Introduction
Organizational change in healthcare is one of the best methods to address specific issues that decrease patient outcomes and prevent medical workers from leveraging their potential. An evidence-based change in nursing practice is offered as a solution to the growing rates of pressure ulcers. The latter condition has many adverse effects on clients’ health, medical professionals’ workload, healthcare costs, length of hospital stays, and patient and worker satisfaction rates. The key factor contributing to the identified concern is a lack of nursing knowledge and awareness of the best evidence-based strategy to prevent bedsores. This paper aims to discuss the ethics of the proposed intervention, which is based on offering nursing training and education related to the use of the SSKIN care bundle.
Defining the Area of Nursing Ethics
To begin with, it is essential to explore the area of nursing ethics that pertains to the identified nursing practice problem. This can be done with the help of the Code of Ethics for Nurses (The American Nurses Association, 2001). Provision 5 reads: “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth” (The American Nurses Association, 2001, p. 9).
As evident from the nursing practice problem analysis, medical professionals lack the required knowledge and skills to reduce the incidence of decubitus ulcer development (James & Abraham, 2020). Therefore, many nurses fail to adhere to the mentioned ethical principle, as they do not develop professionally and lack awareness about the best strategies for preventing bedsores. Nursing ethics indicates that it is impossible to remain without learning new evidence-based treatment methods or expanding one’s knowledge. Otherwise, patient outcomes cannot be improved because nurses lack adequate skills.
Additionally, the violation of Provision 5 also refers to a failure to adhere to Provision 6.2. The latter refers to nurses’ responsibility to “create, maintain, and contribute to environments of practice that support nurses in fulfilling their ethical obligations” (The American Nurses Association, 2001, p. 11). In healthcare settings with higher rates of pressure ulcers, management does not provide professional development opportunities for the medical staff, preventing them from promoting ethically sound practices. In other words, it is much more challenging for nurses to respond to the mentioned provisions when there is no support from their leadership.
Therefore, two related areas of nursing ethics must be addressed when solving the identified issue of growing rates of decubitus ulcers. Firstly, nurses should be encouraged to develop and expand their qualifications using the latest evidence-based bedsore prevention and management strategies. Secondly, healthcare leadership must take a more active role in promoting education, offering these opportunities to nurses, and ensuring that their facilities and workers adhere to the most effective pressure ulcer management methods.
Addressing the Ethical Concern
Unfortunately, specific issues and obstacles might appear even when the most efficient and required intervention is proposed. These concerns often arise from nursing ethics, and this section of the paper is devoted to exploring some scenarios that may occur during the implementation of nursing training. According to Nilsen et al. (2020), worker resistance is one of change implementers’ most frequent problems. Yoo et al. (2019) support this statement, as “while the performance of EBP positively improves nursing-sensitive outcomes, the process of establishing such EBP also creates a work and psychological burden for clinical nurses and can also lead to resistance” (para. 6). There may be numerous factors that lead to nursing resistance to change, so it is critical to review and address several potential scenarios.
The Impact of Poor Communication About Intervention Reasons and Benefits
Firstly, consider that a healthcare facility’s leadership fails to inform its nurses about the reasons for the intervention’s implementation and its expected positive effects. In this case, nurses must change their bedsores prevention and management routine, spend time on additional training and education, and understand how to perform their updated duties. All these requirements can seem meaningless and purposeless to them, so they can resist the change, preferring the previous actions and guidelines they are acquainted with.
Indeed, “resistance to changes is more likely if employees consider the changes to have little or no value for themselves” (Nilsen et al., 2020, p. 6). This may appear if nurses are unaware of the statistics related to bedsores development and consequences, the ineffectiveness of the currently adopted measures to manage decubitus ulcers, and the urgent need to reduce the prevalence of this condition.
Consequently, healthcare leadership needs to inform their nurses about all the facts mentioned to address this potential problematic scenario before implementing the change. They can refer to successful cases of providing nursing training and using the SSKIN care bundle in other hospitals and demonstrate how statistics become more positive. Nilsen et al. (2020) found out that “changes that were communicated to allow for preparation increased the chances for success” (p. 4). Suppose nurses learn about their primary role in improving patient outcomes related to pressure ulcers and understand that higher rates of this condition lead to increased healthcare costs and prolonged stays. In that case, they will be more eager to accept and promote the change.
Nurse Dissatisfaction with Limited Involvement in the Implementation of Interventions
Another possible scenario is that nurses get dissatisfied with their limited participation in implementing the intervention. Even if nurses understand the need for change but are not allowed to be involved in decision-making, their readiness, motivation, and enthusiasm can be affected (Nilsen et al., 2020; Yoo et al., 2019). Consequently, it is recommended that healthcare leaders allow nurses to actively prepare for the change actively, even if their influence and decision-making will be limited to some extent.
Provisions 5 and 6 should be used as guiding lines to foster this intervention (The American Nurses Association, 2001). Nurses are active participants in ethics and morale promotion and must be allowed to create and maintain ethical practices (Chadwick & Gallagher, 2020). Further, they must receive high-quality and relevant training and education to develop professionally and perform their duties using the latest evidence-based methods, such as the SSKIN care bundle, to manage pressure ulcers.
Adopting and Maintaining Ethical Principles
Eventually, deciding how ethical principles can be adopted and maintained within the nursing project is essential. Adherence to the norms and rules of morale can help ensure that the project’s participants can leverage their potential, stay motivated, and achieve the most effective results. The first ethical principle to maintain is the mental and physical safety of those nurses who will receive additional training and education. According to Ferrari et al. (2018), it is critical to establish adherence to this ethical component for the success of the project and its participant’s well-being. Adopting this moral principle will ensure that training programs will not disrupt nurses’ work-life balance and will not bring them additional stress.
Further, there is an important matter to consider regarding patients and the maintenance of ethics. During the implementation of the project, nurses will be told to carefully use their new knowledge when evaluating clients for risk or the presence of pressure ulcers (Varkey, 2021). Nurses have to adhere to the principles of beneficence and nonmaleficence, which means that they are expected to prevent bedsores development while also avoiding bringing other harm to the patients. They will be instructed and taught to do that during the initial training sessions. Moreover, to follow the ethical principle of patient autonomy (Varkey, 2021), nurses will receive updated information about educating clients about the risk of pressure ulcers. This practice will allow nurses to promote knowledge and support patients in their care for their well-being.
Conclusion
To conclude, ethics plays a significant role in preparing and implementing evidence-based nursing interventions. Provisions 5 and 6 of the Nursing Code of Ethics are violated in the case of improper management and prevention of bedsores due to the medical staff’s lack of relevant skills and knowledge. When addressing this problem, the project’s management should address potential worker resistance to change by including nurses in the implementation process. Lastly, nurses’ and patients’ well-being is the ethical principle to maintain when adopting the change.
References
The American Nurses Association. (2001). Code of ethics for nurses with interpretive statements [PDF document]. Web.
Chadwick, R., & Gallagher, A. (2020). Ethics and nursing practice: A case study approach. Bloomsbury Publishing.
Ferrari, A., Manotti, P., Balestrino, A., & Fabi, M. (2018). The ethics of organizational change in healthcare. Acta Bio-Medica, 89(1), 27–30. Web.
James, J., & Abraham, R. P. (2020). Effect of education intervention on knowledge and practice on SSKIN care bundle pressure ulcer prevention. International Journal of Nursing Care, 8(2), 4–9. Web.
Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: An interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20, 1-8. Web.
Varkey B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. Web.
Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS one, 14(12). Web.
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