Ethical Case Studies Essay

Ethical Case Studies Essay

Ethical Case Studies Essay

Repeat Admissions
Ethical issues form part of the healthcare professionals’ daily practice in the care environment. Such issues usually test the professionals’ knowledge and skills in solving such problems to help improve care outcomes and organizational performance. Fortunately, various ethical decision-making models can be used in such situations to ensure that the decisions made serve the patients’ interests and are morally upright (Grace & Uveges, 2022). In most cases, the models are usually built on justice, autonomy, beneficence, and nonmaleficence. Apart from the help of the models, making an ethically sound decision in the face of an ethical issue requires that the professional uses moral judgment and possesses moral awareness. Therefore, the purpose of this assignment is to explore an ethical case by developing a solution to a dilemma faced by a healthcare professional.

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The Summary of The Case Study Facts and Components of An Ethical Decision-Making Model
The case entails the effects of repeat admissions and the usage of the emergency department, as reported in an article concerning central hospitals in Texas which could be a reflection of what is going on at the County General Hospital. Up to nine residents had undergone over two thousand admissions in the past six years, which led to a consumption of resources of over $2 million dollars. Emergency room visits and repeat non-emergent have proven to be common. Nonetheless, the Federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires that every hospital that gets federal funding offer treatment to any individual visiting the emergency department without considering their paying capability.
The Ethical Issues
Losinski gets concerned after reading an article about the emergency department and resource use at hospitals in Texas. After an analysis of what is happening at County General Hospital, he realizes that some patients have had a high number of emergency department visits with medical problems not specified and minor problems that contribute to an annual loss of up to $200,000. There is a concern that the lost amounts of money can be used to offer other necessary services and address problems causing repeat emergency department visits. The CEO got different and diverse responses from the executive committee, which he was not amused by. The losses incurred lead to increased strain on the profit made by the facility, considering that the rates of reimbursement are not at the expected rate. The facility has to follow the EMTALA guidelines, which is a concern due to increased rates of ED visits and resource use. Therefore, the hospital staff and the community members are impacted by the problem.
Application of Ethical Decision-Making Model
The suitable model to be applied is based on ethical behavior, moral judgment, and moral awareness. Ethical behavior entails taking actions informed by the right choices, while moral judgment refers to choosing what is wrong or what is right (Rainer et al.,2018). In addition, moral awareness entails a realization that there is a problem, and therefore, the decisions made in connection to the problem could affect others. Losinski read an article regarding the overuse of the resources and services at the emergency department, which triggered his moral awareness, setting him on the path of thinking that their institution (CGH) could be facing a similar problem. He then went ahead and initiated research into the problem at CGH, which showed his moral judgment and went further to present his findings to the executive committee with the major focus of dealing with the dilemma. By applying ethical behavior and the four ethical principles as a health care professional, he should make the right choice and solve the situation since it is evident that the loss of revenue resulting from the overuse of the ED resources and services is related to the ethical dilemma.
Overcrowding in the ED department is one of the negative impacts of its overuse. As such, there are numerous literature reports published in the peer-reviewed journal which address this issue. One of the articles is an article by Slankamenac et al.(2020). According to these authors, overcrowding in the emergency department is a concern and has continually led to enhanced mortality, negative impacts on patient satisfaction, longer hospital stays, longer waiting times, and increased healthcare costs. They further observe that the overcrowding of the emergency department can be reduced by efficient patient transfer to inpatient clinics to save costs.
Effectiveness of The Communication Approaches
Communication is a key component of leadership. Therefore, leaders should strive to use effective communication to help enhance their leadership skills and chances of success. One of the known approaches to effective communication is active listening (Sibiya, 2018). Mary Scott practiced active listening and was able to remind Losinksi that three-quarters of the costs for ED recurrent visits are covered by Medicare. Losinksi also communicated effectively when he requested Patel, the administrative resident, to obtain data on the use of ED. He further brought this data before the executive committee, which led to open communication between the committee and himself. He also practiced active listening, where he was able to listen to other members divergent opinions regarding the issue. Therefore, the use of effective communication in this case study can enhance the success of the organization by supporting a long-term and sustainable solution to the problem.
The Effectiveness of The Approaches Used By the Professional
Effective approaches are key to organizational growth and development. An effective approach is evident when Losinski made a request that research be accomplished to help justify the fears he had before he could go to the executive committee. He then went ahead and professionally managed the information which he had obtained and concluded that the repeat ED visits were straining the resources and services and eating into the profit margins. He was, therefore, able to present the data to the executive committee, which triggered a discussion in a bid to get an appropriate solution. Therefore, the approaches were effective and are likely to lead the organization to a better future.
Application of Ethical Principles to A Possible Solution
Ethical principles play a critical role in helping healthcare professionals resolve ethical dilemmas. Therefore, all four principles, justice, nonmaleficence, beneficence, and autonomy, should be applied in the solution (Grace & Uveges, 2022). One of the solutions is offering education. The facility should make arrangements to educate the patients who recurrently visit the ED for cases that should not end up in the ED. The education will be key in letting the patients know of the strain on available resources, offering them assistance and guiding them to make follow-up treatments with professionals, and also helping them know when to call or visit the ED. Such a step would help reduce the cases of recurrent ED use and increase revenue without harming the patients.
Conclusion
Ethical dilemmas are common in healthcare organizations as healthcare professionals strive to offer the best care to patients. Therefore, ethical principles should be at the center of any potential solution to such problems. It is evident that the organization found itself in a dilemma situation on how to reduce the overuse of ED resources and services without harming patients. The effective communication and strategies employed by the professionals would likely lead to appropriate solutions.

