PART A: Ethical Challenges in School Nursing

Introduction

School nurses practice in a multi-disciplinary environment that integrates many stakeholder perspectives. Differing values and views of parents, administrators, teachers, students and the school nurse can culminate in ethical conflicts in decision-making on health issues. In this sense, school nurses work setting can result in opposing values of people student needs, family need and school staff dictates and opinions. Therefore, school nurses need to be able to identify, analyze and resolve states that encompass ethical conflict as reviewed in this article.

Ethical Challenges

DNR Policy

Empirical evidence reveals nurses encounter dilemma, uncertainty and distress. Uncertainty details when a nurse is hesitant of the ethics of the event and dilemma describes the existence of two equivalently objectionable choices such as enabling a patient remaining on life support or patient give up life-support and expires (Savage, 2017). Moral distress occurs when a nurse believes he or she discerns the right guiding principle to take, but think they are restrained from acting.

For a school nurse, distress occurs when parents forbid a nurse from resuscitating children when at school and the school guidelines are against a CPR through the Do Not Resuscitate (DNR) directive. In the face of the nurse’s exertion to amend the decree, she senses inhibited to withhold artificial respiration, so undergoes anguish of being impotent to proceed in a manner that compliments the parent’s requests. The physician would be legally obliged to revive the child, notwithstanding being aware that parents are against this action. The nurse has to ignore the interests of the parent because the patient is the priority (Walden University, 2020). In this case, the school nurse might suffer moral grief when they think they cannot provide the quality of care that they consider is harmonious with the parent’s needs.

Maintaining confidentiality

According to the ANA Code of Ethics, nurses must keep all data private and only share pertinent information with members of the healthcare team, and only through suitable channels that adhere to proven procedures(Walden University, 2020). From personal knowledge, upholding the confidentiality of student’s health and family distresses is a significant concern in a smaller community where people know each other in and beyond the school setting. For instance, in a causal context, a teacher laments on a student whose performance was dismal, and the teacher was becoming frustrated; however, the nurse is aware of the student’s family situations, but because of confidentiality the teacher cannot divulge the information. In this case, the school nurse experiences some discomfort, which provides an impetus for resolving a stressing situation. The nurse supposes that if he or she informs the teacher of the student’s family situation, the teacher might be more understanding and helpful to the student. On the other hand, the nurse would violate a patient’s confidentiality and might be legally liable for breaching confidentiality.

Data indicates that among situations encountered by nurses, moral distress is rated high in especially among school nurses. School nurses report a higher level of moral anguish because they collaborate with parents, teachers and other stakeholders to prepare care plans(Powell et al., 2017). As such, the nurses are overloaded as they have a considerable amount of work to provide the care they consider necessary. Also, they have an added task of discussing with non-nurse managers the necessity of hiring a competent school nurse.

PART B

B1: Role of Nurse Leader in Resolving Ethical Challenges

Pundits define nursing leadership as persuading others to enhance the quality of care, coupled with direct contribution in medical care(Al-Dossary, 2017). While the position is rewarding, nurse leaders grapple with resolving dilemmas associated with their nurses’ needs against the essentials of patients and the community. Although all nurses experience predicaments, nurse leaders deal with an extra load as they have to assist their subordinates in navigating and overcoming uncertainty and moral distress. In this regard, nurse leaders have an integral role to play in ensuring the adoption of published ethical decision-making models.

Excellent nurse leaders serve as ambassadors of change and are on the frontlines advocating for change. The scenario is similar in the application of published ethical decision-making models as nurses are often reluctant to integrate research in their practice. The leader will inspire the use of such models in practice by ensuring that patient-centered care plans are grounded on ethical decisions(Johnson & Johnson Services, Inc., 2018). The leader can accelerate the process by appointing ambassadors of published ethical decision-making models and making them agents of ethical practice. Appointing ambassadors is an effective strategy for the leader to be informed of what happens on the frontlines and gather cross-functional opinions on how to improve and mitigate dilemmas in the facility.

Additionally, a competent leader collaborates with GPs and other health specialists in reforming and remodeling the delivery of care across the facility. In this regard, the leader must be an advocate of nursing studies and practice and continue to pinpoint and cultivate evidence-based enhancements to care. These enhancements are adopted through policy changes at the facility. Change policy to support and encourage the adoption of published strategies of overcoming dilemmas shifts the mindset of subordinates to embrace the published decision-making models. While advocating for the approval of the available models, the leaders must acknowledge the reservation of nurses and address them accordingly because the misgivings can evolve into resistance which is likely to jeopardize the safety and quality of care.

Nurses are reluctant to adopt publications due to organizational or individual factors. Individual factors include lack of knowledge about the published model, poor awareness on the decision-making process and negative attitude towards new approaches to the decision-making process(Eaton et al., 2017). In this sense, the nurse leader must make the published decision-making model meaningful and how it impacts the subordinates’ practice.  Thus can be attained through practical training and navigation through all steps of the model. Coaching creates an opportunity to collaborate and gain further in-depth on the subject and hence ease of adoption.

