Wednesday, February 14, 2007
Nursing Ethics and Pedagogy
Many community colleges in North Carolina require nursing students to take introductory ethics as one of their humanities courses. My institution, Guilford Technical Community College, does not. It, and several others like it, choose to satisfy the Board of Nursing's requirements for ethical instruction by incorporating "ethics modules" in specific nursing courses. Nevertheless, after much tireless missonary work, I feel like I am making SOME headway, and each semester that I teach the subject, I have 3 or 4 nursing students in both sections. Not enough, to be sure, as I consider it to be self-evident that every human being who claims to be truly educated should have (at least) one general survey course on the history of philosophy, and one introductory ethics couse. Still, progress is being made. Enough progress that a pedagogical question arises.
As I survey (via the internet) various approaches to providing people (and especially nurses) with an introduction to the subject of ethics, there is a growing trend in the US to "specialize" the subject, even at the introductory level. Courses entitled "healthcare ethics," "business ethics (an oxymoron?)," and the like, abound. None of them have prerequisites, so it is NOT the case that these courses constitute a more focused, "in depth," look at some narrow issues of special interest to one particular profession or another. Instead, these courses are the FIRST, and often the ONLY, courses of the field that these students will take. I see this as an unfortunate trend.
First, if the published syllabus for the typical course is any guide, these courses rarely "survey" the field. Some philosophers of vital importance are often left out entirely (Hume and Adam Smith come to mind), and others are often marginalized and their views traduced (Kant especially). In other words, after completing the class the student remains uninformed or, worse, misinformed.
Second, as a dogmatic moral realist (or, at least, quasi-realist), the idea that 'the right and the good" might somehow be different in the case of, say, nurses, as opposed to doctors, lawyers or indian chiefs, is something I find highly suspect.
Third, these specialized approaches seem to involve a good deal of "rules of the profession" instruction, the discussion of which takes the students no where near "the right and the good." For example, in a "legal ethics" course in the USA (another oxymoron?) one will learn that, in a criminal case, if the defendant wishes to testify in his own behalf, his counsel ought to call him to the stand even when counsel knows the defendant intends to testify falsely (our UK cousins have a different rule, I hope and believe). Little, if any, discussion time will be devoted to the question of whether or not this OUGHT to be the rule, whether counsel as a moral agent has a duty to disobey the rule and accept the consequences (and there will be some - see my Vita if you think there won't be), etc.
In sum, the very notion a profession specific "ethics" at least SUGGESTS a form of ethical relativism I find repugnant. This is NOT to say that a member of a profession does not have special obligations that others do not. I would argue, on broadly kantian grounds, that they often do, inasmuch as the acceptance of a professional role can amount to a promise to perform certain acts, or undertake to do certain things, that other people are not, in general, obliged to do. A blunt illustration: most people are not obliged to wipe someone else's bottom after an episode of bowel incontinence, but nurses on duty are. Still, I think this sort of example is not contrary to my general point. Nurses, lawyers, plumbers and politicians all inhabit a single moral universe; one in which, per Kant, it is always wrong to, say, tell a lie or subourn one. If members of a special profession have special duties, they are surely grounded upon, or arise from, the same considerations of "right and good" that should guide the conduct of everyone.
I have another source of unease, as regards the notion of "nursing ethics" as a distinct area of inquiry. Nursing, it seems to me, still suffers a bit from "ghettoizaton" in the American academy. Even at the community college level, the students and their faculty spend most of their time over in their own building doing "nursing stuff." They venture "outside" only when they must. As a nursing student, I have taken nursing, and nursing related, courses at two different community colleges and two (very good) 4 year universities. In each case, interdepartmental activities were notably absent. Four schools is not enough in the way of data points to reach any firm conclusion, but I can't help but wonder if things are much different anywhere else. A study of ethics, at least, could be a shared experience.
Here's a thought - good "transcultural" nursing is going to necessitate, on the part of nurses, the development of something like the "kosmos polis" of the stoics - a sense of world citizenship, and a sense of identity with all that is "human." It is difficult for me to see how we can care for humanity if we decide there is no such THING as "humanity," or that "humanity" is a social construction we somehow "make up" which fails to somehow pick out any real features of an objective world. One way to START developing that "sense" is to participate in a learning experience which at least explores the possibility that all human beings inhabit the same universe - the MORAL one.
¶ 4:55 PM
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I was working Sunday, and I got this new admission, a 21-year-old male who had been drinking on Saturday night, rolled his car, suffered a subdural hematoma in
his frontal lobe, and had been shipped to us in Boston because the community hospital was
uncomfortable with a brain bleed.
He had tenderness at C4-C5, was in a Miami J collar, and had really
bad head pain (had received a total of morphine 8mg in the ED).
So, I get him into my step-down unit, taking care of him and his parents, getting his pain under control, assessing him, he's at risk for seizures, get the
dilantin mixed, he's NPO for potential surgery if the hematoma expands, he tells me he's hungry,
he's shaky, I take a blood sugar (it's 76), so I get the order for D5NS @100, know I need a second line for the dilantin, etc etc. I am working with this guy.
My nurse colleague, a nurse for 15 plus years, says "Why are you in there [his room] so much, he's
easy, he's talking, the family is in there, you should take a break, what's the deal?"
I was pleasant with her, but thought, where's the humanity? The guy is a human being,
forget the alcohol, he has a brain
bleed, let's do the most we can for him.
