the tenets had a health emergency. I assisted in this emergency even though it is not in my job description. I am friends with this person. However, I have been reminded that as an employee I am not allowed to give out personal information to anyone, including the ambulance staff. This is a government rule and I was not hired as a nurse. It has been tricky getting around this aspect of my job. Strategy: Although I probably would not be fired for helping this person I had to tell my friend that he has to have others such as friends in the building, give the information to the ambulance personal. In addition, having revisited the nursing code of ethics, realize this is good practice in maintaining role clarity, abiding by the rules and regulations of my position, and has allowed me to recognize potential conflicts of interest (Porche, 2012). Objective conflict of interest: involves a financial relationship (Porch, 2012). Example: An example of objective conflict of interest could be a professional writing an article on medication, specific procedures, or other health care issues. If this person is being paid by anyone who has an interest in the article or outcome of the article could be creating an objective conflict of interest. Strategy: First examine whether or not being paid is settling you up for potential bias toward the subject matter and outcome. This would require self-reflection and consulting with other professionals about ones‟ motives. Get an opinion before investing the time on the article to determine potential conflicts. It probably does not help the medical community to write an article that will not be respected or acknowledged nor will it help the patients. 5. Some have said that ethical managed care is an oxymoron. Do you think this is true' Why' The recent passing of the Affordable Patient Act is an example of an oxymoron. The bill‟s intention is to limit cost and make the present health care system more efficient. This is supposed to happen by giving guidelines for insurance coverage, giving incentives to those who provide best practices, and decrease competition among public insurance companies. Many people believe that health care reform is the same as managed care and will limit access to health care. Most that are under managed care are part of employer-sponsored health care plan. Any kind of managed care will limit services to reduce cost and creates ethical problems. This limit of services can have a profound effect on the trust between patient and provider. Is the provider doing all he can or trying to limit care because of cost. Ethics is the basis of providing good care which includes beneficence, non-malfeasance and autonomy (Porch, 2012). Patients as a result of this bill may not receive the best care. 6. Why is justice in health care more complicated than just doing what is fair' The World Health Organization defines disparities as “differences in health which are not only unnecessary and avoidable, but, in addition, are considered unfair and unjust.”Whether or not a health difference is considered unfair depends on whether or not people chose the situations that resulted in poor health. As examples, poor populations may have little choice about living in unsafe and unhealthy neighborhoods, while differences in sports injuries by certain groups would not be considered unfair. The stated policy implication of this definition is not to eliminate all health differences, but to reduce or eliminate those resulting from factors both avoidable and unfair.” This is just one of many definitions of disparities Examples of these disparities are all around us as health care professionals. Health disparities still exist for minorities, ethic groups and the poor and as a result they encounter many health problems from low birth weight babies to poor dental hygiene, poor nutrition and other health problems. In an article by Herbert, Sisk, and Howell defining disparities will go a long way in eliminating them from the health care system. The present health care system is not addressing these disparities well and this has resulted in the unfair distribution of health care. I believe that addressing these disparities will go a long way in improving health care. Hebert, Sisk, Howell. When does a difference become a disparity' Conceptualizing Racial and Ethnic Disparities In Health. Health Affairs vol. 27 number 2. Porche, D. J. (2012). Health Policy: Application for nurses and other healthcare professionals. Massachusetts: Jones & Bartlett Learning.