Fourth Session

Wednesday, November 16, 2011

“Caring for Patients, Helping with Recovery, Dealing with Lingering Worries and Challenges”

Reading Assignment: Chapters 26-36 and Afterword

Objectives:

  1. Explain how “leadership” and “institutions that follow that leadership” are important in resolving professionalism and ethics dilemmas today.
  2. Discuss the professional and ethical implications of “ruthless action” to stop the spread of pandemic disease.
  3. Evaluate the sentence, “Vaughn [one of America’s leading pediatricians and medical educators] believed that the influenza virus came close to threatening the existence of civilization” and discuss a practitioner’s responsibility to each patient and the community in pandemics.
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20 Comments (+add yours?)

  1. Suja Thomas
    Nov 03, 2011 @ 19:31:08

    Collaborate for success is very important element of an effective leadership. Leaders are never solo practitioners, but are able and willing to work with others for the greater good. Collaboration is fostered when you create a climate of trust. Leaders who know how to collaborate also foster accountability within the group.Nurses are in the best position to advocate for the rights of their patients and are frequently involved in ethical issues and ethical decision-making processes. Ethical dilemmas arise daily when the nurse is confronted with a choice, in which ethical reasons both for and against the choice are equally desirable (Pierce, 1997). The New York State Nurses Association believes the registered professional nurse should respond to ethical dilemmas by:
    • Recognizing the increasingly complex ethical issues in practice
    • Practicing in accordance with the American Nurses Association Code of Ethics for Nurses (ANA, 2001)
    • Demonstrating sensitivity to diverse cultural needs.
    Integrating ANA’s ethical provisions in practice and the corresponding measurement criteria identified in Standard 12 of the Scope and Standards of Practice (ANA, 2004, p. 39), which include: preserving and protecting patient autonomy, dignity and rights, acting as a patient advocate, maintaining a therapeutic and professional patient-nurse relationship, demonstrating a commitment to self-care, participating on ethics committees and contributing to resolving ethical issues of patients, colleagues, or systems, and reporting practices that are illegal, incompetent or impaired.

    Reply

    • Sarah Botting
      Nov 16, 2011 @ 16:02:43

      I sometimes think a nurse has one of the hardest jobs in the health care field. They are the ones that have the most interactions with patients and have to do as told by the doctor. If it weren’t for them, there would be a lot of patients left with not enough appropriate care. Like you said, it really is the collaboration between every healthcare provider that truly provides the safest healthcare to patients. In our book, you can see that as much as healthcare professionals wanted to work together and have a coordination of care, they could not simply due to the lack of help during the influenza pandemic. Most healthcare professionals were on their own to provide what little care they could.

      Reply

      • Emily Mozingo
        Nov 16, 2011 @ 17:44:57

        Sarah I could not agree more. It is my opinion that the nurses are often the most knowledgeable and intuitive to their patients needs. The Nursing Staff is the foundation/ the core of the hospital. I think that there ought to be collaboration amongst health care providers on an everyday basis but it is crucial in an epidemic to combine experience and knowledge. When resources are limited and the pathogen is destructive it is the responsibility of all health care professionals to provide care for their patients.

      • Brittany Fitzpatrick
        Nov 16, 2011 @ 20:11:05

        I think there has to be collaboration amongst health care professionals, and I am thrilled to see it heading in the direction. Without collaboration there’s a possibility of duplication of tests, misdiagnosis and medications. This would lead to a large financial burden, and possible exacerbation of certain disease states. Collaboration of health care professionals provides improved patient care. The knowledge of different medical professionals provides various viewpoints and perhaps a new view on certain circumstances. Collaboration during a time of crisis is essential to its success.

  2. Thochaporn Tesasil
    Nov 14, 2011 @ 06:30:45

    Health Care Leadership is crucial in leading changes in professional practices and the advancement of public health and healthcare. Previously, visionary leaders such as Dr. William H. Welch at Johns Hopkins Medical School and Dr. William Flexner at the Rockefeller Foundation not only led these two institutes to become world renown, but also transformed Medical and Public Health Training and Education in America (Barry, 2009). They supported, mentored and inspired their followers in providing leadership that created radical changes for curriculum and training for the medical profession.

