Promoting Nursing Students’ Ethical Development in the Clinical Setting

Ethics professor discusses high-fidelity patient simulation exercise with student. Photo courtesy of Linda Koharchik.

I once spent an hour in an ambulatory surgery PACU when interviewing for work at the place. A few minutes into my visit, one of the patients awoke in tears. The PACU RN proceeded to slap the woman across the face. An open-handed, full-face slap. “No crying here!” she snapped.

I was floored, and reported the incident to the clinic’s medical director. This nurse not only assaulted a patient, she did so in full view of a visitor (me). I suspect that if, instead, I had been an instructor from their medical center with students in tow, she would not have behaved differently. And would I have responded differently if students were present? Would I have confronted the nurse while other patients were watching, to make clear to the students that willfully harming a patient can never be tolerated?

Approaches to ethical instruction.

In “Promoting Nursing Students’ Ethical Development in the Clinical Setting” (free until December 13) in the November issue of AJN, Linda Koharchik and colleagues discuss the ways in which we can further students’ understanding of ethical practice—not only in the classroom, but also when we are with them on the clinical units. […]

2017-11-29T15:45:34+00:00 November 29th, 2017|Nursing|2 Comments

When a Family’s Faith in Healing Collides with a Busy Hospital Unit’s Pressures

Illustration by McClain Moore for AJN/all rights reserved.

What happens when a family of strong religious faith is determined to continue praying for a young father’s healing even after he dies of a terminal brain tumor in the MICU? The room is needed for other patients; a nursing student and her preceptor cared for the patient during his final hours of life and are now expected to provide postmortem care.

It’s a tricky, somewhat tense situation, and initial reactions among the nurses in the hospital vary. Melody Sumter, the author of this month’s Reflections  (“A Place for Faith: My First Experience of Cultural Competence in Nursing“), was the nursing student assigned to the patient, who left behind a young wife and 10-month-old child.

Looking back on the event, Sumter recalls her competing sympathies at the time, and the way she was gratified to learn that the nursing staff at last found a way to honor the wishes of the patient’s family and also see to their responsibilities to other patients. Writes Sumter:

Seeing this family practice their faith was encouraging for a young nursing student like myself—as was the nursing staff’s acceptance and support of a belief that most of them didn’t […]

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 […]

Nursing Insights: The Experience of a Chronic Illness as a Series of Subtractions

Illustration by Janet Hamlin for AJN. All rights reserved. Illustration by Janet Hamlin for AJN. All rights reserved.

Chronic illness is often experienced by patients as a series of subtractions. A progressive illness like Parkinson’s reveals this process vividly as the ability to move, speak, care for oneself, all gradually disappear or diminish.

The grief of lost freedom, lost abilities, lost agency, lost avenues of communication is easy to overlook. But it’s real, and can come out in uncomfortable ways. Here’s an excerpt from the start of this month’s Reflections essay in AJN, “A Room With a View.”

David was in his late 50s and had been diagnosed with Parkinson’s disease several years previously. Following a lengthy hospitalization, David’s wife agreed to a placement on the subacute/rehab unit in the facility where I was the instructor for nursing students during their older adult clinical rotation. . . . Although ravaged by the disease, David seemed to like having students provide his nursing care. . . .

One of his favorite activities was sitting by his room window, which overlooked the facility gardens and a play area for the preschool next door. For several weeks, I discovered a nursing student and David sitting by the window watching the outdoor activities in companionable silence. Students worried they weren’t providing nursing care, but I […]

Seeing Potential: The Joys of Teaching Nursing

By Ruth Smillie, MSN, RN, associate professor of nursing at Saint Josephs College, Standish, Maine.

"Buck Up," by zenera / via Flickr. by zenera / via Flickr.

The day I come to class pregnant is one of my favorites. I really hate to be pregnant; I’m 55, grey haired, and way too old to be pregnant. My students are obviously surprised when I waddle in swaybacked with my sudden eight-month pregnancy. They snicker and smile, and then the magic begins.

As each one brings up the “change” they were assigned, I acquire the mask of pregnancy: larger breasts (made from paper bowls), kidney stones and gallstones (collected from outside), more blood volume (once, in a soda bottle), varicose veins (pipe cleaners or string), and so on—all carefully attached to me by duct tape.

I look and feel ridiculous and we all laugh a lot, but that’s not the point. The point is that they remember the changes of pregnancy. Embarrassing as it is, I would do it every day if it helped them learn. I love to teach nursing and it has been an amazing experience.

Students have no idea how incredible they are. Most of mine are just out of high school, young and unaware of their potential. But they have it, and I can see and feel it. I love watching students […]