I figure, I can't teach my colleague anything if she doesn't have it already. The best I can do
is benignly neglect her, and hope she doesn't get my family member. All the stuff in nursing about judgment, advocacy, caring, empathy, ethical response, ... I'm
not sure if nurses learn it at some point and lose it along the way, or if nursing has become
commodified, or if ethics is a little bit genetic.
Sincerely,
Patty
his frontal lobe, and had been shipped to us in Boston because the community hospital was
uncomfortable with a brain bleed.
He had tenderness at C4-C5, was in a Miami J collar, and had really
bad head pain (had received a total of morphine 8mg in the ED).
So, I get him into my step-down unit, taking care of him and his parents, getting his pain under control, assessing him, he's at risk for seizures, get the
dilantin mixed, he's NPO for potential surgery if the hematoma expands, he tells me he's hungry,
he's shaky, I take a blood sugar (it's 76), so I get the order for D5NS @100, know I need a second line for the dilantin, etc etc. I am working with this guy.
My nurse colleague, a nurse for 15 plus years, says "Why are you in there [his room] so much, he's
easy, he's talking, the family is in there, you should take a break, what's the deal?"
I was pleasant with her, but thought, where's the humanity? The guy is a human being,
forget the alcohol, he has a brain
bleed, let's do the most we can for him.
I figure, I can't teach my colleague anything if she doesn't have it already. The best I can do
is benignly neglect her, and hope she doesn't get my family member. All the stuff in nursing about judgment, advocacy, caring, empathy, ethical response, ... I'm
not sure if nurses learn it at some point and lose it along the way, or if nursing has become
commodified, or if ethics is a little bit genetic.
Sincerely,
Patty
# posted by 
: 10:09 AM
: 10:09 AM
I can't let Patty's post go by without saying just how wonderful I think it is, for a couple of reasons.
First, it details, in clear, terse prose, what it is that a good nurse does every damn day he or she is on duty. If I have another heart attack, I hope it is in Boston and Patty is my nurse. Anyone the least bit interested in healthcare policy who reads it, and still thinks nurses should be paid what the heating and airconditioning guys are, is either dumber than a box of rocks or a sociopath.
Second, she does raise a couple of interesting points. Philosophers still struggle to give a persuasive account of why one should be moral in the first place. Why not be David Hume's "sensible knave?" Hume recognized the problem, but I am not sure he persuasively solved it (for that matter, neither was he). Why not do as little for the patient as you can get by with without getting fired or sued? Kant has an answer (sort of) but not everyone (to put it mildly) has found it persuasive. I read Hegel's "master/slave" argument as TRYING to put a bit of flesh on the Kantian answer, but I am not sure that it is really even coherent (just like the rest of Hegel), and, besides, not everyone agrees that this is what Hegel was even trying to accomplish with that argument. Aristotle also has, I think, a sort of answer, one that persuades thinkers such as Hursthouse, but not many others.
Finally, Patty is raising this question: when I am "teaching ethics" to all of these heathen, am I really doing anything besides blowing smoke? By the time they get to me, at age 18+, will anything I say, or anything they read, affect their future conduct? Good questions!
First, it details, in clear, terse prose, what it is that a good nurse does every damn day he or she is on duty. If I have another heart attack, I hope it is in Boston and Patty is my nurse. Anyone the least bit interested in healthcare policy who reads it, and still thinks nurses should be paid what the heating and airconditioning guys are, is either dumber than a box of rocks or a sociopath.
Second, she does raise a couple of interesting points. Philosophers still struggle to give a persuasive account of why one should be moral in the first place. Why not be David Hume's "sensible knave?" Hume recognized the problem, but I am not sure he persuasively solved it (for that matter, neither was he). Why not do as little for the patient as you can get by with without getting fired or sued? Kant has an answer (sort of) but not everyone (to put it mildly) has found it persuasive. I read Hegel's "master/slave" argument as TRYING to put a bit of flesh on the Kantian answer, but I am not sure that it is really even coherent (just like the rest of Hegel), and, besides, not everyone agrees that this is what Hegel was even trying to accomplish with that argument. Aristotle also has, I think, a sort of answer, one that persuades thinkers such as Hursthouse, but not many others.
Finally, Patty is raising this question: when I am "teaching ethics" to all of these heathen, am I really doing anything besides blowing smoke? By the time they get to me, at age 18+, will anything I say, or anything they read, affect their future conduct? Good questions!
Hi Bob and Patty,
I got fixated on what may have been a misunderstanding of Bob's post. Something about questioning whether there were differences in ethical imperatives among the various professions.
It got me thinking - whether by mistake or not, about those differences. Drs of course, do have different ethical issues even when caring for the same patient as the nurse. The reason for this is at least two-fold. First, the Gestalt is different. Where the nurse may have 8 patients to juggle and is making time and resource allocation decisions for 8 patients, the docs may be making time and resource allocation decisions for 100s of patients. Since the Gestalt is different, their allocative choices reflect not just differences in professional knowledge and practice, but different criteria by which their acts are judged, the different financial implications of their allocative decisions, and their different peer reference groups.
As well, when patients are moved around an organization or out of the organization, docs may continue to be involved while the nurses have been relieved of their professional role for the patient. All of this tends to dramatically alter the nature of the relationships.
