Comments for The Nursing Ethics Blog

Comment on Flu Shot Ethics: the Value & Limits of Autonomy by Chris MacDonald

Chris MacDonald — Sat, 18 Feb 2012 22:24:10 +0000

Karen:
Your points are well taken, but I think we need to be cautious about letting autonomy trump all other considerations. After all, no one says health professionals “must feel free to choose” whether to have sex with patients. It is simply forbidden, as it should be. With professionalism comes a range of responsibilities, many of which limit professionals’ freedoms. So it’s at least not obvious that health professionals *must* feel free to choose.

Chris.

Comment on Flu Shot Ethics: the Value & Limits of Autonomy by Karen Oostra

Karen Oostra — Sat, 18 Feb 2012 20:37:29 +0000

Requiring immunization against influenza for healthcare workers is an ethical question that must be considered carefully. While it is desirable for employees to be protected for their own health benefit, for the employer’s benefit in that the employee more likely to report for work, the real benefit is to the patients they serve. For vulnerable patients or clients to be infected with influenza by a healthcare worker is unacceptable. If this were the only consideration, the answer would be quite simple. The other side of the story, however, is that requiring healthcare workers to provide proof of annual immunization violates their autonomy and does put them at some risk The pressure of occupational requirements erodes the concept of informed consent. No immunization comes without the risk of side effects or the possibility of adverse outcomes. An employee must feel free to choose influenza immunization based on an informed assessment of benefits and risks. As fellow healthcare providers our role is to provide a fair assessment of benefit and risk in the context of their health history and health beliefs. I will be the first to say we need to do a better job of this, as well as portraying the reality that choosing not to be immunized affects the welfare of their patients.

Comment on Doctors, Nurses, and the Ethics of Bullying by Rick Turner

Rick Turner — Sat, 04 Feb 2012 00:20:00 +0000

Hi thanks so much for a very interesting article. As a registered nurse I think it is very important that we understand where nurse bullying comes from and why it continues to flourish in our healthcare systems.

http://critcare-reflectionsofamalenurse.blogspot.com/2011/09/hospital-corners-origins-of-nursing.html

Comment on Compassion Fatigue by Raigne Symes

Raigne Symes — Tue, 31 Jan 2012 17:29:18 +0000

I agree that it is important to address the impact of compassion fatigue on nurses as well as patients. This is an important idea presented in this article. I also agree with your statement that it is the obligation of healthcare to safeguard their employees mental and emotional health. I do wonder if the onus of compassion fatigue should however remain primarily with the individual nurse.

Lombardo & Eyre suggest that “the nurse’s relationship with self is a core concept in managing compassion fatigue. Nurses need to be assertive, to express personal needs and values, and to view work-life balance as an achievable outcome. This relationship with self is essential for optimizing one’s health, for being empathic with others, and for being a productive member of a work group within a healthcare facility.” The nurse must actively strive to balance his/her professional and personal life in order to prevent compassion fatigue. I am not suggesting that the healthcare organizations have no role to play in offering assistance to staff with identification and resolution of compassion fatigue, but the primary responsibility must remain with each nurse.

Reference
Lombardo, B. & Eyre, C. (2011). Compassion fatigue: A nurse’s primer. Online journal of Issues in Nursing, 16(1).

Comment on Doctors, Nurses, and the Ethics of Bullying by mohinder

mohinder — Mon, 09 Jan 2012 08:27:06 +0000

Bullying is getting more and more common in workplace, the power the manager had is too much. The hardest part is that even you know that you are treated unfairly there are nothing much you can do, because some hidden bullying is hard to prove. Most of the time the bullies know how to bully you and not get in to trouble by doing so. Another thing I had seen in nursing is that nurses rarely stood up for another nurse because they don’t want to be the next target. With no peer support you cannot do much against the bullies especially when that is your manager or charge nurse. So you think you can ask the union to help, but no since bullying is not violating the collective agreement. I had experienced being bullied, it was obvious but I was not able to proof it and had to stick it out until the manger leaves. It caused so much unhappiness and my life was miserable, going to work was like going to a jail. It affects my health, my social life and personal relationship. Making matter worse even though I was qualified to get job and many job was offered, the manager decided to not to give me a reference, so all the 5 years I spend at that place would have gone unnoticed, no choice just stay at the miserable job thinking only about paycheck and waited until she was transferred.

Comment on When Did We Stop Talking About End of Life Care? by mohinder

mohinder — Mon, 09 Jan 2012 08:02:06 +0000

This was quite unacceptable to make patients DNR without discussing with family or patients, there are times when the patient are near death and doing CPR will cause more harm than good, that time the physician made decision and write DNR order. Being nurse for many years I had always discuss the DNR with the family, it can be a very difficult discussion during a traumatic event especially when the family are still in the initial denial phase. When reading the article I was quite impressed that it was mentioned that it is something that is a responsibility of the whole team. Frankly, other than the nurse bringing this to the attention of the doctors no one does, the team member will discuss with the nurse by saying Yeah, he/she should be a DNR. But no one take initiation to actually address the issue many are afraid to offend the families. So in other word the nurses end up mostly bear the responsbility of discussing it with the families and notifying the doctors regarding their wish or arrange for a family conference.

