Ethical Implications of Disclosure and Nondisclosure
Healthcare providers are professionals who have been given the task to provide a service that is unique in that it determines the health of a human being. They, therefore, need to act with the utmost professionalism to ensure such desires are achieved. The nursing professional that includes the advanced nurse practice falls under the nurses and also has to act within the confines of their provided coverage in service provision (Aly et al., 2020). They, therefore, must be guided by principles that they have acquired while in training. These principles are ingrained and reiterated in the code of ethics. The American Code of Ethics for Nurses provides all that a nurse should do in order to remain professionally in line of duty. The federal and state laws also have provisions that ensure that healthcare workers provide their services to patients with high regard in terms of ethics and ethical acts. The law recognizes the American Code of Ethics for Nurses as a provision that ensures that all nurses act within the confines of the law and that they remain productive in their profession (Gaffney et al., 2016). Nursing beliefs are another part of the nursing provision that ensures that the nurses remain faithful to their calling. The ethical consideration for nurses includes autonomy and the right to self-determination, beneficence, and nonmaleficence, disclosure, and right to knowledge and veracity. Disclosure and nondisclosure is a very imperative part of medical ethics that should be observed at all times since medical errors occur now and then for all the cadres in the health profession, including the advanced practice nurse. This essay provides an analysis of the ethical implications for the disclosure and nondisclosure of a medical error where a mistake was made by an advanced practice nurse while prescribing to a patient. It explores implications both at the individual level and at the facility level.
Disclosure refers to a scenario where a person provides or reports an activity that has happened to another party. As an advanced practice nurse, one has an obligation to share any information that will affect the wellbeing of a patient. In provision 3 of the American Code of Ethics ForNurses provides that a nurse promotes, advocates, and protects the rights, health, and safety of a patient (Butts & Rich, 2019). This shows that every patient under the nurse’s care should be the responsibility of that particular nurse. In the state of California, the same ethical provisions that are provided by the American Code of Ethics for Nurses is used and utilized within its boundaries. As a nurse who has made an error in prescribing for the patient, it will be my duty to disclose that information to the relevant people. This starts with the patient himself or herself.
It will be important to disclose that there was a medical error for the same of the patient and their health. It will not cause harm to admit that the prescription that was made had an error so that it can be rectified as soon as possible. The advanced practice nurse observes that all the intentions should be for the beneficence of the patient. A medical error in a prescription, if concealed, would cause harm, and at times it can lead to the death of the patient hence the need to rectify that mistake by the disclosure. According to Doody and Noonan (2016), Provision 4 in the American Code of Ethics for Nurses provides that the nursing officer has the authority, accountability, and responsibility for nursing practice. Every decision that an advanced practice nurse takes should be accompanied by accountability for such an action. The nurse should, therefore, be responsible and accountable for the medical error that was committed unknowingly or knowingly. The nurse, if guided by the code ethics for the nurses, should, therefore, disclose the mistake in the prescription to the patient and other colleagues who will be affected by the act.
The importance of disclosure of the medical error is that it will be corrected promptly and make the necessary step in preventing the negative effect of the medication prescribed. It is known that there are various antidotes for an overdose of certain medications if taken in excess. For example, in a case where a patient is given an overdose of morphine, naloxone is the antidote and is given immediately. In addition, in case there is no antidote for a certain medication, but close monitoring is required, the nurse would ensure that such measures are taken by the hospital so that there is the preservation of that life. Disclosure is, therefore, paramount to the patient for them to be reassured of their health. Unintentional medical error is an occurrence that often happens among all the cadres in the healthcare system, and this should be expected at times (Fowler, 2016). This is bound to happen, especially during burnouts for the advanced practice nurse. Disclosure of any medical errors to the patient builds confidence and trust in the advanced practice nurse by the patient. They would feel that despite the error, the healthcare practitioner was open enough to disclose such to the patient for correction and necessary measures to be taken in order to correct that mistake. Ethically perspective, it would be the right thing to do as it is part of professionalism and acting in the best interest of the patient.
The disclosure should not only be on the patient but also for the clinic. The advanced practice nurse works collaboratively. The patient is cared for by other cadres and hence the need to work together. In the American Code of Ethics for Nurses, provision 2 provides that the patient belongs to more than one cadre hence the need to collaborate so that the patient gets the highest standard care (Olson & Stokes, 2016). Disclosure of the medical error for the prescription to the other team members in the clinic would ensure that the best decision is made regarding protecting the patient against any side effects that would be caused by the medication if it has already been taken.
Nondisclosure of the medical error will amount to negligence and a lack of responsibility by the nursing officer. Provision 3 of the American Code of Ethics for Nurses provides that every nurse should be accountable and take responsibility for their actions. The medical error on prescription was made by the nurse, and it is unethical not to own that action by not disclosing. Nondisclosure would mean that the advanced practice nurse is not ready to take responsibility for their action (Doody&Noonan, 2016). In addition, nondisclosure violates the autonomy and right to knowledge that every patient is entitled to as guaranteed by the Bill of Rights and the American Code of Ethics for Nurses. The nurse would also be liable for the violation of their code of ethics as per the federal and state laws.
The Institute for Safe Medication Practices provides the process that should be followed when prescribing medication for a patient. The steps include evaluate and clearly define the patient’s problem, specify the therapeutic objective, select the appropriate drug therapy, initiate therapy with appropriate details and consider nonpharmacologic therapies, give information, instructions, and warnings, evaluate therapy regularly, consider drug cost when prescribing and use computers and other tools to reduce prescribing errors(Aly et al., 2020). If the eight steps are followed, the institution notes that there would be fewer medical errors in the form of prescriptions. There are strategies that, if implemented, would reduce prescription and medical errors. Always ensure that the five rights of medication administration are confirmed before the procedure is done. These five rights include correct patient, correct dosage, the correct route, correct medication, and correct time(Butts & Rich, 2019). In addition, proper medication reconciliation procedures should be followed by the advanced practice nurse so that transfer of medication from one unit to another is correct, and hence no mix-ups that would lead to medical errors. The procedure should be double-checked before it is undertaken so that the right medication is given and administered, and this, too, would avoid a medical error. In conclusion, disclosure is a medical ethic that should be practiced by all, including advanced practice nurses, to ensure the patient receives the highest standard of care.
References
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Butts, J. B., & Rich, K. L. (2019). Nursing ethics.Jones & Bartlett Learning.
Doody, O., & Noonan, M. (2016).Nursing research ethics, guidance and application in practice. British Journal of Nursing, 25(14), 803-807.
Fowler, M. D. (2016).Nursing’s code of ethics, social ethics, and social policy. Hastings Center Report, 46, S9-S12.
Gaffney, T. A., Hatcher, B. J., & Milligan, R. (2016). Nurses’ role in medical error recovery: an integrative review. Journal of clinical nursing, 25(7-8), 906-917.
Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation, 7(2), 9-20.