Standards of Ethical Healthcare Practice in Nursing Homes

In the healthcare industry, organizations are governed by ethical, and state and federal laws that aim to protect the rights and dignity of the ailing. However, regulations and ethical considerations that apply to the organization and the individuals who work on their behalf are separate from each other and should be regarded as such.
To that end, the author intends to develop a critical code of business ethics as it as applied in the management of nursing homes and key ethical standards that should be upheld by professional employees of the same.  Furthermore, a sound criterion for the consistent implementation of ethics will be established along with its corresponding grounds for disciplinary action.

Organizational Code of Ethics

The construction of an effective organizational ethical principle must be based upon the integrated normative theories of consequentialism, summum bonum and, utilitarianism. As “caregivers, employers, citizens, and managers” (Sussman, 2005, p.1), healthcare organizations are commonly faced with critical ethical decisions that should reflect the objectives of the organization as a whole. In this respect the author would like to propose the following ethical standards that should serve as a guide in the decision-making process of nursing home administrators and their constituents.

As Compassionate Caregivers

Based on the Resident’s Rights, as stated by Cengage and Phelps (2006), the following
ethical principles shall be applied by the nursing home administrators in the interest of providing quality and compassionate care to its residents.
1.1.1. Respect for Self-Determination. Residents will be given the freedom to choose his/her physician, accept and refuse treatments and, receive advanced information on changes to his/her care plan.
1.1.2. Equal Access to Health Care. Residents will receive equal or similar standard of health care regardless of financial or payment issues.
1.1.3. Servicing of Needs. Residents’ requests for services will be accommodated satisfactorily provided that the request does not put the health of the client and the others at risk.
1.1.4. Advocates of Active Lifestyle. Residents will receive proper orientation to the nursing facilities and on-going activities to promote an active lifestyle within the compound.
1.1.5. Informed Rights. Clients will be duly notified of their rights as residents of the facility.
1.1.6. Respect for Privacy and Confidentiality. All information pertaining to the treatment and medical condition of the resident will be strictly protected and used only for the betterment of the client’s health maintenance and/or improvement.
1.1.7. Visitation Rights. The nursing home will respect the rights of the client to receive visits from friends and family provided that rules of conduct during visits are observed and visits are done in a timely manner.
1.1.8. Freedom from Abuse and Neglect. Residents shall receive competent and managed care that is free from any form of abuse and willful neglect.

As Moral Employers

As fair and just employers, the nursing home facility will adapt the following principles in the management of its employees.
1.2.1. Equal Treatment. Individuals working for the nursing home will receive equal treatment and rights regardless of character, rank, age, gender, ethnicity, religious, social or political background.
1.2.2. Equal Opportunities. Individuals working for the nursing home will receive equal professional growth opportunities based on qualifications, performance, moral and professional conduct and, enthusiasm for personal and professional growth.
1.2.3. Adequate Compensation and Benefits. Employees shall receive just and timely compensation with performance bonuses as is standard to the individual’s qualifications and responsibilities.
1.3. As Socially Responsible Citizens
As responsible citizens, managers of nursing homes must conduct business, based on the ethical principles of summum bonum and utilitarianism.
1.3.1. Veracity. The healthcare organization (HCO) shall divulge truthful information to the public whenever information is solicited for whatever purpose.
1.3.2. Report of Misconduct. The HCO shall dutifully report all forms of criminal misconduct to the authorities.
 1.3.3. Involvement in Social Welfare. The HCO shall engage in social projects whenever it is plausible to offer its services and resources to the welfare of the general public.
1.4. As Honorable Managers
Managers of the nursing homes shall observe honorable rules of conduct based on the ethical principles of consequentialism and summum bonum.
1.4.1. Free from Corruption. Managers shall exhibit freedom from any form of corruption-social, financial or political.
1.4.2. Free from Bias. Managers shall allocate organizational resources and manage its personnel without bias and prejudice.
1.4.3. Client Advocate. Managers shall demonstrate strong principles of client advocacy through conscientious monitoring of the client’s health and general well being.

