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 requires submission of one (1) document for all five parts. Save your file as LE001_firstinitial_lastname (for example, LE001_J_Smith).

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. 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. 

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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.
  • 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.  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.