NRSG370-Safety Issues For ICU Nurses Working For Long Hours

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NRSG370-Safety Issues For ICU Nurses Working For Long Hours

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Questions:
1.Write 600 words on your understanding of the dilemma of providing information to carers while considering the confidentiality concerns relating to the patient/client. Don’t forget to consider the ethical implications in your consideration of the issues (ethical vs. legal dilemma for nurses). Ensure it is specifically related to the specialty area that you are/will be completing your placement in.

2.Where do carers stand in healthcare law and ethics? It is important to understand that while the holistic approach to healthcare is preferred it is hard to balance the rights of all parties. What is the nurse’s role in ensuring carers and patients/clients have a say and that all opinions are respected? Sharing of information is fundamental to this consideration. The carers play an important role in providing information to health care professionals but do they have any rights to be considered in the decision making of care if there is no legal directive? The patient/client has rights but do the carers have rights as well? Further to this ethical dilemma, theories are often at the foundation of nurse’s approach to care. Ethics of Care theory claims that moral agents (carers, clients, health care professionals and institutions) are not separate entities and that the application of universal ethics is not inappropriate. This theory is based on consensus ethics which incorporates the views of all involved in care (Buchanan, Cooper & Fielding et. al, 2012).
Read the following articles as a starting point, there are many similar articles out there that you can source for further reading. It might be good idea to bring out your ethics text book again and revise the ethical theories related to this matter. Once you have completed the readings undertake the activities to find information on how the institution you are working views these issues, then complete the component of the assessment task.

Answers:
1.Safety issues for ICU nurses working for long hours and in different work shifts
Long working hours and shift work scheduling has been proven to pose ramifications towards nurses in the Intensive care unit (ICU), as they affect their social, physiological and psychological live. These factors have led to a number of risks that are associated to shift work (Cribb, 2010). Shift work is commonly associated with night shifts and rotational shifts. This, in turn, has forced ICU nurses to change their sleeping patterns, consequently causing them to experience insomnia or excessive sleeping hence reducing the efficiency to perform their duties effectively. During the night shifts, ICU nurses do sleep more while on duty than during the day shifts (Cribb, 2010). This leads to the lowered neurocognitive functioning and subsequently their performance is highly compromised. The brain feels sleepy hence the making of quick decisions that needs accurate procedures as it is the normality of the ICU nurses is again compromised.
Injuries that are associated to fatigue are always elevated when ICU nurses work for long hours and change the shifts. These injuries can lead to fatal incidents that can threaten the life of both the ICU nurses and the patients. More injurie occur in the evening’s shifts than during the day shift ( de castro et al 2010; Gershon et al, 2009)
There have been high psychological effects associated with work shift. These include but not limited to; depression, mood disturbances, relationship problems as well as personality changes. Since the job also involves a lot of straining, the ICU nurses also experience a lot of tension which can also lead to anger, anxiety and mental fatigue. Long working hours also can lead to consequences associated with physical and psychological harm, hence compromising the concentration of nurses in the emergence department to offer their services that patients are in dire need of. According to Spurgeon, they found that working overtime for approximately 50 hours a week, can lead to adverse effects as mentioned above. There has also been reported a high incident rate for musculoskeletal injuries for nurses working overtime (Sujan & Spurgeon, 2014). To overcome these mental and psychological effects, in French workers that are assigned in the shift modules used more antidepressants in a bid to reduce the effects of depression and anxiety. Other related effects that have been recorded is the consumption of alcohol, smoking and the use of caffeine, all with an objective of reducing the physical and anxiety that is experienced in the working environment. The ICU nursing speciality is emotionally demanding, it also requires that nurses are always alert with high concentration. ICU nurses have to interact one on one with visitors, clients, patients, and other staff members. Therefore, this interaction needs them to have more emotional effort. However, this leads them to experience emotional exhaustion and showing symptoms of anxiety. If this emotional pain is not solved, then it can affect the level at which ICU nurses offer services to the patients (“NICE Evidence Search | five rights medication”, n.d.).
It has also been proven that these shifts can affect the circadian rhythms leading to gastrointestinal complaints. There is a high risk of colon cancer for ICU nurses working for three or more nights per month for fifteen years or more. For the reproductive health studies, the long working hours, as well as the shift of work, have grave effects as far as reproductive health of women is concerned. There have been reports on spontaneous abortions, preterm birth, and lower fertility rates. Studies have also shown an elevated risk of breast cancer among the women in night shift. This has been associated with the exposure of light during the night (Callara, 2008). For those suffering from chronic diseases, shift work makes it difficult to control and manage the disease and its symptoms. This is caused due to failure to follow strict adherence to meals, exercise as well as the time to take medicines. The most common medical conditions affected include but not limited to; hypertension, asthma, myocardial infarction, insulin-dependent diabetes, substance abuse, and psychiatric illnesses and renal failure. Other diseases like diabetes and hypertension may lead ICU nurses to have low concentration and have low tempers to deal with patients. This in turn leads to the lowered safety issues for both nurses and patients.
2.The patient right to privacy and confidentiality is one of the essential components of human rights; these rights strengthen the patients and the clients’ social life. To ensure that there is confidentiality of information of clients and patients is an ethical obligation of every nurse in their place of work as well as outside the working environment. The four major concepts of ethics that intensive care nurses should safeguard include the respect to the patient to autonomy, beneficence, non-maleficence, and justice (“NICE Evidence Search | five rights medication,” n.d.).

