Widespread Support for Nurse’s Refusal to Force-Feed: Grounded in Ethical Principles

By Maureen Shawn Kennedy, AJN editor-in-chief

Nasal tubes, gravity feeding bags, and the liquid nutrient Ensure used in Guantanamo force-feeding/ image via Wikimedia Commons Nasal tubes, gravity feeding bags, liquid nutrient Ensure used in Guantanamo force-feeding/Wikimedia Commons

Last week, reports hit the news media of a nurse in the U.S. Navy facing possible discharge for refusing to participate in force-feeding a hunger-striking prisoner at Guantanamo Bay. An early discharge, two years shy of the 20-year mark, could cost him his pension and other benefits.

The nurse had initially volunteered for duty at the Guantanamo facility, but then, as we noted in a blog post examining the ethics of his decision back in July, decided he could not continue to participate in force-feeding detainees in violation of professional ethics.

In a letter to Chuck Hagel, U.S. secretary of defense, the American Nurses Association has supported the decision of the naval nurse. ANA president Pam Cipriano reaffirms that a nurse’s primary commitment is to the patient and “in addition, this commitment is present regardless of the setting in which nursing care is provided. The military setting does not change the nurse’s ethical commitments or standards.” […]

2016-11-21T13:03:29-05:00November 24th, 2014|career, Ethics, Nursing, nursing perspective, Patients|2 Comments
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A Nurse’s Legal Duty to Discern Potential Harm and Protect Patients

Illustration by Janet Hamlin for AJN. Illustration by Janet Hamlin for AJN.

By Jacob Molyneux, AJN senior editor

The November installment of AJN’s Legal Clinic column by nurse and attorney Edie Brous, “Lessons Learned from Litigation: The Nurse’s Duty to Protect,” describes a case in which nurses were held responsible for not adequately protecting a sedated patient from a sexually predatory physician. The case description begins this way:

NX was a young woman who underwent a laser ablation of genital warts at Cabrini Medical Center in New York City. While still under the effects of general anesthesia, she was transferred to a small, four-bed section of the recovery room. Shortly after her admission to the recovery room, the nurses admitted another patient to a bed two feet away from NX. The curtains were not drawn and there were no patients in the other two beds.

A male surgical resident, Andrea Favara, entered the recovery room wearing Cabrini scrubs and Cabrini identification. Residents were not directly assigned to the recovery room and were seldom called there. The nurses knew all of NX’s physicians but did not know Favara; he wasn’t one of NX’s physicians . . .

The details that follow are disturbing. After describing the case and the failure of nurses to confront this unknown physician or actively monitor his interactions […]

2017-06-22T18:59:56-04:00November 7th, 2014|career, nursing perspective, Patients|0 Comments
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Nurses, Brittany Maynard, Methods of Hastening Dying: No Easy Options

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

Last weekend, 29-year-old Brittany Maynard died, in her bed, in her bedroom, with her husband and immediate family beside her. I learned of her death on Twitter, along with millions of other readers. Several weeks earlier, Maynard had publicly announced, in a YouTube video, the way she planned to end her own life: using a lethal dose of medications prescribed to her for that purpose.

Maynard, while a compelling public advocate, is not the first to choose to die this way. Compassion and Choices, the organization that worked with Maynard to publicize her choice, lobbies for the drafting and passage of “death with dignity” laws, which currently exist in some form only in Oregon, Washington, Vermont, New Mexico, and Montana. Arizona.

In Oregon, where Maynard moved in order to be able to legally end her life before she was incapacitated by the effects of terminal brain cancer, approximately 71 other people made the same choice in 2013, the most recent year of reported data—the peak of a gradual increase from the law’s inaugural year of 1998, when 16 people did so.

Illustration by Denny Bond for AJN. All rights reserved.

2016-11-21T13:03:35-05:00November 5th, 2014|Nursing, nursing perspective, patient engagement|8 Comments
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Presence, Improvisation, Dark Humor: Crucial Skills of a Hospice Nurse

Illustration by Pat Kinsella for AJN. Illustration by Pat Kinsella for AJN.

Here’s the start of “Molly,” the Reflections essay in the November issue of AJN, written by hospice nurse Thom Schwarz.

Late evening, early spring, the peepers not yet trilling. I am in my car, rain streaking the windshield, reading a New Yorker essay about war writing, an ironic distraction from my visiting hospice nursing work.

This is a piece that doesn’t offer any easy answers for the facts of suffering and death. But it does posit a certain consolation in staying present, undaunted, engaged, and resourceful when faced with the power and mystery of each patient’s encounter with impending death.

All Reflections essays are free, so give it a look.—Jacob Molyneux, senior editor 

2016-11-21T13:03:36-05:00November 3rd, 2014|narratives, Nursing, nursing perspective, patient engagement|3 Comments
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Choosing Wisely: American Academy of Nursing Highlights Unnecessary Nursing Practices

The American Academy of Nursing (AAN) recently announced that it has joined the ABIM Choosing Wisely campaign with a list that focuses specifically on nursing interventions or practices that are not supported by evidence. The list is called Five Things Nurses and Patients Should Question. Here it is in short form—full explanations of the rationale for each item are available at the above link.

  1. Don’t automatically initiate continuous electronic fetal heart rate Screen Shot 2014-10-24 at 11.10.10 AMmonitoring during labor for women without risk factors; consider intermittent auscultation first.
  2. Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
  3. Don’t use physical restraints with an older hospitalized patient.
  4. Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
  5. Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.

The Choosing Wisely initiative encourages health care provider organizations to create their own lists of tests and procedures that may be overused, unsafe, or duplicated elsewhere. Using these lists, providers can initiate conversation with their patients to help them choose the most necessary and evidence-based care for their individual situations. The lists are not meant to be proscriptive, and also address situations where the procedures may be appropriate. […]

2016-11-21T13:03:40-05:00October 24th, 2014|health care policy, nursing perspective, nursing research, patient engagement, Patients|6 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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