reply to this discussion

On February 25th, 2021 Alaska Senator Lisa Murkowski proposed a bill to the United States Senate amending the Public Health Service Act to include a program that helps better identify and treat patients at risk of suicide. S.467, known as the Effective Suicide Screening and Assessment in the Emergency Department Act of 2021 has currently been referred to the Committee on Health, Education, Labor, and Pensions (Congress, 2021). If this bill passes, policies and procedures will be implemented for identification and assessment of individuals at risk of suicide and improving coordination of care upon discharge for the individual. The passing of this bill will allow certain critical access facilities to be eligible for a grant which could be used to provide education for their staff members on proper assessment and identification of at-risk patients, to establish and implement new policies and procedures used to better care for these patients, and even hire behavioral healthcare staff (psychologists, psychiatrists, etc) able to provide proper care to identified patients (2021). 

800,000 people die annually from suicide and suicide is the 11th leading cause of death in the United States (Brenner et. al., 2020). 8% of individuals who present to the ED have had recent suicidal ideations (2020). The Suicide Prevention Resource Center reports individuals at risk for suicide often seek help at an emergency department and up to 70% of patients who leave the ED after a suicide attempt do not go to their first outpatient appointment (SPRC, n.d.). With this knowledge, it is obvious that there is a brief period of time that medical staff can intervene and a need to improve the continuity of care for suicidal patients upon discharge. I strongly believe there is an ample amount of information related to caring for suicidal patients in the emergency room setting. This is a setting many patients seek care in and having trained staff to properly determine if each individual is at risk is crucial to changing their path and helping them obtain appropriate care. 

Response to 2 Peers

1. Consider your peer responses.  Are they similar or different than yours?

2. How do other’s perspectives on ethical considerations impact your view?

**When I accept the bid I will be sending you the two peer posting which to respond to. Please use their name at least twice but not excessively. Do not compare the two peers with each other only compare their individual post with mines. 250 words each with two references each, the references are not included in the word count. 

MY POST:

How often do healthcare providers encounter ethical dilemmas in end of life care?

            Medical practitioners come across moral dilemmas more frequently in their professional careers and practice (Odgers, 2019). In these situations, the no-correct response is stark evidence. This is particularly true in end-of-life treatment, where clients and families may be dealing with intense feelings, sadness, and tragedy.

What is the source of the ethical dilemma?

Communication problems, clinical confidentiality being harmed, inadequate treatment control, non-beneficial treatment, and joint decision-making can all lead to ethical dilemmas. Communication is a key model in the moral quagmire (Liu, 2017). It affects how patients perceive information about the prevailing health conditions.

What is the nurse’s role in this situation?

Immunology clinicians can help patients, close relatives, and guardians overcome ethical dilemmas by providing the best quality treatment while helping them to encounter EOL with integrity (Liu, 2017). Nurses can keep the patients in terms of the current health status while offering solace and guidance.

What legal and ethical standards must health care personnel be expected to consider in end of life care?

The medical personnel should provide full information to the patients. Another standard is confidentiality where the clinical person should disclose the details to the patient only.

The information on the health of the patient can only be disseminated to other parties with his or her consent (Tahan, 2020). Another standard is disclosure. The patient should be briefed on all matters concerns his or her health.

If you did not agree with the decision being made, can you excuse yourself from caring for the patient?

The medical practitioner can express dissatisfaction with the exercise. This can be contained in the fact that an incorrect decision may be made (Croxon, 2018). The clinical expert can decide to part ways with the therapy for it may result in a negative outcome.

Ultimately, who should make a decision about end of life care? Explain your rationale.

The patient can make a judgment about the end of life care. This is because they are the consumers of health products and dictate their preferences (Tahan, 2020). In the case, the patient feels incapable of continuing with the therapy they can request termination. The medical personnel is bound to offer guidance and facilitate the process.

How healthy is your workplace?

You may think your current organization operates seamlessly, or you may feel it has many issues. You may experience or even observe things that give you pause. Yet, much as you wouldn’t try to determine the health of a patient through mere observation, you should not attempt to gauge the health of your work environment based on observation and opinion. Often, there are issues you perceive as problems that others do not; similarly, issues may run much deeper than leadership recognizes.

