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. […]

February 3rd, 2017|Ethics, Nursing|0 Comments

Top Nursing, Policy, Clinical Stories of 2016

Crowd members hold candles during a vigil for the victims of a mass shooting at the Pulse nightclub in Orlando, Florida. Photo © Associated Press

Late last year, we asked our editorial board members and contributing editors to tell us what they thought were the most important health news stories of 2016. In our January article “The Year in Review 2016,” we take a closer look at three of their most-mentioned topics: the Affordable Care Act (ACA), opioid misuse, and Zika virus.

What other issues stood out last year in specific areas of health care? We compiled top news story roundups for several categories—here’s an overview (click the links below to read the full articles):

Health Care Policy

  • Gun violence
  • Access to care: LGBT health, migrants, mental health care, medication costs, rural health care

Nursing

  • Workplace stress: 12-hour shifts, EHRs, evidence-based practice, staffing
  • Nursing education: increased access, faculty shortage, expanded simulation, improved employment prospects
  • Care delivery barriers: care for veterans, nurses’ practice authority

Clinical News

  • Sepsis awareness
  • Maternal mortality
  • Patient engagement
  • Population health trends

Finally, see “Stories to Watch in 2017” for a discussion of a few health topics, aside from the fate of the ACA, that we expect to hear more about this year.

January 23rd, 2017|Nursing, Public health|0 Comments

Health Care Terms and Words To Retire and Replace?

This week, two bloggers posted lists of words or terms they felt should no longer be used when referring to health professionals or patients.

  • Harrison Reed, a physician assistant who writes for In Practice, a blog at NEJM Journal Watch, wrote “Seven Medical Terms to Ditch in 2017.” On his list was LFTs (liver function tests); regular rate and rhythm (RRR): little old lady (LOL); AAM or AAF (other potential objections aside, these are often taken to mean African-American male or female, but can just as easily mean Asian-America male or female); and nauseous when one actually means nauseated. He also would like to see an end to the use of the modifier “midlevel,” as when it’s used to refer to NPs or PAs as “midlevel providers.”
  • Over at KevinMD.com, physician Pamela Wible published “Stop saying these 7 shaming words in medicine. Right now.” Her list included phrases to abandon, along with replacements that she believes to be more accurate and/or respectful. For example, she advocates replacing “is bipolar” with “has bipolar […]

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 […]

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 […]

December 16th, 2016|Ethics, healthcare social media, Nursing|2 Comments