PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention?

PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention?

PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention?

Read “Workplace Health Model,” by Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion (2016), located on the Centers for Disease Control and Prevention (CDC) website (https://www.cdc.gov/workplacehealthpromotion/model/index.html). It is supposed to be a coordinated approach to workplace health promotion programs.  Do you see any of these interventions in place at your workplace?

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There is a coordinated approach to workplace health promotion programs, interventions in place at the workplace is the use of local fitness facilities, tobacco-free campuses, health education classes, and healthy food options. There are local fitness facilities located within the hospital and the workers have an option to do an outside gym membership that is payroll deducted. The tobacco-free campus has been in effect since 2009. There are health education classes to help with weight loss and each year there is a competition for groups and a large prize is given out to the team that loses the most weight. Healthy food options are available in the cafeteria and employees receive discounts on the price when they select them. There is currently an internal market being created in the hospital that will give healthier options then the venting machine options.

National Center for Chronic Disease Prevention and Health Promotion (2016). Workplace Health Model. https://www.cdc.gov/workplacehealthpromotion/model/index.html.

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Population-based interventions have the potential to improve patient care and population health outcomes. However, some interventions may not be considered to be in every individual’s best interest in every situation, resulting in ethical and legal issues for public health professionals. Furthermore, population-based interventions can push public health nurses (PHNs) toward traditional public health ethics, where decisions are based on the primary concern for large groups of individuals (DeCamp et al., 2018). PHNs are required to uphold the ethical principles of beneficence and nonmaleficence when planning and implementing population-based interventions. Beneficence requires PHNs to support interventions that benefit individuals, while nonmaleficence requires PHNs to ensure the interventions cause no harm (DeCamp et al., 2018). Nonetheless, the lines between harmful, non-beneficial, and beneficial effects of population health interventions for individuals may blur.

Interventions could enhance a population’s overall health while causing unintended non-beneficial, or even harmful, consequences to individuals, which can result in legal consequences. Legal aspects of implementing a population-based intervention align with justice. PHNs are expected to uphold procedural justice by ensuring that fair decision processes govern individual and organizational deliberations. It requires opportunities to involve individuals in their care and healthcare decision-making (Shahzad et al., 2019). PHNs are also required to observe regulations when implementing population-based interventions. For example, the law regulates public health officials by requiring the development of safer interventions. Thus, the PHNs must observe the regulations and implement safe interventions for the target population.

The smoking ban in public places is an example of a population-based intervention. It accounts for ethical standards by promoting the overall health of the general population by reducing exposure to second-hand smoke. This prevents harm to individuals by reducing their risk of passive smoking-related diseases, thus upholding nonmaleficence (Shahzad et al., 2019). It also accounts for legal standards by outlining that there should be specific locations for smoking, allowing smokers to smoke. Regulation standards are accounted for by adhering to the environmental regulations on reducing smoke emissions.

References

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., Reynolds, P. P., Sulmasy, L. S., & Tilburt, J. (2018). Ethical Issues in the Design and Implementation of Population Health Programs. Journal of general internal medicine33(3), 370–375. https://doi.org/10.1007/s11606-017-4234-4

Shahzad, M., Upshur, R., Donnelly, P., Bharmal, A., Wei, X., Feng, P., & Brown, A. D. (2019). A population-based approach to integrated healthcare delivery: a scoping review of clinical care and public health collaboration. BMC Public Health19(1), 1-15. https://doi.org/10.1186/s12889-019-7002-z

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Public health professionals consider nursing ethics, and legal and regulatory laws during the development and

PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention
PHN 652 What are the ethical, legal, and regulatory aspects of implementing a population-based intervention

interpretation of population-based interventions. The rationale is that despite population-based interventions benefiting most patients, in some circumstances they may not benefit every individual (DeCamp et al., 2018). Ethics and regulations protect populations from harm and guide nurses to implement evidence-based interventions with high benefits and low human risks. Ethical aspects of implementing a population-based intervention include non-maleficence, beneficence, respect for persons, and justice (DeCamp et al., 2018). Ethics of non-maleficence and beneficence guide nurses not to harm patients and to act in the patient’s best interest.

