Category: Ethics

The most important immediate response of a nurse during a disaster is to activate the disaster plan in their hospital. This includes triaging patients, coordinating evacuations, and communicating effectively with other healthcare providers. Perhaps one of the most important factors when it comes to any emergency situation is maintaining organization and teamwork, which is seen in The Story of Hurricane Sandy and NYU Medical Center. 

Although nurses have a duty to care for their patients, it should not extend to the point where a nurse must feel as though they must negate their own needs for that of others. Situations in which a nurse may be faced with making a decision that prioritizes themselves or their patients include mass casualty events in which triaging becomes necessary, or if a scenario warrants that only one person may survive. It is the decision-making process of the nurse that needs to be refined to deal with emergency situations. All nurses should be trained in emergency preparedness, as it is unknown when these situations may occur and this training may help prevent a nurse from having to struggle between the code of ethics and their duty to self. However, nurses must also recognize the power that they hold from the viewpoint of their patients. A patient has a strong reliance and trust in their nurse to do what they believe is best. If a nurse decides to choose themselves over their patients, how will patients be able to trust not only nurses but the healthcare team? In these situations, we must remember that no single life is more important than another, it simply must come down to the professional opinion of the nurse to decide which life is more viable at that moment.

Al Harthi, M., Al Thobaity, A., Al Ahmari, W., & Almalki, M. (2020). Challenges for Nurses in Disaster Management: A Scoping Review. Risk management and healthcare policy, 13, 2627–2634. https://doi.org/10.2147/RMHP.S279513

Everyone is going to die, it’s just a matter of when and how. Every day, people choose whether they want to live. My opinion of death with dignity is that it allows an individual to have autonomy over their life. If someone no longer wants to live, they’ll find a way regardless of the law. My belief has always been quality over quantity because otherwise, what’s the point. 

Death with dignity does not challenge my beliefs of the first ethical principle of nursing. I believe that the purpose of a nurse is to promote a healthy lifestyle and to improve health. Despite the great lengths that nurses go to to help avoid a patients’ deterioration in the hospital, it happens, especially in cases in which a patient is immobile or comatose. I feel like a nurse would be doing a great disservice to their patients to believe or promote life when it is no longer feasible. Nurses can not always improve life and when they can’t, they should promote comfort and autonomy. Although I agree with the death with dignity act, it doesn’t come without its complications. At what point can it be determined that someone is within their mental capacity to consent to physician-assisted death.

Smith, M. A., Torres, L., Burton, T. C. (2020). Patient Rights at the End of Life. Wolters Kluwer Health, Inc. 25(2), 77-84.

I think the electronic health record is a productive way of attaining a thorough health history of a patient, especially in instances in which a patient is unresponsive. The electronic health record improves efficiency between hospitals- no need to track down and contact the hospital for records. 

Health Info Net is an organization that allows health care providers to access patient information from any hospital that a patient has visited or been admitted to in the state of Maine. The way in which health information is accessed is called the Health Information Exchange (HIE). Health Info Net was incorporated in 2006 and since then has been advocating for patient care by combining health information from unaffiliated healthcare organizations to create a single electronic health record, the HIE (HealthInfoNet 2021). This health record is accessed by providers across the state of Maine in order to provide better patient care. The health information exchange improves communication between providers and helps prevent pertinent information from being overlooked or forgotten. The HIE improves nursing care by providing a patient history that nurses can refer to when providing patient care. 

As a nurse, knowing that the notes and data that I record will be embedded into a single health record, I will want to make sure that what I am recording is as accurate and detailed as possible. This exchange allows for quick access to previous assessments and could allow me to trend vital signs and labs from the previous data and compare them to current data. Prior health history can be critical in determining the path a patient is heading towards and helping to prevent it.

Bearor, S., Yeo-Fisher, N. (2021). Maine’s Health Information Exchange. [Powerpoint Slides]

Trauma exposure, whether experienced as a child or an adult, has the ability to create a lasting impact on someone’s life just by the way the situation was handled or the events leading up to the trauma. Trauma can cause long-lasting psychological effects, such as anxiety and PTSD. If the trauma had caused a physical malformation, it may be more difficult to move forward in life. Spiritually, individuals may believe that they deserved the trauma, that their higher power had intended it for them. Victims of environmental traumas such as hurricanes or tornados may fear specific regions that are more likely to experience those weather events. Overall, traumas can impact our ability to form relationships, or to even maintain them. Some may fear leaving their home and some are not allowed to leave, especially in instances of domestic violence. The inability to develop new relationships or maintain current ones can lead to isolation which is neither healthy for the body or mind.

An adverse childhood experience is a traumatic or negative event that specifically happens to individuals as young as a newborn to seventeen years of age. Long term impacts of adverse childhood experiences immediately predispose adolescents to the risk of substance use problems, mental illness and chronic health conditions. As well as the potential for the adolescent to continue the trauma they experienced into adulthood. 

As a future nurse, it is important to remember that every patient, whether a victim of trauma or not, deserves respect. One of the first things a nurse should do, and perhaps the most important things to do, is to establish trust and rapport with the patient and family members, if applicable. As a nurse, I will have to investigate the impact of trauma on my patient while maintaining respect and establishing boundaries. I must also be aware that it’s okay to ask direct questions about trauma, as it is unlikely that those questions will send them reeling back into the trauma.

Public health nurses are an elite group of individuals whose purpose is to integrate themselves into their communities and act as resources and educators specifically for vulnerable and marginalized populations. Their role is all-encompassing, which also includes new Mainers and asylum seekers. These nurses bear witness to the impact of the opioid crisis and gun violence on families and their communities. These individuals fall into a category known as vulnerable populations and this is because these communities are more susceptible to violence and abuse due to low socioeconomic status. Community health nurses watch as families are torn apart and kids orphaned as parents find themselves bound to their chemical addiction. These nurses are also responders of the climate crisis. As temperatures rise, individuals find themselves struggling to not only stay cool but to also afford it. Nurses are privy to these issues because more people are seeking treatment for heat stroke, sun burns, and dehydration. 

The social determinates of health are economic and social conditions that influence the health status of individuals. From high-income to low-income communites, there is a clear disparity in health due to the ability to not only access care but to also afford it. This disparity is predominant in low-income communities comprised primarily of African Americans and is influenced by a history of racism and continues to be an issue as our past has led to a mistrust of future care. Culturally, some medical conditions are not seen as a condition at all, they are simply a spiritual connection (Hmong). Often times western medicine is regarded as the standard of care, and from this arises the issue of when medical intervention is warranted. This is because of the varying expectations of individuals of different nationalities, cultures, and religions as western medicine may not be their idea of medicine. 

Strategies for improving the health of vulnerable and marginalized populations would be adequate access to healthcare, affordable healthcare, and education. Individuals should be aware that emergency rooms cannot be utilized for check-ups and to combat this, clinics need to be made available in these areas. However, this isn’t so easy as clinics require manpower and currently there is a lack of healthcare workers. There is where education can play a powerful role in preventing recurrent healthcare visits. If these individuals can be made aware of the lifestyles that put them at risk for health conditions, they could make the changes to live a healthier life (i.e. no smoking, minimal alcohol, exercise). 

To manage the care of an individual who lives and/or has different beliefs than I do requires that I hold myself accountable and refrain from judgment. It requires that I am well-rounded and well-informed of the communities around me and that I have effective communication skills.