There are many factors and measures that may impact organizational health. Among these is civility. While an organization can institute policies designed to promote such things as civility, how can it be sure these are managed effectively? In this Discussion, you will examine the use of tools in measuring workplace civility.

To Prepare:

Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).

Review and complete the Work Environment Assessment Template in the Resources.

By Day 3 of Week 7

Post a brief description of the results of your Work Environment Assessment. Based on the results, how civil is your workplace? Explain why your workplace is or is not civil. Then, describe a situation where you have experienced incivility in the workplace. How was this addressed? Be specific and provide examples.

Please write replies for the discussions posted below all in APA 7 format and  well written and explained.

SHELLs 

Eliminating incivility must be part of any healthcare culture to increase employee satisfaction and retention. The way in which this can be accomplished is by intentionally instituting and promoting a culture of respect within an entity (Broome & Marshall, 2021). Incivility within a healthcare facility fosters many negative outcomes, and in my opinion and on the top of the list, is decreased patient safety (Clark et al., 2011). The fact that nursing is up to four times more hazardous than many occupations should garner the attention of everyone (Clark et al., 2011). Polite and respectful communication is linked to happy, productive employees (Clark, 2015).

I completed the work environment assessment for my employer. The total score was 40. This indicates a very unhealthy work environment. Some of the reasons why it is unconsidered unhealthy are the fact that there is no shared decision-making, teamwork and collaboration are not promoted, there is no mentoring program available, no employee wellness program, nothing is done is resolve or fix conflicts that arise, and there is little to no advancement opportunities available. As you can imagine, this makes for a difficult work environment. The culture is that we treat our patients with the utmost respect and dignity while delivering excellent care, however, the same is not placed on the employee side. There is a great deal of turnover amongst the nursing staff. This leads to working short many times, which makes for an even more unhealthy and unsafe working environment.

There was a situation where one nurse bullied another nurse, and there were witnesses to this event. This unfortunate event happened in front of a patient in a patient’s room as well. One of the witnesses told her supervisor. This situation created an uncomfortable working environment as there was nothing done about it. It was casually brought up at the next staff meeting that bullying was not permitted. This led to the nurse who was bullied quitting her job. There was a lot of sadness and disbelief by the staff because nothing was done, as well as the loss of a valuable staff member. This created poor working conditions and decreased employee satisfaction. The staff member that did the bullying was not written up or reprimanded, and often joked about the event and how she got the other nurse to quit. This was a disrespectful situation that created increased incivility in the workplace.

There are many solutions to fix incivility, and one of them I would like to highlight is accountability as a useful tool and a solution for multiple challenges (Mentzer et al., 2017). Accountability can be increased by a simple technique of peer-evaluation amongst team members (Mentzer et al., 2017). This technique is known to create healthy teams and cultures (Mentzer et al., 2017). This is done by having individual staff members rate themselves, and then their peers do the same, and comparing the results (Mentzer et al., 2017). I have always said if we could see ourselves as others see us, we would work on self-improvements efforts. I believe this technique provides this an opportunity for self-improvement. I would like to see a lot of positive changes made at my employer to promote a healthier culture where everyone can thrive.

References:

Broome, M., & Marshall, E.S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Clark, C.M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18-23.

Clark, C.M., Olender, L., Cardone, C., Kenski, D. (2011). Fostering civility in nursing education and practice. The Journal of Nursing Administration, 41(7/8), 324-330.

Mentzer, N., Laux, D., Zissimopoulos, A., & R.Richards, K.A. (2017). Peer evaluation of team member effectiveness as a formative educational intervention. Journal of Technology Education, 28(2), 53-82. https://doi-org.ezp.waldenlibrary.org/10.21061/jte.v28i2.4

Kels 

The workplace environment and culture are often a topic of discussion in healthcare, as they can have a significant impact on job satisfaction and patient outcomes. Knowing this impact, leaders aim to create a culture of excellence (Broome & Marshall, 2021). The American Association of Critical-Care Nurses (AACCN) has outlined six standards which will help to create a healthy work environment. These include open communication, team collaboration, productive decision making, staff recognition, and authenticity (Clark, 2015). When leaders look to address the culture within their setting, they must identify the strengths and weaknesses of the current environment, and invoke stakeholders input through open communication channels. This comprehensive assessment will guide the transformational leader towards cultural change (Broome & Marshall, 2021). Based on the AACCN standards of workplace excellence, Clark (2015) created a tool to assist in a workplace environment assessment. 

