Bringing Clinical Organizational Ethics into Practice

Abstract

This dissertation consists of four papers that focus on the integration of clinical organizational ethics (COE) concepts into clinical practice. As defined by Miller and Hartsock, COE is a distinct area of ethics that addresses recurrent clinical ethics dilemmas. These dilemmas are issue-based and arise directly from patient care, yet these issues affect multiple patients. The resolution of these dilemmas are often revisions of procedures, policies, or practices.1 By analyzing specific organizational-level policies and practices, I attempt to ground these theoretical ideas by considering their impact on clinical outcomes. These four papers illustrate the integration of COE into practice in three ways: conceptually, empirically, and through recommendation of change in practice. "Victims of Violence, Hospital Policies, and Potential for Bias" and "Opioid Prescribing, Hidden Influences, and the Cultural Impact of Christianity" conceptually discuss a policy or practice affecting clinical care. "Victims ofViolence ... " investigates the implications of No Information Status policies and suggests that they may burden bedside staff while providing a false sense of safety and may exacerbate existing health disparities. "Opioid Prescribing ... " examines how Christian frameworks may be implicitly shaping clinicians' approaches to opioid prescribing within the setting of chronic nonmalignant pain management. "Evaluation of Security Emergency Responses: Racial Disparities in Activation" uses empirical evidence to discuss racial disparities in security emergency responses (SERs) within a hospital. This paper used a retrospective, descriptive cohort study to illustrate ethical implications of polices that exacerbate health disparities. Finally, "The Importance of Data Collection in SERs" proposes a framework for collecting data and addressing SER challenges within an organization. This improvement in hospital practices will provide opportunities to address some of the complex challenges surrounding SERs. Collectively, these papers aim to fill gaps in the literature, challenge implicit biases, and address specific challenges in clinical care using a Clinical Organizational Ethics framework.