Sunday April 20th 2014

An ethical discussion

Conference focuses on advocacy, moral distress, integrity

While the public continues to rate nurses as No. 1 in honesty and trustworthiness, more than 350 RNs attending the 2nd National Nursing Ethics Conference were delving into what earns them that trust, how it can be compromised and the effects that such a breach could have on both them and their patients.

The conference, “Cultivating Ethical Awareness: Moments of Truth,” was held March 21 and 22 in Los Angeles and was sponsored by Ethics of Caring and the UCLA Health System. The American Nurses Association (ANA) and several health care systems and nursing educational institutions also sponsored the two-day event.

Ethics expert Sarah E. Shannon, PhD, RN, who holds faculty positions in the schools of nursing and medicine at the University of Washington, provided a thought-provoking keynote speech in which she suggested that nurses reframe how they think about patient advocacy.

She noted that historically, a nurse was first defined as the virtuous person, then the loyal soldier (with the physician as captain) and then, driven by the consumer rights movement and other factors, the patient advocate. Shannon also highlighted many national reports and studies – such as To Err is Human and Silence Kills – as evidence that all members of the health care team — nurses, physicians and social workers, for example – need to advocate for patients in today’s complex health care environment.

“Let’s think of ourselves less as the [only] advocate and instead focus on what are the advocacy needs of the patient and who can best meet them,” said Shannon, a Washington State Nurses Association member. “This is the language of ‘collaboration’ and ‘team.’”

In her presentation, second-day keynote speaker Lucia Wocial, PhD, RN, asked nurses “to imagine the best thing that could result from learning to break the silence in ethically sensitive situations.”

Wocial, like other presenters, used case studies to illustrate points. Hers involved “Dr. B,” a top revenue-generator credited with excellent patient outcomes, who asks nurses to hold down a patient during a procedure instead of giving her pain medication. Dr. B perceived the patient as a drug-seeker.

“People are expecting us to not let bad things happen to them,” said Wocial, nurse ethicist and program leader in Nursing Ethics for the Fairbanks Center for Medical Ethics at Indiana University Health and an Indiana State Nurses Association member. However, nurses need to have strong communication skills —  and be able to practice them — so they can address problems or conflicts in a way that best meets the needs of their patients.

She also asked nurses to consider certain strategies when raising a problem, such as focusing on the situation, issue or behavior and not the person, as well as using facts and data to support a position.

Katherine Brown- Saltzman, MA, RN, president of Ethics of Caring, welcomed and thanked nurses for their participation in the conference, in addition to presenting a framework that could help nurses analyze and strengthen their ethical discussions.

Participants also engaged in a range of break-out sessions, talked with other nurses who presented posters on moral distress and varying ethical issues, and networked with colleagues from around the country.

For more information on ANA’s ethics-related resources and efforts, go to www.nursingworld.org/ethics. To learn more about Ethics of Caring, go to www.ethicsofcaring.org.

— Susan Trossman is the senior reporter for The American Nurse.

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