Legal Requirements and Ethics in Nursing

LE001: Legal Requirements and Ethics: Summarize legal mandates and ethical principles to address complex challenges, manage risk, and advance organizational integrity. Assessment Rubric Rubric Criteria Needs Improvement Meets Expectations Exceeds Expectations Part 1: Principles of Autonomy and Nonmaleficence Learning Objective 1.1: Define the principles of respect for autonomy and nonmaleficence. Learning Objective 1.2 Explain the prioritization of respect for © 2020 Walden University Response does not provide or provides partial or inaccurate definitions of the principles of respect for autonomy and nonmaleficence. Response provides two thorough and accurate definitions of the principles of respect for autonomy and nonmaleficence that apply to the situation. Response includes examples that demonstrate an understanding of how the principles of respect for autonomy and nonmaleficence can conflict. Response does not provide an explanation or provides a partial or unclear explanation of which principle to prioritize or fails to provide support for reasoning Response includes references to relevant academic/professional resources. Response clearly explains which principle to prioritize when patients refuse care. Response demonstrates the same level of achievement as “Meets,” plus the following: Response includes three definitions and examples that demonstrate an understanding of how the principles of respect for autonomy and nonmaleficence can conflict. Response demonstrates the same level of achievement as “Meets,” plus the following: Response provides at least two relevant examples of 1 Rubric Criteria autonomy and nonmaleficence. Needs Improvement about which principle to prioritize. Response provides an irrelevant example of information the hospital would use to determine whether to prioritize respect for autonomy or nonmaleficence. Legal Requirements and Ethics in Nursing

Rubric Criteria Needs Improvement Part 2: Clinical Ethics Learning Response does not identify, or Objective 2.1: one or more responses Identify conflicting inaccurately identify s a ethical principles. conflicting ethical principle, or the response does not address each scenario individually. Meets Expectations information the hospital would use to determine whether to prioritize respect for autonomy or nonmaleficence. Response includes references to relevant academic/professional resources. Meets Expectations Exceeds Expectations Response accurately identifies one conflicting ethical principle in each scenario. Response demonstrates the same level of achievement as “Meets,” plus the following: Response justifies the importance of each of the principles in conflict. Response includes references to relevant academic/professional resources. Learning Objective 2.2: © 2020 Walden University Response does not select or selects inappropriate actions for one or more scenarios. Exceeds Expectations Response provides at least three relevant examples of information the hospital would use to determine whether to prioritize respect for autonomy or nonmaleficence. Response selects appropriate actions to resolve the conflicting ethical principles in each scenario. Response accurately identifies at least two conflicting ethical principles in each scenario and justifies the importance of each of the principles in conflict. Response demonstrates the same level of achievement as “Meets,” plus the following: 2 Select actions to resolve conflicting ethical principles. Response provides compelling justification and reasoning to support the selected action in each scenario. Response is written substantively and thoroughly related to these topics. Response includes references to relevant academic/professional resources. Rubric Criteria Needs Improvement Meets Expectations Exceeds Expectations Part 3: Risk Assessment Framework Learning Objective 3.1: Use the seven-step risk assessment framework described by the Joint Commission. Response does not complete or completed some of the seven steps incorrectly or fails to complete all seven steps. Response accurately completes each of the seven steps to illustrate how the hospital in the scenario might use a risk assessment framework. Response includes a thorough reflection on the value of the Joint Commission standards and their impact on providers and patients. Response demonstrates the same level of achievement as “Meets,” plus the following: Response is written substantively and thoroughly related to these topics. Response includes references to relevant academic/professional resources. © 2020 Walden University 3 Rubric Criteria Needs Improvement Meets Expectations Exceeds Expectations Part 4: Impact of Regulatory Guidelines on the Delivery of Care Learning Objective 4.1 Explain how shortages of healthcare workers impact the ability to deliver quality care and manage risks. Response does not provide or provides an unclear or partial explanation of how shortages of healthcare workers impact the ability to deliver quality care and manage risks for each scenario provided. Legal Requirements and Ethics in Nursing

Response includes an inappropriate explanation of how to mitigate the impact of shortages of healthcare workers on the delivery of quality care and the management of risk for each scenario presented. Response clearly explains how shortages of healthcare workers impact the ability to deliver quality care and manage risks for each scenario presented. Response includes at least one appropriate explanation of how to mitigate the impact of shortages of healthcare workers on the delivery of quality care and the management of risk for each scenario presented. Response demonstrates the same level of achievement as “Meets,” plus the following: Response provides more than one appropriate explanation of how to mitigate the impact of shortages of healthcare workers on the delivery of quality care and the management of risk for each scenario presented. Response includes references to relevant academic/professional resources. Learning Objective 4.2 Explain how revenue and resource constraints may limit the ability to © 2020 Walden University Response does not provide or provides an unclear or partial explanation of how changing reimbursement rules for Medicare impacts the ability to deliver quality care and manage Response clearly explains how changing reimbursement rules for Medicare impacts the ability to deliver quality care and manage risks for each scenario presented. Response demonstrates the same level of achievement as “Meets,” plus the following: 4 deliver quality care and manage risks. risks for each scenario presented. Response makes an inappropriate explanation regarding how to mitigate the impact of changing reimbursement rules for Medicare on the delivery of quality care and the management of risk for each scenario presented. Rubric Criteria Needs Improvement Response makes at least one appropriate explanation regarding how to mitigate the impact of changing reimbursement rules for Medicare on the delivery of quality care and the management of risk for each scenario presented. Response provides more than one appropriate explanation regarding how to mitigate the potential impact of changing reimbursement rules for Medicare on the delivery of quality care and the management of risk for each scenario presented. Response includes references to relevant academic/professional resources. Meets Expectations Exceeds Expectations Part 5: Is healthcare a right or a privilege? Learning Objective 5.1: Analyze whether healthcare is a right or a privilege. Legal Requirements and Ethics in Nursing

