Role of Advance Practice Providers in Team Based Medicine

Professional Ethics
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Introduction
Ethics in medicine are guidelines of the professions that are written or oral and are used to maintain integrity and competence of the nurses and physicians. It provides protection, optimization and promotion of health. It involves autonomy, veracity and fidelity of the medical practitioners. Among the various ethical issues include the following;
Advanced care planning
The main aim of advanced planning is to provide support to the patients. It is a way of providing patients with self-determination and foster decision-making that enhances a soothing care at the end of one’s life. It is the help determine the best way of encouraging terminally ill patients as well as those with chronic diseases. The advanced care planning is essential to all people regardless of age, sex or current health status. The planning helps patients to make an informed decision on factors that foster their health situation and assist individuals in choosing values that will govern their care. It also helps patients to acknowledge on the significances of quality life. In so doing, the patients will feel the need to reflect on their lifestyle and eventually make sound preferences. The interventions provided by the physicians and nurses seek to give patients an opportunity to identify specific people to express their feelings and help them in making decision when they are not able to stand for themselves.
In such a case, the physicians are therefore required to acknowledge that families and patients approach in decision making regarding their culture, life experience and faith governing their tradition’s faith.

It is the duty of the nurses and physicians to be responsive to patients’ preferences and other difficult situations especially as they approach the end of their life.
To achieve these roles, nurses and physicians need to be proactive when discussing with the patient on issues that would help alleviate and address patients’ expectation and concerns. The advanced care planning provides a way of clarifying some misunderstanding concerning medical conditions that depresses the patient. It is the duty of the physicians, therefore, to ensure that there is a regular encouragement of the patients by always thinking about their perspectives and values of quality life.
Peers as patients
The physician should be mindful for a fellow physician so should the nurses to their fellow peers. They should help one another in building up their experience in work. Being mindful, such serves as a show of competence and respect to each other in the working environment. It is also within the ethical codes of the physicians and nurses that each one of them should provide medical care for their fellows in a professional manner. The physicians should, therefore, share information and recognize the privacy of the colleagues. It is also important that all physicians should have confidentiality on each. In emergency cases especially in rural areas, the physicians should be quick to treat their colleagues even if it means traveling for long distances. They should show commitment to treating their workmates just like when attending to the critical patients. The physicians and nurses should, therefore, make a professional and unbiased judgment when treating their peers for example when making a recommendation for the patient.
The nurses should be very sensitive to potential emotional and psychological stresses of their peers in the delivery information on the results of examinations and analysis. It is also ethical for them to respect the informational and physical privacy of the patient who in this case is their fellow peer. Providing information to the patient that help make a voluntary and well-informed decision is part of the fundamental ethics of the physicians to deliver to the patients at all times.
Advance Directives
It is the most ethical obligation of all nurses and physicians. In the professional ethics of medicine, the nurses and physicians should have respect for fidelity and autonomy to their patients. The ethical values are important when the patient himself is not able to make the decision for him or herself. In such instance, a third-party is required to provide the advanced directive to the patient. The advanced directives are tools important in providing the patient with a chance of expressing their goals for care, values, preferences and treatment options critical in giving direction on the patient’s future health care. It also helps the patient to recognize and identify persons who will help them in the making the concerning their health when they are not able to do it for themselves. In such situations, the patient will only make a good-faith effort to trust the third-person party. The nurse or physician given this role should have respect for the patient especially regarding privacy of the condition of the patient (Coppola et al, 2001)
When the patient is not able to take part in the treatment process such as during emergency cases, the nurses or physicians should provide a surrogate that will guide in decision making. The nurses should intervene in such emergencies to cater for patients care immediately. It is also an ethical obligation of the physicians and nurses to implement the documented decisions orders for treatment in the medical records. It is called palliative interventions which are accurate and ongoing. There is another order that should be foregone as provided by the ethical codes of physicians and nurses ( Ramsaroop, 2007).