Caregivers should respect patients’ choice to either participate or not participate in population-based interventions by supporting free and informed decisions. In addition, nurses should observe patient justice through a fair decision process and allocation of health improvement resources (DeCamp et al., 2018). Nurses are committed primarily to the best interests of individual patients, thus observe these ethics to maintain trust in the medical profession. According to Lévesque et al. (2018), adequate management of ethical, legal, and regulatory aspects related to population-based interventions’ implementation promotes optimal translation of scientific evidence into clinical practice. Therefore, healthcare organizations should design evidence-based population interventions that align with nursing ethics, nurse responsibilities, and patient preference and needs.

One existing population-based intervention is the Omics-based risk prediction of women’s cancer. The intervention accounts for the ethics of autonomy and informed consent by ensuring caregivers provide relevant screening information, the significance of the interventions, and the implications of the genetic test to promote informed decision-making (Lévesque et al., 2018). Public health nurses also consider social inequities and potential barriers to the equitable access of the developed intervention due to discrimination by insurers. Public health professionals enforce anti-discrimination legislation and restrict access to cancer prediction results to protect patients.

References

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., … & Tilburt, J. (2018). Ethical issues in the design and implementation of   population health programs. Journal of general internal medicine33(3), 370- 375. doi: 10.1007/s11606-017-4234-4.

Lévesque, E., Kirby, E., Bolt, I., Knoppers, B. M., de Beaufort, I., Pashayan, N., &          Widschwendter, M. (2018). Ethical, legal, and regulatory issues for the   implementation of omics-based risk prediction of women’s cancer: Points to     consider. Public Health Genomics21(1-2), 37-44. doi: 10.1159/000492663.

Population health has the potential to improve patient care and health outcomes for individual patients. However, specific population health activities may not be in every patient’s best interest in every circumstance, which can create ethical stress for individual physicians and other healthcare professionals. Primely, because individual health care professionals remain committed mainly to the best interests of the patients. All healthcare providers have a unique role to play in providing population health supports this ethical obligation(Lévesque, et. al.,2018)With that there are some ethical, legal, and regulatory aspects to consider when implementing a population -based intervention are respect, beneficence and justice. These are the principles that form the foundation of ethics research today. It’s important to implement all these principles in all health care channels from the informed consent process to privacy and confidentiality.

One example suggested by DeCamp, et al., pg,33(3), 370–375,2018 “In practice, the lines between harmful, non-beneficial, and beneficial effects of PHPs for individual patients may blur. PHPs could improve a population’s overall health while resulting in unintended non-beneficial or even harmful individual consequences. For instance, implementing a standard colorectal cancer screening metric with an age cut off of 75 year ; as might be done with an electronic health record pop-up reminder; appears to have been associated with under screening of healthy individuals over age 75 and over screening of unhealthy individuals under age Unintentionally, a metric appeared to discourage appropriately individualized clinical decision-making.” This was one great example and as future advance practice nurses it important to practice these standards in the health care setting.

 

References

 

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., Reynolds, P. P., Sulmasy, L. S., & Tilburt, J. (2018). Ethical Issues in the Design and Implementation of Population Health Programs. Journal of general internal medicine33(3), 370–375. https://doi.org/10.1007/s11606-017-4234-4

 

Lévesque, E., Kirby, E., Bolt, I., Knoppers, B. M., de Beaufort, I., Pashayan, N., & Widschwendter, M. (2018). Ethical, Legal, and Regulatory Issues for the Implementation of Omics-Based Risk Prediction of Women’s Cancer: Points to Consider. Public health genomics21(1-2), 37–44. https://doi.org/10.1159/000492663