Wk2Responses/Response # 1 To Tigist
Week 2 Initial Post: Ethical Challenges in Health Care for Practicing NPs
An explanation of whether NPs should treat family members.
Treating patients or family members include prescribing diagnostic tests, diagnosing and prescribing treatments (drug or other treatment plans). Some states are allowing Nurse practitioners (Nps) or care providers to provided treatments to family members only in emergency situations and some allow with written record of an exam and treatment is needed (Midlevel U: The Online Hub for Midlevels, 2013). Buppert (2004), suggests that NPs should review the laws governing in his/her state and not to prescribe controlled medications to family, coworkers, and friends: as this will be a red flag to pharmacist, other legal teams, and organizations to keep an eye on the prescriber.
What are the ethical dilemmas in this situation?
In this week case study, the Mother who is a NP should know better not to prescribe an antibiotic. The mother did a mistake not wearing her six thinking hats: she went ahead and gave her daughter treatment without any evidences of strep infections, such as fever, throat/tonsils (exudates, edema, erythema,), tender lymph nodes, or positive strep test (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2013). The mother also should have known that her daughter’s situation is an emergency: her daughter pain symptoms could have been treated with over the medications such as ibuprofen or acetaminophen Tylenol, others (Buttaro, et al., 2013).
In addition, as NP and a care provider understanding the term beneficence is vital to prevent other from harmful conditions (Buppert, 2018). The antibiotic that the mother prescribed have many side effects that may cause more discomfort to her daughter such as vomiting, diarrhea, abdominal cramps, allergic reaction, vaginal itching, misuse of antibiotics may arise in bacterial resistance, and more (Buttaro, et al., 2013).
What are the laws in your state for NPs treating themselves, family, or friends?
There is no specific written law that I have found which states New Jersey Nps not to treat family, friends, family, or themselves as they are technically independent providers. NJ NPs are responsible ethically and legally for any care they provided including diagnosing and treating any individuals (Midlevel U: The Online Hub for Midlevels, 2014). Physicaials do not need to be on a site with the NPs when prescribing medications or treatments yet they need to keep communication with the collaborative physician (Midlevel U: The Online Hub for Midlevels, 2014). Although, NPs in New Jersey are allowed to prescribe schedule II-V controlled substance after completing six contact hours of substances pharmacology course,
personally, I would not prescribe any controlled medication to any of my friends, families, or co-workers (Stokowski, 2015).
Refrences
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.).
Sudbury, MA: Bartlett & Jones Learning
Buppert, C. (2004). Can NPs Prescribe for Family Members or Themselves? Retrieved
from http://www.medscape.com/viewarticle/478418
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013).
Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
Midlevel U: The Online Hub for Midlevels. (2013 January 14). Should Providers Treat
Their Friends and Family? [Blog Post]. Retrieved from
http://midlevelu.com/blog/should-providers-treat-their-friends-and-family
Stokowski, L. (2015). APRN prescribing law: a state-by-state summary. Available from:.
Accessed,10, 16. Retrieved from http://www.medscape.com/viewarticle/440315
Midlevel U: The Online Hub for Midlevels. (2014 September 12) Nurse Practitioner Scope of Practice:New Jersey retrieved from http://www.midlevelu.com/blog/
nurse-practitioner-scope-practice-new-jersey
Response # 2 to Jennifer Lambert
In this case study, there are some questions that one should consider prior to a decision. Buppert (2018) briefly discusses ethical principles and ethical decision processes when faced with different types of ethical dilemmas. The legality of this situation would need to be the first consideration, then the ethical issues if any.
Treating family or friends is sometimes a gray area and not addressed legally in certain states. Some states recommend against it except in emergency situations and some states allow this practice provided the documentation shows a physical exam and treatment plan along with the prescription. Treating family for minor illnesses may be acceptable but prescriptions for controlled substances are not good practice due to the inability to participate in a true unbiased patient-provider relationship (MidlevelU, 2013).
Ethical issues in the case study
A couple of dilemmas stand out in this example such as the NP seeing her daughter as the patient without taking time to properly evaluate her as the patient. Also, prescribing an antibiotic even after a negative Rapid Antigen Detection Test(RADT), just to appease the patient.
There was no indication for this treatment regimen. Acute pharyngitis, either viral or bacterial is almost always a self-limiting condition but GABHS is the only diagnosis and cause for acute pharyngitis where antibiotics are recommended. RADT false negative results are usually low while the expense of DNA backup testing is usually very high. Antibiotics are given to reduce the severity of symptoms or possible complications such as peritonsillar abscess, lymphadenitis, mastoiditis, or rheumatic fever. Rheumatic fever rates are very low in the United States as are the other suppurative complications with GABHS. Waiting on DNA probe testing delays antibiotic treatment which could mean the patient may not benefit from the treatment and prescribing an antibiotic for negative RADT while awaiting the back-up testing causes an over-use of antibiotics and possible resistance (Nakhoul, & Hickner, 2013).
I believe in this situation, the NP should have suggested another provider see her daughter or to encourage analgesics for throat pain and to increase fluids, due to the high probability that it was viral in nature (UpToDate, Inc. 2017).
State law
The Nurse Practice Act in Arkansas does not specifically address or regulate the treatment of family or friends except that documentation has to be that of other patients in the practice which would consist of physical exam, treatment plan, and prescription all present in the chart. Best practice is encouraged which is to have another provider see them especially if controlled substances are involved. Also, to remember that objectivity is harder to maintain when treating family or friends and the objectiveness of decision making should make sense in front of any jury (Arkansas State Board of Nursing, 2016).
References
Arkansas State Board of Nursing (2016). Advanced Practice Nursing in Arkansas: A Legislative
Update. Retrieved from http://www.arsbn.org/.
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide, (6th ed.). Sudbury,
MA: Bartlett and Jones Learning.
Midlevel U: The Online Hub for Midlevels. (2013 January 14). Should Providers Treat Their
Friends and Family? [Blog Post]. Retrieved from
http://midlevelu.com/blog/should-providers-treat-their-friends-and-family
Nakhoul, G. N., & Hickner, J. (2013). Management of adults with acute streptococcal
pharyngitis: Minimal value for backup strep testing and overuse of antibiotics. JGIM Journal
of General Internal Medicine, 28(6), 830-834. doi: 10.1007/s11606-012-2245-8.
UpToDate, Inc. (2017). Symtomatic treatment of acute pharyngitis in adults. Retrieved from
https://www.uptodate.com/.