While there are still vestiges of the old ethics - as exemplified by Patty's story - that each patient deserves to be treated on the basis of their needs regardless of ability to pay, docs are held far more clearly to the financial implications of their allocation decisions, through bonus systems, retrospective audits, etc. Nurses, while we are clearly moving in that direction, are still more insulated from such direct financial accountability.
To participate in ethical practice, I would argue that nurses need to understand not only ethics and philosophy, but the frame of mind of their colleagues in medicine, physical therapy, hospice, admin, finance, accounting, billing... If nurses do not understand the fractures in the environment, even good ethics classes will not enable them to see the often conflicting Gestalts being brought to the table by their colleagues.
Interesting topic Bob.
bear
I got fixated on what may have been a misunderstanding of Bob's post. Something about questioning whether there were differences in ethical imperatives among the various professions.
It got me thinking - whether by mistake or not, about those differences. Drs of course, do have different ethical issues even when caring for the same patient as the nurse. The reason for this is at least two-fold. First, the Gestalt is different. Where the nurse may have 8 patients to juggle and is making time and resource allocation decisions for 8 patients, the docs may be making time and resource allocation decisions for 100s of patients. Since the Gestalt is different, their allocative choices reflect not just differences in professional knowledge and practice, but different criteria by which their acts are judged, the different financial implications of their allocative decisions, and their different peer reference groups.
As well, when patients are moved around an organization or out of the organization, docs may continue to be involved while the nurses have been relieved of their professional role for the patient. All of this tends to dramatically alter the nature of the relationships.
While there are still vestiges of the old ethics - as exemplified by Patty's story - that each patient deserves to be treated on the basis of their needs regardless of ability to pay, docs are held far more clearly to the financial implications of their allocation decisions, through bonus systems, retrospective audits, etc. Nurses, while we are clearly moving in that direction, are still more insulated from such direct financial accountability.
To participate in ethical practice, I would argue that nurses need to understand not only ethics and philosophy, but the frame of mind of their colleagues in medicine, physical therapy, hospice, admin, finance, accounting, billing... If nurses do not understand the fractures in the environment, even good ethics classes will not enable them to see the often conflicting Gestalts being brought to the table by their colleagues.
Interesting topic Bob.
bear
# posted by : 1:06 PM
: 1:06 PM
Hi Tom!
It has been a while since I have heard from one of my favorite sparring partners!
Actually, the question you are pondering isn't EXACTLY the one I had in mind, but it is a good one nevertheless, and a fair reading of my initial post does raise it.
My principal concern is whether the current fashion in ethics instruction here in the USA, which seems to focus on considering ethical questions in a "profession specific" context, is necessarily a good idea, especially if this is going to be the ONLY course in ethics that the student takes. Let me elaborate just a bit with another specific example.
The textbook I use for introductory ethics is "The Moral of the Story," by Nina Rosenstand. It isn't perfect, by a long shot (it leaves David Hume and the sentimentalists out almost entirely, for one thing, and absolutely traduces Kant's views on the virtues, for another), but the students love the way it frames the issues in terms of films and short stories they are familiar with. Also, Nina includes a CD for instructors with lots of tips, exercises, etc., that are the result of her years of teaching experience, and this is VERY helpful. She also includes suggestions for constructing a syllabus.
ONE of her syllabus suggestions is a suggested way to construct a course, using her textbook, which emphasizes virtue ethics and "ethics of care." Looking that specific syllabus over, I would have to believe that any student completing the course would come away with the idea that rival ethical theories deserve the short shrift they get. While Nina doesn't specifically say this, I get the distinct impression that THIS syllabus suggestion has been made at the behest of instructors (many of them with minimal backgrounds in Philosophy) tasked with teaching "Nursing Ethics."
I want to challenge the appropriateness of this entire enterprise.
It is certainly true that the "Gestalt" for the nurse and the doctor are different in many respects. It is certainly true that each "player" in the healthcare environment is facing review of the appropriateness of their actions in terms of resource allocation, financial policies and implications, and the like. However, those questions take the form of "did you follow the rule," or "is this consistent with hospital policy," or "will medicare re-imburse us for this PT/INR or do we have to eat the $35.00", or "can we be sued for this," or... ad nauseam. These are important questions of professional competence and responsibility, but they aren't ETHICAL questions, unless, of course, one is prepared to concede victory to Protagoras in his battle with Socrates, and say that all terms like "good" and "right" amount to are compliments we pay to the rules and expectations of some particular community.
I, for one, am not going to give a single inch to Protagoras, or any of his modern descendants. And it seems to me that when we are asked, as ethics teachers, to conflate professional custom, habit and "responsibility" with inquiry into the "right and the good," we are being asked not to give Protagoras and inch, but a mile.
Bob
It has been a while since I have heard from one of my favorite sparring partners!
Actually, the question you are pondering isn't EXACTLY the one I had in mind, but it is a good one nevertheless, and a fair reading of my initial post does raise it.
My principal concern is whether the current fashion in ethics instruction here in the USA, which seems to focus on considering ethical questions in a "profession specific" context, is necessarily a good idea, especially if this is going to be the ONLY course in ethics that the student takes. Let me elaborate just a bit with another specific example.
The textbook I use for introductory ethics is "The Moral of the Story," by Nina Rosenstand. It isn't perfect, by a long shot (it leaves David Hume and the sentimentalists out almost entirely, for one thing, and absolutely traduces Kant's views on the virtues, for another), but the students love the way it frames the issues in terms of films and short stories they are familiar with. Also, Nina includes a CD for instructors with lots of tips, exercises, etc., that are the result of her years of teaching experience, and this is VERY helpful. She also includes suggestions for constructing a syllabus.
