NR703 Week 4 Leading Through Ethical Relationships Discussion
NR703 Week 4 Leading Through Ethical Relationships Discussion
Purpose
The purpose of this discussion is to prepare the DNP-prepared nurse leader to guide social justice reform.
Instructions
For this discussion, address the following:
- Identify a health inequity in your healthcare setting, community, or population.
- Propose how you could address this identified healthcare inequity describing attributes of an effective leader guiding a healthcare team.
Construct your responses using the CARE Plan method.
Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:
- Link (webpage): DNP Discussion Guidelines
Also Read:
NR703 Week 5 Discussion Leading Through Innovation
Effective Leadership Styles Week 6 Discussion NR703
Program Competencies
This discussion enables the student to meet the following program competences:
- Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
- Appraises current information systems and technologies to improve health care. (POs 6, 7)
- Creates a supportive organizational culture for flourishing collaborative teams to facilitate clinical disease prevention and promote population health at all system levels. (PO 8)
Course Outcomes
This discussion enables the student to meet the following course outcomes:
- Investigate the role of advanced nursing practice in innovation and transformation to propose solutions impacting healthcare systems. (PCs 2, 4; PO 6)
- Differentiate attributes of effective leaders and followers in influencing healthcare. (PCs 2, 4; PO 6)
- Formulate selected strategies for leadership and influence across healthcare systems. (PC 6; PO 8)
Due Dates
- Initial Post: By 11:59 p.m. MT on Wednesday
- Follow-Up Posts: By 11:59 p.m. MT on Sunday
Sample NR703 Week 4 Leading Through Ethical Relationships Discussion
Dr. Dickson and class,
An example of a health inequity within a healthcare facility would be the judgement that is passed on patients that are actively battling addiction or have a past history of addiction. After the delivery of a baby, it is expected that our patients are uncomfortable and will need pain medication to help with the discomfort they are experiencing.
However, if the patient has a history of substance abuse, it is not uncommon for those providing care to make comments such as “they must be drug seeking or of course they want the strong medication”. The moment a comment like that is made as a leader it is clear to me that there is bias present that will affect the quality of care being delivered.
Having stigmatizing attitudes and thoughts towards a patient who may use drugs such as, the belief they are unfit to parent, they do not care about their baby, they should have their parental rights taken away, negatively impacts the care they receive (Weber et al., 2021). Addressing this issue is important to ensure high quality care is provided to all patients regardless of their history and situation.
As a leader, discovering this example of inequity I believe would need to be addressed immediately. Having strong communication and interprofessional relationships with the team will allow for conversations to be had to understand where one maybe coming from. However, after that, providing education about the mission of the organization, about bias and inequities, putting the patients health first and illustrating how that correlates with healthcare outcomes would be something I would like to do with the team.
Each individual as their own opinions, work experiences and personal experiences that guide them in their thoughts and actions. A strong leader is able to recognize that but at the same time build up the team to be the best they can be while breaking down the inequities that exist. The challenge is that there is a significant amount of data that shows the existing disparities that exists but there is a strong need of evidenced-based recommendations for the interventions to be used to improve health equality needs (Kovach et al., 2019). Remembering that there is room for growth in all of us and being able to self-reflect on our own ideas and bias that may exist can open up avenues to the way we practice in healthcare.
– Maggie
References
Kovach, K.A., Lutgen, C.B., Callen, E.F., & Hester, C.M. (2019). Informing the American academy of family physician’s health equity strategy – an environmental scan using the delphi. International Journal for Equity in Health, 18(97), 1-12. doi:10.1186/s12939-019-1007-1Links to an external site.
