Learning Objectives
By the end of this section, you will be able to:
- Describe health policy and the role of the nurse as they relate to patient-centered care
- Identify social determinants of health
- Explain core principles of ethics and their application to health care
Health policy regulates the delivery of health-care, with the focus on optimal patient outcomes. Everyone has the right to have access to the highest quality and safest care, regardless of their social status or other factors that might affect their health. This idea is the core of health-care reform, an important issue of our day. Ethical considerations are also key to ensuring that all patients are treated fairly and justly, with dignity and respect. Ethical health care promotes trust and confidence.
What Is Health Policy?
The laws and regulations that define the actions and decisions that promote a society’s health goals make up its health policy. Regardless of one’s profession or position in society, everyone has a stake in health policy. Nurses, however, have a unique perspective because they work directly with patients, observing firsthand the types of reform that would best serve the community.
Advocacy in Nursing
Nurses have a frontline role in direct patient care, giving them firsthand experience in all aspects of the health-care system. As direct care providers, nurses also understand what individual patients value the most—a key consideration in providing quality PCC. Nurses varied experiences enable them to provide a voice of expertise as advocates for health-care reform, particularly with respect to the delivery of care and patient safety. With the support of the ANA, nurses work diligently to make their voices heard at all levels where health policy decisions are made.
The Affordable Care Act
The Affordable Care Act (ACA) led to a significant regulatory overhaul and expansion of health-care coverage in the United States. It was signed into law in March 2010 to promote health equity throughout the country. The goals of the ACA include providing health coverage without limits and protecting people with preexisting conditions. The ACA has led to historic health-care advancements, enabling millions of Americans to have access to essential health benefits such as preventive care, wellness visits, rehabilitative care, mental health care, and prescription medications.
Social Determinants of Health
Factors that appear to fall outside of the healthcare system but play an active role in the health outcomes of a population are called social determinants of health (SDOH). They include environmental factors (e.g., where one was born, where one grew up), as well as a broader set of factors that shape daily life, such as access to health care and education, economic stability, community development, social and society norms, education, and political systems. A person’s race and ethnicity can also play roles in their health; for example, certain groups are genetically predisposed to certain diseases. Examples of SDOH include
- access to healthy food and physical activity
- education, language, and literacy skills
- job opportunities and income
- race and ethnicity
- safe housing and transportation
SDOH can result in health disparities and inequities, which is why it is important for public health organizations to partner with education, transportation, and housing sectors to improve underserved residential communities.
Ethics
The study of right and wrong actions is called ethics. Each profession has its own code of ethics, providing an agreed-upon framework for making and evaluating decisions. In this respect, ethics is different from morality. Although the terms are often used interchangeably, ethics generally refers to standards of right and wrong that are agreed on by a particular community (e.g., a professional nursing organization); morality refers more to a personal standard that an individual uses to determine what is right and wrong.
Nurses make life-and-death decisions daily, making ethics an especially important foundation for the nursing profession. Ethical decision-making respects the patient’s rights and individuality and ensures equitable treatment and care that aligns with each patient’s beliefs and values (Sinaiko et al. 2019; Ethics in health care 2023). The ANA and other professional nursing organizations work diligently to develop ethics and human rights policies at the state, national, and international levels. The ANA Center for Ethics and Human Rights was established to help nurses navigate the ethical complexities of life-and-death decisions commonly found in everyday practice. Regardless of the present-day challenges in health care, the ANA’s Code of Ethics for Nurses unites nurses in advocating for safe, quality care for all patients and communities, regardless of socioeconomic status.
Link to Learning
Read the entire ANA Code of Ethics on their website.
Ethics in Nursing
The nursing code of ethics provides a solid foundation for nurses as they navigate the complex health-care system. It reminds nurses to keep several ideals foremost in mind as they make decisions and practice their skills. The following are four main principles in the field of nursing ethics:
- Patient autonomy acknowledges that patients have the right to maintain control and make their own decisions related to treatment and care.
- Provider beneficence refers to the health-care provider’s responsibility to act in their patient’s best interests. The ANA defines beneficence as “actions guided by compassion.”
- The principle of justice means treating all patients fairly.
- Provider nonmaleficence refers to the health-care provider’s responsibility to do no harm (Gaines, 2023).
Cultural Context
Patient Dilemma: Cultural Context in Health Care Decision-Making
Scenario
Imagine a patient—let’s call him Mr. Nguyen—who finds himself grappling with difficult health-care decisions without a clear understanding of his treatment options. Mr. Nguyen, an older adult who has emigrated from Vietnam, lacks fluency in the local language and faces barriers in accessing culturally appropriate health-care information. Furthermore, he has no family members available to assist him in making critical decisions, such as choosing between treatment options or considering a do-not-resuscitate order.
