Defending Against Moral Distress

A collaborative initiative offers recommendations to build moral resilience.

All nurses have at some point been faced with situations that challenge their values. Whether dealing with families or patients or the actions of colleagues, we may be faced with acting (or not acting) in accordance with our professional or personal values. I can easily recall several situations (which I detail in my February editorial) that involved unnecessary invasive procedures and surgery or removing life support.

Such situations take a toll on the individual and the care team and ultimately have a negative effect on patient care quality. Moral distress is not something that can be entirely eliminated—there will always be situations that provoke angst. But individuals can build moral resilience if they learn to recognize it when it occurs and if their organizations support them in finding ways to manage ethically challenging situations. […]

2017-02-06T09:15:27+00:00 February 3rd, 2017|Ethics, Nursing|0 Comments

Stop the Eye Rolling: Welcoming Future Nurses to the Profession

Rosemary Taylor

One perennial topic that comes up among nurses on social media is the extent to which many nurses have been treated unkindly by colleagues at some points in their careers. New nurses and nursing students are, for obvious reasons, particularly vulnerable to rudeness and other forms of unprofessional conduct. The Viewpoint in the January issue of AJN,Stop the Eye Rolling: Supporting Nursing Students in Learning,” by Rosemary Taylor, PhD, RN, CNL, assistant professor of nursing at the University of New Hampshire, makes the case that nursing students often face an “unwelcoming introduction” to the profession when they venture out of the classroom for clinical instruction.

Writes Clark:

Nursing students are often targets of the kinds of incivility that can be classified as vertical violence. The majority of these incivilities are “low risk,” as described in Cynthia Clark’s “continuum of incivility,” with eye rolling (“low risk”) just below sarcasm on one end of the spectrum and threatening behaviors and physical assault (“high risk”) on the other.

Citing her own students’ sometimes disheartening experiences, as well as Cynthia Clark’s book Creating and Sustaining Civility in Nursing Education, Taylor makes a convincing argument that “eye rolling, a seemingly trivial gesture, is in fact a particularly hurtful form of nonverbal aggression.”

Yet, says Taylor, these and other forms of incivility can become […]

Speaking Publicly ‘As a Nurse’: Case in Canada Highlights Risks, Responsibilities

Douglas P. Olsen, PhD, RN, associate professor, College of Nursing, Michigan State University, writes about ethical issues for AJN.

Recently, a disciplinary committee in Canada found a nurse in breach of the Canadian Nurses Association’s Code of Ethics for Registered Nurses for posting negative comments on Facebook and Twitter about the care given to her grandfather in a long-term care facility before his death. The nurse was accused of violating her grandfather’s confidentiality, not using proper processes for noting complaints about his care, and potentially harming the institution’s reputation. She was found guilty of professional misconduct but not guilty of violating his privacy. The ethical breach was based on her public declarations about the nursing care.

Key to the Saskatchewan Registered Nurses’ Association decision to find the nurse guilty appears to have been the fact that the nurse prefaced remarks with the phrase, “As a nurse . . . ” Adding this phrase to one’s communications confers the authority of scientific and experiential expertise. It further implies that one is versed in the proper procedure and standards for evaluating accuracy and relevance of clinical information and that one’s conclusions are communicated honestly for constructive purposes. The credibility added by identifying the nursing credential is deserved—and therefore carries responsibilities.

What are the conditions for an ethical response when speaking publicly ‘as a nurse’?

The voice […]

2016-12-20T15:09:59+00:00 December 16th, 2016|Ethics, healthcare social media, Nursing|2 Comments

Information for Nurses on Voluntarily Stopping Eating and Drinking (VSED)

The New York Times recently published an article by Paula Span called “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission.” VSED stands for voluntarily stopping eating and drinking, an end-of-life option that is, on the surface, as simple as its name suggests. Span, who recently attended the first conference devoted to VSED, gives an overview of one mother’s choice to end her life using this method. She also does an excellent job enumerating the ethical, practical, and legal implications of choosing to stop eating and drinking.

screen-shot-2014-11-05-at-4-39-13-pmWhich types of patients is such a choice appropriate for? How much suffering does it involve? Are there legal pitfalls of involvement in the VSED process by nurses and physicians? We can expect that all of these questions and more will be receiving growing attention in the coming years.

Late in the article, Span quotes Judith Schwarz, PhD, RN, now clinical coordinator of End of Life Choices New York. In 2009, AJN published a CE article, “Stopping Eating and Drinking,” by Schwarz. This substantive article centers around a detailed case study. “Gertrude,” we learn, has lived a very full life. All the things that give her pleasure and a modicum of freedom are gradually being removed as her body’s […]

2016-11-21T13:00:53+00:00 October 24th, 2016|Ethics, Nursing, patient experience|0 Comments

Appropriate Use of Opioids in the Management of Chronic Pain

Painted by Martin Edwards as part of the Paint Your Pain program initiated by the Pain Management Center at Overlook Medical Center, Atlantic Health System, Summit, New Jersey. For artwork of other patients in the program, go to http://bit.ly/ 1Ns0PxL.The dangerous misuse of prescription opioids and drugs like heroin has been much in the news, but millions of patients continue to suffer both acute and chronic pain. For many, prescription opioids play a vital role in alleviating that pain. How can health care providers most effectively and safely use opioids in the treatment and management of chronic pain? Some answers can be found in a CE article in the July issue of AJN: “Appropriate Use of Opioids in Managing Chronic Pain.”

Related questions on opioids and chronic pain addressed in the article include:

  • What is the best way to assess chronic pain patients?
  • Which patients—for example the elderly, those with compromised renal or hepatic function, those with a history of substance abuse—may require special considerations when opioids are prescribed?
  • Which opioid medication or medications, if any, should you select for your patient?
  • And what are the legal and practical challenges to prescribing opioids?

[…]

2016-11-21T13:01:03+00:00 July 22nd, 2016|Nursing, pain management, patient safety|0 Comments