Weber, A., Miskle, B., Lynch, A., Arndt, S., & Acion, L. (2021). Substance use in pregnancy: Identifying stigma and improving care. Substance Abuse and Rehabilitation, 12, 105-121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627324/pdf/sar-12-105.pdf
NR703 Week 4 Leading Through Ethical Relationships Student Lesson Plan
Overview
- Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
- Appraises current information systems and technologies to improve health care. (POs 6, 7)
- Creates a supportive organizational culture for flourishing collaborative teams to facilitate clinical disease prevention and promote population health at all system levels. (PO 8)
Schedule
| Section | Read/Review/Complete | Course Outcomes | Due |
| Prepare | Assigned Readings | COs 2, 3, 5 | Wednesday |
| Explore | Lesson | COs 2, 3, 5 | Wednesday |
| Translate to Practice | Discussion: Initial Post | COs 2, 3, 5 | Wednesday |
| Translate to Practice | Discussion: Follow-Up Posts | COs 2, 3, 5 | Sunday |
| Reflect | Reflection | COs 2, 3, 5 | No submission |
Foundations for Learning
The foundational resources for this week begin with the exploration of your own emotional reactions to social injustice, whether experienced vicariously or personally. These feelings and reactions will inform your leadership development for leading through ethical situations.
Start your learning this week by reviewing the following video:
Psych Hub Education. What is cultural humility? [Video]. YouTube. https://www.youtube.com/watch?v=c_wOnJJEfxE
Student Learning Resources
Click on the following tabs to view the resources for this week.
Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). Springer Publishing Company.
- Read Chapter 3
- Section: Social Determinants of Health
- Read Chapter 8
Learning Success Strategies
- As you read the Week 4 lesson, consider how each topic can be transferred into your current practice and leadership style.
- The discussion topics this week focus on social injustice, implicit biases, and cultural humility. Reflect on each of these in the lesson to better prepare your thoughts for discussion.
- You have access to a variety of resources to support your success. Click on the DNP Resources tab on the home page to access program and project resources.
- Your course faculty is here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions.
Interacting with Feedback
Each week your course faculty will provide feedback in the rubric and on any assignment you have submitted. Take a moment to review the following video on how to view rubric feedback in Canvas:
- Link (video): Looking at FeedbackLinks to an external site.(2:26)
Review the following video on how to accept/reject track changes when viewing course faculty feedback on your assignment:
- Link (video): Word: Track Changes and Comments(4:19)
Week 4 Lesson Leading Interprofessional Teams
Chamberlain Care
Chamberlain Care (Groenwald, 2018) is a cultural model that evolved through the vision of Chamberlain College of Nursing’s founding president and became the philosophy of Chamberlain University College of Nursing. A philosophy can become our belief system when we accept its concepts as our own beliefs. Most faculty and colleagues already had similar values and attitudes about caring for students, so the concept quickly was accepted and became the culture. Dr. Groenwald (2018) explains:
Clearly, there was an opportunity in higher education, and especially in nursing education, to create a bold new vision of student services and student support. Chamberlain’s hypothesis was that by modeling and teaching critical values while students are in school, we would arm our graduates with the characteristics that would empower them to be leaders in creating positive, healthy work environments.
To achieve our mission of creating an environment in which students and colleagues thrive, and students become extraordinary nurses, we shaped and drove a culture of care that incorporates the concepts of care for self, care for colleagues, and care for students. What started as a quality improvement initiative drove a new vision, mission, and purpose for Chamberlain University College of Nursing, making us who we are today (pp. xiii-xiv).
Bridging Traditional Ethics and Contemporary Practice
Test your memory: Match each term to the image representing it.
Branches of Philosophy Interactive Transcript
Epistemology, ontology, and axiology, the three historical branches of philosophy or underpinnings of science, which most of you have seen in ethics courses over the years, describe how we understand the world from different perspectives. They have laid the foundations for more contemporary discussions of ethics.
Traditional Ethics Approach and the Ethic of Care Versus the Ethic of Justice
Ethical principles inform our sense of moral obligation and responses to ethical dilemmas, and they may look familiar to you. They include the following principles:
- Autonomy
- Beneficence
- Confidentiality
- Fidelity
- Nonmaleficence
- Veracity
In addition, two competing leadership paradigms of ethical comportment that have emerged in recent healthcare discussions, especially in leadership, are the Ethic of Care and the Ethic of Justice (Juujärvi et al., 2020). It is typically the competing values, both of which may be morally correct, that result in an ethical dilemma or conflict for leaders.