I completed the Clark (2015) assessment on my own workplace to get an idea of how healthy the culture is for me. The answers are given on a scale of 1 to 5, with 5 being the most healthy, and total points are added up from 20 questions for a total as high as 100 and as low as 20. My total score was 77, indicating that my workplace environment is mildly healthy. This result is not overly surprising to me, as I mostly feel satisfied with my job, but there are areas that I think need improvement. The questions that got a lower score were the questions that asked about work compensation and options for career advancement, as this is a common complaint among school nurses. Foley, Lee, Wilson, Cureton, and Canham (2004) looked at school nurse job satisfaction, and proposed that Maslow’s hierarchy of needs can be applied to the workplace to explain why pay and job security impact nurse’s satisfaction the most. 

Foley, Lee, Wilson, Cureton, and Canham (2004) also discussed how positive workplace interactions can increase employee satisfaction. In my survey, I scored issues of workplace civility high, because I find that my leader does an excellent job of resolving issues. This is not always the case though, as incivility in the healthcare industry is a major problem affecting nursing retention and nurse job satisfaction. Incivility can come from disgruntled patients as well as disgruntled employees (Clark, Olender, Cardoni, & Kenski, 2011). In a school setting, it is not uncommon for parents to have negative interactions with the school nurse. In light of recent events, this is more true than ever. In my practice since returning to school in September during the covid-19 pandemic, tensions are high among parents who are navigating difficult and stressful decisions involving the schooling of their children. Elevated stress levels are shown to increase incivility, so it is not surprising that I have had parents upset with me over newly implemented rules (Clark, Olender, Cardoni, & Kenski, 2011). This has included a new guideline that all students are required to receive the influenza vaccine, as well as strict exclusion guidelines that require a student be sent home for symptoms that could be caused by something other than covid-19, in order to rule out the virus. However, an important role as the leader is to be able to assist in conflicts and make staff feel supported (Broome & Marshall, 2021). My supervisor has supported our work, which is grounded in following protocols. She also encourages us to send parents her way if there continues to be issues, and she can reiterate the protocols that the district follows. When issues like this become frequent, my leader engages all of the nurses to express our views and have an open discussion about how situations can be handled. Feeling supported has gone a long way in my job retention and satisfaction. 

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert 

clinician to influential leader (3rd ed.). New York, NY: Springer.

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American 

Nurse Today, 10(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing 

education  and practice. The Journal of Nursing Administration, 41(7/8), 324–330. 

Foley, M., Lee, J., Wilson, L., Cureton, V. Y., & Canham, D. (2004). A Multi-Factor Analysis of 

Job Satisfaction among School Nurses. Journal of School Nursing, 20(2), 94–100.

Technology is integral to successful implementation in many projects, through either support or integration or both. Name at least one technology that could improve the implementation process and the outcomes of your capstone project change proposal. Do you plan to use this technology? If not, what are the barriers that prevent its use?

Remember the project change proposal is based on after discharge patient’s follow up

Discussion 1

 The four principles, especially in the context of bioethics in the United States, has often been critiqued for raising the principle of autonomy to the highest place, such that it trumps all other principles or values. How would you rank the importance of each of the four principles? How do you believe they would be ordered in the context of the Christian biblical narrative? Refer to the topic study materials in your response 

Discussion 2

 What do the four parts of the Christian biblical narrative (i.e., creation, fall, redemption, and restoration) say about the nature of God and of reality in relation to the reality of sickness and disease? From where would one find comfort and hope in the light of illness according to this narrative? Explain in detail each part of the narrative above and analyze the implications.