Answer this post with new information and references: This author’s advanced practice registered nursing (APRN) role will include working as an orthopedic first assist in orthopedic surgery. The role will also include seeing patients for a preoperative and postoperative assessment in an outpatient clinic. The surgical environment has been in the spotlight in the last decade due to rising of adverse events found occurring more than half the time in hospitalized surgical patients (World Health Organization [WHO], 2016). The use of a surgical safety checklist (SSC) during surgery to enhance communication, patient safety and teamwork within the surgical environment is the phenomenon of interest. This discussion will break down the framework for praxis to discuss the ideological and theoretical influences, and ethical framework that guide one’s nursing practice. Ideological Influences This author’s primary philosophical perspective is quantitative and includes objects that can be tested (Butts & Rich, 2015). The measurable data that an analytical approach can offer allows one to assess the significance of adopting the World Health Organization SSC. For example, one can hypothesize a decrease in surgical site infections with the use of an SSC and measure the data against not using one. Measuring quantifiable results will impact how the SSC is viewed because it would have either reduce errors and enhance patient safety or it would not. Theoretical Influences Theories selected for this nurse’s framework include Jean Watson’s human caring theory and Nathaniel’s moral reckoning theory. Watson’s human caring theory is a grand theory that accents a holistic relationship between the nurse and patient (Watson, 2008). The caring approach guides nursing practice because it offers a framework and ethical foundation for professional nurses to perform caring interventions (Watson Caring Science Institute, 2012). For example, high-tech equipment is used every day on patients during the intraoperative period, but the theory of human caring provides patients in the operating room with a caring touch by the nurse that technology cannot provide. Furthermore, Nathaniel’s theory of moral reckoning is a mid-range theory that can guide nursing practice because it can predict outcomes due to individual actions and choices by the nurse, brought on by distressing situations. In surgery, nurses find themselves in morally stressful situations, such as communication failure, which can lead to concerning consequences for the health care population (Nathaniel, 2004). The theory of moral reckoning will provide a profound understanding of the phenomenon and why one should apply one’s morals and values as a nurse to the ethical dilemma. Ethical Framework If an APRN is faced with a moral dilemma in surgery, one should approach the situation ethically (Hamric, Hanson, Tracy & O’Grady, 2014). The nursing ethical core values in keeping one healthy and safe should be included in standard nursing care (American Nurses Association, 2016). Along with the nursing core values, a consequentialist ethical framework can guide ethical decision-making, because it looks at the future effects of possible courses of action that will produce the most good for the most patients (Butts & Rich, 2015). Since the WHO (2016) determined an SSC was useful in surgery due to the decrease in adverse events, the consequentialist framework would look at what was the least damaging to most patients’ to improve patient safety. Thus, using a consequentialist ethical framework to weigh what is good and bad for the maximum number of people would be useful in deciding if using a SSC would benefit the majority of patients. References American Nurses Association (ANA). (2016). Code of ethics for nurses. Retrieved from Butts, J.B. & Rich, K.L. (2015). Philosophies and theories for advanced nursing practice. Burlington, MA: Jones & Bartlett. Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5th ed.). St. Louis, MO: Elsevier Nathaniel, A., K. (2004). A grounded theory of moral reckoning in nursing. Grounded Theory Review, 4 (1), 43-58. Retrieved from Watson Caring Science Institute: International Caritas Consortium. (2012). Retrieved from Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). Boulder, CO: University Press of Colorado. World Health Organization (WHO). (2016). Safe surgery saves lives. Retrieved from


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