ONE of her syllabus suggestions is a suggested way to construct a course, using her textbook, which emphasizes virtue ethics and "ethics of care." Looking that specific syllabus over, I would have to believe that any student completing the course would come away with the idea that rival ethical theories deserve the short shrift they get. While Nina doesn't specifically say this, I get the distinct impression that THIS syllabus suggestion has been made at the behest of instructors (many of them with minimal backgrounds in Philosophy) tasked with teaching "Nursing Ethics."
I want to challenge the appropriateness of this entire enterprise.
It is certainly true that the "Gestalt" for the nurse and the doctor are different in many respects. It is certainly true that each "player" in the healthcare environment is facing review of the appropriateness of their actions in terms of resource allocation, financial policies and implications, and the like. However, those questions take the form of "did you follow the rule," or "is this consistent with hospital policy," or "will medicare re-imburse us for this PT/INR or do we have to eat the $35.00", or "can we be sued for this," or... ad nauseam. These are important questions of professional competence and responsibility, but they aren't ETHICAL questions, unless, of course, one is prepared to concede victory to Protagoras in his battle with Socrates, and say that all terms like "good" and "right" amount to are compliments we pay to the rules and expectations of some particular community.
I, for one, am not going to give a single inch to Protagoras, or any of his modern descendants. And it seems to me that when we are asked, as ethics teachers, to conflate professional custom, habit and "responsibility" with inquiry into the "right and the good," we are being asked not to give Protagoras and inch, but a mile.
Bob
Hi Bob!
You make excellent points and they are well taken. I too miss our occasional sparring - been up to my neck learning all sorts of new things of late...
Having an axe and not much use for it, perhaps I can attempt to split a hair or two.
My sense is that there is a duty of caring that is pre-eminent and which is most certainly being lost sight of if not simply denigrated in care giving environments, and with which most thinking and caring nurses would of course agree.
The point I meant to make (Sort of like the WYSIWYM {What you see is what you meant} LateX takeoff on WYSIWYG of Windows fame), was that the ethical obligations to other patients implicit in the allocation decisions were the most problematic and differ drastically from profession to profession. The nurse balances service to one patient against caring service to 7 other patients. Equipment, supplies, and time given to pt #1 come at the cost of deferred, delayed, or denied services to 7 other patients. So the ethical quandary is not 1-1 what does nurse A do for Patient 1 but what effect do the allocation decisions of Nurse A have on patients 2 - 8 as well as Patient 1 and potentially to the other patients on the unit, division, or facility.
If there is only one PCA pump left on the unit or in the facility and Nurse A grabs it and sets it up for their Patient 1, none of the other patients on the unit will get a PCA pump as quickly. Those patients, whether known or unknown to Nurse A, may have objectively greater need for pain relief.
So, we may all agree that Nurse A should do his/her best for Patient 1 when we ignore patients' 2 - 8, but the allocative activities have a broader ethical base than just whether Patient 1 is well treated. While there are certainly other issues as well in the Gestalt, the decisions made by Nurse A with his/her patients are allocative decisions under the influence of resource scarcity, and in the end, are individual answers to the most basic economic question - who gets what, and how does it impact the dependent web that connects all patients and all caregivers, when not all will get what they want or need.
So, if I understand your point, I am amending or perhaps clarifying my point to suggest that even if we completely discount the financial issues, the retrospective audits, and the issues related to the rules, standards, and customs of practice, we still have nurses making multiple ethical/resource decisions per shift, almost any one of which would likely lead to a lengthy Socratic dialogue about what duties are owed, what the good and just choices should be, and how nurses can lead ethical lives.
With tongue in cheek regard for Tom Lehrer, perhaps what is really needed is a good Classics Illustrated comic book on ethics for the working nurse - but I suspect anything other than a rule-based decision making procedure would be nearly impossible for most working nurses to implement because the trade offs involved are too broad, have long tails, and unknown, perhaps unknowable, consequences at the time of decision-making.
As one additional example, suppose the allocative decision of the nurse is the last straw in the process of deciding whether to curtail all future services to the defined patient population, so that extending the stayof Patient 1 by one day results in the entire service being closed down and no longer available to the population of patients who would have benefited in the future...
bear
Thomas Cox PhD, RN
You make excellent points and they are well taken. I too miss our occasional sparring - been up to my neck learning all sorts of new things of late...
Having an axe and not much use for it, perhaps I can attempt to split a hair or two.
My sense is that there is a duty of caring that is pre-eminent and which is most certainly being lost sight of if not simply denigrated in care giving environments, and with which most thinking and caring nurses would of course agree.
The point I meant to make (Sort of like the WYSIWYM {What you see is what you meant} LateX takeoff on WYSIWYG of Windows fame), was that the ethical obligations to other patients implicit in the allocation decisions were the most problematic and differ drastically from profession to profession. The nurse balances service to one patient against caring service to 7 other patients. Equipment, supplies, and time given to pt #1 come at the cost of deferred, delayed, or denied services to 7 other patients. So the ethical quandary is not 1-1 what does nurse A do for Patient 1 but what effect do the allocation decisions of Nurse A have on patients 2 - 8 as well as Patient 1 and potentially to the other patients on the unit, division, or facility.