B2: stakeholders affected by the ethical decision-making process

Patients

Patients are leading beneficiaries of ethical decision-making in the healthcare system. According to the ANA Code of Ethics, nurses must act with empathy and veneration for the intrinsic dignity, significance, and distinct traits of everybody(Walden University, 2020). About this guideline, when nurses make ethical decisions, they uphold the right to self-respect by regarding the values and needs of each patient by suspending their biases and prejudices. For instance, when a student needs resuscitation and the school policy is against the procedure, the nurse makes an ethical decision by prioritizing the interest of the student by performing CPR to alleviate the situation. In this case, the nurse has wrestled institutional guidelines to make an ethical decision where the benefitting stakeholder is a patient.

Nurses

In making ethical decisions, nurses must consider various forces that influence their decisions. In most cases, nurses are grappling with dilemmas in deciding what to do in complicated patient care situations. In this regard, before solving any situation, nurses consult ethical principles to ensure the resolution embodies care, veneration, honesty and sincerity(Sarı et al., 2018). The outcome of such an assessment often results in moral distress, especially when they are faced with conflicting situations. Misery also occurs when a nurse is faced with uncertainty where both options are disagreeable. For instance, when a patient’s choice to stay on life support or forgo life-support and die.

Patient’s Family

Family and friends are vital in hospital treatment of patients as they offer psychological and emotional support to patients. While they are essential in the recovery process, family and friends can be a nuisance to caregivers, especially when they attempt to influence care. In some instances, they resort to disruptive behavior such as yelling at nurses and issuing directives or trying to undermine the patient’s decisions. In these cases, nurses make ethical decisions to prioritize the interests of the patient and ignore family and friends’ suggestions. The outcomes of such ethical decisions negatively affect this group of stakeholders as their wishes were overlooked in care planning.

Hospital administration

While healthcare facilities are designed to provide care, they serve as business entities too. Operating as a business entity implies that hospitals also have limited resources and must strive to maximise them to generate profit and remain operational. The realization of such objectives has forced most facilities to be understaffed as they attempt to cut costs. In such situations, nurse leaders make ethical decisions to discuss with the administration on adequate nurse coverage in the facility. The administrators can either accept or decline to hire more nurses, but either way, the facility’s administration is affected by either lawsuits or increased operational cost.

B3:Role of Interdisciplinary Team Members in Ethical Decision-Making Process

Traditionally, most clinical and ethical judgments concern a patient and his or her physician. However, there is an increasing shift from the conventional relationship between patient and physician towards that of the patient and a team of health care providers, especially in rehabilitation medicine. Teams are increasingly becoming common in healthcare, especially in specialty areas that deliver intricate and often chronic patient care. As such, the interdisciplinary team members have a role to play in the team’s ethical decision-making process.

Since the teams are composed of a diverse field of care, each member has a different primary duty and concern. For instance, an anesthetist is focused on the safety of dispensing anesthetic and wellbeing of practitioners involved in the surgery. Similarly, practitioners must collaborate with others in ensuring the process is ethical and remain supportive throughout the process(Wiles et al., 2016). Also, collaboration removes tensions as all members respect each other’s views and perception of a given procedure and often can only offer suggestions for better practice. Elimination of friction through collaboration is essential in fostering patient’s safety and quality of care which guides the ethical decision-making process in the team.

Interdisciplinary team members contribute towards making ethical decision-making through sharing of information. Information sharing is fundamental in ensuring patients receive safe and quality care as it allows other caregivers to make informed decisions(Cumin et al., 2016). It also improves the quality of care and patient outcome. It makes care more efficient as other teams are informed on areas that need to be addressed instead of conducting unnecessary tests. Sharing of information is attainable through effective communication between members as it boosts morale and job satisfaction in the team.

In instances where the teams carelessly ignore the patient’s wishes when they determine the ‘best’ treatment option, members have to share the moral responsibility of their decision. However, individual team members sustain personal moral accountability to their patient. Team members must respect the patient’s choices during the decision-making process, even if it conflicts with their recommendations. Each team member should uphold the values of providing and encouraging team members to remain loyal to codes of conduct to ensure all decisions are ethical and patient-centered. Cultivation of such working conditions makes it easy for members to consult when faced with dilemmas or when attempting to integrate evidence-based practice in their service.

B4:Transformational Leadership Strategy to Promote Interdisciplinary Team Collaboration in Ethical Decision-Making

Achieving a mutual purpose is the primary function of leadership. Data indicates that leadership is an essential antecedent to the attainment of safety and quality in patient care, and critical success factor in significant change initiatives (Al-Dossary, 2017). The success of leadership is hinged on the leader’s vision, demeanor and satisfaction of subordinates. In nursing, scholars give prominence to transformational leadership because it contributes to enhancing patent safety and job satisfaction among followers (Boamah et al., 2018). This leadership strategy operates on collaboration as those led feel elevated and inspired to be active because the relationship is mutual. Leaders achieve transformational leadership through the identification of an initiative and committing to a relationship with subjects.

