ethics

Hooray for the holidays! And a little bit of downtime to lay back, spend time with loved ones, and peruse the news. Here’s some of what I’ve been checking out these days:

What have you been reading this holiday season?

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MashupAdmittedly, my extra reading has been limited recently due to other priorities. That’s okay, I’ve still caught bits and pieces of some really great stuff lately such as:

What have you been reading lately?

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Here’s some of what I’ve been putting into my brain this week:

So what has caught your attention this week?

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Four years ago Diane Forster-Burke, MS, RN, professor at Westminster College in Salt Lake City, was looking for a way to recharge her teaching and utilize different education strategies to drive home the ethics of every day healthcare decisions nurses and other healthcare professionals make in routine practice. A colleague directed her to The Anatomy of Care, a serious role-playing game developed by WILL Interactive and MedStar Washington Hospital Center to improve customer service and increase patient satisfaction.

(Via WILL Interactive)

 

Professor Forster-Burke is now in her fourth year utilizing The Anatomy of Care game with undergraduate BSN students in their leadership capstone course. Forster-Burke states that even though there are no course points for how student groups progress through the game, the student nurses make decisions on a case-by-case basis and watch the expected and unexpected outcomes of their decisions; seeing senior nursing students “sit forward in their seats, engaged, interacting, and often laughing” during an 0800 class is worth it. She reiterates several times the safety of the simulation; “no one gets hurt.” Students can see the preferred choices as well as the worst-case scenarios of their decisions.

David Versaw, WILL Interactive CFO, explains The Anatomy of Care is used in several acute care hospitals and is sold through various distributors. The simulation methodology, which allows professionals and professionals in training to “step into someone else’s shoes, has shown dramatic improvements in HCAHPS scores, and WILL Interactive is even in the process of pursuing continuing nursing education credits for the course. 

If you’re like me and sometimes roll your eyes at nursing school simulations, you should view the demo. I agree with Forster-Burke that the game focuses on real-world pressures intertwined with patient care – like the nurse taking a personal call at the nurse’s station in the midst of patient care needs. “It really gets students thinking,” explains Forster-Burke, “about the role of the nurse as an advocate.” The game has quite the decision algorithms to allow for a broad simulation experience.

Simulation in professional education is not new, and role-playing games are increasingly providing “edutainment,” or education in the form of entertainment. Still, nursing education seems to be a late adopter to such technological education innovation. Simulation mannequins have sprinkled nursing education programs going on 15 years now, yet the education strategy is omitted from numerous programs due to financial and other barriers. Web-based simulation programs like The Anatomy of Care could be one solution to help undergraduate nursing students bolster their critical-thinking skills and decision making.

Have you ever used The Anatomy of Care or any other simulation game in your nursing education?

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Ethical Reasoning and Online Social Media

by Nursetopia on December 18, 2012

The Article: Englund, H., Chappy, S., & Jambunathan, J. (2012). Ethical reasoning and online social media. Nurse Educator, 37(6): 242-247.

Big Idea: While nurses and nursing students frequently utilize social media, little research has been done to understand nursing students’ own understanding of the ANA’s Principles for Social Networking or their accountability for their social media posts and how they relate to the ANA Code of Ethics. After experiencing an increase in students’ unprofessional use of social media, researchers at the University of Wisconsin Oshkosh surveyed their first semester and last semester undergraduate nursing students using a 21-item survey corresponding to the nine provisions within the Code of Ethics.

Survey Says!: 124 nursing students completed the surveys. Mean ages of the two semester groups were young – 22.4 and 24.4 years of age. The convenience sample was predominantly female, and the two groups – first semester and last semester students – had significant differences in their understanding of ethical decisions to not post certain information. Be sure to view the original article for the specifics of all the tests.

Quotable: “The increasing use of social media sites by nursing students has opened a ‘‘Pandora’s box’’ of issues related to ethicality and nursing professionalism in a cyber world” (p. 243).

“Although the CON [College of Nursing] has a policy in place, unfortunately, results of this study indicated that 27.5% of the sophomore 2 students and 30.4% of the senior 2 students were either unaware or unsure if the CON had such a policy. Clearly, more effective methods are needed to ensure that students are aware of the CON’s social media policy” (p. 247).

So What?: The stories of nurses and nursing students (and other healthcare professionals/students) misusing social media are everywhere. This study indicates nursing students have varying levels of understanding of ethical boundaries while using social media and that it is a learned skill. Perhaps nursing schools and programs should more heavily focus on this skill early in the curriculum to circumvent future issues.

This study could be easily replicable in any nursing school in the world. In fact, the authors encourage others to use their tool to further validate the survey. Every nurse should reach out to his alma mater to make it aware of this study and the tool as it just might shed some light on this highly unstudied yet incredibly needed area of research.

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By now, most know Susan G. Komen for the Cure reversed its decision to pull funding from Planned Parenthood for breast cancer screening services for low-income women.

Planned Parenthood is once again at the epicenter of a Federal and State blame-game that is about to leave 130,000 uninsured and underinsured Texas women without breast and cervical cancer screening services as the Medicaid Women’s Health Program slips into a Lone Star State oblivion.

130,000 women.

Imagine the entire population of New Haven, Connecticut was female and completely unable to access routine Pap smears or mammograms due to funding issues. There would be outrage. One “minor” difference – Texas is not Connecticut. Texas leads the nation in uninsured, with nearly 25% of our entire statewide population – one of every four Texans – lacking health insurance. What’s 130,000 more women? Cancer directly and indirectly costs Texas approximately $228 billion annually. What’s a few more billion in lack of healthcare access leading to an increase in late-stage breast and cervical cancers resulting in poorer health and economic prognoses?

