Posts Tagged ‘ethics’
October 7, 2011
Performance measurement, an increasingly pervasive trend in health care, is credited with significant improvements in the quality of care . . . . Even so, this is little comfort when a nurse faces a situation where an action necessary for meeting a performance measure isn’t what she or he believes is best for a particular patient. For example, falls are often tallied as a performance measure, but frail patients need to be walked; raising the head of the bed to prevent pneumonia is often counted in performance evaluation but may result in less turning of the patient, which may mean more sacral ulcers—which may or may not be tallied as a separate performance measure.
That’s from an article in this month’s AJN by nurse ethicist Doug Olsen. It’s called “When Being Good Means Looking Bad,” and is about potential unintended effects of some well-intentioned performance measures that don’t easily allow for consideration of clinical context. Olsen writes that the nurse may, in certain situations, find herself or himself faced with three highly imperfect options to choose between:
- Conform care to get the best score on the performance measurement, although that may mean less than the best care for the patient.
- Use deception, in the form of a work-around or an outright lie, to give the appearance of meeting the measure—while actually doing what one thinks is best.
- Give the best care, document accurately—and accept the consequences.
Olsen explains the ethical principles in play, weighs the options, and then offers nurses some succinct advice for finding a way forward. Please have a look and let us know if you’ve ever experienced such a conundrum.—Jacob Molyneux, senior editor
Posted in ethical issues, nursing perspective, professional identity | Tagged ethicist, ethics, nurse, Performance measurement | 5 Comments »
June 27, 2011
Ben’s inability to understand even the basics of his situation, combined with his lack of family support, made it seem that we were in effect imprisoning him and torturing him.
That’s an excerpt from the Reflections essay in the June issue of AJN. By Theresa Brown, a nurse who regularly writes for the New York Times “Well” blog, “Right Treatment, Right Patient?” explores the ethics and emotions involved in providing an unpleasant but potentially life-saving treatment to a patient who can’t understand what’s being done to him (click through to the PDF for the best version).
We hope you’ll read it through and let us know if you’ve ever faced a similar ethical quandary as a health care professional (or, for that matter, as a family member or patient).—JM, senior editor
Posted in ethical issues, nursing perspective, patient perspective, writing and nursing | Tagged ethics, New York Times, nurse, nurse blogger, standard of care, Theresa Brown | Leave a Comment »
January 19, 2011
By Julianna Paradisi, RN
Zuckerberg/via Flickr, World Economic Forum
Before the placenta picture posted on Facebook made national news, I read Time Magazine’s “Person of the Year 2010,” by Lev Grossman. Born in 1984, Mark Zuckerberg, the inventor of Facebook, is decades younger than the average working nurse. According to the article, so many people now belong to Facebook that if the Web site were a country “it would be the third largest, behind only China and India.” To refuse to recognize the social impact of Facebook is to miss the boat.
Throughout the nurse blogosphere, nurses are demanding that hospitals create policies about the use of social media. Some hospitals have. Not surprisingly, these documents state that no unauthorized photographs of staff, patients, or patient care areas should be taken, let alone posted on the Internet.
Hospitals with social media policies are not necessarily squelching their employees’ right to freedom of speech. They don’t want to spend time and money in court defending their public image. They already spend lots of money on marketing. They are in the business of patient care, not entertainment. So hospitals with social media polices take the position that you can post or tweet to your heart’s content, but should keep in mind the following:
- Nothing you post is private.
- If your online behavior disrupts patient care or creates hospital liability, the hospital reserves the right to fire you.
Consider your personal commitment to your own rights. Do you really want to catch every ball that’s thrown to you? Hospitals don’t want to spend their time and money on social media lawsuits. Do you?
Social media is not going away. One of Mark Zuckerberg’s profitable insights is that people like reading about and seeing their friends and friends of friends online. A few years ago, many of us were upset when the Patriot Act made it possible to force libraries and bookstores to report which books their patrons read. Now we want everyone to know what books we “like,” and no one seems to mind that Amazon tracks what we read, then focuses ads according to our purchases.
My own concept of privacy is changing. Read the rest of this entry ?
Posted in art and nursing, ethical issues, health care reform, media depictions of nursing, patient perspective, social media, writing and nursing | Tagged Affordable Care Act, ethics, Facebook, HIPAA, Mark Zuckerberg, Patient Protection and Affordable Care Act, Patriot Act, privacy, social media | 6 Comments »
January 17, 2011
Image via Wikipedia
By Maureen ‘Shawn’ Kennedy, AJN editor in chief
On January 13, news from Texas let nurses everywhere take heart that, sometimes, the system works. According to a report by the Odessa American, the Winkler County, Texas, officials, Sheriff Robert Roberts and attorney Scott Tidwell, who had filed charges against whistleblower nurses Anne Mitchell and Vicki Galle, have been indicted on felony charges of misuse of official information. The hospital administrator who fired the two nurses, Stan Wiley, was also indicted. For more on the story, which we’ve kept a close eye on since October 2009 in our news reports and on this blog, see this ABC World News article; the Texas Nurses Association also has an archive of the case.
