By Stacey Kusterbeck
Nurses spend more time with patients and families than other healthcare providers. “Yet, they do not always have the greatest authority and power. This means that they can experience ethical challenges and burdens in a different way to other healthcare professionals,” says Georgina Morley, PhD, MSc, RN, HEC-C, director of the Nursing Ethics Program at the Cleveland Clinic.
Morley and colleagues created an ethics education program specifically to meet the needs of nurses. The education program is one component of a larger Nursing Ethics Program, which conducts empirical research on ethical challenges through the lens of nursing practice. “Nurses report feeling underprepared to address the ethical issues they encounter in their practice. Our overall program mission is to empower nurses with greater ethics knowledge and skills,” says Morley.
Nurses get ethics education on neuroethics, research ethics, and transplant ethics, and other topics. All the education is centered around the questions clinical nurses face.
The researchers surveyed 20 nurses who completed the program.1 The nurses reported that the content increased their ability to provide ethical care and their confidence in ethics. The participants also reported a strong preference for nursing-focused ethics training. “Nurses really did want to receive education from other nurses,” reports Morley.
The ethics education faculty provided additional sessions specifically for nurses. Some of the sessions focused on hospital policies with an ethical aspect, such as workplace violence. “This is such a challenging ethical issue across all of healthcare. We had a really thorough debate about various approaches to address workplace violence,” says Morley. Nurses talked about the ethical complexity of restricting visitation when a family member is violent because they are upset that their loved one is dying, and how to balance a compassionate response with caregiver safety.
Typically, ethics education programs bring all healthcare professionals together in a multidisciplinary forum. “Those programs are great, but they should be in addition to nursing-oriented programs,” argues Morley. “Nurses need their own unique spaces to think through and discuss ethical challenges as they are encountered by nurses. There is a danger that this orientation is lost when the education is provided to a broader group.”
Bioethics education often covers attention-grabbing topics. Those include conflict relating to life-sustaining treatment and allocation of scarce resources. “Although these topics also relate to nursing, to an extent, they oftentimes focus on the provider-patient dyad,” says Shika Kalevor, MBE, BSN, RN, HEC-C, a clinical ethicist and program director of the Integrated Ethics Program at Children’s Minnesota.
In Kalevor’s experience, everyday ethics topics resonate most with nurses. “Nurses act as what I like to call the ‘hands of medicine.’ If nurses lack confidence in their ability to address ethical issues in their role, it can absolutely increase moral distress, burnout, and suboptimal care outcomes. This occurs frequently in settings where you are more likely to encounter ethically challenging situations, like an ICU [intensive care unit],” says Kalevor. Ethicists at Children’s Minnesota offer ethics education for nurses in the following ways:
- providing continuing education sessions for nursing in the form of grand rounds;
- encouraging nurses to attend weekly interdisciplinary rounds to address any ethical concerns as they come up;
- presenting on ethics topics during nursing staff meetings.
Nurses with an interest in ethics can participate in the ethics liaison program. Those nurses receive ethics training, and host monthly ethics forums for their respective units. At these forums, the nurse ethics liaison explores real-life ethical issues with colleagues. “The goal is to provide an environment for reflective dialogue and sharing of experiences, to increase participants’ confidence in dealing with ethically challenging situations,” says Kalevor.
Nurses face many “everyday” ethics issues that do not rise to the level of a formal ethics consultation. “The issue appears to be a clinical situation, but there is an underlying ethical concern. Such problems, when not recognized or unaddressed, may later lead to conflictual situations,” says Pamela J. Grace, RN, PhD, FAAN, associate professor emeritus at Boston College.
Nurses may feel conflicted if they learn that a patient was given advice from a specialist that is narrowly focused on a specific medical condition, without considering the patient’s overall well-being. For instance, cardiology may recommend drugs that adversely affect the patient’s psychological status.
For example, a cardiologist may change a patient’s anti-hypertension drug to a beta-blocker, and the patient reports worsening depression. The nurse updates the physician on what is happening, but the physician brushes off the concern. “It is possible that the increasing depression is not caused by the beta-blocker alone. But the nurse’s concerns should be taken seriously if the patient is to get optimal care and not be harmed. While a seemingly trivial example, it would not seem that way to the patient,” says Grace.
Nurses also are involved in discharges that appear unsafe. Patients may be discharged home in the care of a spouse, when nurses know that the patient is the caregiver for the spouse who suffers from dementia.
In these situations, ethicists can assist simply by being visible on acute care and specialty units. “Ethicists can ask the nurses questions, show respect for their point of view, and help them identify resources for educating themselves,” says Grace.
Reference
1. Morley G, Copley DJ, Bena JF, et al. “Moral spaces”: A feasibility study to build nurses’ ethical confidence and competence. Nurs Ethics. 2024; Sep 27. doi: 10.1177/09697330241284356. [Online ahead of print].
Nurses spend more time with patients and families than other healthcare providers. “Yet, they do not always have the greatest authority and power. This means that they can experience ethical challenges and burdens in a different way to other healthcare professionals,” says Georgina Morley, PhD, MSc, RN, HEC-C, director of the Nursing Ethics Program at the Cleveland Clinic.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content