Yes, those last few statements are dripping with sarcasm and disgust. My stomach turns, and I am angered as I read about President Obama and Governor Perry both claiming their hands are tied, they each are right, and the other is wrong and putting women’s lives at risk. As an oncology nurse focusing on Central Texas’ underserved women (whose faces may surprise you) – women (and their families) benefiting from the Medicaid Women’s Health Program  every single day – I can honestly say many will suffer if Texas is unable to use Federal funds for the Medicaid Women’s Health Program. Not only do the Medicaid Women’s Health Program funds cover breast and cervical cancer screenings, but the funds also cover expenses for women who have already been diagnosed with breast or cervical cancer, paying for life-saving treatments and provider appointments.

I understand the strong views behind both sides of abortion, which is stirring this big mess pot, as Planned Parenthood provides a myriad of women’s health resources ranging from family planning to cancer screenings. I imagine if we were talking about testicles rather than breasts and cervixes, though, this conversation would be very different.

Put away the partisanship. Women’s lives are not political pawns.

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The Huffington Post reported Linda Harvey, Mission America radio host, warned parent listeners to not allow gay healthcare professionals to care for their children while in the hospital. Actually, she said it was okay in emergent situations; but in non-emergent situations, openly gay healthcare professionals should not care for their children as they could erroneously influence them. She even told listeners they should file a letter with their pediatricians indicating such.

This story infuriated me as I first heard about it on the radio (a different station) and then read about it again later in the day. Infuriated me. It should really anger us all.

I’ve thought a lot about it, and this story angers me for two reasons. First, I am beside myself because Linda Harvey is a self-proclaimed Christian making these statements of hate. I don’t speak much about my religious beliefs here, but I am an unashamed Christ-lover. Nothing has influenced my life more than His Unconditional Love. Ms. Harvey’s words contradict so much of what I know is True. Second, I am angry because my gay healthcare colleagues – who went to school, trained over years to develop their services (and continue to do so), and work daily to care for and save the lives of complete strangers – have to deal with people claiming their sexual identities will ruin the lives of their patients.

Seriously? What year is this? Maybe Ms. Harvey would like us to eat in different restaurants, drink from different water fountains, and go to different schools, too?

Appalling.

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[Poll] Health Care a Human Right?

by Nursetopia on September 13, 2011

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A Real Nightmare: Serial Killer MDs and RNs

by Nursetopia on August 4, 2011

Last week The Advisory Board Company shared a brief article* indicating physicians and nurses were among the world’s top serial killers. Upon reading the article title, I thought, Oh, they must be talking about medication errors, right? Meh. Great title. You got me. [Click.]

"Instruments_of_Healing_02-HenriBlock" by HenriBlock via Flickr

Apparently not. The news brief was referring to Jeremy Laurance’s article “The Dangerous Power of Healing Hands” published by The Independent indicating physicians and nurses are among the most sinister serial killers in history – at least in the UK. Is this true for healthcare professionals in other countries? I have no idea, but others have, indeed, studied killer healthcare professionals throughout the world. John Field wrote his entire nursing PhD dissertation on the subject of nurses who murder, and he also points out the lack of this discussion within the nursing literature. Amazing. Who knew?! Herbert Kinnell wrote in a 2000 BMJ article that he believed the medical profession “attracts some people with a pathological interest in the power of life and death.” That’s very likely so. As a labor & delivery nurse turned oncology nurse, I’ve witnessed many of the soul-stirring life and death moments, and I must admit the fragility of life intrigues me.

However, let me reassure you it’s far from a “pathological interest”; I entered into nursing to help, not harm. Is that true for all nurses and physicians? Obviously not. People who were suppose to care and do no harm became the most terrifying individuals on our planet. They abused the trust for which our professions are known. There’s no doubt the healthcare professions worldwide are sprinkled with mal-intentioned people. So is every other profession. It is unfortunate. Thankfully, the altruistic individuals outnumber the malevolent ones.

*I tried – unsuccessfully – to locate this great snippet. Apologies, Friends.

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The Article: Gallagher, A. (2011). Moral distress and moral courage in everyday nursing practice. Online Journal of Issues in Nursing, 16(2).

Big Idea: Nurses must be courageous in the profession. Giving bad news, caring for angry patients, and asking tough questions of other colleagues and professionals requires courage. Yet, nurses often know the “right” things to do but don’t do them. That action – as a direct result of an organizational system – is defined as moral distress.

Survey Says!: Moral distress is quite common in nurses and the nursing profession. Often systems – whether knowingly or unknowingly – keep nurses from doing what they know is right. This article explores moral distress and moral courage among nurses in several situations in the UK and Ireland. Interestingly, nurses with higher levels of education and more experience have higher levels of moral distress. Strong coping strategies and peer support decrease moral distress and increase moral courage.

Quotable: I apologize I do not have page numbers for the following quotations as I printed the article in plain text rather than PDF format.

“…moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.”

“Additionally moral distress has been found to affect the health of nurses and their provisions of care, job satisfaction, and retention. Nurses who experience moral distress have reported physical symptoms, such as headache, neck pain, and stomach problems. Psychological and emotional symptoms include anger, guilt, depression, frustration, and feelings of reduced self-worth. They may also withdraw from family and friends (Schluter et al., 2008).”

“Aristotle has explained that courage is developed by habituation. This means that nurses and others become courageous by doing courageous things, by getting into the habit of acting courageously. However, courage is also a reflective activity requiring self-scrutiny and learning from the feedback and role modeling of others.”

So What?: Moral distress is very real within our profession. Nurses and nursing leaders can make a difference by role modeling courage in everyday practice, supporting moral courage, and working to deconstruct the systems perpetuating moral distress.

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