Withdrawing or Withholding Life-Sustaining Treatment
Though the decision of either withholding or withdrawing emergency treatment is emotionally and ethically challenging, it is the ethical responsibility of the nurses and physicians to intervene in the decision-making process especially for the patient who do not have that capacity of making the decision for themselves and those who are unconscious. In a difficult situation like that, it should be the physician aim and goal to deliver the appropriate decision to the patient although there is usually no moral difference between withholding and withdrawing the treatment. However, the physician or will have to review the medically medical directive together with the patient. The nurse will in such a case involve the patient in conversation if possible and eventually leave the patient to make the final decision.
Provision of Euthanasia
The Euthanasia is the provision of a lethal agent which could be tablets or parental administrations to the patient by the nurse or the physician according to the ethical guidelines with the aim of alleviating the patient’s incurable and intolerable suffering. It is a process that involves terminating the patient’s life in extreme cases of illness. It is done to terminally ill patient and to reduce expenses incurred by the family with no hope of the patient healing.
In most cases, the act ending one’s life is not compatible with the nurse or physician as a healer, but it is uncontrollable. This act is unique and unethical to be done by anybody in the society. The administration of the euthanasia by the physicians and nurses should respect the patients’ autonomy. The other ethical roles of the nurses and physicians include providing sedation at the end of life of the patient and respect the order to attempt resuscitation ( Haverkate et al, 2007).
Informed consent
It’s a fundamental factor that facilitates proper medical treatment to patients; perhaps all information’s about the ailment is clearly conveyed to the patient for verification and appropriate recommendation for the treatment process. This successful communication for the patient –physician affiliation fosters truthfulness and promotes shared decision consensus. Furthermore, it enables a patient to make agreement authorization in case particular medical intervention is required .practitioners ensure proper assessment patients level of educational understanding on given medical information and any implication that might arise due to treatment alternative treatment or independent voluntary decision. Nurses are required to provide all relevant details sensitively and accurately that are kept for patient preferences during the entire period of treatment to ascertain the nature and importance of any recommendations interventions. In emergencies, the decision must be made urgently. Thus patients are not involved in decision participation, but physicians informed patient earlier treatments to act as a guideline for successive treatment.
Respect for patients decisions is fundamental professional ethics despite some cases whereby the patient lacks enough capacity to make any decision .physicians are expected to identify patient’s surrogate who will make decisions on behalf for all previous medical treatment records and information that the patient. Any family member or intimate associate can be chosen as a surrogate who is entitled to full respect and any advisory on clarifications on guidelines that involve medical treatment records of the patient. Furthermore, physicians are required to offer substantial assistance that facilitates surrogate to make proper decisions in case a substituted judgment arise due to patient’s preference, views, life history and attitudes toward medical procedures, sickness and sufferings. Also, an open and truthful form of communications must exist amongst all medical practitioners and patients to avoid any conflict that might arise if some medical information’s are withholding from access by the affected patient since it will reduce patient respect and welfare autonomy in general. For any medical confidentially or secrecy of patient’s medical condition, practitioners are required to convey this information over time to match with patient preferences and its capability to comprehend the given details; perhaps the communication should be respectful and sensitively toward a patient( Kušec et al, 2006).
In regards to withholding medical information, medical physicians are required to encourage a patient to explicitly specify any suitable preferences that involve all medical details before it becomes available. Moreover, proper assessments of the amount of medical details that should be conveyed to the patient at an instantaneous time and tailor disclosure to satisfy patient expectations and needs that are in line with individual desired preference. Proper consultations regarding the delayed disclosure from the patient’s relatives, ethical committee and physician’s colleagues facilitate proper determination of extent implications and consequences that might pose to a patient in the long run. Proper and consistent monitoring of patient’s decision’s on when to be given any medical information according to definite plan to avoid any delay. The honest and professional way of medical provision has triggered a lot of concerns in relations to medical conditions that are viewed as private and any disclosure without any authority of the patient might pose conflict, condemnation and public stigmatizations which are a significant challenge that might be avoided. Medical errors being mistakes that might occur due to the poor judgment of the disease should be provided to a patient, this will promote concerns and trustworthy for physicians ethical guidance.
