Ethics In Practice Tension between Individual and Societal Rights Gail A. DeLuca Havens, PhD, RN Codes of ethics can be thought of as moral codes. Moral commitments “to adhere to the ideals and moral norms of the profession,” such as maintaining competency in practice, are expressed in the American Nurses Association (ANA) Code of Ethics for Nurses (2001, p. 5) and are made by individuals when they become nurses. The fundamental concept underlying the Code of Ethics for Nurses is respect for persons. Certain principles growing out of this concept guide nurses’ decision making. These include fostering self-determination, doing good, avoiding harm, being truthful, respecting privileged information, keeping promises, and treating people fairly. In their moral decision-making hierarchy, Beauchamp and Childress (2001) refer to principles and rules as action guides. Principles are the more global and basic conceptions that justify the rules. When ethical principles are being considered, it is important to remember that individuals are interdependent members of a community. The nurse will encounter situations in which the tension between individual liberty and the need to preserve the health and well-being of the community creates an ethical dilemma in practice. For instance, the nurse promises, as expressed by the principle of fidelity in the ANA Code, to maintain client confidentiality. However, such a promise is not absolute when innocent parties are in direct jeopardy (e.g., threatened with being killed) (ANA, 2001). This particular kind of dilemma is made even more troublesome for the nurse who is attempting to deal with two opposing or contradictory promises. For example, the implicit promise of the nurse to maintain client confidentiality, as expressed in the ANA Code, may contradict the nurse’s obligation to obey a law that requires reporting a particular situation (ANA, 2001). The nurse also has an ethical responsibility to respect the client and promote self-determination. Consider the following situation. Kay is a community health nurse who has been employed by a home health agency for more than 10 years. Several of her clients live in a homeless shelter and have been referred to her agency for follow-up tuberculosis treatment after hospital discharge. Today she is making her first visit to Paolo, a 33-year-old Hispanic man discharged after treatment in the hospital for acute, infectious tuberculosis. Kay explains that her agency, along with the city’s health department, helps persons with tuberculosis continue to take their medication as prescribed until they are cured. Kay asks Paolo how he is feeling this morning. He replies that he is tired; he did not sleep well this first night in a place not familiar to him. After she completes Paolo’s admission history and physical examination, Kay tells him that she, or a nurse substituting for her, will be visiting Paolo daily for 2 weeks to observe him taking his medication and then twice weekly for at least 6 months. Paolo protests that he is not a child and that he can be depended on to take his medication as prescribed. Kay explains that the current standard of care is that everyone in the community being treated for tuberculosis receive directly observed medication therapy. It will help him remember to continue to take medication as prescribed, particularly when he begins to feel better. Stopping the medication makes the treatment he received in the hospital ineffective. When medication is stopped, often the tuberculosis becomes infectious again. In addition, not completing treatment increases the likelihood that he will develop a type of tuberculosis that is resistant to medication therapy (Centers for Disease Control and Prevention [CDC], 2003a). He could be very ill again. The city has an obligation to protect its residents from becoming infected with tuberculosis. Kay tells Paolo that she will be communicating with health department personnel because they are the ones who referred him to her. Paolo agrees, reluctantly, to cooperate in therapy. He asks how long it will take to be cured. Kay knows that the response to therapy varies, but most persons can be cured within 9 months (CDC, 2003b). Kay explains that 6 months of medication has been prescribed to cure his tuberculosis. Before Kay leaves, Paolo takes his first dose of medication, and they establish a schedule for his observed daily self-administration. Paolo’s treatment continues as planned over the next several months. He gains strength and eventually finds a job. Returning to work requires that his medication regimen be modified. Paolo has no trouble adapting it to his more demanding schedule. Several weeks pass with this new arrangement until, one evening, Paolo does not appear. Kay leaves a message for him to call her, but does not hear from him. When Paolo fails to appear again the following evening, Kay returns to the shelter. Eventually, Kay learns that Paolo has not been complying with his prescribed medication regimen. He does not deny it and tells Kay that because he has been taking medication for more than 3 months and feels better, he believes that he is cured of his tuberculosis and no longer needs therapy. How should Kay respond? Should she respect Paolo’s right to self-determination by not interfering with the decisions he has made? What if Paolo were to be harmed by this noninterference? What if others were to be harmed? Does Kay’s obligation to Paolo to maintain confidentiality remain even when his behavior might compromise the health and well-being of others? Under what circumstances might a nurse place the health and well-being of members of a community before those of an individual client? In this situation, because Paolo is an adult who is responsible for his own health, Kay could simply disregard the fact that Paolo has not been adhering to his prescribed medication regimen. However, she would not be helping Paolo to protect himself or others. Another strategy that Kay might employ would be to engage Paolo in problem solving to further explore his reasons for not complying with the medication regimen. Uncovering reasons for noncompliance often results in identifying ways to avoid it. One of the strategies recommended for directly observed therapy is for the nurse to adopt a nonjudgmental attitude toward clients, acknowledging that individuals often will not be 100% compliant with medication regimens. Kay could acknowledge that, because Paolo is feeling better, it is understandable that he is not taking his medication as prescribed. However, she also ought to remind him that he places himself at great risk for getting very sick again and developing drug-resistant tuberculosis by not following his medication regimen. This course of action might also be an opportunity to foster Paolo’s self-determination, to maintain the confidential nature of his care, and to strengthen the client-nurse relationship. However, adopting this strategy does jeopardize Paolo’s health and the health of the people with whom Paolo comes in contact. Kay does not know whether Paolo’s tuberculosis is infectious. Kay initiates tuberculosis screening for the people with whom Paolo has been in contact and creates an opportunity for Paolo to have his tuberculosis reevaluated. This action ought to diminish the potential for harm from active tuberculosis to Paolo and to others with whom he has been in contact. Because Kay’s authority has been delegated to her by the health department, she can communicate with the health department without legally violating confidentiality. Kay is aware that many states require quarantine of individuals who do not successfully complete a medication regimen for tuberculosis. To protect the public, a community health nurse can recommend that formal action be taken to ensure that a person complies with treatment. In this instance, quarantine means that individuals can be hospitalized or incarcerated for treatment of tuberculosis against their will. As a third strategy, Kay can follow the established protocol to initiate quarantine, reporting Paolo’s lack of compliance with medication therapy to the appropriate people. However, this breaches the confidential nature of the client–nurse relationship and compromises the trust and mutual respect that have been established between Paolo and Kay. The ANA Code (2001) alerts nurses to the reality of suspending individual rights but warns that this ought to “be considered a serious deviation from the standard of care” (p. 9). Usually, a nurse does not select the third alternative until the second alternative has proven ineffective. 

