Ethical Evidence And Application • Online Nursing Essays

The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course and text readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

Ethical Evidence and Application

In this assignment, you will discuss ethical evidence as it pertains to your topic. Everything we do in nursing should be supported by evidence. Nursing is a profession that demands ethical practice. We encounter ethical dilemmas on a daily basis. Most often, the ethical dilemma is directly related to care, be it overly aggressive care or suboptimal care, depending on the patient’s wishes. Visit the South University Online Library and retrieve two peer-reviewed articles pertaining to ethical research (or perhaps ethical theory) related to your topic of interest. Critique each article, highlighting the strengths and the weaknesses of each article. Interpret the statistical analysis and significance of results. Finally, analyze the feasibility of applying this evidence to your topic of interest in your current practicum setting. Both articles should support nursing standards and patient safety within your chosen topic.

Ethics in my proposed topic of interest revolves around the adolescent patient population, which is a protected population. Adolescents can be easily influenced by those who are perceived to be in an authoritarian position, which could include health care professionals.  Coercion is a concern for the youth seeking medical care (Salamanca-Buentello et al., 2020). This has weighed heavily on me as I continue to develop my project topic and anticipate the trajectory of the project.  Currently, my plan is to develop an improvement project that benefits the identified patient population but does not directly include them in the improvement. However, ethical considerations are still a concern.

The articles I selected both have relevance to some degree for my project as outlined below.

Article 1 – The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world.

This article provides several ethical considerations based on a quantitative Delphi study aimed at identifying gaps in screening children and adolescents for mental health disorders in Low- and middle-income countries.  A Delphi study is a collection of opinions from professionals about a specific topic after multiple rounds of questioning (Polit & Beck, 2017).  Several ethical topics were identified. First and foremost, the fact that many of the screening tools are Westernized, which may not account for cultural, ethical, or traditional norms of other countries.  The influence of the Western biomedical culture assumes universal causes, signs, and symptoms, and screening techniques which may not reflect accurately or consider local customs or norms resulting in improper diagnosis or treatment modalities that are not sensitive to these differences (Salamanca-Buentello et al., 2020).  Additionally, behaviors normal to a specific culture or geographic location, when applied to Western screening norms, may result in mislabeling of those behaviors as pathologic (Salamanca-Buentello et al., 2020).  Other ethical issues raised by this study indicated that the recommendation of screening provided in educational or primary care settings does creates a disparity in access to those marginalized communities or locations who do not have either of these organizational institutions (Salamanca-Buentello et al., 2020).  Failing to provide adequate prevention by way of screening creates an ethical dilemma to those populations who are underserved. 

One of the questions I have considered as I work through m project details is what to do with results from completed screenings once these are implemented as a routine workflow component. Salamanca-Buentello et al. (2020) identify this as an ethical issue.  Not only how to proceed with treatment once screening is completed, but also identifying that the need of the target population is more important than the personal, academic, or professional interest of the person performing the screening.

Lastly, this source brought to light trust issues and cultural norms that may lead to misuse of collected information. For example, historical colonization of some countries has led to fear and distrust of what will become of the information collected and if negative outcomes, such as removal of children will occur (Salamanca-Buentello et al., 2020). Similarly, in countries with gender inequities, fears about how treatment will be offered and if the information gathered will be used in a manner that further suppresses the limited rights of these individuals is questioned (Salamanca-Buentello et al., 2020).

The Delphi study is both a strengths and weaknesses of this study. First is a well-documented method that provides a diverse voice from professionals in this topic area. However, this is a weakness related to the professionals that participated in the group.  This group also may not be representative of the patient population, which is identified as general weakness for this type of study (Polit & Beck, 2017).

This article will be extremely helpful to the project topic since the patient population is a protected class. It will be important to consider many of the ethical questions that this source highlighted.  What will come from the data collected, how will the data be protected, and what ethical considerations will need to be addressed are all essential to ponder as the project continues to develop.

Article 2: A cross-cultural qualitative study of the ethical aspects in the transition from child mental health services to adult mental health services

This article provides an interesting look at the ethics involved as children who receive mental health care transition into adulthood. Several important questions were raised and discussed in focus groups to identify what considerations should be addressed.  There were 3 main questions explored:

1. How should the transition of care from child to adult services occur?
2. Who makes the decision for continuity of care?
3. What are potential harms for the child transitioning to adult care?

O’Hara et al. (2020) found that the majority of these questions were highly dependent on the mental health disorder and capability of the affected client to make decisions. While they state that becoming majority (turning 18) elicits a sense of autonomy, clinical providers may have to intervene with professional expertise in conjunction with parents to make decisions for those transitioning child-to-adults who do not demonstrate capability to decide if further treatment is needed. In response to this, focus group members felt that inclusion of their desires for treatment was essential to avoid a complete refusal to continue with care (O’Hara et al., 2020).

Strengths and weakness of this study are that a focus group was the primary method for data collection that was interpreted by a researcher. The reported information may have bias or translation effects based on personal interpretation of data.  Furthermore, the data was collected from different countries throughout Europe. This may result in differences among how services are rendered, or transition occurs.  The focus group did not include responses from anyone who had transitioned from child to adult mental health services, so the responses were hypothetical in nature.  This is an important topic to continue exploring and this paper helps provide evidence for that need.

This article brought up important insight into continuity of care as children age out of care primarily directed by providers and their parents. The patient population and ethics is loosely relevant to the QI topic of interest, but overall, it provides a more specialized niche that will not be included in the paper.  The idea of a focus group is not similar to the type of data collection I will perform. Additionally, the study was performed in European countries where the process and modalities of mental health care is more social than private as it is in the US. This equates to differences in processes of transition of care for the patient population identified in the quality improvement project.

References

O’Hara, L., Holme, I., Tah, P., Franic, T., Vrljicak Davidovic, N., Paul, M., Singh, S. P., Street, C., Tuomainen, H., Schulze, U., McNicholas, F., & Consortium, M. (2020). A cross-cultural qualitative study of the ethical aspects in the transition from child mental health services to adult mental health services. Child and Adolescent Mental Health, 25(3), 143-149. https://doi.org/10.1111/camh.12377

Polit, D. F., & Beck, C. T. (2017). Nursing research : generating and assessing evidence for nursing practice (Tenth edition. ed.). Wolters Kluwer Health.

Salamanca-Buentello, F., Seeman, M. V., Daar, A. S., & Upshur, R. E. G. (2020). The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world. PLoS One, 15(8), e0237853. https://doi.org/10.1371/journal.pone.0237853