In a separate civil suit against the county, Mitchell and Galle were awarded $750,000. Very excellent.
Why is this so exciting and significant? The case outcome supports nurses who raise concerns about unsafe patient care and upholds the nurse’s right—duty, really—to advocate for patients. Hopefully, the nurses’ victory and the award from the civil suit will give pause to those who think they can intimidate nurses who are acting on good conscience and within legal and ethical boundaries.
Kudos to the courts for realizing who the real criminals are.
Posted in ethical issues, legal issues, media depictions of nursing, nursing perspective, patient safety, Shawn Kennedy, AJN editor-in-chief | Tagged ethics, nurse, Odessa American, whistleblower, Winkler County Texas | 3 Comments »
October 20, 2010
By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN. She has also contributed a number of thought-provoking posts to this blog (here’s the most recent).
puddle reflection/by joiseyshowaa, via Flickr
I’ve been precepting a new ICU nurse intern, which I generally enjoy doing. The only downside (from the preceptor’s perspective) is that I’m obliged to call ahead and request “unstable” assignments. This is meant to enhance the clinical aspect of the internship, and it definitely does. Considering that I work in a trauma center, though, reserving the sickest patient in the unit feels a bit like ordering up a large serving of chaos. And although I can request the assignment, I can’t predict what will be learned.
Our most recent patient was a new admission with a traumatic brain injury. At the start of our shift he had a grim neuro prognosis and was hemodynamically unstable. His condition deteriorated throughout the day and he was eventually diagnosed as brain-dead. His family chose to donate his organs.
Taking care of an organ donor is difficult. Brain-dead patients are inherently unstable, yet certain parameters must be maintained to ensure adequate organ perfusion. It’s tedious and meticulous. It also requires a shift of perspective—ironically, even though the patient is legally dead, the medical interventions are aggressive and the stakes feel higher than ever. Despite the fact that for the patient, at least, there is nothing left to lose, the potential organ recipients weigh heavily on our minds. Read the rest of this entry ?
Posted in nursing perspective, nursing students, writing and nursing | Tagged brain death, caring, ethics, ICU, intern, nurse preceptor, nursing student, organ harvesting | 6 Comments »
August 25, 2010
By Marcy Phipps. Marcy is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN, and she has contributed several thoughtful posts to this blog in recent months (here’s the previous one).
by Van Der Elst/via Flickr
My patient’s ICU stay was short, as his injuries were fairly unremarkable. Far more striking were the circumstances of his admission; he’d been injured while committing an appalling act of grisly violence. An armed police officer stood sentry at his bedside, and the nature of his crimes gave him a sinister notoriety among the medical staff.
“Alleged” crimes, I should say.
But it was difficult to give him the benefit of the doubt. I’d read the paper and seen the crime scene photos on the news. The media’s case against him made his innocence hard to fathom, and as a police officer’s daughter I found myself inclined to prejudice. I not only planned on, but also counted on disliking him, at least on some level. Although I would certainly provide care to this man, I exempted myself from caring about him as an individual.
I was surprised to find his demeanor dramatically different than my expectations. He was soft-spoken and retiring, exceedingly polite and appreciative.
I don’t mean to imply that we chatted. Our conversations were limited to his physical condition and general plan of care. He never acknowledged the officer at the bedside or spoke of his alleged crimes, and neither did I.
It’s possible that I was being charmed by a deviant mind. But at the end of the day I not only didn’t dislike him, I was left with a sincere hope that he finds peace, regardless of his past, his actions, or whatever his personal demons may be. The sympathies I developed for him unsettled me, given my initial repulsion, and I’m humbled by the reminder that in the wishing of peace for another, neither their crimes nor demeanor should matter.
Posted in ethical issues, nursing perspective | Tagged ethics, nurses | 3 Comments »
April 16, 2010
By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
Tough Decision/by love4loaded, via Flickr
Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.
In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.
These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units with little time to get to know the patient or families? (This is the “nurse-is-a-nurse-is-a-nurse” concept—also known as the “just send me a warm body” approach.)
So now I wonder: will employers at hospitals where nurses strike try to make nurses the “bad guys,” claiming striking nurses have no regard for patients or are failing to follow the professional code? This has been the argument that has stopped nurses from striking for years and is still the reason many nurses will cross a picket line or not join a union.
But the alternative question is this: is it better to take a stand now to change the status quo so that, ultimately, patient care and working conditions and staffing improve—and thus, in the long run, more patients get better care? It’s a question I’ve always struggled with. I have been fortunate in that I’ve not worked in a facility during a labor dispute—but that’s perhaps because the state nurses’ association that negotiated our contracts did a good job and I was a recipient of others’ hard work and hard choices.
