Ethical Competencies in the DNP Essentials

Integrate nursing science with knowledge: from ethics and biophysical psychosocial analytic, and organizational sciences as the basis for the highest level’ Of nursing practice.

(I) Develop and/or evaluate effective strategies for· managing the ethical dilemmas inherent in patient care, the healthcare organization; and research.

(II) Design, direct, and evaluate quality: Improvement methodologies to promote safe, timely, effective, efficient, equitable (emphasis added), and patient-centered care.·

(I!I) Provide’leadership in the evaluation and resolution of ethical and legal issue’s within health care systems relating to ‘the use of information, information technology, communication networks; ‘and patient care technology.

(IV) Advocate for social justice, equity; within all health care arenas.

(V)

Ethical decision making processes by APN students and preceptors. In another study, Laabs (2005) noted that 67% of NP respondents claimed that they never or rarely encountered ethical issues. Some respondents showed confusion regarding the language of ethics and related principles. In a later study, Laabs (2012) found that APN graduates, most of whom had had an ethics course in their graduate curriculum, indicated a fairly high level of confidence in their ability to manage ethical problems, but their overall ethics knowledge was low. These three studies provide compelling commentary on the need for Phase 1 activity in graduate curricula.

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The core knowledge of ethical theories should be supplemented with an understanding of issues central to the patient populations with whom the APN works. As APNs assume positions in specific clinical areas or with particular patient populations, it is incumbent upon them to gain an understanding of the applicable laws, standards, and regulations in their specialty, as well as relevant paradigm cases. This information may be garnered from current literature in the field, continuing education programs, or discussions with colleagues. Information on legal and policy guidelines should be offered during graduate pract- icum experiences in the area of clinical concentration.

Although Phase 1 is the building block for the other phases of this competency, it is also an ongoing process. APNs will gain core knowledge in graduate education but, as societal issues change and new technologies emerge, new dilemmas and ethical problems arise. The ability to be a leader in creating ethical environments involves a commitment to lifelong learning about ethical issues, of which professional education is just the beginning.

Developing an Educational Foundation As noted, education in ethical theories, principles, rules, and moral concepts provides the foundation for developing skills in ethical reasoning. Because the APN will apply these theoretical principles in actual encounters with patients, it is imperative that consideration of the context in specific situations be strengthened. A portion of graduate ethics education should involve discussion of typical issues encountered by APNs, rather than issues that receive extensive media attention but occur infrequently.

Howard and Steinberg (2002) maintained that graduate curricula need to go beyond traditional ethical issues to encompass building trust in the APN -patient relationship, professionalism and patient advocacy, resource allocation decisions, individual versus population-based responsibilities, and managing tensions between business ethics and professional ethics. The latter three areas are crucial for developing the Phase 4 level of the ethical decision malting competency.

Continuing education programs are also effective and necessary forums in which current information can be provided in a rapidly changing health care environment. As technology changes and new dilemmas confront practitioners, the APN must be prepared to anticipate conditions that erode an ethical environment. Knowledge and skills in all phases of this competency depend on the appli- cation of current ethical knowledge in the clinical setting; ethical reasoning and clinical judgment share a common process and each serves to teach and inform the other (Dreyfus, Dreyfus, & Benner, 2009). Therefore, the importance of clinical practice cannot be overemphasized.

Overview of Principle-Based model.

Although ethical decision making in health care is extensively discussed in the bio- ethics literature, two dominant models are most often applied in the clinical setting. The first model of decision making is a principle-based model (Box 13-2), in which ethical decision making is guided by principles and rules (Beauchamp & Childress, 2009). In cases of conflict, the principles or rules in contention are balanced and interpreted with the contextual elements of the situation. However, the final decision and moral justification for actions are based on an appeal to principles.