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Want to Achieve the ‘Greatest Good’? Listen to Your Patients

Ethical dilemmas abound in nursing practice. Consider these commonplace scenarios:

* An angry patient threatens to leave the hospital against medical advice. Should you hold him against his will?

* A cancer patient fears chemotherapy. Should you give less detailed information about the effects of anticancer drugs?

* An obese home care patient with pressure ulcers refuses to cooperate in turning. Should you turn her anyway?

Such conflicts between the patient’s wishes and the nurse’s perception of the patient’s best interests occur regularly. That doesn’t make these ethical dilemmas any easier to resolve, but how nurses approach them can significantly affect clinical outcomes. Taking the time to listen to patients—and to integrate relationship skills with principles of ethical practice—can help nurses achieve solutions that are both ethical and appropriate for individual patients.

ky olsen/via Flickr

That’s from the February issue of AJN, in which nurse–ethicist Doug Olsen (who has in the past written for this blog on ethical issues related to mandated H1N1 vaccinations for nurses) offers a thoughtful discussion that may resonate for all nurses who’ve ever faced a situation like those in the above examples. It may seem obvious or cliched to say that listening to patients can help solve apparently intractable problems—but just because listening as a skill is hard to measure doesn’t mean that it’s not sometimes effective where more rigid tactics would fail.

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:19:32-05:00February 9th, 2010|Ethics, Nursing, patient engagement|0 Comments

Oh for a Thimbleful of Gratitude!

By Christine Moffa, AJN clinical editor

I had surgery 12/28 and spent four days on med-surg afterwards. I literally spent 3/4 of my time sleeping (bliss! oh rapture unforseen!), but *every single time* anyone came into my room for any reason (meds, IV change, turn off the freaking IV alarm, phlebotomist, housekeeping, whatever), I said “thank you.” I got the feeling I was abnormal. . . . So. How often do your pts say thank you, and does it come as a surprise when they do?

It’s been a few years since I’ve worked directly with patients, but in the past when I had a particularly tough day I would tell people that “nursing is a thankless job.” I’m talking about the kind of day when you barely had time to use the bathroom, never mind eat something, and the only feedback you heard from patients and administration was about what you didn’t get done. So when I saw a post (excerpted above) called “How often do your pts thank you?” at Allnurses.com, it hit a nerve.

The responses to the post were mixed, with some saying it’s common to be thanked by patients and others arguing the opposite. Maybe it’s regional—I’ve only worked on the East Coast, and in my experience complaints seem to get more air time than gratitude. Or maybe it’s just the times we’re living in. Either way, I’m sure most nurses would say they didn’t choose this career in the hope […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:19:44-05:00January 29th, 2010|nursing perspective, patient engagement|7 Comments

An End to Interruptions: Nurses Preventing Medication Errors

By Christine Moffa, MS, RN, AJN clinical editor

By NathanF/via Flickr (Creative Commons)

Interruptions are distracting.

I have a hard time focusing when I am repeatedly interrupted. How many times have you walked down the hall to get something, met with an unexpected request or encounter, and then found you couldn’t remember where you were going or why?

A few years ago I was working as float nurse in an outpatient facility. One of the specialties I floated to was the pediatric clinic. There were seven or eight nurses (a mix of RNs and LPNs) working at the same time, with half assigned to administering medication, mostly vaccines, and the others performing telephone triage and monitoring patients in the observation room. I can now admit that I used to pray to get assigned to the triage section—not because giving injections was a problem, but because the setup of their system terrified me. […]

Guest Author2019-04-11T14:14:07-04:00November 5th, 2009|nursing perspective, nursing research, patient safety|7 Comments

Voluntarily Stopping Eating and Drinking (VSED): What Is It and How Does It Work?

Is there a legal end-of-life option for people who are terminally ill or whose quality of life has reached what they feel to be an unbearable level? Even in states without right-to-die laws, there is. It’s called voluntarily stopping eating and drinking (VSED). Judith Schwarz wrote about VSED in the September 2009 issue of AJN. The article includes a case study. Here’s an excerpt:

Gertrude (not her real name; other identifying details have been changed) was 99 years old. Having survived the Holocaust and overcome many other challenges in her long life, she thought it ironic that she had to ask her children to help her die.

Although she was not terminally ill, the quality of her life was significantly diminished by many chronic ailments. Despite two hearing aids, her hearing loss was such that she could no longer indulge her one remaining pleasure: listening to classical music. She had fallen and broken a hip when she was 96 and now had to use a wheelchair when moving around her apartment. She had severe arthritis, and she rarely left her apartment except for medical appointments. All friends and many family members had long since died, and her deteriorating vision-a result of a recent bout of shingles-left her unable to read or watch television. After years of living with these and other chronic conditions, she told her family she was tired of life and was ready to leave. Her children and grandchildren told her to be patient. She was almost 100; […]

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Jacob Molyneux, senior editor/blog editor2016-10-23T10:59:26-04:00September 18th, 2009|Ethics, Nursing, Patients|1 Comment

Nurse Ethicist Weighs in on Nurses Who May Have Helped Merck Hawk Vioxx

By wonker, via Flickr.

According to a story in The Australian, the drug company Merck has been accused of paying nurses to sift through patient medical records in search of potential candidates for the drug Vioxx. Here’s what nurse ethicist Douglas Olsen, who recently wrote a two-part article (here’s part one; part two is here) for AJN on nurses and the pharmaceutical industry, wrote to us about the story:

The news report demonstrates the public’s visceral sense that the Merck program in Australia was unethical. Nurses, as well as doctors and pharmacists, can anticipate righteous indignation whenever their clinical deliberations appear compromised by a company’s desire to sell a particular drug. […]

Guest Author2016-11-21T13:28:15-05:00May 19th, 2009|Ethics, Nursing, patient safety, Public health|0 Comments