    During the past century, each health profession has transformed and developed their own identity, value, roles, and accountability to advance their professional growth and practice. However, “old approaches to professionalism have been criticized as being self-serving and are seen as creating barriers between the professions and impeding the improvement of health care” (Interprofessional Education Collaborative Expert Panel, 2011). Recently, leaders in healthcare who recognize the value of interdisciplinary partnerships in improving quality of healthcare have supported the establishment of inter-professional collaborative core competencies for practice and education.

    I strongly agree with this a paradigm shift effort in striving for a new approach of collaborative inter-disciplinary professionalism. Using this new approach, multidisciplinary learn and discuss inter-professional values and ethics in an effort to move toward patient centered care; grounded in a sense of shared purpose to support the common good in health care, and reflect a shared commitment to creating a safer, more efficient, and more effective system of care (IECEP, 2011). I believe that this type of health professional education will assist students learn to work effectively as a healthcare team while maintaining a professional identity with mutual respect. This team approach will help to address professional and ethical dilemmas for the common good of the patient and family.

    Reference
    Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

    Reply

    • Dan Corwin
      Nov 16, 2011 @ 03:06:08

      The leaders of both the John Hopkins and Rockefeller center did help bring those institutions to great prestige. It was also due to great followers as well though. Behind every great leader are followers who believe in them and what they do, so to have a great institution (hospitals especially) there needs to be people who will work with them to solve problems. These could be ethical dilemmas and other issues that are complex. This is where the interdisciplinary aspect is needed in society today because some ethic dilemmas aren’t always simple so all aspects of each decision need to weighed.

      Reply

      • Emily Mozingo
        Nov 16, 2011 @ 17:50:34

        I think that the very definition of an effective leader is a person who is able to command the masses (or even just a few influential people) and elicit their support. Without support no effective change can be made. This support creates loyalty and draws in other resources. Without a following a leader would simply not be a leader.

  3. Premjit Klaipetch
    Nov 14, 2011 @ 12:26:34

    Due to the rising number of individuals with influenza, there were “ruthless actions” initiated to halt the spread of pandemic disease. For example, there was a special police force to arrest anyone who spit or coughed without covering his mouth. According to the text, some cities hired guards to set up a “shot gun quarantine,” to keep the town entirely free of the disease. To keep outsiders out of town, the lawmen also put up roadblocks. If anybody from another town attempted to enter the city, with or without influenza, they would be arrested and quarantined for five days. These practices were examples that compromised and decreased the autonomy of people and their basic human rights.

    During the pandemic, people were fearful of contracting this highly contagious disease. People were afraid of talking to or contacting one another because they were afraid they would be exposed and contract this dreaded illness. Fear destroyed community life. Fear also kept people apart. Another example of “ruthless action” included police placing signs written in red “INFLUENZA” or “SICKNESS” nailed to the door of a home. This was an action to quarantined sick people, but it also spread fear and isolated the infected family from receiving help. People would panic and would not go near the sick. No one would offer to bring food or visit these affected individuals. Consequently, the sick were often left alone including children whose parents were too sick to get out of bed and care for them. This was very upsetting for me when I read in the book that; “Fear really did kill people. It killed them because those who feared would not care for many of those who needed but could not find care, those who needed only hydration, food, and rest to survive.“

    Reply

    • Kristin Pesto
      Nov 16, 2011 @ 19:59:46

      In reply to Premijit Klaipetch: It saddened me to read this as well, but I wonder how and if it would be any different if you put it into context today? If there was an unknown virus or bacteria that was making the people around us sick and killing them, would people really step up to help them out? Quarrantining has been brought up even when talking about AIDS patients only 20 years ago. I tend to think that if we were faced with an pandemic, especially one of unknown origin, that we would again respond with “ruthless actions.” In reference to AIDS again, there have even been court cases where people with AIDS have been sentenced to jail time for knowingly spreading their disease to their partners through unprotected sex. This is very similar to arresting people who were coughing in public without covering their mouths. Maybe without such actions the epidemic would have been allowed to spread and infect others. Maybe these “ruthless actions” are necessary for survival.

