A Nurse Ethicist’s Analysis of a Recent Nursing Home Sexual Consent Case

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scales of justice/by waferboard, via Flickr scales of justice/by waferboard, via Flickr

An 78-year-old retired state legislator and farmer in Iowa is currently on trial for having sex with his wife, who has severe Alzheimer’s disease, in her shared room in a nursing home. He has been charged with rape.

The case highlights two ethical questions or conflicts:

  • When is protection needed and when is it intrusive and harmful?
  • What are the mental abilities required to consent to sex?

Consenting to sex is not the same as informed consent for treatment. In treatment, a clinician obtains consent to act on (treat) the patient in a way that will benefit the patient. By contrast, proper consent for sex is mutual and both parties benefit.

To extend the comparison: a patient’s decision to consent to treatment is generally made by balancing the benefits, harms, and risks to the individual patient. The decision to engage in sex often involves consideration of another’s satisfaction—it is not unknown for one spouse to agree to sex to please the other, even though he or […]

2016-11-21T13:02:41-05:00April 21st, 2015|Ethics, Nursing, nursing perspective, Patients|4 Comments
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AJN’s Spring Break with the Student Nurses in Phoenix: Sunnier Job Outlook for New Graduates?

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

PhoenixSkylineAfter a long winter in the Northeast, it was wonderful to visit Phoenix last week for the 63rd annual convention of the National Student Nurses’ Association (NSNA).

Like other meetings, this one was packed from morning to late evening with educational sessions, exhibits, resume-writing consultation, and for some, deliberating over 60 resolutions at the House of Delegates. Keynotes addressed:

  • health care reform (Gerri Lamb).
  • progress on implementing recommendations from the Future of Nursing report (Susan Hassmiller).
  • clinical ethics and moral distress (Veronica Feeg and Cynda Rushton).
  • and, the closing speech, a charge to continue nursing’s legacy into the future (yours truly).

Concurrent sessions, most of them well attended by Starbucks-fueled students, covered nursing specialties, exam help, licensure and legal/ethical issues, and clinical topics. (Betsy Todd, AJN‘s clinical editor, who is also an epidemiologist, led a session called “Is It Safe: Protecting Ourselves and Our Patients from Infectious Diseases.”)

Changing job climate? Several students I spoke with who were graduating at the end of the semester didn’t seem to have the anxiety of previous years’ students over securing a job. Maybe this is because things are looking up in the job market for new graduate nurses, at least according to recent figures in NSNA’s annual survey of graduates.

Reporting in the January issue of Dean’s Notes, researcher Veronica Feeg, associate dean of Molloy […]

2016-11-21T13:02:41-05:00April 17th, 2015|career, Nursing, nursing perspective, students|0 Comments
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Never Too Late: One Family Practice’s Shift to EHRs after 50 Years of Paper

Editor’s note: We hear a lot about the stress and lack of time for direct patient care that nurses (and physicians) have experienced with the movement to EMRs or EHRs. We’re in a transitional period, and in some instances the use and design of these systems has a long ways to go. But here’s a story with a positive slant, written by someone who might easily have responded very differently, given the circumstances. Change is inevitable; how we react to it throughout our lives, less so. 

By Marilyn Kiesling Howard, ARNP

Niklas Bildhauer/ Wikimedia Commons Niklas Bildhauer/ Wikimedia Commons

I am a nurse practitioner and my husband of 60 years is a family practitioner. We still work full time in our Gulf Breeze, Florida, practice. About five years ago, we first learned that our paper records were becoming archaic and that Medicare was planning to penalize providers who didn’t switch to the use of electronic health records (EHRs) by a certain date.

It was terrible news—we had 50 years of work in the paper chart genre, and were unsure about how to make the transition. Some who were in our position took the pending requirements as an opportunity to retire, but we weren’t ready for that.

Embracing a predigital innovation. In the 1960s, we started a small family practice […]

2016-11-21T13:02:42-05:00April 16th, 2015|digital health, Nursing, Technology|4 Comments
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Recent End-of-Life Care Links of Note, by Nurses and Others

nature's own tightrope/marie and alistair knock/flickr creative commons nature’s own tightrope/marie and alistair knock/flickr creative commons

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent

2016-11-21T13:02:42-05:00April 13th, 2015|career, Nursing, nursing perspective, patient engagement|0 Comments
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Bedpans and Learning: Nursing Basics Still Matter

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

Photo by Morrissey, via Flickr. Photo by Morrissey, via Flickr.

There I was, orienting to a busy medical ICU, perplexed over a bedpan. You’d think, since I was just graduating from nursing school, that bedpans would be my area of expertise. Critical thinking and vent strategies came easy; how could I possible admit I had no idea how to give a bedpan to a patient?

Frightening, to graduate from nursing school and a competitive externship program without this competency. Somehow, though, every unit I’d experienced offered patient care assistants, or patients who didn’t need this age-old tool. I’d certainly helped patients to the bathroom and cleaned incontinent ones. Despite the barrage of clinical learning, the basics of offering the pink plastic tool hadn’t sunk in.

Paralyzed, I stood with it in my hand, looking at my intubated, awake patient. I’d had the wherewithal to ask the family to step out, but couldn’t figure out which end went first. The horror of my preceptor finding it backwards would end me. Did the pointed end go towards the patient’s back? The larger end toward the feet for better coverage? Why couldn’t I remember?

Somehow, I managed to decide, and […]

2016-11-21T13:02:43-05:00April 8th, 2015|career, narratives, Nursing, nursing perspective, patient engagement|7 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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