Role of the Advanced Practice Nurse
As medical and scientific technology advances, nurses, as frontline health care professionals, face ethical dilemmas related to life and death in health care. These could be issues related to, the right to health and access to health care, euthanasia, quality of treatment and life for people with terminal illness, and cloning and reproduction. While these issues continue to attract public attention, they present greater challenges to nurses and other health care providers, as they fight ethical dilemmas faced in their clinical practices and professional responsibilities.
A healthy work environment can instigate a healthy and quality performance, and so, it is imperative for any organization to ensure that there is an increasing level of cooperation between men and women employees. This can be done by creating a better awareness of gender differences, building different leadership styles and introducing flexible work/career patterns. Both men and women can use a variety of flexible work options to enhance their performance at home in support of their family, and by providing quality treatment and care at work. In order to do this, organizations can include programs such as establishing mentoring programs, eliminating policies and procedures that rake of biases, provide equal opportunities, and impart training and conduct workshops for all personnel periodically to enhance inclusiveness.
The aviation industry functions quite similarly to the health and medical industry, where, the focus is on operational importance, and safety. Humans, no matter how hard they try, are prone to make mistakes, and so, it shouldn’t come as a surprise that human errors has been implicated in a variety of occupational accidents, “including 70% to 80% of those in civil and military aviation,” says O’Hare et al (1994), and Wiegmann & Shappell (1999). The flight of an aircraft weighs heavily on a number of factors, which includes the weather. Turbulence and wind speed, lightning and low pressure can upset an aircraft’s predictable flight trajectory, which could at times, lead to accidents. “Human Factors Analysis and Classification System (HFACS) is a theoretically based tool for investigating and analyzing human error associated with accidents and incidents. Research has shown that HFACS can be reliably used to analyze the underlying human causes of both commercial and General Aviation (GA) accidents,” says
Wiegmann & Shappell (2001: i), in A Human Error Analysis of Commercial Aviation Accidents Using the Human Factors Analysis and Classification System (HFACS).
Such analyses have helped identify general trends in human errors that have contributed to civil aviation accidents. It’s quite difficult to find an incident that was the doing of an individual. Invariably, accidents that have been recorded and investigated into have shown that accidents occurred due to a chain of events that culminated with unsafe practices by aircrew. The most common reason for such lapses is stress. As mentioned earlier, humans are prone to make mistakes, and studies conducted by HFACS has proved that it is human error that caused most accidents and that they could have been avoided to a large extent (Pape & Wiegmann, 2001).
In the 1990s, a program (sponsored by the FAA and the aviation community) was established to include all aviation industry members such as Air Carriers, Air Operators and Air Agencies to minimize damage to self and property. The accident reduction focus was also revised to include aviation maintenance technicians and pilots as well. This program came to be known as the Aviation Safety Action Program (ASAP) (FAA, n.d).
ASAP was introduced with the view to support airline and maintenance staff of aviation and other industries to voluntarily report on safety information that might be critical in identifying potential precursors to accidents. FAA believes that by introducing such a program on safety, accidents would reduce by a long distance, and induce confidence in passengers on the safety of air travel. Under this program, personnel are encouraged to solve critical issues using corrective methods rather than punishment and/or discipline. Such practices can alleviate the mind of the concerned individual or group, and help them overcome such grave mistakes in future. These programs are linked through partnerships between employee and FAA, and employees are encouraged to report on his/her safety issue(s) to ensure that safety gets priority over personal matters. In order to encourage employees to come forward, ASAP has enforcement-related incentives designed into its program to make employees become more interactive.
The basic idea of this program is to identify problematic issues that run concurrently with an employee’s routine work and see that they do not reoccur. A panel of members appointed to look into them then reviews these issues. The panel then suggests corrective measures to remove this. ASAP also provides a vehicle whereby an employee of the airline or the ground maintenance staff can safely identify and report safety issues to the management and FAA without prosecution. The ASAP is signed in a Memorandum of Understanding (MOU), between FAA, the certificate holder management, and the employee’s labor organization or a representative. The program encouraged employees to disclose safety information that which may include possible violation of 14 CFR without fear of punitive enforcement sanctions and disciplinary action.
The ICN Code of Ethics for Nurses (2000) confirms that duty nurses have four fundamental responsibilities; promoting health, preventing illness, restoring health, and alleviating suffering. Now in order to do this, they have to have the authority to act in situations that require the permission from their superiors. While this may not be possible at all times, a critical inaction could cause loss of life. It is during such times that nurses should have the power to act in situations that require immediate action. A patient who suddenly develops spasms that could affect the patient’s heart and brain may need an on-the-spot assessment and treatment that could prove fatal otherwise. In such a situation, a nurse must have the authority to act and relieve the pressure on the patient. Waiting for a higher official to arrive or take a decision may not be the ideal solution. Thus, nurses, who are the front line health care professionals must be given training to develop leadership qualities and initiate remedial measures on their own (Ghebrehiwet, 2005).
Ghebrehiwet T, (2005), Helping nurses make ethical decisions, Reflections on Nursing: Leadership, Accessed June 21, 2014, from http://nursingsociety.org/RNL/3Q_2005/features/feature6.html
Wiegmann, D, and Shappell, S, (2001), A Human Error Analysis of Commercial Aviation Accidents Using the Human Factors Analysis and Classification System (HFACS), Accessed June 21, 2014, from http://www.hf.faa.gov/docs/508/docs/cami/0103.pdf, p.2
Pape, A, M, and Wiegmann, D, A, (2001), Human Error Analysis of Commercial Aviation Accidents: Application of the Human Factors Analyses and Classification System (HFACS), Journal of Aviation, Space, and Environmental Medicine, Vol. 72, Accessed June 21, 2014, from http://www.beta-research.com/r0360302abstract.html, p.1006-1016