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Tuesday, May 7, 2013

Ethics And The Core Functions Of Public Health Nursing

Kapevi Hatake | 11:19 PM |

Assessment is systematic data collecting about the population, monitoring of the populations health status, and making information available about the health of the community. The following three ethical tenets support these core functions :
1.      Competency related to knowledge development, analysis, and dissemination. An ethical question related to competency is, are the persons assigned to develop community knowledge adequately prepared to collect data on groups and populations? This question is important because the research, measurement, and analysis techniques used to gather information about groups and populations usually differ from the techniquest used to assess individuals. Wrong research techniques can lead to wrong assessment, which in turn may hurt rather than help the intended group or population.
2.      Virtue ethics or moral character. An ethical question related to moral character is, do the persons selected to develop, assess, and disseminate community knowledge possess integrity? Beauchamp and childress (2001) define integrity as “ soundness, wholeness, and integration of moral character”. The importance of this virtue is clear : without integrity, the core function of assessment is endangered. Persons with compromised integrity are easy prey for potential or real scientific misconduct.
3.      “Do no harm”. An ethical question related to “do no harm” is, Is disseminating appropriate information about groups and populations morally necessary and suficient? The answer to “morally necessary” is yes, but to “morally sufficient” it is no. The fallacy with dissemination is that there is no built-in accountability that what is disseminated will be read or understood. If it is not read or understood, harm could come to groups and population regarding their health status.

Case Study
Because finding affordable housing was difficult. 26 years old Terri White lived with her 6 months old son. Tommy, and his father, Billy Smith, in one room of the landlord own house. Ms White was morbidly obese and diagnosed with bipolar disease : Mr. Smith had served time for drug dealing and was out on parole and staying straight. Neither had finished high school. Mr. Smith’s past drug use had rendered him unable to do much manual labor because of heart damage, but on occasion he would work construction to support the family.
Public health nurse Jim Lewis had received a referral on Tommy when he was diagnosed with failure to thrive (ftt) to 2 months earlier. Ms. White, who had had two children removed from her custody by child protective services (CPS) in the past, and Mr. Smith seemed to adore their baby so much so that Ms. White would hold the baby all day long. In the past 2 months the nurse had taught Ms. White about infant nutrition, gotten her enrolled in the womans, infants, and children (WIC) nutrition program, and now Tommy had increased his rate of physical growth and was above the 5% of this growth percentile. Yet, he was not meeting his gross motor milestones per Denfer Developmental Screening Test II (DDSTII) testing. Mr. Lewis thought that Tommy was not allowed to play on the floor enough to process in sitting, pushing his shoulders up, or crawling. Most of their smallroom was taken up with the bed and the boxes that stored their belongings. There wasn’t really space for “tummy time” or play. When not in the room, the family would take the bus to a discount store and spent the day walking around to get a change of scene.
One week Ms. White told the nurse she was not taking her medications for bipolar disease anymore because they caused her to gain weight. The next week she confided that Mr. Smith had had a “dirty” urine specimen check and would have to return to prison in the near future. The following week Mr. Lewis found the family leaving in a rundown motel since they had been evicted by their landlord after a disagreement. Ms. White was very agitated. She confided in the nurse that they had $100 left, Mr. Smith was going to have to return to prison that week, and the motel bill was already $240. Ms. White knew she would be homeless soon without the support of Mr. Smith but refused to talk with her social worker about her needs. She asked the nurse not to tell anyone about her situation because she was afraid CPS would take Tommy from her. As they had her other children. It was clear to Mr. Lewis that she might not know where Tommy was after they left this motel. 

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