How might Paolo be affected by this experience? How might Kay be affected by this experience? 

Which alternative would you choose?

Should individual rights be compromised to control the spread of communicable diseases for the good of society? 

What is the role of boards of health in your community and state in preventing and controlling communicable diseases?  

For this assignment, assume you are a compensation analyst in a large financial services company. You have been in your role for almost a year. At your weekly one-on-one with your boss, she tells you that the human resources representatives at the company are fielding a number of questions from employees and applicants about compensation. The human resource representatives’ knowledge of compensation is not deep.

She asks that you prepare and deliver a 10- to 15-minute PowerPoint presentation (10–15 slides) at an upcoming departmental meeting that provides basic information about what is going on in the compensation field today. Specifically she wants you to address compensation strategies that companies employ, note three of their best compensation practices, and examine three compensation challenges today’s companies are facing.

Develop and deliver a 10–15 minute audio PowerPoint presentation (10 to 15 slides) in which you:

1. Analyze the compensation strategies companies use to attract and retain talent.
2. Determine three best compensation practices used by companies.
   • Be sure to provide your rationale for selecting these best practices as opposed to others.
3. Examine three compensation-related challenges companies face.
   • Be sure to provide your rationale for selecting these compensation challenges as opposed to others.
4. Explain what discretionary benefits are and how companies use them to benefit the company and its stakeholders.
5. Examine how laws, labor unions, and market factors impact companies’ compensation strategies and practices.
6. Deliver a succinct, engaging, and informative presentation on compensation strategies, best practices, and challenges.
   • Note: Be sure to include additional detail about what you will say as you deliver your presentation on the notes pages in PowerPoint.
   • Consult Use Kaltura [PDF] for help in recording your presentation and uploading it to the assignment area.
7. Integrate at least three quality resources using in-text citations and a reference page in your assignment.
   • Note: Wikipedia and similar websites do not qualify as quality resources.
8. Format your assignment according to the following formatting requirements:
   • This course requires the use of Strayer Writing Standards (SWS). For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course.
   • Use a readable size font (24 pt or above) on your slides. For your slide notes, the preferred method is to use Times New Roman font (size 12).
   • Include a title slide containing the assignment title, your name, your professor’s name, the course title, and the date. The title slide is not included in the required number of slides.
   • Include a source list slide. Citations and references must follow SWS format. The source list slide is not included in the required number of slides.

Note: Last week’s assignment preparation activity provides resources on how to:

• Avoid plagiarism.
• Integrate resources into your presentation.
• Adhere to the Strayer Writing Standards.
• Develop and deliver a succinct, engaging, and informative presentation.

The specific course learning outcome associated with this assignment is:

• Research current compensation strategies, best compensation practices and compensation challenges facing companies.

In this assignment, you will analyze the nature and dimensions of the corporate culture at the various stages of organizational growth. You will examine the dimensions of a sustainable organizational structure, the key elements of performance management, and control factors of leadership development related to the stages of organizational growth. You will be graded on the quality of your answers, the logic or organization of the report, your language skills, and your writing skills.

Instructions

Write a 3–4 page paper that answers the following:

• Discuss the keys to effectively managing leadership development at each of the following levels:
  • First-line supervisor.
  • Middle manager.
  • Senior manager.
  • President or CEO.
• Compare and contrast strategic leadership and operational leadership, explaining which type of leadership is essential for the long-range survival and growth of an entrepreneurial organization and why.
• Discuss the most common style of leadership used by effective leaders of larger companies (Stage III and beyond) and explain why this style of leadership is used.

This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.

The specific course learning outcome associated with this assignment is:

• Assess leadership development strategies and leadership styles respective to the growth of an organization.

As you read for Journal Entry #4 (and part of #3 too), Luis J. Rodriguez becomes involved in social activism and works toward making progress in his school as well as his overall community.  We’ll break down our new unit topic more later in our module today, but for the moment…

What are some examples of times Rodriguez worked to bring about change in the book?  And, did he attempt this alone or did he work with others to do this?  Look through your Reading Journal and book and write down specific times you see Rodriguez engaging in social activism, noting whether he did so alone or with the help of others.  You can find a lot of this information in the pages we read for Journal Entry #4, but you can add other examples too.  After you’ve written done the examples you found, take a moment when you’re done to write a sentence or two explaining whether you think Rodriguez would have been successful in bringing about change if he had worked completely on his own.

Note- You don’t need full sentences for this activity, but make sure you list how Rodriguez tried to bring about change (so, what event/occurrence), if Rodriguez did this alone or with others, and the page(s) you found this information on.  You can write this in the text box below or in another document that you attach here.