In interdisciplinary teams, leaders can motivate team members to collaborate in an ethical decision-making process through the cultivation of relationships and sharing of objectives. The leader can achieve commitment by the establishment of proper, continuing structures that foster cooperative communication and exchange of information and ideas(Deshpande et al., 2018). On an ongoing basis, the nurse leader is essential in upholding and nurturing the relationship with interdisciplinary team members. During this period, the leader informs the members about the benefits of making ethical decisions and how they contribute to the enhanced outcome for both team members and the patients. The nurse leader can advance the need for participation in making ethical decisions by listening and addressing the concerns of the team members.

Cultivation of excellent relationships is an effective strategy in transformational leadership as it unites all members towards the realization of a common goal. The approach is also useful as it allows the leader to make necessary adjustments on their leadership strategies based on the preferences and the needs of followers and the pursuit of ensuring making of ethical decisions in interdisciplinary settings. The pooling of interests towards the realization of a common goal is essential in the fulfillment of the objective of ethical decision making in multi-disciplinary teams and the delivery of excellent care.

Also, basing transformational leadership on interpersonal relationships is essential in the management of the delivery of the objective. In this case, the leader would be aware of the team members concerns and would formulate strategies to navigate with members through their apprehensions and ensure all are comfortable to participate. Also, when the relationship is founded on mutual benefits, all participants would feel pleased to contribute to the decisions making process as their opinions would be respected and tolerated.

PART C:Role of Nurse Leader in the Success of Organizational Mission

School nurses are fundamental in the constant delivery of comprehensive health care to students. Growing the number of students with special medical disorders that necessitate management when schools are in session. It is on this observation that my organization’s mission is to enhance the academic accomplishment of student’s and wellbeing of employees through health education, nursing services and environmental safety. The organization believes the success of this mission is hinged on the collective efforts of all stakeholders. Therefore, the institution is an advocate of collaboration in the execution of tasks focused on the health and wellbeing of students being the priority.

Since the school environment presents unique challenges to nurses, especially in the ethical decision-making process, nurse leaders have an essential role in alleviating the situation. Nurse leaders advocating for adherence to published ethical decision-making models by being ambassadors of change is aligned with the mission of my organization such that it will be advancing patient care and education. Also, the leaders will partner with the other stakeholders in restructuring and reshaping the public schools’ health service department in all faculties. The nurse leader can achieve this by advocating for the integration of nursing research into practice and continued development of evidence-based improvements to ensure delivery of care that enhances the students’ and teachers’ health and wellbeing.

From personal knowledge, school nurses grapple with numerous disputes with non-nurse supervisors related to interpretation of duties, culpability and span of practice. Due to their broad range of expertise, abilities and tasks, they are vulnerable to stress in an extensive school system. Susceptibility to subjugation, especially when nurses are expected to assume non-nurse duties is a threat to the fruition of the organization’s mission. Participation of multidisciplinary team members in the course of making ethical decision reduces pressure on school nurses, thus safeguarding the mission of the department. Involvement of all members is essential as the delivery of care in a school setting is different from conventional health facilities where care is between the patient and the physician. In a school setting, the school nurse serves as the coordinator in delivery of care between the patients, school administration and parents. In this sense, involving all interdisciplinary team members in the course making resolutions is fundamental in the realization of the organization’s mission.

Closer assessment of the institution’s mission implies that to some degree, it is hinged on ethical decision-making as it revolves around the delivery of care and ensuring wellness among stakeholders. In nursing, observing to doctrines of autonomy and beneficence are preliminary to the ethical decision-making process. Appreciating a patient’s independence means allowing a competent patient to exercise the privilege of choosing care and treatment irrespective of medical opinions and associated endorsements. ANA Code of Ethics embedded edicts allowing nurses to encourage and advocate for the liberties of a patient, an undertaking that should be the core of all judgments, especially in a school setting (Walden University, 2020). Advocating for patients might involving offering care that is essential to the student or listening to suggestions of the student in care planning. Therefore, when a nurse advocates for patients contributes to the success of the institution’s mission of enhancing educational success and wellness of learners and staff.

School nurses are essential in promoting the wellbeing, academic achievement and health of schoolchildren because they concentrate on safeguarding the health of students and staffs. Achievement of these goals necessitates competence in leadership as nurses have to participate in the formulation of policies, programs and procedures related to promoting health(Hoekstra et al., 2016). An effective leadership style is transformational leaders where the nurse leader has to cultivate relationships with the school district, parents, students, the community and other healthcare providers to ensure participation and commitment towards the attainment of academic success and wellness of staff. Through transformational leadership, the nurse can pursue the school district to allocate sufficient resources to school healthcare facilities, employ more nurses and ensure schools have competent nurses. The leadership strategy is effective because all stakeholders would be committed to working together towards the success of the organizational mission and as such, will be willing to subdue any barriers.

From personal knowledge, transformational leadership is useful in the introduction and implementation of change as all stakeholders share a common goal and vision. In this case, the nurse leader can introduce new ideas to other stakeholders and educate them on how they advance safety and quality of care. Involving all stakeholders in the decision-making process creates a conducive environment that fosters the integration of evidence-based practice in service delivery as members are open to new ideas. Also, transformative leadership eradicates friction points in interdisciplinary teams as each member has a specific responsibility, and they are aware of how their roles contribute towards the realization of the primary objective.

References

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