Week 3: Legal and Ethical Considerations during Cost-Benefit Analysis

NR650 Week 4: Effective Leadership
August 2, 2018
NR 650 Week 2: Involvement throughout the Policy Cycle
August 2, 2018

Week 3: Legal and Ethical Considerations during Cost-Benefit Analysis

Healthcare policy often impacts organizations and/or individuals financially, either through monetary or resource utilization. The cost must be weighed against human benefit to patients and nursing practice. Consider policy involvement in your practicum experience. What legal or ethical dilemmas might you encounter when making policy decisions based on costs versus benefits?

Exemplary Answer 1

According to this week’s lesson, “costs associated with the development and initiation of policies, a review of possible costs associated with unintended consequences, costs of possible alternatives, and costs of not implementing policy should all be presented and discussed with stakeholders for input” (Chamberlain College of Nursing, 2018). Our new plan of care/admission/readmission policy will involve patients as participants in making decisions and assessing quality of care received. We know that there is rarely just one way of doing things that can be considered ethical.

There are some approaches that may in fact be unethical because they violate or ignore central ethical values. More typically, however, there is a range of possible approaches to problems, all of which may be deemed ethically justifiable (Bergmo, 2015). I believe that every organizational policy and every tough decision and communication between patient and provider must address competing ethical values of true worth. “Consequently, there will be many ways to balance these values and realize an ethical outcome” (Bergmo, 2015). For example, in making decisions about care planning and reassessments patient-centered values should be taken into consideration. Patient-centered values include giving proper attention to important patient needs, avoiding harms that can arise from managing uncertainties and risks through collaborative treatment planning.

The conflict between autonomy and paternalism challenges practitioners in various contexts. In this case, we are dealing with patients who do not enjoy complete autonomy due to various factors, such as their age and age-related illnesses. Some values that should be considered here are autonomy, non-maleficence, and beneficence. The organization is promoting the freedom of patient to make decisions about their own care and evaluate the quality of care provided by the facility. When facing serious ethical dilemmas, each practitioner (e.g., nurse, social worker, OT, PT, etc.) has to rely on his or her own code of ethics which is similar to that of his profession and includes such characteristics as respect for others, honesty, and genuineness. In this case, we have to carefully coordinate how the choice(s) a patient expresses balance against their safety and our responsibilities to that patient. In addition we have to balance patients’ choices against the choices of their caregivers (i.e., family members).

Bergmo, T. S. (2015). How to measure costs and benefits of eHealth interventions: An overview of methods and frameworks. Journal of Medical Internet Research, 17(11), doi:10.2196/jmir.4521 (Links to an external site.)Links to an external site.

Chamberlain College of Nursing. (2018). NR-650 Week 3:legal, ethical, and fiscal responsible policy.[Online lesson]. Downers Grove, IL: DeVry Education Group

Exemplary Answer 2

This week’s discussion question is a bit more difficult than most. I had to really ponder what the legal/ethical issues might be for my policy project. I actually see more legal and ethical issues without implementation of my policy project than I do if it were to be implemented. As a reminder, my policy project seeks 24-hour RN coverage as a federal mandate within long-term care facilities.

Current staffing levels in nursing homes already cause legal issues. Facilities are frequently sued due to poor care delivery resulting from low staffing or untrained staff. Having higher levels of RN coverage would improve care delivery. Research has illustrated that 24-hour RN coverage has lowered nursing home litigation (Eliopoulos, 2015). Furthermore, there are ethical concerns about care delivery in nursing homes and this may worsen without positive action of RNs in long-term care (Harden & Burger, 2015).

Costs of adding RNs to the nursing home budget is also a little tricky to calculate. In many cases, this RN would replace an LPN so the cost would be less than what many providers think but it would still be an added cost to providers. The benefit to the residents, and the facility for that matter, would be higher quality of care with the potential for lower hospital readmissions.

Lastly, one concern that my mentor and I have discussed is the fact that we are not protecting LPNs as we fight for more RN coverage. Because I work for a long-term care nursing association, we have a number of LPN members. As such, we are concerned that these members won’t feel they are being advocated for as we continue our quest for more RN coverage.

Eliopoulos, C. (2015). The clinical and business case for improving nurse staffing in long-term care. Retrieved from: http://www.annalsoflongtermcare.com/article/clinical-and-business-caseimproving-nurse-staffing-long-termcare#sthash.HTfGg9Bf.dpuf

Harden, J. T., & Burger, S. G. (2015). They are called nursing homes for a reason: RN staffing in long-term care facilities. Journal of Gerontological Nursing, 41(12), 15-20. doi:http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.3928/00989134-20151116-01

Answer 3

This week we look at if while addressing policies needs do we encounter or might encounter any ethical problem that may cause patients to be at risk. Many time nurses are face with issues that have to do with financial issues that need to be address before it causes or lead to harm to patients. Some-time decisions must be made to help with financial bottom line but don’t look at what might be at stake for the people it will impact.

My project is involving the Hazel Crest Fire Department and it staff. The Emergency Medical Services (EMS) department, which is under the fire department provide invaluable services in the community to assist citizens in their medical needs. They respond to tons of calls services dealing with services needs per year. They are also given extra role that might include responding to natural disasters, hazardous material, incidents and technical rescues that acts of terrorism have caused to steady to be increase.

Based on these added roles that they may face along with the issues of the local government budgets being stretched increasing thin I can see that an ethical concern might arise. Citizens needing service from them and they not being able to respond in a timely manner due to not enough staff due to budget being a ethical concerns. They now need to have priorities in place of who to help first.

Nurses in healthcare policy can help them through their knowledge of the policy making and their new founded skill of using the legislative and political process to address concerns facing ethical decisions that may have negative effect on citizen. The health care policy nursing leaders understand that critical health and public policy decisions affecting nurses, their practice and patients require participation in and understanding of the legislative process (Saria, et al., 2014).

In conclusion, nurses are keenly aware of the need to be aware of what might occur when financial concerns arise that might lead to ethical concern for patients. Nurses oath say to do no harm. Nurses will do ever thing in their power to live up to that oath to have the best possible outcomes for all who might have a medical concern.

Reference:

Saria, M., G., Stone, A., Walton. A., L., Brown, G., Norton, V., Barton-Burke, M. (2014). Voices of oncology nursing society members matter in advocacy and decisions related to U. S. Health Policy. Journal of Oncology Nurses, 18(6): 719-721. Doi: 10.1188/14.CJON.719-721.

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