      Reply

      • Sarah DeRuosi
        Nov 16, 2011 @ 21:01:40

        I, too, found these “ruthless actions” to be saddening to read about. I can see the connection to modern day with the example of AIDS punishments, but I am not sure how necessary it is to follow through with these types of actions. I am not sure if it is just my way of thinking, but if someone was ill from a disease/virus such as these two different scenarios, wouldn’t a normal civilian want to try and take all necessary precautions to prevent spreading of the disease to themselves or any other loved one? I know I would take those matters into consideration and do whatever I could to prevent contraction of the virus. If the world could see in that mindset, would we necessarily need these ruthless actions? In the case that Kristin brought up, wouldn’t individuals who have AIDS not want to have unprotected sex with their partners to prevent spreading of the disease and harming others?

  4. Dan Corwin
    Nov 15, 2011 @ 22:06:38

    Explain how “leadership” and “institutions that follow that leadership” are important in resolving professionalism and ethics dilemmas today.
    Leadership is definitely needed to help make the important decisions based on certain ethical dilemmas faced by institutions. They are the ones willing to make the final decision based on (hopefully) logical reasoning and evidence based on previous circumstances. They are also the ones to help people understand ethical dilemmas and the decisions needed to get through them. Sometimes those leaders also need to know when to take back their first decision based on new evidence as well. Such as the Los Angeles public health director said “If ordinary precautions are taken then there is no cause for alarm”, he then closed school, churches and theaters 48 hours later. (Barry 336) This shows how he made the decision even after saying otherwise that was necessary to protect the public

    Discuss the professional and ethical implications of “ruthless action” to stop the spread of pandemic disease.
    Ruthless action didn’t do much to help stop the pandemic. It possibly did help to slow its spread, but nothing majorly helped. The only places that avoided exposure were small islands that cutoff total interaction with the outside world. “Small towns in Alaska would have guards on trails and all roads into the city”,(Barry 376) this shows how some cities were desperate after hearing some of the news and death rates. Some of the ethical implications is that some people might have went to those cities for help because they couldn’t get it their smaller village. This is a draw back along with if cities needed supplies they wouldn’t be able to get them in at a regular interval and shortages of supplies and food would begin to get worse over time.
    Evaluate the sentence, “Vaughn [one of America’s leading pediatricians and medical educators] believed that the influenza virus came close to threatening the existence of civilization” and discuss a practitioner’s responsibility to each patient and the community in pandemics.
    This is a very valid sentence because government offices begin to shut down due to personal shortages. Also corpses began to back up in the morgue and grave diggers stopped doing their job. This was from fear of getting the flu and then dieing themselves. Volunteers didn’t keep going back to help out because of how gruesome and terrible the conditions were. People weren’t trying to help others in a time of need. This sort of sounds like a degeneration of society and sort of apocalypse type of scenario. So I would agree with this virus came close to threatening to destroying society, and even thought is didn’t destroy the society s a whole, it did wipe out villages and small towns that were greatly susceptible.

    Reply

  5. Emily Mozingo
    Nov 16, 2011 @ 01:46:34

    1.Discuss the professional and ethical implications of “ruthless action” to stop the spread of pandemic disease.

    In The Great Influenza once the virus had consumed a region; desperate measures were taken to minimize spread of the disease. A scene, that I have referred to often, illustrates in the “ruthless action” taken to stop the spread of the disease, “The train would have filled with panic. At stops for refueling and watering, men would have poured out of the train seeking any escape, mixed with workers and other civilians, obeyed and reluctantly when officers ordered them back into cars, into this rolling coffin” (217). These men were forced to submerge themselves in the virus and many died. Barracks, cities, trains, and ships were overcrowded, contained and isolated despite the rapid spread and fatality of the disease. Officers and political figures quarantined and crammed ill patients into small quarters- in effort to contain the disease.

    2.Evaluate the sentence, “Vaughn [one of America’s leading pediatricians and medical educators] believed that the influenza virus came close to threatening the existence of civilization”
    “This was influenza, only influenza” (231). This strain of the influenza virus did indeed threaten the existence of civilization. This virus struck quickly and without warning and killed millions. Influenza is unique to others viruses in that it does not need a human host to survive and thrive. It could transfer from human to animal host and vice versus to achieve near maximum efficiency in its ability to spread and infect. Like a martain invading earth influenza, “loosed upon the world their death ships and they were indomitable. They began to feed on humans, sucking the life force from them down to the marrow of the bone” (369). The virus was capable of mutating rapidly. Furthermore, it affected the population equally, “Did not in general demonstrate a pattern of race or class antagonism. In epidemiological terms there was a correlation between population density and hence class and deaths, but the disease still struck down everyone” (395).