Ethical Standards and Criteria in the Delivery of Care

The healthcare team including but not limited to medical doctors (M.D.’s), registered nurses (R.N.’s), licensed practical nurses (L.P.N.’s) and, certified nursing assistants (C.N.A.’s), are expected to act in accordance to the ethical standards of their profession. Moreover, based on the collective ethical theories of consequentialism, summum bonum and, utilitarianism, the following criterion for the delivery of key ethical principles in health care must be observed and maintained at all times:
2.1. Autonomy
The principle of autonomy refers to the clients’ inherent right to self determination and privacy that is free from external constraints (Bare and Smeltzer, 2004). The healthcare team is therefore expected to act truthfully and knowledgeably in order for the client to arrive at an informed decision concerning his health. With respect to the client’s right to privacy, the healthcare team shall observe basic etiquettes of respect such as knocking on the before entering a resident’s room and conceding requests for privacy whenever plausible.
2.2. Beneficence
Beneficence is the duty to do good and the performance of kindly deeds. Health care givers are therefore expected to act in a caring and compassionate manner towards the clients.
2.3. Nonmaleficence
Nonmaleficence, in relation to beneficence, is the obligation to do or cause no harm to another (Bare and Smeltzer, 2004). The health care team shall provide quality health care to the client and should not inflict harm as well as prevent harm to the client.
2.4. Confidentiality
The health care team shall not engage in wrongful or malicious distribution of client information and medical status unless it is for the betterment of the individual or in direct threat to the greater population.
2.5. Fidelity
Members of the health care team should remain faithful in their commitment to preserve and enhance quality of life. Professional responsibilities should be performed diligently, carefully and, superiorly.
2.6. Justice
The delivery of healthcare should be free from any form of discrimination and bias. Health care team members are expected to deliver equal care towards all the clients, regardless of character, gender, age, ethnicity, religious, social or political background.
2.7. Veracity
The principle of veracity is based on the obligation to be truthful in all situations. The health care team is expected to uphold this virtue especially when it comes to the timely and appropriate disclosure of the client’s health standing provided that they act in accordance to the limitations of their authority.
2.8. Respect
Respect for all persons, including but not limited to clients, clients family, and coworkers should be inherent to all employees in all situations. Misunderstandings between coworkers and difficult situations arising from the delivery of care to residents should be handled professionally and delicately.
III. Promotion of Ethical Conduct
The promotion of ethical conduct among employees can be achieved by observing the following provisions: (1) managers should demonstrate and model ethical behavior; (2) ethical conduct among employees shall be duly rewarded through incentives and bonuses; (3) equivalent punishment will be imposed on the employee guilty of unethical behavior; (4) provision of ethical support group and discussions, and; (5) continued equal treatment of employees (Sussman, 2005).

Grounds for Disciplinary Action

Employee’s who have been suspected of unethical behavior shall be subjected to a thorough ethical review. If the employee is found guilty of violating the code of ethics, the employee shall receive accompanying punishments ranging from vocal or written warnings to suspension and termination. The company also reserves the right to determine if legal charges against the offending employee are necessary.

References
Ascencion Health (n.d.). Health Care Ethics: Key Ethical Principles. Retrieved on December 18, 2008, from http://www.ascensionhealth.org/ethics/public/key_principles/main.asp
Bare, B.G., and Smeltzer, S.C. (2004). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing (10th ed).. Wyoming: Lippincott Williams and Wilkins.
Cengage, G., & Phelps, S. (2006). Nursing Homes. Encyclopedia of Everyday Law [Electronic Version]. Retrieved December 17, 2008 from http://www.enotes.com/everyday-law-encyclopedia/nursing-homes
Datta, R. (2006). Phil 430: Business Ethics. Retrieved on December 17, 2008, from, http://faculty.uncfsu.edu/rdatta/phil430.htm
Medicare: The Official U.S. Government Site for People with Medicare (2008). Nursing Homes. Retrieved on December 17, 2008 from http://www.medicare.gov/Nursing/Overview.asp
Sussman, A. (2005). First Principles: Substantive Ethics for Healthcare Organizations. Journal of Healthcare Management. Retrieved on December 17, 2008 from
http://www.allbusiness.com/management/3604889-1.html