References
Grace, P. J., & Uveges, M. K. (2022). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461. https://doi.org/10.1111/jocn.14542
Sibiya, M. N. (2018). Effective communication in nursing. Nursing, 19, 20-34.
Slankamenac, K., Heidelberger, R., & Keller, D. I. (2020). Prediction of recurrent emergency department visits in patients with mental disorders. Frontiers In Psychiatry, 11, 48. https://doi.org/10.3389/fpsyt.2020.00048

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Incident 2: Emergency Department Repeat Admissions — A Question of Resource Use

Matt Losinski finished reading an article that provided grim details of a study of the overuse of emergency services in hospitals in central Texas. He smiled that sardonic half smile that meant there was a strong possibility that County General Hospital (CGH) might have the same problem. As chief executive office (CEO), Losinski always saw the problems of other hospitals as potential problems at CGH, a 300–bed, acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was established as a county–owned hospital; however, 10 years ago the county wanted to get out of the hospital business and the assets were donated to a not–for–profit hospital system. The new owner has continued a strong public service orientation, even though CGH no longer receives the tax subsidy it did when it was county owned; it must look to itself for fiscal health.
The study data showed that nine residents of a central Texas community had been seen in emergency departments (EDs) a total of 2,678 times over 6 years. One resident had been seen in an ED 100 times each year for the past 4 years. Given that an ED visit can cost $1,000 or more, the nine residents had consumed $2.7 million in resources. These high users of ED services were middle age, spoke English, and were split between male and female. To Losinski, the problem seemed like a manifestation of Wilfredo Pareto’s classic 80/20 rule.
Losinski forwarded the article on a priority basis to Mary Scott, his chief financial officer (CFO), and asked her to see him after she read it. Scott stopped by Losinski’s office late the next day and began the conversation by asking him why he thought the article was a priority. Scott reminded Losinski that Medicaid paid 75% of costs for eligible ED users and that the cross subsidy from privately insured and self–pay ED admissions covered most of the unpaid additional costs. Losinski had a good working relationship with Scott, but he was a bit annoyed by her rather indifferent response.
Losinksi wanted details on use of the ED at CGH. He asked the administrative resident, Aniysha Patel, to gather data to identify use rates for persons repeatedly admitted to the ED. The findings that Patel gave to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few persons were repeatedly admitted to the ED and accounted for hundreds of visits in the past year. The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.
Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.
Losinski asked his senior management team for recommendations to address the problem of ED overuse.

