Chamberlain College of Nursing NR660 Capstone Project Barriers Encountered Identify what barriers you have encountered while developing the Capstone Project. What have you done to resolve these issues? (Team Communication strategies) This course is now more than halfway completed, and your project should be halfway done. How are you doing? Have you experienced any barriers? Be sure to consider whether any ethical and/or legal concerns are present and how these will be resolved. This week, we will be addressing legal and ethical dilemmas in nursing. Course Outcomes 2 Demonstrate effective leadership skills that promote quality nursing practice. (PO 1, 2) Weekly Objectives • Demonstrate leadership skills to strengthen quality nursing practice in education and healthcare settings. 6 Incorporate human caring and legal and ethical principles within the concepts of person, health, environment, and nursing for the benefit of society and the profession of nursing. (PO 6) Weekly Objectives • Discuss legal and ethical factors that influence nursing education and healthcare systems. Week 5: Lesson Table of Contents Ethical and Legal Dilemmas in Nursing Detour Ahead Let’s check the roadmap to see just where we are on this journey to the master’s degree. Oh, yes, we are a little more than halfway there. Do you see that railroadcrossing arm coming down across the road ahead? It looks like we will be waiting a while for the train to pass—just another barrier that has to be encountered on this journey. Speaking of barriers, what barriers did you encounter while working on your capstone project MSN 3 Miles to go Dilemmas in Nursing Stakeholders Cost Resources Equipment Technology Legal/Ethical Dilemmas MSN 4 Miles to go Resolving Problems Problem Identification Literature Review Evidence Based Literature Solution to problem Outcome Stakeholders Facilitators Barriers Summary References MSN 5 Miles to go Theoretical Bases Nursing Theories EBP Knowles’s Adult Learning Theory Quantum Leadership Theory Change Theories MSN 6 Miles to go Characteristics of Nursing as a Profession Use of Theory * Knowledge Base * Research Autonomy Community Service Code of Ethics Professional Culture Communication/Publication Participates in Professional Organization MSN 7 Miles to go Scholarship and Nursing Profession Research National Guidelines Quality improvement Professionalism Ethics Foundations of Nursing Practice Core Competencies Barriers As we know, there may be a number of barriers that one encounters when implementing a change in practice to resolve a problem or concern. Some of those barriers include resistance to change from the staff, lack of leadership support, lack of resources (financial and fiscal), environment, communication, and stakeholders, to name just a few (Pexton, 2005). If a barrier is recognized, then actions can be taken to remove it. Funk, Tornquist, and Champagne (1991) developed a scale based on four categories of barriers to the use of research (evidence) by nurses in their practice. They identified the four factors as 1. characteristics of the potential adopter; 2. characteristics of the organization; 3. characteristics of the research; and 4. characteristics of the communication of research. Barriers to EvidenceBased Practice The first barrier describes characteristics of the adopter. The nurse’s research values, skills, attitudes, and awareness makeup this barrier. Lack of awareness of research Not seeing the value of research for practice Being isolated from knowledgeable colleagues with whom to discuss the research Not feeling capable of evaluating the quality of the research Feeling the benefits of changing practice will be minimal Seeing little benefit for selfUnwillingness to change/try new ideas Not perceiving a need to change practice The second barrier describes the characteristics of the organization. These characteristics focus on different types of settings, barriers and limitations. Insufficient authority to change patient care procedures Insufficient time on the job to implement new ideas Physicians not cooperating with implementation Administration not allowing implementation Other staff not being supportive of implementation Research results not generalizable to own setting Inadequate facilities for implementation Insufficient time to read research The third barrier describes characteristics of the innovation. There are six items that are noted for this characteristic. Research has not been replicated Uncertainty about the believability of the results of the research Literature reports conflicting results Methodological inadequacies of the research Research reports/articles are not published fast enough Conclusions drawn from the research are not justified The fourth barrier describes characteristics of the communication. Communication focuses on the presentation and accessibility of the research. statistical analyses are not understandable the relevant literature is not compiled in one place implications for practice are not made clear research reports/articles are not readily available the research is not reported clearly and readably the research is not relevant to the nurse’s practice Ethical and Legal Dilemmas in Nursing Just as we can get a speeding ticket while rushing to graduation, there may be ethical and legal factors that influence nursing in education and healthcare systems. One needs to consider these factors when practicing nursing. Ethics and