Privacy and confidentiality
Patient’s privacy should not be disclosed to public unless the patient provides authority to an individual to access any detailed medical information that concerns him. Individuals that are legitimate and allowed to be present at patient –physician happenstance includes any health care team, pharmaceutical employees and any medical device company who assist in the provision of any technical assistance by ethical guidelines. In an event where individuals need to be present in during patient –physician encounter for educational purposes, patient’s explicit agreement, no compromise of care, the observer understanding to kept and adhere to all required standards of medical privacy and confidentiality. It is mandatory and the requirement for all physicians under no circumstance to allow and accept any payment by any outside observers for them to be present during any clinical encounters.
Visual or audio recordings of patients medical information is considered to be a valuable tool that is used to educate health care professionals, but it the requirement of medical practitioners to balance educational objectives with patients confidentiality and privacy. The audiences should be bound by all professional standards that are needed for respect for complete patient autonomy, confidentiality and privacy. Perhaps it is an essential obligation of medical practitioners to provide accurate contents for all processes and medical products in line with the standards of professional conducts. Patients are required to trust all the physicians’ assistants for the protection of detailed information that are shared confidential situation. Furthermore, it is needed to offer full sensitive information to facilitate and allow the physicians for efficiently and precisely provision of needed services. Some instances, the medical practitioners to provide personal health information without ant consent of patients perhaps to other medical personnel for an offering of medical operations. Also upon authorization by law, details regarding individual health information can be publicized or disclose to all parties to facilitate the mitigations of any threat that might arise ( Perera et al, 2011).
Management of medical records
Medical records fulfill important patient desires for current health care and all future needs, perhaps also serves as the source of employment, insurance and other many important individual’s health information. Physicians and nurse practitioners are responsible for professional Safeguarding of all confidential patients’ information without disclosing to anybody whatsoever (Perera et al, 2011). All medical institutions and statutory bodies that concern with medical delivery should ensure that clear policies must be enforced too strongly prohibit any possibility of access to medical records by an unauthorized individual. Also, physicians must apply medical considerations in case any records is required by new physicians being introduced to the patient; that is immunization records or records that address significant health events, interventions or conditions that might trigger future health care needs of the patient,( Gilbody et al, 2003).
Conclusion
In conclusion, several ethical practices are required for all physician ‘assistants and nurse practitioners that include provisions of medical details clearly to minimize any misunderstanding and conflicts that might arise. Patients have a right to be respected and treated well despite their health conditions; that is all personal records should not be accessed by anybody unless with the authority of the patient .privacy and confidentiality should also be protected to safeguard patients interests and preferences. Furthermore, all strange medical information should be conveyed to the patient with a lot of cautiousness and sensitivity to contain all the reactions that might emerge due to surprises. Moreover, all medical records should be kept properly to facilitate easy retrieval in future health needs and interventions .proper communication between patient and physician should be upheld to foster a good relationship and consistent trust for all involving parties.

References
Kušec, S., Orešković, S., Škegro, M., Korolija, D., Bušić, Ž., & Horžić, M. (2006). Improving comprehension of informed consent. Patient Education and Counseling, 60(3), 294-300.
Perera, G., Holbrook, A., Thabane, L., Foster, G., & Willison, D. J. (2011). Views on health information sharing and privacy from primary care practices using electronic medical records. International journal of medical informatics, 80(2), 94-101.
Coppola, K. M., Ditto, P. H., Danks, J. H., & Smucker, W. D. (2001). Accuracy of primary care and hospital-based physicians’ predictions of elderly outpatients’ treatment preferences with and without advance directives. Archives of Internal Medicine, 161(3), 431-440.
Ramsaroop, S. D., Reid, M. C., & Adelman, R. D. (2007). Completing an advance directive in the primary care setting: what do we need for success?. Journal of the American Geriatrics Society, 55(2), 277-283.
Van Marwijk, H., Haverkate, I., & Van Royen, P. (2007). Impact of euthanasia on primary care physicians in the Netherlands. Palliative Medicine, 21(7), 609-614.
Gilbody, S., Whitty, P., Grimshaw, J., & Thomas, R. (2003). Educational and organizational interventions to improve the management of depression in primary care: a systematic review. Jama, 289(23), 3145-3151.