Comment on Disaster Relief, Positive Role Models, and Everyday Heroism by Yvonne

Yvonne — Thu, 08 Dec 2011 22:31:57 +0000

Dear Colleagues,
I came across an article in the Maple Ridge/Pitt Meadows Times Dec 6/2011 written by D. Gardner regarding his experience with the Health Care Professionals. He recently lost his wife of more than 35 yrs to chronic disease and he states “my family and I are grateful for the skill, sensitivity and respect shown by Fraser Health physicians, nurses and home care providers who supported us through a very difficult time” p. A9. According to William, 2010, ethics isn’t just about avoiding wrongdoing. It’s also about doing good things.” pg. 2
Williams, S (2011) talks about the wonderful work nurses are doing in Haiti in an article posted on The Nursing Ethics Blog. The article goes on to say that these acts by the nurses may appear heroic to the public. William, S. (2011) goes on to say that in this scenario nurses deserve praise and what they’re doing is truly wonderful. But it’s also worth remembering that, within the nursing profession, the line that most of the public sees between “just doing your job” and going “above and beyond” gets blurred ” http://nursingethicsblog.com/page/2/.
Not too long ago I got an employee letter from my Hospice manager thanking me for going “above and beyond” regarding the care of one of my patient and their family. I was happy to get such recognition. Upon reflection I realized that I would have done the same in any situation as a nurse. According to William, S. (2011), this is every day ethical nursing and there are ofcourse limits to what we can and cannot do as human beings.
In my scenario, I like that as a nurse, I am doing the right thing when I make decisions to advocate for my patients and their families. Because I am leading to Utilitarian theory most of the key stakeholders are happy with the care I have provided. Moreover, I value patient autonomy and therefore I work towards empowering patients and their families towards their health and well being.

References
Williams, S. 2011. Nurses Head To Haiti On Teaching Mission. The Nursing Ethics Blog. Retrieved on Dec 7, 2011 http://nursingethicsblog.com/pg 2
Gardner, D. 2011. Fraser Health Owned a Family’s Gratitude. Maple Ridge/Pitt Meadows Times

Comment on Families at the Bedside by Mohinder Mann

Mohinder Mann — Tue, 06 Dec 2011 05:38:42 +0000

Mohinder

I don’t like restricted visiting hours, sometimes there are family members who fly overseas just to visit their parents. When my father had a stroke, I went to visit him and they restricted my visiting hour there was no exception. When I was there I was able to feed him and get him up to the chair and take him down for a walk in the wheelchair, I even made his bed and clean the bedside area for him. The nursing staff was way to busy to perform this minor duties which was actually very important for my father. Me being there had helped him so much, it actually prevented him from getting DVT and depressed and for a 70 years old man staying in hospital all day long was very difficult.

When your visiting hours are restricted obviously all the families members are going to come and visit within the visiting hours, then you are restricting the visitors which is very inconveient for the family members. Neither should be restricted.

Comment on Nurses Top Honesty and Ethics List by May Tao

May Tao — Sat, 03 Dec 2011 17:06:48 +0000

Hello Dr. MacDonald,

Hurray! I am proud to be a nurse!
My name is May Tao and I am studying in the Masters of Nursing at Trinity Western University. My professor asked us to read your blog, thinking critically of the issues and providing comments and feedback.

I am delighted to know that the American community ranked nurses number one as the most honest profession. I think there would be a similar result in Canada. As Morrison (2011) mentioned, truth-telling is a crucial characteristic in health care organizations and the profession.

Despite the moral distress that we experience in our day to day practice, we as nurses treat the characteristic of truth-telling as the prime virtue to possess in the profession. It is also embedded under the fifth provision of the American (ANA) Code of Ethics for Nurses as the responsibility to preserve integrity. In Canada, our Code of Ethics for Registered Nurses from the Canadian Nurses Association also stated that nurses do not engage in any form of lying. Nurses are obliged to be truthful not only in their professional life but also in their personal life.

Hardingham (2004) also emphasized a pivotal factor in building integrity is to create a moral community as an environment to practice ethically. As a moral agent and leader, I would urge all the health care organizations to provide an open and safe space and time for nurses to express their moral issues. By providing excellent care with integrity to our clients and our communities, we would continue to shine and honor our nursing profession.

References
American Nurses Association. (2010). Code of ethics for nurses. Washington, DC: Author.

Canadian Nurses Association. (2008). Code of ethics for Registered Nurses. Ottawa, ON: Author.

Hardingham, L. (2004). Integrity and moral residue: Nurses as participants in a moral community. Nursing Philosophy (5)2: 127–134.
Doi: 10.1111/j.1466-769X.2004.00160.x

Morrison, E. (2011). Ethics in Health Administration: A practical approach for decision makers. Sudbury, MA: Jones and Barrlett Publisher.

Comment on When Did We Stop Talking About End of Life Care? by Ellen Ramsden

Ellen Ramsden — Fri, 02 Dec 2011 05:31:46 +0000

As part of admission and clinical assessment, the nurse must ask the patient if they have Advance Directives, who have they appointed to make decisions for them, and in their own words, do they want the hospital staff to perform CPR if their heart stops – in other words do they want to be a full code. The hospital should make provisions for patients who do not have Advance Directives – perhaps pastoral care can fulfil this service at no cost to the patient – Until a doctor writes a DNR order, the patient is a full code, a nurse is in a position to communicate to the physician a patient’s wishes – and so is the family.