If there is only one PCA pump left on the unit or in the facility and Nurse A grabs it and sets it up for their Patient 1, none of the other patients on the unit will get a PCA pump as quickly. Those patients, whether known or unknown to Nurse A, may have objectively greater need for pain relief.
So, we may all agree that Nurse A should do his/her best for Patient 1 when we ignore patients' 2 - 8, but the allocative activities have a broader ethical base than just whether Patient 1 is well treated. While there are certainly other issues as well in the Gestalt, the decisions made by Nurse A with his/her patients are allocative decisions under the influence of resource scarcity, and in the end, are individual answers to the most basic economic question - who gets what, and how does it impact the dependent web that connects all patients and all caregivers, when not all will get what they want or need.
So, if I understand your point, I am amending or perhaps clarifying my point to suggest that even if we completely discount the financial issues, the retrospective audits, and the issues related to the rules, standards, and customs of practice, we still have nurses making multiple ethical/resource decisions per shift, almost any one of which would likely lead to a lengthy Socratic dialogue about what duties are owed, what the good and just choices should be, and how nurses can lead ethical lives.
With tongue in cheek regard for Tom Lehrer, perhaps what is really needed is a good Classics Illustrated comic book on ethics for the working nurse - but I suspect anything other than a rule-based decision making procedure would be nearly impossible for most working nurses to implement because the trade offs involved are too broad, have long tails, and unknown, perhaps unknowable, consequences at the time of decision-making.
As one additional example, suppose the allocative decision of the nurse is the last straw in the process of deciding whether to curtail all future services to the defined patient population, so that extending the stayof Patient 1 by one day results in the entire service being closed down and no longer available to the population of patients who would have benefited in the future...
bear
Thomas Cox PhD, RN
# posted by : 8:12 AM
: 8:12 AM
Perverted female nurses
Go to www.allnurses.com
search the site whoa..inappropriate
and read the continuation
Go to www.allnurses.com
search the site whoa..inappropriate
and read the continuation
# posted by : 3:11 AM
: 3:11 AM
Public health nursing practice is rooted in the core value of social justice. Nursing faculty whose expertise is in public health are often the content experts responsible for teaching this essential, yet potentially controversial, value. Contemporary threats to academic freedom remind us that the disciplinary autonomy and academic duty to teach social justice may be construed as politically ideological. These threats are of particular concern when faculty members guide students through a scientific exploration of sociopolitical factors that lead to health-related social injustices and encourage students to improve and transform injustices in their professional careers. This article (a) reviews recent challenges to academic freedom that influence social justice education, (b) explores academic freedom and duty to teach social justice within the discipline of nursing, and (c) proposes a praxis-based approach to social justice education, which is grounded in transformative pedagogy.
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chris
Internet marketing
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chris
Internet marketing
The reason humans need morality is simply: in order to LIVE! Man's nature requires ethics because he has no automatic means of survival, like animals do. To live, man must think (using reason & logic); to think, man needs freedom from force or fraud by others; that's where morality comes in. Ayn Rand's book 'The Virtue of Selfishness" explains the proper role of morality much better that I can; I highly recommend it.
BTW, if someone is looking for an LVN school in Orange county CA, checkout Summit Career College in Colton CA.
BTW, if someone is looking for an LVN school in Orange county CA, checkout Summit Career College in Colton CA.
# posted by : 12:52 PM
: 12:52 PM
After 21 years in the nursing field, I recently decided to go back to get my Masters in Nursing Education. I was hesitant to learn that my first course would be in Ethics. I thought this would be easy because how hard is it to make the "right" decision when it comes to patient care? I am learning that it is way more than that. In my reading thus far, studies show that not much emphasis is given in teaching the Advanced Practice Nurse (APN) about Ethics. Therefore, I am glad that I am taking this course and learning so much.
Our assignment this week was to read a Chapter from Nursing Ethics and Professional Responsibility and post a blog about it. I chose to read Chapter 8, Nursing Ethics and Advanced Practice: Children and Adolescents. So many times as nurses, we direct all of our attention and communication to the parent, or caregiver, of the child without including the child (patient) in the decision making process. I learned that children can be “active social players with a voice”. Sometimes, we don’t want to hear that screaming, crying voice but as the APN, we can learn to lessen the child’s fears and apprehension thus creating a stable, caring relationship while promoting healing and growth.
Parents or the legal guardian are ultimately responsible for making decisions on behalf of the patient and the child is dependent on that person. As the APN, we must make sure that we are educating the caregiver with knowledge regarding the risks and benefits so that the best, informed decision can be made for the patient. Autonomy is still very important with knowing that communication with the caregiver making the decision is of utmost priority. We, the healthcare team, are the patient advocate. What is best for the patient is our goal and with good communication, a caring attitude, attentiveness and compassion, we can achieve this.
Hillary Clinton once said, “It takes a village to raise a child.” Grace, the author, echoes this by saying it takes a village in caring for the child or adolescent patient. The nurses, doctors, other healthcare providers, parents, patient, family members, supporters, etc.. are all involved in making the best decisions in the best interest of the patient. We can’t take this lightly. It is our moral, ethical responsibility to ensure that “our nation’s most treasured resource” has access to the best healthcare possible.