INSTRUCTIONS:
Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.
Introduction
Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.
Instructions
At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.
For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:
1. Access the Ethical Case Studies media piece to review the case studies you will be using for this assessment. (case study is above)
 Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
• Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APA section of the Writing Center for guidance.
2. Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
• Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.
• Identify who is involved or affected by the ethical problem or issue.
• Access the Ethical Decision-Making Model media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.
 Apply the three components outlined in the Ethical Decision-Making Model media.
• Analyze the factors that contributed to the ethical problem or issue identified in the case study.
 Describe the factors that contributed to the problem or issue and explain how they contributed.
3. Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
 In addition to the readings provided, use locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation.
 Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.
 Review the Think Critically About Source Quality resource.
 Assess the credibility of the information source.
 Assess the relevance of the information source.
4. Discuss the effectiveness of the communication approaches present in a case study.
• Describe how the health care professional in the case study communicated with others.
• Assess instances where the professional communicated effectively or ineffectively.
• Explain which communication approaches should be used and which ones should be avoided.
• Describe the consequences of using effective and non-effective communication approaches.
5. Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
• Describe the actions taken in response to the ethical dilemma or issue presented in the case study.
• Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
• Discuss the key lessons this case provides for health care professionals.
6. Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
• Describe the proposed solution.
• Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
• Discuss how likely it is the proposed solution will foster professional collaboration.
7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
• Apply the principles of effective composition.
• Determine the proper application of the rules of grammar and mechanics.
8. Write using APA style for in-text citations, quotes, and references.
• Determine the proper application of APA formatting requirements and scholarly writing standards.
• Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.
Additional Requirements
Your assessment should also meet the following requirements:
• Length: 3–5 typed, double-spaced pages, not including the title page and reference page.
• Font and font size: Times New Roman, 12 point.
• APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance.
• Written communication: Use correct spelling, grammar, and punctuation.
• References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
• APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
• Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.
• Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
• Competency 3: Apply ethical principles and academic standards to the study of health care.
• Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
• Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
• Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
• Competency 4: Write for a specific audience, in appropriate tone and style, in accordance with Capella’s writing standards.
• Discuss the effectiveness of the communication approaches present in a case study.
• Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
• Write following APA style for in-text citations, quotes, and references.
Use the Distinguished criteria
Applying Ethical Principles Scoring Guide
CRITERIA PROFICIENT DISTINGUISHED
Summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case. Summarizes the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case. Assesses the facts of the case study using peer-reviewed journal articles as evidence to support analysis of the case, including reasons why the chosen articles support the analysis.
Discuss the effectiveness of the communication approaches present in a case study. Discusses the effectiveness of the communication approaches present in a case study. Discusses the effectiveness of the communication approaches present in a case study, explaining which approaches should be used more and which should be avoided.
Discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model. Discusses the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model. Discusses the effectiveness of the approach used by the professional in the case study as it relates to the ethical decision-making model, including consequences of using effective and noneffective approaches.
Apply ethical principles to a possible solution to the proposed problem or issue from a case study. Applies ethical principles to a possible solution to the proposed problem or issue from a case study. Applies ethical principles to a possible solution to the proposed problem or issue from the case study, explaining why the proposed solution is based in ethical principles.
Produce text with minimal grammatical, usage, spelling, and mechanical errors. Produces text with minimal grammatical, usage, spelling, and mechanical errors. Produces text free of grammatical, usage, spelling, and mechanical errors.
Integrate into text appropriate use of scholarly sources, evidence, and citation style. Integrates into text appropriate use of scholarly sources, evidence, and citation style. Integrates into text appropriate use of scholarly sources, evidence, and citation style without errors and uses current reference sources.

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