    Reply

    • Dan Corwin
      Nov 16, 2011 @ 03:01:26

      I would agree with this disease definitely threatening the existence of civilization. Really I think because it did cross so many social and racial boundaries that at this time in history it was a great sort of equalizer. I know we briefly made this connection in class, but I would go as far as saying this epidemic is our modern day black death. The difference I would point out is less was written and talked about this due to the war. But the black death also brought the European civilizations to their knees just as this one did to almost the whole world.

      Reply

  6. Brittany Fitzpatrick
    Nov 16, 2011 @ 12:06:26

    Dan I agree with your statement in regards to having great leaders and followers. I think interdisciplinary is so essential to society, and specifically in health care. There are many ethical situations that can arise in health care and it is important for all different forms of health care to be weighed and evaluated. This could also help in a situation of medical malpractice. A physician, pharmacist or facility could benefit from input from other parts of the health care field. Interdisciplinary work is so important and that is why this class is so beneficial to our futures. Getting input and views from other fields is invaluable.

    Reply

    • Sarah DeRuosi
      Nov 16, 2011 @ 20:29:42

      Brittany you make a very valid point about the importance of interdisciplinary health care practice. This is the whole purpose of this seminar class we are currently in – and it truly opens all of our eyes on how much we rely on the various professions in various aspects of practice. In your example of medical malpractice, we require the support and expertise of lawyers to help the physicians and medical facilities that are in a state of turmoil. When working with patients, there are the nurses for constant patient care around the clock, the physician to provide the diagnosis and provide treatment, and pharmacists are there to monitor the treatment regimens. Without the expertise of these healthcare professionals, there would be chaos – not one person can handle all of these jobs..

      Reply

  7. Sarah Botting
    Nov 16, 2011 @ 15:54:50

    Leaders come in many shapes and sizes. A leader is anyone who has an influence over other people and we are all leaders in our own rights. In everyone’s opinion, was there one person, or a single group of people during the Spanish Influenza that stood out as the biggest leader(s) during this time? I personally do not think that I could choose just one person because what each medical profession and non-medical profession did was so important to helping improve the nation’s quality of life.

    Reply

  8. Kristin Pesto
    Nov 16, 2011 @ 20:09:15

    Does anyone else agree with the connection between the treatment of the sick and the “ruthless actions” during the Great Influenza and the treatment of patients in the AIDS epidemic? Do you think that if an epidemic/pandemic broke out this day in age that we would still resort to harsh legal actions to prevent the spread of the disease? Here is an ethical dilema: do you agree with the use of these actions or do you think that human rights play a role even in light of a pandemic? How far can we take these actions, where do we draw the line between necessary and unethical?

    Reply

  9. Brittany Fitzpatrick
    Nov 16, 2011 @ 20:23:18

    What do you think is the most important aspect of being a leader in the health care field? Does it differ from the time of the flu pandemic and today? Has it changed with the improvement of medicine and technology, and cant it be reflected within the ethical values of the profession?

    Reply

    • Sarah Botting
      Nov 16, 2011 @ 20:57:20

      Being a leader in the healthcare field means advocating for a patient’s healthcare. A leader will show others in the health field that they need to step it up and strive to enhance technology, guidelines, and therapies. Leadership was depicted throughout the Spanish Influenza and today in present healthcare dilemmas. Society is always trying to improve its ways and we have seen healthcare policies grow leaps and bounds over the past few years. I think technology is the biggest contributor to all of our advances. It allows more time to spend with patients and more time to provide the best healthcare possible.

      Reply

      • Sarah DeRuosi
        Nov 16, 2011 @ 21:12:03

        A leader in the health profession is one who is passionate about the healthcare of a patient, and doing so with a positive emotion. A great leader can take in all different emotions and difficult situations relating to health care, and turn the mood around to something of a positive nature. It is with that type of attitude that a healthcare leader and tackle any issue and lead a team to victory. With the improvement of medicine and technology, this aspect of a leader is amplified even more. As in Sarah’s response, technology allows us to focus more on patient care, and less on just diagnosing. The healthcare leader utilizes the positive emotions to interact with patients and bring out the best resolutions.

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