© 2020 Walden University Response does not provide or provides an unclear explanation of whether healthcare is a right or a privilege. Response provides a logical justification for whether healthcare is a right or a privilege. Response demonstrates the same level of achievement as “Meets,” plus the following: Response chooses incorrect or irrelevant citations or does not provide citations. Response appropriately cites from relevant academic/professional resources to support the justification. Response is written substantively and thoroughly related to these topics. 5 Overview . Rubric This Assessment requires submission of one (1) document for all five parts. Save your file as LE001_firstinitial_lastname (for example, LE001_J_Smith). Healthcare consists of individuals with health problems and the professionals who care for them. These combinations require at least two levels of expertise. One area concerns the medical treatments that may lead to positive outcomes. The other level of expertise concerns the decision-making process and communication with patients and families. This competency consists of five separate sections that work together to illustrate the judgements involved in patient care, which often includes ethical issues concerning patients, families, and quality care. This assessment has six parts. Click each of the items below for more information on this Assessment. Part One: Principles of Autonomy and Nonmaleficence • • • An 83-year-old diabetic male, Mr. Jones, is brought into the emergency department because of respiratory distress by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle. Mr. Jones’ daughter reports that her father has been diagnosed with Alzheimer’s disease. A preliminary capacity assessment is consistent with mild dementia but one of the nurses suggests that Mr. Jones’ confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department. The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact. Does the father have autonomy to make this decision? Why or why not? Discuss the principle of nonmaleficence as it relates to actions of the providers. (1–2 pages) Part Two: Clinical Ethics • Clinical ethics requires grasping ethical issues, such as informed consent, truth-telling, confidentiality, end-of-life care, treatment futility, pain relief, and patients’ rights to self-determination. Legal Requirements and Ethics in Nursing

For each hypothetical situation described below, identify the conflicting ethical principles involved, and select at least one appropriate action to resolve conflicting ethical principles in each case. (2–3 paragraphs for each topic) ▪ An elderly patient suffers cardiac arrest and enters the intensive care unit. Her son insists that “everything possible” be done for her, and yet, she slips into a coma and is nonresponsive for months. As a healthcare administrator who oversees the organization, what steps would you recommend to address the son’s concerns? ▪ You are a healthcare administrator reviewing statistics on lab tests ordered and realize that a few physicians account for the majority of orders of a certain very expensive lab test. You do a bit of research and realize that these physicians have relationships with the manufacturers of this testing equipment. What are your next steps? Please write a brief policy statement about conflicts of interest in the organization. Part Three: Risk Assessment Framework • A hospital finds that hypodermic needle-stick injuries have increased over the last year and, when they conduct an audit, they find evidence that there is wide variation in practice from unit to unit. Some rooms have sharps boxes and others do not, the sharps boxes are of different sizes, and there is variation in how often they are emptied. ▪ Using the seven-step risk assessment framework described by the Joint Commission (available at 7 Steps to Comply with Joint Commission) outline each of the steps to illustrate how a hospital might use a risk assessment framework to manage the risk of needle-stick injuries. (2 pages) • Note: Registration is required to access the link referenced above. Legal Requirements and Ethics in Nursing

▪ Once the seven steps have been outlined, write an email to the Director of Nursing about your concerns and recommendations. Part Four: Impact of Regulatory Guidelines on the Delivery of Care • You are a nursing supervisor in a small rural healthcare facility. Explain how each of the following scenarios will challenge your ability to deliver quality care and manage risks; discuss specific regulatory guidelines that may apply and explain your approach to mitigating each. Write out the following information as a report you will present to the administrative leadership about the negative implications of these issues. ▪ ▪ A shortage of three certified nursing assistants (CNAs) due to influenza and one registered nurse (RN) scheduled leave for a family wedding (2–3 paragraphs) Changing reimbursement rules have a negative impact on revenue that will potentially eliminate the budget for planned renovation to the patient rooms equipped with a winch to lift patients over 200 lbs. (2– 3 paragraphs) Part Five: Is healthcare a right or a privilege? • Provide your opinion about whether healthcare in the U.S. should be is a right or a privilege. Apply ethical standards and state and federal laws to support your position. Legal Requirements and Ethics in Nursing

Write your position as though you are sharing it through a blog post or letter to the editor of a local paper. (1–2 pages) Part Six: Behavioral Ethics ▪ Visit the ACHE Ethics Pre-Assessment website (http://www.ache.org/newclub/career/ethself.cfm) and take the ethics pre-assessment to help you identify areas where your ethics are strong and where they might need further reflection. After reviewing your responses to the pre-assessment ▪ Describe your results from the ACHE Ethics Pre-Assessment including the areas where your ethics are strong and where there might be red flags. ▪ Explain what you might do to change any red flags that might exist. Finally, describe what resources you think would help you promote integrity and ethics as a leader of healthcare organizations. … Legal Requirements and Ethics in Nursing