What about you? Would you strike now for better conditions in the future, or would you cross the line to provide care for the patients already there?
Posted in advocacy/political action, ethical issues, legal issues, nursing perspective, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged ethics, mortality, NEBR, nurses strike, Temple University Hospital | 5 Comments »
February 7, 2010
KERMIT, Tex. — It occurred to Anne Mitchell as she was writing the letter that she might lose her job, which is why she chose not to sign it. But it was beyond her conception that she would be indicted and threatened with 10 years in prison for doing what she knew a nurse must: inform state regulators that a doctor at her rural hospital was practicing bad medicine.
That’s from an article in today’s New York Times about a Texas nurse who’s being prosecuted for blowing the whistle on what she asserts were inappropriate medical practices by a doctor she worked with. We’ve posted on this as the case has developed and also written about it in the journal. Ultimately, the judgment is up to the court. But the concern we’ve expressed and which others have also voiced is that this will have the effect of silencing others who should be speaking out. In the process it may well reinforce old nurse–physician dynamics that profit no one. What do you think?
UPDATE: She was acquitted today (February 11)!
Posted in ethical issues, legal issues, nursing perspective | Tagged ethics, nurse, prosecution, Texas, whistle-blower, whistleblower | 5 Comments »
October 26, 2009
By Shawn Kennedy, MA, RN, AJN interim editor-in-chief
bv alvi2047/via flickr
There’ve been articles, blog posts, a court ruling in New York State halting mandatory H1N1 vaccinations for health care workers, and last week a suspension of the mandatory vaccinations by Governor Paterson (who explained the decision in terms of the vaccine shortage). Earlier this month, we ran a poll on this site related to whether or not nurses and other health care workers who work as direct caregivers should be mandated to receive the flu vaccine. In reading the poll results, I notice that many of the arguments against mandatory vaccination focus on the right to decide about one’s own body—a powerful argument, indeed.
It did make me wonder: do those who stand by this reason for not getting an H1N1 vaccination shot (or nasal mist) recognize that this argument—that one has a right to determine what happens to one’s body—is the same argument used by women who want to choose whether to have a baby or not? At the very least there’s an interesting parallel, even if some people I’ve pointed this out to don’t seem to agree. I’d like to know if others feel there is a difference—and if so, what?
Posted in children's health, ethical issues, H1N1 virus (swine flu), legal issues, Shawn Kennedy, AJN editor-in-chief | Tagged abortion, ethics, feminism, freedom to decide, keep your hands off my body, mandatory vaccination, nurses, Paterson | 8 Comments »
October 21, 2009
UK National DNA Infographic/ by blprnt_van, via Flickr Creative Commons
By Diana J. Mason, PhD, RN, editor-in-chief emeritus. Mason often writes for this blog about policy and research issues.
Last week, I attended the annual conference of CANS, the Council for the Advancement of Nursing Science, the “research-facilitation arm” of the American Academy of Nursing. The title of the conference was “Technology, Genetics and Beyond: Research Methodologies of the Future.”
‘Genomics’ vs. ‘genetics.’ I’m not a genomics researcher but I found the sessions enlightening in two ways. First, I admit to struggling with the terminology (and jargon) of the field. I was reminded today that the correct term for the field is “genomics,” since “genetics” refers to the study of single genes and thus limits the focus of study mostly to rare diseases. Genomics looks at associations among genes in the whole person—a shift in perspective that was enabled by the mapping of the human genome.
Targeted interventions. The second enlightenment came from keynote speaker and senior nurse researcher Christine Miaskowski, a dean and a professor of physiological nursing at the University of California at San Francisco School of Nursing. She noted that this shift to a focus on the whole person is what makes nurses and nursing research essential to the field. She gave an example from her own research looking at fatigue among people with cancer. When all patients are grouped together, it looks as if there is little variation across time. But when you diagram each patient’s changes in levels of fatigue, there is actually huge variation. By looking at the genetic composition of individual patients, she’s been able to determine who might respond best to a specific intervention that appears to have no effect when all patients are considered together. Such close examination of patient characteristics can help nurses and other health care providers to better tailor their interventions for the individual patient.
Ethical issues in research. That said, Suzanne Feetham, a nurse who has been a leader in advancing health care professionals’ understanding of genetics and genomics, talked about the ethical issues involved in conducting such research. Read the rest of this entry ?
Posted in Diana Mason, editor-in-chief emeritus, ethical issues, nursing innovations, nursing perspective, nursing research | Tagged American Academy of Nursing, cystic fibrosis, end of life care, ethics, genetics, genomics, mapping, National Institute for Nursing Research, NIH, nursing research, point-of-living research, underfunded | Leave a Comment »