I believe that if we start them out early realizing that they need to respect self and care about their health, knowing they have a voice in the healthcare decisions, then this lays a stable foundation with caring relationships that will last a lifetime. Isn't that the most ethical thing to do?
Our assignment this week was to read a Chapter from Nursing Ethics and Professional Responsibility and post a blog about it. I chose to read Chapter 8, Nursing Ethics and Advanced Practice: Children and Adolescents. So many times as nurses, we direct all of our attention and communication to the parent, or caregiver, of the child without including the child (patient) in the decision making process. I learned that children can be “active social players with a voice”. Sometimes, we don’t want to hear that screaming, crying voice but as the APN, we can learn to lessen the child’s fears and apprehension thus creating a stable, caring relationship while promoting healing and growth.
Parents or the legal guardian are ultimately responsible for making decisions on behalf of the patient and the child is dependent on that person. As the APN, we must make sure that we are educating the caregiver with knowledge regarding the risks and benefits so that the best, informed decision can be made for the patient. Autonomy is still very important with knowing that communication with the caregiver making the decision is of utmost priority. We, the healthcare team, are the patient advocate. What is best for the patient is our goal and with good communication, a caring attitude, attentiveness and compassion, we can achieve this.
Hillary Clinton once said, “It takes a village to raise a child.” Grace, the author, echoes this by saying it takes a village in caring for the child or adolescent patient. The nurses, doctors, other healthcare providers, parents, patient, family members, supporters, etc.. are all involved in making the best decisions in the best interest of the patient. We can’t take this lightly. It is our moral, ethical responsibility to ensure that “our nation’s most treasured resource” has access to the best healthcare possible.
I believe that if we start them out early realizing that they need to respect self and care about their health, knowing they have a voice in the healthcare decisions, then this lays a stable foundation with caring relationships that will last a lifetime. Isn't that the most ethical thing to do?
# posted by : 7:25 PM
: 7:25 PM
I’m currently pursuing my Master in Nursing. This assignment required each student to select and read a chapter for the course textbook, then post a blog. I chose chapter 7, Nursing Ethics and Advanced Practice involving Neonatal Issues. I could personally relate to the content. First I would like to applaud all healthcare providers who are blessed with the gift to administer care to the premature and extremely low birth weight neonates. This area of healthcare can offers wonderful results; but, at the sometime it has some unpleasant outcomes. Family and providers collaboration is so important in healthcare.
Ethical issues and dilemmas occur daily in the Neonatal Intensive Care Unit (NICU). Settle (2009) believes that the advance practice nurse (APN) is in an unique position to model transparency with both the medical team and the direct care nurse. In this influential position, the APN can reduce the barriers parents face in participating in the decision-making process for their infants. APNs play an important role in fostering collaboration decision making in the NICU by ensuring regular meetings, especially when goals of treatment between disciplines conflict. Being a parent who was a recipient of services provided by the NCU, I truly support the Settle’s, beliefs that medical futility is difficult to identify. The use of futility as a clinical criterion in the NICU must be determined individually by each infant’s condition.
Being on the other side of healthcare was not easy. In August 1996, I went into premature labor. I was hospitalized and treated aggressively to stop my labor. Despite all efforts, my son was born at 28 weeks gestation weighing only 2 pounds, 3 ounces; his weight dropped as low as 1 pound, 15½ ounces. He progressed well for the first two weeks of life. Then he developed necrotizing enterocolitis (NEC), and later disseminated intravascular coagulation (DIC). He also required ventilator support. As I watched by baby’s condition worsen, I prayed for his survival.
A surgical consult was order; it revealed no surgical abdomen; but, if the baby starts to deteriorate, please re-consult. While discussing my son’s condition with the neonatologist, I asked what his definition was of deteriorate. I felt my son was deteriorating prior to the surgeon’s exam, he agreed and ask if I would like to transfer him. Without hesitation, I said “yes”. He was transferred to Children’s Hospital, Birmingham, Alabama.
Throughout his hospital stay, there were many ethical dilemmas to consider. In his first week of life, I was told he had a possible intracranial bleed; the neurologist reviewed his CT scan, he felt the grey/white matter alterations were a result of his premature status. Other issues included the ventilator support, the discussion to transfer, and multiple blood products (RBC, platelets, and plasma) transfusions. Even though I was recovering from a C-section, post-op sepsis, atelectasis, and an ileus, I was at his bedside from 8a.m. to 10:30p.m. every day after he was transferred to Children’s Hospital.
During my personal experience, I truly needed an experienced, knowledgeable CNS to provide proper couching/teaching to ease my pain. I was helpless and sometime not so hopeful; I lived every day in fear not knowing if he was going to live or die. The staff was very helpful; but, I desired more resources. I feel that a CNS role could have provided those resources.
My son has a few battle scars; but, thank God, he never perforated. He had hemocult positive stools until he was one year old. Today, he is 12 years old; in August he will celebrate his 13th birthday. He’s preparing to begin the 8th grade; he’s also on the middle school’s foot ball and basketball teams.
Reference
Settle, P. D. (2009). Nursing ethics and advanced practice: Neonatal issues. In P. J. Grace (Eds.) Nursing Ethics and Professional Responsibility in Advanced Practice. (pp. 191-219). Sudbury, MA: Jones and Bartlett Publishers.
