|Type of paper:||Essay|
|Categories:||Ethics Public health Nursing leadership|
The leaders of public health encounter various ethically challenging situations that require them to make decisions which sometimes may be very difficult. According to Johnson (2012), a good example may be the administrator of an emergency department in a hospital which is highly overcrowded with patients. Given that there is inadequate staff, the administrator may be caught in a dilemma whether to strictly consider the qualification of new staff being recruited or to go on to recruit them unconditionally to address the situation at hand. Barret (2016) defines an emergency department as a medical area of specialty that deals with all ages of patients with all kinds of complications that require quick medical attention. Unlike other departments in a hospital, the emergency department places no restrictions on the type of patients to be admitted for medical service (Johnson, C. E. 2012). Therefore, nurses working in the emergency rooms need to be very alert and ready to handle many patients with various kinds of health complications which may come, usually without an appointment. Due to the situations present in the emergency rooms, many nurses report that the emergency department poses the most stressful work environment. The emergency rooms are very challenging and volatile because nurses are frequently exposed to stressful, critical events. According to Rigolosi (2013), the number of patients arriving at the emergency rooms is very many and at very frequent intervals, everyone having different critical comorbidities and highly expectant for proper healthcare provision. As a result, the nurses are put into tough situations, having to handle these many patients as fast as they arrive to reduce the waiting times while also considering the efficiency and quality of their emergency services. According to Johnson (2012), moral distress is the condition whereby, one is aware of the right course of action to take but cannot afford to take it due to institutional constraints which make it almost not possible to accomplish. In the emergency room, moral distress is highly inevitable since the nurses know exactly the right actions to take but, because of administrative or technical constraints, they are not able to make the right course of action (Rigolosi, E. L. M. 2013). The nurses are susceptible to moral distress due to the frequent exposure to the stressful conditions such as deaths of patients, trauma, and the unrealistic expectations of patients, overcrowding, or chaos which are very much emotionally challenging. Furthermore, there may be restrictions in service provisions by such factors as the language barriers, institutional constraints, and worries for futile actions. Additionally, the nurses may also have inadequate resources necessary for the medical procedure, too many responsibilities to carry out as well as insufficient skills or experience in some areas of medical specialties such as neuro-surgical operations (Johnson, C. E. 2012).
According to Shi (2013), despite all these moral distress and challenges, there are various ethical principles that they have to adhere to while delivering medical services to patients. First, nurses are expected to handle all patients with a lot of care, fairness, and justice. The healthcare provision must be equitably, justly and fairly distributed to every patient in the group. Considering the large numbers of patients coming into the emergency room for medical care, nurses find it very rough to provide the fair services to all of them. According to Burke (2011), it is challenging to uphold fairness in the provision of healthcare services for all patients since the nurses can sometimes be exhausted with too much work, caring for patients in critical conditions. Second, the nurses' commitment to beneficence in their work requires that they must always do what is good and right for each patient no matter what situation it may be. As a result, the nurses may be highly distressed trying to save lives of patients at the expense of their welfare. In addition to that, the ethical principle of non-maleficence requires nurses not to harm patients under their service, whether deliberate or not (Rigolosi, E. L. M. 2013). Moreover, nurses are ethically required to be accountable for their actions while handling patients. They should be ready to accept and own any personal or professional consequences which may arise from their actions. Moreover, the nurses must always uphold the ethical principle of fidelity. They must always be faithful and remain true to professional responsibilities and promises by delivering safe and high-quality healthcare in a very competent way (Rigolosi, E. L. M. 2013). The nurses must accept every patient and consider them as unique persons with rights to express their values, opinions, beliefs, and perspectives which affect the way they are supposed to be served. Patients must be free to make their decisions and judgments without any manipulations by the nurse. Nurses must consider with great respect those decisions made by patients, whether to receive treatment or not and in what manner (Shi, L., & Johnson, et al. 2013). Furthermore, nurses are supposed to be very truthful with a patient whom they serve. They must not withhold any information about the patient, but instead, they are expected to tell the whole truth about the condition of the patient, even if that might cause distress to the patient. All these are coupled with the other ethical concerns and issues such as the distribution of the institution's scarce resources as well as the end of life issues.
Given the stressing conditions that nurses are exposed to, there may be possibilities that the patients may be inadequately attended to by the nurses (Rigolosi, E. L. M. 2013). Since patients can gauge the level of services they receive, this may bring several implications on the patient, or the patient's family. First, the patient may decide not to receive any form of treatment at all. Since the patient has the right to decide on what befits him or her, the hospital has to release the patient. As a result, the hospital is most likely to lose very many clients who are the basis for the functioning of every hospital. Second, the overcrowding of patients who seek emergency services at the hospital may result in the extended waiting time that may consequently discourage the patients in the waiting line. Moreover, since nurses handle very many patients every time, they may be exhausted causing them to deliver incompetent services to the patients (Johnson, C. E. 2012). Suppose there arise any complications after that as a result of medical error; the nurse may be susceptible to legal measures.
According to Rigolosi (2013), the emergency department administrator is also gripped between the need to address the moral distress of healthcare providers, quality of services provided and the interests of stakeholders. The following are the primary stakeholders who are mostly interested with the quality of services at the hospital's emergency department; the nurses, patients, hospital administration, the general public, and the government. The nurses may pressurize the administration to reduce their workload by recruiting new healthcare providers, as well as demand for the better working environment. The patients demand that nurses may give them high-quality healthcare services which is just, fair, and cost-effective (Shi, L., & Johnson, et al. 2013). The hospital administration expects the nurses to work with great determination to exceed patients' expectations, hence, putting a lot of pressure onto the nurses. Moreover, the general public also expects that the hospital should provide very high quality and cost-effective services that meet their expectations. Furthermore, the government, on the other hand, is determined to see that the nurses and the hospital administration strictly adhere to the legal framework of health provision (Johnson, C. E. 2012).
In conclusion, the administrator of the hospital's emergency department faces complicated decision-making phenomena where the emergency rooms are always overcrowded, and there is inadequate healthcare provision staff. According to Barret (2016), it requires sagacious reasoning to find the most appropriate solution which takes into consideration the alleviation of the existing stressful situation, upholding ethical principles, enhancing the better working environment for nurses, as well as protecting the interests of the key healthcare stakeholders.
Barrett, D. H., Bolan, G., Dawson, A., Ortmann, L. H., Reis, A., & Saenz, C. (2016). Public Health Ethics: Cases Spanning the Globe.
Burke, & Friedman, L. H. (2011). Essentials of management and leadership in public health. Sudbury: Jones & Bartlett Learning.
Johnson, C. E. (2012). Meeting the ethical challenges of leadership: Casting light or shadow. Thousand Oaks, Calif: SAGE.
Rigolosi, E. L. M. (2013). Management and leadership in nursing and health care: An experiential approach. New York: Springer.
Shi, L., & Johnson, J. A. (2013). Novick & Morrow's Public Health Administration. Sudbury: Jones & Bartlett Learning.
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