Explain how an awareness of your own personal integrity helped you decide on a strategy.
Write a 4-6 page executive report that analyzes ethical dilemmas presented in a case study, identifies the ethical principles that guide decision making and describes the external and internal factors that must be considered in ethical dilemmas. Explain evidence-based strategies to resolve ethical dilemmas and how personal moral integrity influences decision-making.Introduction
The health care system in the United States is in the process of being transformed from a patriarchal health care system to the currently emerging patient-centered care model. The patient cultural revolution, boosted by technological advances and increased access to health-related information, presents tremendous change and managerial challenges throughout the entire health care system. These changes affect direct patient care facilities as well as the organizations and administrative departments related to, and supporting, their efforts. The patient-centered care model has increased the need for a solid leadership understanding of the patient experience and an enhanced ability to measure, interpret, and report it accurately. Ethical challenges related to patient-centered care present additional considerations to the existing managerial task of balancing quality care and fiscal responsibility.Preparation
Suppose you are the new health care administrator at Brookside Hospital. Brookside Hospital is in the process of strategically aligning with patient-centered care principles, which are founded on ethics and represent a major transformation away from the patriarchal health care system of the past. End-of-life care and death with dignity are two important aspects of patient-centered care.Read the patient-centered care Case Study Scenario [PDF]. Within the case study provided are three distinct ethical dilemmas:
- An internal or organizational dilemma.
- A formal process dilemma.
- A discharge and end-of-life planning dilemma.
- You must now prepare an executive report for the hospital’s board of directors to explain the situation and how you handled it.Review the resources provided to see how they may help you in completing this assessment. Conduct your own search in the Capella library and on the Internet to locate authoritative resources on patient-centered care. You will need at least four resources to support your work in this assessment.Format this assessment as an executive report. It should be well organized and logical, include a title page and references page, and follow APA guidelines for citations and references.Instructions
In your executive report and for each of the ethical dilemmas, be sure you include the following: - Analyze the ethical dilemmas presented in the case study.
- Describe each of the ethical dilemmas.
- Explain the factors that contributed to each dilemma.
- Identify the ethical principle that you used for each ethical dilemma to help guide your decision making.
- Describe the external forces and internal organizational factors you considered for each dilemma.
- Describe any legal or regulatory forces.
- Describe any organizational policies and/or processes.
- Explain the evidence-based strategy you used to resolve each ethical dilemma. (Hint: another way to think of this is to imagine that you did take action on each of the dilemmas. With that in mind, what strategy would you use and what supporting evidence do you have that the strategy is sound and effective?)
- Explain how an awareness of your own personal integrity helped you decide on a strategy.
- Additional Requirements
- Include a title page and references page.
- Number of pages: 4–6, double-spaced.
- At least four current scholarly or professional resources.
- APA format for citations and references.
- Times New Roman font, 12-point.
- Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: - Competency 1: Explain how ethical theories and principles influence health care organizational management practice.
- Identify the ethical principles that guide decision making in health care management.
- Analyze the ethical dilemmas in health care management.
- Explain evidence-based strategies to resolve ethical dilemmas in health care.
- Competency 2: Describe how external forces and internal organizational factors influence ethical health care management practices.
- Describe the external and internal factors that guide health care management practices.
- Competency 3: Examine the role personal moral integrity plays in ethical leadership practice.
- Explain how personal moral integrity guides ethical decision making in health care management.
- Competency 4: Communicate ideas effectively.
- Correctly format citations and references using current APA style.
- Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
- Case Study ScenarioYou are the health care administrator at Brookside Hospital, a privately owned, 250-bed facility located in a rural town in West Virginia. You receive an emergency call from the hospital director of security at 7:00 a.m. on a Thursday morning, just as you are preparing to leave your home for your 20-minute commute. Apparently, there has been a disturbance in the ICU waiting room involving family members of a new patient admitted through emergency services during the night. Security is attempting to de-escalate the situation and 911 has been called with law enforcement on the way.When you arrive, you are met in your office by the director of nursing services and director of security for debriefing on the situation. The family members have been somewhat calmed and are located in the ICU family waiting area and the cafeteria of the hospital with security officers present. The daughter of the patient has demanded to meet with you immediately.Back StoryJoseph and Barbara Nichols have been married for 56 years. They have two children and five grandchildren. Both are in their late 80s and currently reside in a small home they purchased 30 years ago. Their home is located in the same suburban Pennsylvania neighborhood as their daughter, Mary, and her family. Mrs. Nichols suffers from advancing dementia and is easily upset and confused, but she is otherwise in good health. Mr. Nichols has suffered two heart attacks, yet is still able to care for himself and his wife with help from his daughter and a housecleaning and lawn service. Neither drives. Both are very independent individuals and have made it clear to their children that they wish to live out their lives and die peacefully in their own home.This has been an issue between Mary and her brother, John, who resides in West Virginia. Mary defends her parents’ independent living choice and plans to help with securing increased home care as needed. Her brother repeatedly argues that it is in everyone’s best interest, especially with his mother’s dementia and father’s medical history, that the house be sold and his parents placed in a senior care living facility. At their parents’ request, Mary is designated as health care agent if needed, and they both have living wills. Both Mary and John are aware of their parents’ advance directive wishes. The couple relies on Medicare coverage for their medical needs and do not have long-term care insurance. Their source of income is adequate and includes social security and Mr. Nichols’ modest retirement pension. Neither are veterans.Three days ago, Mary and her family left for an annual vacation to New York. They dropped off Mr. and Mrs. Nichols at her brother’s home to visit with his family for the week. As always, Mary left contact and medical information in a file with her brother.On the evening prior to the early morning call, John and his wife had gone out, leaving their 14- year-old daughter at home alone with her grandparents. At 10 p.m., after retiring for the night, she was awakened by her grandmother crying out in the hallway, frantically searching for her husband. She was also highly agitated and confusedabout where she was. Together, they found Mr. Nichols unconscious on the bathroom floor. The granddaughter called 911 but was unable to reach her parents directly. The emergency personnel arrived to chaos, with both women hysterical. Mr. Nichols was treated by paramedics and rushed to the Brookside emergency department, where it was determined that he had suffered another heart attack and was placed in the intensive care unit. Mrs. Nichols and her granddaughter were escorted to the hospital by the local police.BUS-FPX4121 Case Study1BUS-FPX4121When John and his wife finally checked their phones, they rushed to the hospital to find Mr. Nichols unresponsive and on extensive life support. Mrs. Nichols and her granddaughter had been unable to communicate medical history. Neither remembered or mentioned the daughter Mary during all of the disturbance and emotional confusion. Mr. Nichols’ advance directives included a do-not-resuscitate (DNR) order, a do-not-intubate (DNI) order, and his stated preference for no life-sustaining equipment or devices.After John called to give her the news, Mary and her family immediately drove straight through the night to the hospital. Upon their arrival, everyone in the family was stressed, afraid, hungry, and overtired. When Mary spoke to the charge nurse, she was short and curt, informing her that she would have to wait until after the shift change to get complete information and speak with an attending physician. Mary then discovered her father on life support and was unable to control her fear and frustration, lashing out in anger toward her brother.Just as the nursing change of shift meeting began, a loud, verbal argument between Mary and John erupted in the ICU waiting area. The charge nurse briefly attempted to calm the families but called in Security, as the argument appeared to be escalating toward physical violence between Mary’s husband and her brother John.Security has calmed the family and Mary is impatiently waiting to speak to you, the Brookside administrator, as she cannot understand how her father’s wishes were not respected and blames the facility for not taking more extensive efforts to research her father’s medical history and paperwork further. She also plans to lodge a formal complaint against the charge nurse for what she considers rude and unethical behavior toward her.Post ScriptTwo weeks later Mr. Nichols has gained consciousness and is on minimal life support at Brookside Hospital. However, without the life support, he is expected to live no more than a week or so. He is requesting to return to his home in Pennsylvania. His children and wife are divided and conflicted the over next steps to be taken. His daughter Mary is distraught. She feels that if her father is not taken home, he will not experience the death with dignity he wishes and deserves. She has taken a leave of absence from her job and is staying at her brother’s home with her mother to enable them to be at Brookside each day. This is straining her family’s finances and emotional well-being. She is also shouldering a burden of guilt for being on vacation when crucial decisions were made that compounded the situation. Her brother, John, is very frustrated and angry, as he feels that it is more appropriate to move his father to a hospice facility. He is increasingly vocal and adamant about selling the house and securing an appropriate placement for his mother. With all the stress and disruption, Mrs. Nichols’ level of confusion and anxiety has increased significantly and she is unable to fully understand and contribute to discussions and decisions.
- Resources: Library Resources
- Forrestal, E. J., & Cellucci, L. W. (2016). Ethics and professionalism for healthcare managers. Health Administration Press.
- Chapter 7.
- Grob, R. (2013). The heart of patient-centered care. Journal of Health Politics, Policy & Law, 38(2), 457–465.
- Mezzich, J., Snaedal, J., van Weel, C., & Heath, I. (2010). Toward person-centered medicine: From disease to patient to person. Mount Sinai Journal of Medicine, 77(3), 304–306.
- Martin, W. (2013). Beyond the Hippocratic oath: Developing codes of conduct in healthcare organizations. OD Practitioner, 45(2), 26–30.
- Resources: Internet Resources
- Death With Dignity. (n.d.). Death with dignity acts.https://www.deathwithdignity.org/learn/death-with-…
- American College of Healthcare Executives. (2017).The healthcare executive’s role in ensuring quality and patient safety. www.ache.org/about-ache/our-story/our-commitments/…
- Planetree. (n.d.). http://planetree.org/
- National Hospice and Palliative Care Organization (NHPCO). (n.d.). https://www.nhpco.org/
- National POLST. (n.d.). http://www.polst.org/
- Aging With Dignity. (2015). Five wishes. https://www.agingwithdignity.org/five-wishes
- Frontline PBS. (2014, October 12). Dr. Atul Gawande on aging, dying, and “being mortal” [Video]. | Transcript. YouTube.
- Frontline PBS. (2015, February 10). When should dying patients stop treatment? [Video]. | Transcript. YouTube.
- The Kennedy Institute of Ethics. (2014, December 19). Introduction to bioethics: Bioethics at the end of life [Video] | Transcript. YouTube.
- Forrestal, E. J., & Cellucci, L. W. (2016). Ethics and professionalism for healthcare managers. Health Administration Press.
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