Ethical issues and dilemmas occur daily in the Neonatal Intensive Care Unit (NICU). Settle (2009) believes that the advance practice nurse (APN) is in an unique position to model transparency with both the medical team and the direct care nurse. In this influential position, the APN can reduce the barriers parents face in participating in the decision-making process for their infants. APNs play an important role in fostering collaboration decision making in the NICU by ensuring regular meetings, especially when goals of treatment between disciplines conflict. Being a parent who was a recipient of services provided by the NCU, I truly support the Settle’s, beliefs that medical futility is difficult to identify. The use of futility as a clinical criterion in the NICU must be determined individually by each infant’s condition.
Being on the other side of healthcare was not easy. In August 1996, I went into premature labor. I was hospitalized and treated aggressively to stop my labor. Despite all efforts, my son was born at 28 weeks gestation weighing only 2 pounds, 3 ounces; his weight dropped as low as 1 pound, 15½ ounces. He progressed well for the first two weeks of life. Then he developed necrotizing enterocolitis (NEC), and later disseminated intravascular coagulation (DIC). He also required ventilator support. As I watched by baby’s condition worsen, I prayed for his survival.
A surgical consult was order; it revealed no surgical abdomen; but, if the baby starts to deteriorate, please re-consult. While discussing my son’s condition with the neonatologist, I asked what his definition was of deteriorate. I felt my son was deteriorating prior to the surgeon’s exam, he agreed and ask if I would like to transfer him. Without hesitation, I said “yes”. He was transferred to Children’s Hospital, Birmingham, Alabama.
Throughout his hospital stay, there were many ethical dilemmas to consider. In his first week of life, I was told he had a possible intracranial bleed; the neurologist reviewed his CT scan, he felt the grey/white matter alterations were a result of his premature status. Other issues included the ventilator support, the discussion to transfer, and multiple blood products (RBC, platelets, and plasma) transfusions. Even though I was recovering from a C-section, post-op sepsis, atelectasis, and an ileus, I was at his bedside from 8a.m. to 10:30p.m. every day after he was transferred to Children’s Hospital.
During my personal experience, I truly needed an experienced, knowledgeable CNS to provide proper couching/teaching to ease my pain. I was helpless and sometime not so hopeful; I lived every day in fear not knowing if he was going to live or die. The staff was very helpful; but, I desired more resources. I feel that a CNS role could have provided those resources.
My son has a few battle scars; but, thank God, he never perforated. He had hemocult positive stools until he was one year old. Today, he is 12 years old; in August he will celebrate his 13th birthday. He’s preparing to begin the 8th grade; he’s also on the middle school’s foot ball and basketball teams.
Reference
Settle, P. D. (2009). Nursing ethics and advanced practice: Neonatal issues. In P. J. Grace (Eds.) Nursing Ethics and Professional Responsibility in Advanced Practice. (pp. 191-219). Sudbury, MA: Jones and Bartlett Publishers.
# posted by : 12:01 PM
: 12:01 PM
My name is Felicia Gardner. I work in a cardiac cath lab and am going back to school for my master's degree. This is part of our assignment to comment on a chapter we read about ethics. Since I work with adults in a cardiac catheterization lab, I read Chapter 10 related to adult patients. I was surprised and scared by the case studies used in the chapter. One particular case study reports about a patient who goes to a nurse practioner prior to having a biopsy for lung cancer. The patient, having unresolved pneumonia, has no idea why he has come to the referral. The NP in her hurried schedule completely misses the fact that the patient has no idea why they are at an oncologist's office. The NP, in her rushed routine, failed to examine the level of understanding of her patient. This has bothered me as a nurse. I cannot count the number of times that I have rushed in and out of patients room. I do not know myself how many times I failed to really examine what my patient needed. Oh, I charted my I & O's. I charted my vital signs. I charted my restraint flowsheet - well maybe. I crossed my Ts and dotted my Is, but did I really care for my patient. Has nursing become so consummed with forms, flowsheets, and documentation that we cannot provide care for our patients? This is my ethical question tonight.
I am pursuing my Master's in Nursing. We were given an assignment to read a chapter in Nursing Ethics and Professional Responsibility in Advanced Practice. I read Chapter 10 which involved Adult Health. I read a couple of things that really intrigued me. First, the author ponders if it would be beneficial to a patient to have a primary care nurse assigned to them just like insurance companies require a patient to have a primary physician. I'm not exactly sure how that would work logistically but wouldn't that be a great way to help with the continuity of care? As nurses, we get so task-oriented that we forget the person we are trying to help. Health care for patients does not seem to flow like it should. Too many times even in one office, the right hand does not know what the left hand is doing. This was evident in my mother's oncology surgeon's office. She had a hysterectomy a couple of years ago. Her biopsy had shown some cancer cells but they felt it was contained in the uterus and that the surgery would cure her completely. However, she was very much surprised when she received a call from a chemo nurse who called to set up an appointment to start her first treatment. My mother was so shocked she said she didn't hear anything the nurse said after she heard the words chemo and cancer. This was described in the chapter I just read. The nurse was very apologetic when she realized that she had just broken some bad news to my mother. The surgeon called later that day and also apologized but the damage was already done. It is very easy to assume people have all the information they need before we give them instructions. So much heartache can be prevented with slowing down and getting all the facts. I wonder how many patients I have hurt emotionally by being in a hurry and checking things off my list.
# posted by : 12:44 AM
: 12:44 AM
My name is Karen Amos. I am currently pursing my Master’s in Nursing and one of my assignments required me to read a Chapter from Nursing Ethics and Professional Responsibility and post my views about it. I chose chapter 11 “Psychiatry and Mental Illness”, which relates most to my current field of nursing.