Barbara Sorbello (2008) synthesized this ethical foundation for nurse leaders in her landmark discussion of Ray’s theory about these dichotomous ethics.
Nicholson and Kurucz (2020) further help define these ideas as building relational leadership. They stress that a leader’s attitude projects a relational stance that must spring from an Ethic of Care to be sustainable. Although transformational leaders focus on building a relational leadership stance by projecting an Ethic of Care, they must also balance the Ethic of Justice in their management styles.
Ray’s Two Leadership Ethics Image Description
ANA Code of Ethics
One of the primary ethical practice guidelines for nurses and nurse leaders is the American Nurses Association’s (ANA, 2015) Code of Ethics for Nurses with Interpretive Statements. There are nine provisions of the code of ethics. Under each provision are listed sub-provisions of ethical beliefs for nurses. If the provisions were briefly restated for DNP-prepared leaders, they might look like the following list. Reflect on these as you complete your discussions and assignments for the remaining weeks of the course.
View the following activity to examine examples of Provisions for DNP Leaders.
Provisions for DNP Leaders Interactive Transcript
Ethical Dilemmas
The definition of an ethical dilemma explains that there is no clear right or wrong. The constant change in healthcare challenges ethics. Just as informed decision-making influences change, the need to protect patient rights and patient safety are also influenced by decision-making.
We often see the tension among nurses who find themselves trapped between ethical decision-making that leads them in one direction based on their personal values and another direction based on their sense of duty to patients or the profession. These are times when ethical theories provide guidelines for professional behavior and decision-making. Nursing ethical codes have long been the basis of decisional processes, especially in leadership situations.
View the following activity to further your exploration of ethical principles and theories in the healthcare setting.
Workplace Aggression Interactive Transcript
Slide 1
Workplace aggression is still prevalent in most organizational settings today, including the nursing workplace. Although it is hard to imagine that a caring profession such as nursing would tolerate bullying behavior, recent research reveals that such behavior is more prevalent in nursing than in many other professions.
Slide 2
Such concepts have proliferated in nursing literature over just the last decade. Evidence regarding bullying, mobbing, incivility, professional stalking, workplace aggression, and horizontal and lateral violence sums up just a few areas that define a common attack of one nurse upon another.
Slide 3
These forms of behavior have a characteristic of abuse in common, whether verbal, emotional, professional, or otherwise, but they can be arrested through several interventions such as cognitive rehearsal, leadership modeling, and policy enforcement.
Slide 4
What ethical theories and principles would you use to address workplace aggression in your unique
Leading in the Contemporary Social Environment
Social Justice
Most nurses are aware of the social inequities in the healthcare system. Most healthcare systems have addressed common healthcare inequities faced by those living in poverty, people with mental illnesses, and the older adult population. Many healthcare providers actively address health inequities faced by people with substance use disorders or disabilities. These social determinants of health represent systemic disadvantages that have been created by structural inequities in healthcare delivery.
The need to reexamine healthcare’s structural inequities has become apparent. The National Academies Press (2017) defined the root cause of healthcare inequity as structural inequities, the “personal, interpersonal, institutional, and systemic drivers—such as, racism, sexism, classism, ableism, xenophobia, and homophobia—that make those identities salient to the fair distribution of health opportunities and outcomes” (p. 100).
Reflection
What can the DNP-prepared nurse and leader do about structural inequities, systemic racism, and discrimination?