There are rules formulated with an objective of guarding the 12 bills of rights that are expressed in a bid to protect the patient’s right to privacy. This includes but not limited to; The American Hospital Association bill of rig15hts 1972, The World Medical Association’s Declaration of Lisbon on the rights of the patients (Zahedi, 2018).
In The United States of America, The Health Insurance and Accountability Act (HIPAA) of 1996 clearly defines the regulations and guidelines of protecting the health information, making it secure, confidential as well as private. Other conventions that are of great application in the United States of America include; The American Recovery and Investment Act 2009 (ARRA)-HITEC, The Privacy Act of 1994, The Massachusetts regulations and statues patient bill of rights (201 CMR 17.00 Standards for the protection of personal information) (Whelton, n.d.). Consequences of accessing the data and communicating about the patient’s status have been proven to be very detrimental to nurses. Providers some individuals tend to raise concern focus on specific organs rather the patient in question.
These repercussions include but not limited to; being fined as well as lowered one’s job security. For instance, in the Boston medical center, members who breach the stipulated laws are exposed to disciplinary measures which can lead to the termination of their work and contracts (Bratianu, 2018). Relay of different information is also a dilemma which can be solved by ensuring frequent discussions with all the involved parties.
However, access to information and clear and timely communication about the patient’s status to the family members and other compliances raises satisfaction. Otherwise, it raises more questions about the patient, increases tension and therefore makes the family members not satisfied. In many instances, family members would also like to get the information for them to give their say about the decisions and plans in the management and careering of their loved one. Other dilemmas that nurses face are; caring people with disabilities, critically ill patients who want to walk without being helped, families who have young ones who are suffering from mental illness (Mulaudzi, Mokoena & Troskie, 2010).
Healthcare professionals in the intensive care unit are faced with dilemmas such as allocation of the available resources, honoring patient rights of termination of life support and allowing nature to takes its course to death. Nurses in the intensive unit face with an ethical dilemma such as the demoralizing feeling of providing treatment with the aim of saving a life but upon evaluating the critical patient response to treatment is extremely low.
Nurses have therefore faced above challenges regarding g to the sharing of patient’s information. For instance, a wife may ask to know about the health information of her husband which she just got at the bedside of the husband. Sometimes, another nurse or the related health professional may also request to know the information of his/her friend as well as the plan of care. There are also other interested parties who can be family members or friends that call from other places which can be outside the country, demanding to know the status of their patients as well as different results that are deemed to be very confidential (“The Five Rights – PubMed Central (PMC)”, n.d.)

References
Bratianu, P. (2018). Nursing Ethics – Ethical Dilemmas Faced By Nurses Everyday. Retrieved from https://www.nursingexplorer.com/blog/nursing-ethics-ethical-dilemmas-faced-by-nurses-everyday-47
Callara, L. (2008). Nursing education challenges in the 21st century. New York: Nova Science Pub.
Engdahl, S. (2009). Medical rights. Farmington Hills, MI: Greenhaven Press.
Hughes, R. (2010). Rights, risk and restraint-free care of older people. London: Jessica Kingsley Publishers.
Mulaudzi, F., Mokoena, J., & Troskie, R. (2010). Basic nursing ethics in practice. Johannesburg: Heinemann.
Sujan, & Spurgeon. (2014). Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO). [Place of publication not identified]: NIHR Journals Library.
Whelton, B. Nursing Ethics and Professional Responsibility in Advanced PracticePamela J.Grace PhD, MSN, RNBurlington, Massachusetts: Jones and Bartlett Learning, 2018. 3rd edition, 447 pages, including glossary and index. $72.92 soft cover. ISBN 9781284107333.
Cribb, A. (2010). Translational ethics? The theory-practice gap in medical ethics. Journal Of Medical Ethics, 36(4), 207-210. doi: 10.1136/jme.2009.029785
Newham, R. (2014). Virtue ethics and nursing: on what grounds?. Nursing Philosophy, 16(1), 40-50. doi: 10.1111/nup.12063
NICE Evidence Search | five rights medication. Retrieved from https://www.evidence.nhs.uk/Search?q=five+rights+medication
The Five Rights – PubMed Central (PMC). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957754/
The Five Rights of Medication Administration – ihi.org. Retrieved from https://www.ihi.org/resources/Pages/ImprovementStories/FiveRightsofMedicationAdministration.aspx
Zahedi, M. (2018). The Code of Ethics for Nurses. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712593

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