Cultural Barriers to Understanding
Mr. Nguyen’s cultural background and language barriers present significant challenges in navigating the health-care system. Without access to information in his native language or cultural context, he struggles to comprehend complex medical terminology and treatment plans, which hinders his ability to actively participate in decision-making processes regarding his care.
Nursing Role in Cultural Competence
In such cases, nurses play a pivotal role in bridging cultural gaps and advocating for culturally sensitive care. By recognizing Mr. Nguyen’s unique cultural needs and communication preferences, nurses can collaborate with interpreters or cultural liaisons to ensure he receives information in a manner that aligns with his cultural beliefs and values. Through patient education and empowerment, nurses empower individuals like Mr. Nguyen to make informed decisions about their health care, ultimately promoting health equity and enhancing patient outcomes.
Ethical Dilemmas
Nurses will inevitably face ethical dilemmas due to the nature of their work with people. Regardless of the specific circumstances of a given dilemma, here are some common causes of ethical dilemmas in nursing:
- assignments that are contradictory to personal, cultural, or religious beliefs or to the Code of Ethics for Nurses
- burnout associated with unsafe practices
- complicated family dynamics of patients
- dishonesty of peers
- hostile work environments, such as bullying in the workplace
- life and death decisions that must be made
- patients who refuse treatment
- short staffing or staff who fail to meet their responsibilities
Avoiding ethical dilemmas is impossible, but equipping yourself with knowledge and resources to face these dilemmas is essential. The most important thing is to deal with each situation in a professional manner that promotes quality care and patient safety.
The best way to recognize an ethical dilemma is to take notice of how a situation causes you to think and feel. You may feel pulled in two directions as you consider two courses of action. Neither course of action may be clearly incorrect; instead, each may emphasize different principles and values. You may feel you have to choose between right and wrong or that either choice could have negative consequences. Your facility should have some resources to help you make your decision, so be sure to consult them.
Examples of Ethical Dilemmas in Nursing and Health Care
Ethical dilemmas come in all shapes and sizes. Table 1.2 describes a few examples.
| Dilemma | Possible Solution |
|---|---|
| Holly, a nurse on the medical-surgical floor, has been assigned to work on the postpartum floor due to short staffing. Although Holly has been a nurse for 5 years, she has limited experience working with postpartum patients. It is not uncommon for nurses to be reassigned to other areas, but the dilemma occurs when Holly finds herself being asked to provide care she does not regularly perform: helping a mother who is having trouble with breastfeeding. | Holly should notify a supervising nurse that she has limited experience with this type of care and ask for guidance. The supervising nurse should either accompany Holly to the patient’s room to provide instructions for the patient and Holly, or assign an experienced nurse to help Holly. If the supervising nurse refuses to help, it might be necessary for Holly to contact the next highest person in the chain of command or to locate resources on how to teach a new mother about breastfeeding. |
| Bill is a new nurse. He has worked on the medical-surgical floor for a few weeks, but his training on the floor was cut short due to short staffing and he is working unsupervised for the first time. One of Bill’s patients recently had a total hip replacement; there are orders for the patient to be turned every 2 hours. Bill doesn’t feel comfortable turning his patient alone, knowing that he could cause harm to the new hip if the patient isn’t turned properly. | Bill should contact his nursing supervisor to express his concerns. The supervising nurse should either assist Bill with turning the patient or assign an experienced nurse to help him; whoever assists should also take the opportunity to review the proper technique. If the supervising nurse refuses to help Bill, he should contact the next highest person in the chain of command or ask another nurse on the floor for help. |
| Steve and Sandy are nurses caring for cardiac patients. Today was an unusually busy day, which resulted in Steve forgetting to report to the physician that one of his patients experienced an abnormal spike in blood pressure. The patient’s blood pressure returned to normal with no incident, so Steve chose not to document the occurrence. Later in the day, Steve told Sandy what had happened. Sandy now finds herself in a dilemma: she knows that nurses are responsible for providing safe, competent care for all patients and she ought to report Steve’s error and bad decision; however, she worries this will damage what, to this point, has been a positive working relationship with Steve. | Sandy could begin by encouraging Steve to retroactively document the blood pressure spike and report it to the physician. If Steve still does not do this, Sandy should report the incident to the supervising nurse. It’s true this might damage her working relationship with Steve, but the safety and well-being of patients are more important. |