Implicit Bias
The first thing to address is our own thinking and belief systems. Implicit biases are unconscious biases that are projected to others who are different. Systemic racism is generated on the microlevel by implicit racial bias. According to Kempf (2020),
The study of implicit race bias relies on the assumption that our unconscious negative and positive associations regarding people of different races are formed through various processes of socialization and can correspond with and impact conscious race-based interactions. (p. 116)
Our own thinking creates unrealistic (and inaccurate) expectations about others that further contribute to the general racism of our own race toward others who are different. When many individuals of one race have similar implicit racial biases, that racism generates systemic racism and structural inequities in our systems based on race.
The same phenomenon occurs with implicit bias against gender, age, religious affiliation, sexual orientation, and other categories that, ironically, generate issues from the very social determinants of health we overtly work to combat.
Combating Implicit Bias & Social Injustice
Think back on the Week 1 lesson about the emotionally intelligent leader and Johari Window. As DNP-prepared nurses, we can unravel our implicit biases and thoughts by first being aware that they exist. We must seek to open our Johari windows to reveal those unrecognized biases about ourselves that even we do not realize.
These implicit biases may be discovered in the micro-inequities toward others that we unconsciously project, like communicating negative nonverbal insults by eye-rolling, sighing, or unapproving facial expressions. Perhaps you create non-flattering nicknames for some but not others or consistently mispronounce names of those from a different culture or country. These could be cues to you that your implicit and undiscovered biases make you part of the problem, not part of the solution.
To become part of the solution, self-reflect and seek to become emotionally self-aware about your own subtle and unconscious behaviors. Then, integrate these discoveries into your self-regulation while translating them into a revised set of social skills that better empathize with and motivate others around you.
Make your application of emotional intelligence transformative in combating your implicit biases and in speaking up when you see others employ those behaviors to exclude, marginalize, offend, or even harass. As a DNP-prepared leader, stop the micro-inequities by yourself and others in the moment, if possible, or later if needs be.
As Mahatma Gandhi instructed, become the change that you want to see. Only then will you foster diversity and inclusion and help to reverse the systemic discrimination of race, gender, age, religious affiliation, and other diversities.
Cultural Humility
One constructive attitude to combat implicit bias and social injustice is to develop a cultural humility towards others. Cultural humility aligns with Chamberlain Care, as the term captures the importance of being other-focused and building relationships, not walls. The DNP-prepared nurse who becomes open to understanding the cultural identity of others will be less likely to develop biases towards them.
This becomes more relevant when the DNP-prepared nurse explores their own negative, automatic emotional triggers to discoveries of cultural differences that generate avoidance behaviors. As with emotional intelligence, the practice of cultural humility becomes a life-long process of discovery and maturity. This attitude grooms the DNP-prepared nurse leader to guide social justice reform on all healthcare and society levels.
NR703 Week 4 References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Publishing. https://www.nursingworld.org/coe-view-only
Groenwald, S. L. (2018). Designing & creating a culture of care for students & faculty: The Chamberlain University College of Nursing Model. National League for Nursing.
Juujärvi, S., Kallunki, E., & Luostari, H. (2020). Ethical decision-making of social welfare workers in the transition of services: The ethics of care and justice perspectives. Ethics & Social Welfare, 14(1), 65-83. https://doi.org/ 10.1080/17496535.2019.1710546
Kempf, A. (2020). If we are going to talk about implicit race bias, we need to talk about structural racism: Moving beyond ubiquity and inevitability in teaching and learning about race. Taboo: The Journal of Culture & Education, 19(2), 115-132.
Nicholson, J., & Kurucz, E. (2020). Relational leadership for sustainability: Building an ethical framework from the moral theory of “Ethics of Care.” Journal of Business Ethics, 156(1), 25-43. https://doi.org/10.1007/s10551-017-3593-4
Sorbello, B. (2008). The nurse administrator as caring person: A synoptic analysis applying caring philosophy, Ray’s ethical theory of existential authenticity, the ethic of justice, and the ethic of care. International Journal for Human Caring, 12(1), 44-49. https://doi.org/10.20467/1091-5710.12.1.44
The National Academies Press. (2017). Communities in action: Pathways to health equity. https://doi.org/10.17226/24624