Reflections on Ethics: Making Ethics Come Alive in Nursing Today

Transcription

1 Reflections on Ethics: Making Ethics Come Alive in Nursing Today Maryland Nurses Association Center for Ethics and Human Rights Lorraine Perin Huber, MSN, RN-PMNE,CNOR Donna Downing-Corddry, BSN, RN, CAPA Brandy Brown, MA, BSN, RN Ellen Amalfitano, Ph.D., MPH, RN

2 An Unread Book Has No Message Bringing the Code of Ethics to Life Lorraine Perin Huber, MSN, RN- PMNE, CNOR

3 ANA Code of Ethics

4 The Owl and it s Prey

5 First Do No Harm

6 We extend to you, an invitation to become part of MNA Center for Ethics and Humans Rights committee to learn about ethics, to practice seeking the virtues, and to recognize the owl in tree by looking for it.

7 Moral Distress and Culture of Silence Why do we continue in Silence and live with Moral Distress? Donna C. Downing-Corddry, BSN, RN, CAPA Brandy Brown, MA, BSN, RN-BC

8 Objectives: Upon completion of this presentation, the learner is: Able to develop an understanding of the impact of ethics in a nurse s everyday practice.

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10 Moral Distress and You: Supporting Ethical Practice and Moral Resilience in Nursing By Cynda H. Rushton, PhD, RN, FAAN, and Melissa J. Kurtz, MSN, MA, RN Published by Nursesbooks.org, Feb 2015 The Publishing Program of ANA,

11 To download the study: /silencekills/silencekills.pdf

12 The story of Dr. X: Ann has been working in the NICU for 1 year. She is caring for a 30 week gestational infant for the past 2 days. Following her most recent assessment, she is concerned the infant is developing necrotizing enterocolitis(nec). Normally she does not hesitate to contact a patient s attending physician with clinical changes, but this patient s doctor is Dr. X. His behavior has been erratic, inconsistent, with bursts of condescending retorts, and increasingly taking over minutes to return calls. AACN, The 4A s to Rise Above Moral Distress, Facilitator Tool Kit

13 Definitions: Moral Distress Moral Uncertainty Moral Dilemmas Moral Conflicts Moral Residue Moral Distress and YOU, 2015

14 Moral Distress: The condition of knowing the morally right thing to do, but institutional, procedural or social constraints make doing the right thing nearly impossible: threatens core values and moral integrity. The Code of Ethics for Nurses, 2015, p. 44 Moral Distress and YOU, 2015

15 Elements of Moral Distress Recognizing there is a ethical problem. Recognizing you have an obligation to do something. Recognizing that core values are being violated, but perceive that the action you feel is the ethically correct one to take is not an option. Moral Distress and YOU, 2015

16 Moral Distress The frequency (how often) and intensity (how severe) will vary within practice settings and institutional cultures. If a nurse perceives the ethical climate of their work environment to be poor, they are more likely to experience moral distress and a moral residue remains. (Rushton and Kurtz, p. 7) Moral Distress and YOU, 2015

17 Moral Uncertainty: When a nurse (or other party) is unsure whether an ethical dilemma or conflict is present or is unclear what principles to apply to resolve a ethical conflict or dilemma. (Rushton and Kurtz, p.3) Moral Distress and YOU, 2015

18 Moral Dilemma: When two or more ethical principles or values conflict, making it difficult to choose among the various options. (Rushton and Kurtz, p. 4) Moral Distress and YOU, 2015

19 Moral Conflicts: When there are two or more differing opinions surrounding resolving a moral dilemma. (Rushton and Kurtz, p. 5) Moral Distress and YOU, 2015

20 Moral Conflict: When attempting to resolve a moral conflict, it is ideal that neither party be required to abandon their deeply held core values. (Rushton and Kurtz, p. 5) Moral Distress and YOU, 2015

21 Moral Residue: The aftermath of unresolved moral distress. Moral Residue may remain due to persistent feelings by the nurse that his or her moral concerns have not been acknowledged and, as a result, the correct action was not taken. (Rushton and Kurtz, p. 8) Moral Distress and YOU, 2015

22 A Nurses # 1 Resource For Checking your Moral Compass: ANA s Code of Ethics For Nurses, 2015

23 Case Study Discussion: What would you do in this situation? What do you think the issues are? How would you deal with this situation effectively? Would you go for help and guidance? Where would you go for help and guidance?

24 Consequences of Moral Distress Affects the nurse, the healthcare team and ultimately patient care Symptoms: physically, emotionally, behaviorally and spiritually. Unresolved moral distress has the potential to undermine a nurse s sense of integrity and may lead to burnout (Rushton and Kurtz, p. 8) Moral Distress and YOU, 2015

25 Contributors to Moral Distress: Individual Factors: Worldview/Perception Past Professional Experiences Degree of Mental and Emotional Stability Perceived Powerlessness Lack of Moral Sensitivity and Moral Reasoning (Rushton and Kurtz, p. 12) Moral Distress and YOU, 2015

26 Contributors to Moral Distress: Organizational Factors: Scarce Resources Ineffective Teamwork Lack of Leadership and Peer Support Institutional Values and Policies Fear of Litigation (Rushton and Kurtz, p. 12) Moral Distress and YOU, 2015

27 Building Capacities to Address Moral Distress: Individual Capacities Self-Awareness Self-Regulation Moral Courage Self-Reflection and Self-Care Conscientious Objection (Rushton and Kurtz, p. 17) Moral Distress and YOU, 2015