First of all, most of my work experience consisted of working in the medical surgical environment. My latest adventure in nursing involves me working with adults with mental retardation or intellectual disabilities. By far working with mentally retarded individuals have been my most challenging ethically and most rewarding personally and professionally. I have four year old son with autism. So, I have a better understanding of persons with disabilities and the struggles they face in the community and in healthcare.
Often, mental retarded clients suffer from mental illness. The challenges I face are not much different than those discussed in one of chapter 11’s a case study. The case study involved a client who is concern about her medication and questions the side effects and the effectiveness of the medication. Additionally, the client feels her psychiatrist does not spend enough time with her to accurately assess her condition. The client discussed her concerns with a graduate student and his preceptor. The graduated student offers his opinion of changing the client’s medication to one with fewer side effects. The preceptor informed the student he will continue the client current medication and will discuss the client’s concerns later with the psychiatrist.
The above case study gave different scenarios the student could take to advocate for the patient. However, from my experience clients with mental illness and mental retardation require a great amount of collaboration with psychiatrists, their families, case workers, the community and other nurses. Frequently, the primary nurse may know more about the client pass history and may know how the client reacts to medication adjustments. The preceptor should listen to the graduate student, but should also base his decisions on the client’s previous medical history.
As an Advanced Practice Nurse (APN) we must collaborate with others for the collective good of the patient. Often, the mental ill and mental retarded are treated on an outpatient basis. Therefore, APN’s who work in psychiatry has an ethical obligation to try to ensure that their client can function safely within the community. Additionally, they have an obligation to try to make sure the clients do not harm themselves or others. Most importantly APN’s and other care collaborator must determine the ability of the patient to make decisions in their care. The patient comes first. My ethical dilemma usually involves the client’s right to autonomy in their decision making. Also setting limits to their autonomy maybe required, when it is not conducive to their care. Collaboration with other professional seems to alleviate some problems with autonomy. I would like know if others have experienced situation where autonomy is questioned and what other suggestions do you think can help the mental ill in their decision making?
First of all, most of my work experience consisted of working in the medical surgical environment. My latest adventure in nursing involves me working with adults with mental retardation or intellectual disabilities. By far working with mentally retarded individuals have been my most challenging ethically and most rewarding personally and professionally. I have four year old son with autism. So, I have a better understanding of persons with disabilities and the struggles they face in the community and in healthcare.
Often, mental retarded clients suffer from mental illness. The challenges I face are not much different than those discussed in one of chapter 11’s a case study. The case study involved a client who is concern about her medication and questions the side effects and the effectiveness of the medication. Additionally, the client feels her psychiatrist does not spend enough time with her to accurately assess her condition. The client discussed her concerns with a graduate student and his preceptor. The graduated student offers his opinion of changing the client’s medication to one with fewer side effects. The preceptor informed the student he will continue the client current medication and will discuss the client’s concerns later with the psychiatrist.
The above case study gave different scenarios the student could take to advocate for the patient. However, from my experience clients with mental illness and mental retardation require a great amount of collaboration with psychiatrists, their families, case workers, the community and other nurses. Frequently, the primary nurse may know more about the client pass history and may know how the client reacts to medication adjustments. The preceptor should listen to the graduate student, but should also base his decisions on the client’s previous medical history.
As an Advanced Practice Nurse (APN) we must collaborate with others for the collective good of the patient. Often, the mental ill and mental retarded are treated on an outpatient basis. Therefore, APN’s who work in psychiatry has an ethical obligation to try to ensure that their client can function safely within the community. Additionally, they have an obligation to try to make sure the clients do not harm themselves or others. Most importantly APN’s and other care collaborator must determine the ability of the patient to make decisions in their care. The patient comes first. My ethical dilemma usually involves the client’s right to autonomy in their decision making. Also setting limits to their autonomy maybe required, when it is not conducive to their care. Collaboration with other professional seems to alleviate some problems with autonomy. I would like know if others have experienced situation where autonomy is questioned and what other suggestions do you think can help the mental ill in their decision making?
Hello my name is Jackie Queen. One of my assignments was to find a ethical topic and post a blog to initiate conversation of current ethical issues. I chose chapter 8 “ Nursing ethics and advanced practice; frequently encountered concerns”. I am interested in the ethical topic of childhood vaccinations. As a nurse who has experience in pediatrics, I know that parents are concerned with the side affects of vaccinations. Most of the concerns are due to a lack of adequate education provided to the parents. The bottom line is that benefits outweigh the risk. The parents want to make sure that the MMR is safe for their children. Lately there have been a number of court cases on this issue. The Supreme Court has stepped in and ordered the parents to vaccinate their children or provide proof of a religious affiliation that would prevent vaccination. If the parents are unable to do this they face heavy fines or possible jail time. I understand the need for vaccines and that t hey are for the good of the whole community. If I encounter parents who chose not to vaccinate their children we make sure they are aware of the consequences as well as have them sign a release. When should government be involved in personal heath care issues?
Jackie Queen
Auburn University
NURS 7220
Jackie Queen
Auburn University
NURS 7220
The patient comes first. My ethical dilemma usually involves the client’s right to autonomy in their decision making. Also setting limits to their autonomy maybe required, when it is not conducive to their care.
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