legal issues arise on a daily basis in a nurse’s life, regardless of the nursing specialty. The nurse must take appropriate actions to address the issues of professionalism, health policy, reimbursement, and the organizations that provide healthcare. Ethical Issues We first need to understand what ethics means. Ethics refers to a standardized guide or code to one’s behaviors, which focuses on the rightness or wrongness of that behavior. Ethics is not to be confused with morals or values. Morals can refer to one’s acceptable behavior that shapes individual values based on cultural influences. Conflict may arise between a nurse’s morals, values, and ethics and the patient and/or organization’s approach to morals, values, and ethics. Why discuss ethics? At some point in your career as a nurse, you will be faced with these issues. There may be an ethical decision in which you have to make a choice between alternatives, none of which is the ideal solution. It is often difficult to determine whether one alternative is better than another. If this situation occurs with patient care, the nurse should be the patient’s advocate, even if he or she disagrees with the final decision. Professional ethics are part of the nurse’s daily routine. Professional organizations and specialty groups have developed a code to follow. The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2001) is one of those sources nurses use to guide them when ethical issues are experienced in practice. Remember discussing the code of ethics and ethical dilemma scenarios in previous courses? Nurses also have a responsibility to report any unethical, incompetent, or illegal practices to the particular state board of nursing. This is to ensure the quality and safety of patient care and compliance with the state’s Nurse Practice Act, regardless of the focus of nursing. Other ethical issues facing nurses in the workplace include who has access to healthcare, resource allocation, staffing and delegation, healthcare fraud and abuse, endoflife concerns, informed consent, and ethics and research. There has been a history of ethical problems with research, which led to reforms and the creation of legal guidelines in the 1970s. Two of the situations in which research subjects were abused included the Tuskegee Syphilis Study, conducted from 1932 to 1972, and the Willowbrook Study, carried out from the mid1950s to the early 1970s. The Tuskegee Study withheld treatment from AfricanAmerican men with syphilis so that the researchers could observe the course of the disease. In the Willowbrook Study, people with intellectual disabilities in an institute for children were deliberately infected with hepatitis by researchers. Since then, there has been greater attention paid to ethical principles in conducting and reporting research. There must now be informed consent and approval by the Institutional Review Board (IRB) in order to conduct research. Nurses need to be concerned about IRB approval because they have to follow the same rules as anyone else conducting research with human or animal subjects. They also have to continue to be the patient advocate when collecting data where research is ongoing. As a patient advocate, the nurse has to ensure that the rights of the patient are being upheld. Legal Issues Nurses are faced with legal issues on a daily basis. Licensure as a nurse in a particular state allows the nurse to practice within that state’s Nurse Practice Act, which constitutes state law. Failure to comply with the Nurse Practice Act can lead to sanctions placed upon the nurse by the State Board of Nursing. The most serious sanction can come in the form of the nurse losing his or her license to practice nursing. The nurse must take accountability and responsibility for his or her actions when practicing nursing. Malpractice and negligence charges can be filed against a nurse at any time. Medication errors, failing to prevent falls, inadequate provision of patient care, failure to implement and perform appropriate interventions, failure to communicate information that affects patient care, inadequate patient teaching, failure to obtain informed consent, or any act in which the standard of care is compromised are the situations that can lead to legal issues, concerns, or problems. Summary As a nurse educator or executive, you may be faced with ethical or legal dilemmas in daytoday practice. When you understand the ethical principles and the relevance of legal issues to nursing practice, you will be able to provide care to patients and families in a variety of settings, all within the scope of practice. Through the development of the capstone project, you will be able to put into practice the knowledge gained from the courses in the master’s program. This framework will shape the future of your professional practice. It’s just one more stop along the highway of educational preparation. References American Nurses Association. (2001). Code of ethics for nurses with interpretive statements (Publication no. CEN21 10M 08/03). Washington, DC: Author. Finkelman, A., & Kenner, C. (2010). Professional nursing concepts. Boston, MA: Jones and Bartlett. Funk, S. G., Tornquist, E., & Champagne, M. T. (1991). BARRIERS: The barriers to research utilizations scale. Applied Nursing Research, 4, 3945. Pexton, C. (2005, April 13). Overcoming the barriers to change in the healthcare system. 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