28 Building Capacities to Address Moral Distress: Organizational and Professional Capacities Organizational Policies Organizational Support Services Identifying Supportive Leadership Professional Standards and Guidelines Engagement in Political Advocacy (Rushton and Kurtz, p. 19) Moral Distress and YOU, 2015

29 ACT Prepare for Action Prepare personally and professionally to take action. Take Action Implement strategies to initiate the changes you desire. Anticipate Setbacks Temporary setbacks may occur due to personal or professional change. Maintain Desired Change Continue to implement the 4 A s to resolve moral distress. Goal: You preserve your integrity and authenticity. ASK You may be unaware of the exact nature of the problem but are feeling distressed. Ask: Am I feeling distressed or showing signs of suffering? Is the source of my distress work related? Am I observing symptoms of distress within my team? Goal: You become aware that moral distress is present. Creation of a healthy environment where critical care nurses make their optimal contribution s to patients and families AACN, The 4A s to Rise Above Moral Distress, Facilitator Toolkit AFFIRM Affirm your distress and your commitment to take care of yourself. Validate feelings and perceptions with others. Affirm professional obligation to act. Goal: You make a commitment to address moral distress. ASSESS Identify sources of your distress. Personal Work Environment Determine the severity of your distress Contemplate your readiness to act. You recognize there is an issue but may be ambivalent about taking action to change it You analyze risks and benefits. Goal: You establish an action plan.

30 Silence Kills: The Seven Crucial Conversations in Healthcare In a 2005 study, Silence Kills, the American Assoc. of Critical Care Nurses with VitalSmart, a research group that specializes in corporate training and leadership development, found that 84 percent of healthcare professionals observe colleagues take dangerous shortcuts when working with patients and yet less than 10 percent speak up about their concerns. To download the study:

31 Silence Kills: The Seven Crucial Conversations in Healthcare that are NOT happening: Witnessing mistakes Reluctant or refuses to help a peer Incompetence Poor Teamwork Bullying, team divider, cliques Disrespect Insulting, condescending, rude Micromanagement take over, abuse their authority

32 Silence Kills: The group that are willing to have the tough conversations with their peers they are the most effective, satisfied and committed in the organization.

33 Silence Kills: There is a greater percentage, 85-90% of healthcare workers that Do Not speak up BUT There is also The percentage that do, that10-15%...

34 Conclusion: The prevalent culture of silence in healthcare was documented and written about in the 2000 Institute of Medicine report, To Err is Human. UnAccountable: What Hospitals Won t Tell You and How Transparency Can Revolutionize Health Care by Dr. Martin Makary, 2012.

35 Conclusion: Man acquires a particular quality by constantly acting a particular way we become just by performing just actions, we become temperate by performing temperate actions, brave by performing brave action. Aristotle

36 Call to Action Operationalizing the Code in Your Practice Ellen Amalfitano

37 Bold Fearless and daring Requiring or exhibiting courage or daring Strikingly different or unconventional Clear and distinct to the eye Strong or pronounced

38 Bold Ideas for Ethics from JHU Berman Institute of Bioethics Practical Wisdom Changing the way we speak about ethics Eliminating Silos Empowering Nurses

39 Berman Institute Bold Ideas: 4 Categories Clinical Research Education Policy

40 Berman Institute Bold Ideas: Clinical work environments to support nursing ethics Ethics ombudsman Interdisciplinary rounds led by spiritual care Policies that support nurses role as advocates Integrating ethics into nursing practice

41 Research agenda that promotes evidenced based practices with measurable impact and outcomes Nursing ethics database Quality metrics for nursing ethical practice Moral distress measurement, monitoring, and addressing Standardized methods to address ethical issues

42 Berman Institute Bold Ideas: Education to build a diverse healthcare workforce to promote ethical delivery of care Incorporate ethical frameworks into clinical education Teach conflict management strategies Include identification of moral distress

43 Berman Institute Bold Ideas: Policy that create an ethical culture of practice Access to interventions that address moral distress Ethical competencies for employment/licensing

44 So What will YOU do? What is your BOLD IDEA? The Sky is the limit! Dream Big! Don t get bogged down by I can ts, it wont s No idea ever got out of the gate with an it will never work attitude

45 Be the Change You want to See in the World Form a Team Brainstorm ideas Choose an idea Create steps for implementation Create a timeline Define milestones Begin Implementation See change begin

46 Start Small Keep Moving In times of crisis, the only ones who survive are those that keep moving

47 MNA Center for Ethics and Human Rights Mission: provide healthcare ethics educational opportunities facilitate identification and analysis of ethical issues faced by registered nurses, other health care providers, patients, and families in the state through a variety of activities foster collaboration and communication related to healthcare ethics among various healthcare disciplines as well as lay communities in the state review, disseminate, and/or conduct research to expand the knowledge of ethical issues affecting healthcare in Maryland support the MNA Legislative committee in its efforts to advocate for human rights issues that influence the health and well-being of Maryland citizens FY16 Goals: Increase membership and reach of the Center for Ethics and Human Rights Contribute articles to the Maryland Nurse Develop presentations for organizations, nursing groups, nursing schools regarding Ethics in Nursing Join Us! Monthly conference calls Third Monday of each month at 7:30pm for more information: ellen_rice@premierinc.com