Turning the Nurses Week theme into year-round ethical practice.
By Debra Wood, RN, contributor
May 3, 2015 – Call bells, procedures, treatments, med passes, IV adjustments–such tasks fill nurses days, but quality care and satisfying practice involve more than the safe completion of a to-do list. The American Nurses Association (ANA) selected “Ethical Practice, Quality Care” as this year’s Nurses Week theme. But just how does that play out in daily practice?
“Ethics is integral to everything we do, what we say, our behaviors, and the choices we make,” said Cynda Hylton Rushton, PhD, RN, FAAN, the Anne and George L. Bunting Professor of Clinical Ethics at the Berman Institute of Bioethics/School of Nursing at Johns Hopkins University in Baltimore. “Every day, every moment, we are living our values whether we are conscious of it or not. That said, we often need to remind ourselves who we are and what we stand for and continually ask, ‘Is what I am saying and doing a reflection of my core values?’”
Providing safe, respectful and compassionate care is the profession’s ethical foundation, and the ANA Code of Ethics is a roadmap to guide nurses in living their values and language to support doing the right thing, she added.
The code of ethics
Irene Macyk, RN, MS, said ethics assures nurses that they know enough to advocate for what’s
right.
ANA has called 2015 The Year of Ethics and released a revised Code of Ethics for Nurses with Interpretive Statements. It’s divided into three sections: nurse-to-patient interactions, nurse to self and others, and nurse to profession and society.
“The more a nurse knows about ethics and the code, the more comfortable she is and the less likely she is to experience moral distress in the workforce,” said Laurie Badzek, LLM, JD, RN, FAAN, director of the Center for Ethics and Human Rights at the ANA. “The code helps them with their daily practice.”
While the code of ethics does not provide answers, it offers a framework for analyzing a situation and determining a way to move forward.
“Our code also offers language to explain to others when our ethical values are in jeopardy,” Rushton added. “Nurses often know in their gut when ethical values are threatened or compromised. The body’s signal that something is amiss is just the beginning of a process of discerning the facts, values and areas of conflict. Recognizing the seeds of an ethical concern can be leveraged to find more precise language than ‘Why are we doing this?’ to signal the presence of an ethical issue.”
Irene Macyk, RN, MS, chief nursing officer at Lenox Hill Hospital in New York, added that the Code of Ethics reflects “the principals we learned in nursing school and are reinforced throughout our careers. It lies in the background of every decision and discussion we have. We’re driven to do the right thing for the patient.”
Robyn Rice, PhD, RN, associate professor for the online graduate division at Chamberlain College of Nursing, also advised nurses to consult their state nurse practice act to understand their boundaries in terms of practice.
The challenges
Connie Barden, RN, MSN, CCRN-E, CCNS, said nurses must be actively engaged in resolving ethical
challenges and speak up to achieve the best possible patient outcomes.
“Health care teams in ICUs experience a wide range of ethical challenges,” said Connie Barden, RN, MSN, CCRN-E, CCNS, chief clinical officer of the American Association of Critical-Care Nurses (AACN). “Futility of care, lack of resources, pain and suffering, lack of consensus among team and/or family members are among the more common.
“Equally distressing but somewhat less common ethical challenges may include refusal of treatment based on cultural or religious beliefs, eligibility for transplantation and the impact of treatment on the patient’s future quality of life.”
Diversity and cultural issues also might lead to ethical concerns, added Rice, saying nurses must approach patients in considerate and compassionate ways–even when they disagree with the behavior, say in treating a patient with a sexually transmitted disease or an unwanted pregnancy.
“You must rise above old standards and [use] new ways of working with people,” Rice said. “It’s the right of self-determination.”
Putting ethics into practice
Barden advised nurses to anticipate ethical challenges before they become crises, recognize them and address them effectively, since in the complex, emotion-laden critical-care environment eliminating ethical dilemmas is not realistic.
Robyn Rice, PhD, RN, said diversity and cultural differences can lead to ethical challenges for
nurses.
“Bedside ethics rounds focus on creating strong alliances and consensus among team members, the patient and the family,” Barden continued. “By creating a time and process to specifically discuss ethical issues, it ensures they are not ignored. This provides an opportunity for each team member to contribute her or his unique expertise and, because rounds are at the bedside, it’s impossible to ignore the focus of everyone’s attention: the patient.”
At Lenox Hill and other North Shore-LIJ Health System hospitals, nurses can request assistance with ethical dilemmas from the ethics committee.
“They will look at all the factors on an objective level and make decisions that are appropriate,” Macyk said.
Nurses who are advocating for their patients, preserving their integrity, maintaining their health, and working with partners are demonstrating ethical behavior and doing the right thing for the patient. That leads to good outcomes and quality care, Macyk explained.
AACN advocates for healthy work environments, because all members of the health care team need to be able to speak up and voice their concerns.
“A healthy work environment supports the ethical practice of nursing and empowers nurses to speak up confidently and safely to advocate for patients and families,” added Barden.
ANA resources for ethical practice:
National Nurses Week Webinar
My Patient, My Code, My Practice:
Ethical Decision-making and Action
Free webinar
May 7, 1 p.m. Eastern Time
Ethics Symposium
Baltimore, Md.
June 4-5, 2015
2015 Code of Ethics for Nurses with Interpretive Statements
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