Lucia D. Wocial

Team-based learning and ethics education in nursing

This report describes the use of team-based learning concepts in an undergraduate nursing applied ethics course using established reporting guidelines. Team-based learning relies on actively engaging students in the learning process through small-group activities that facilitate the development of skills, including concept analysis, critical thinking, and problem solving. Students are divided into teams of five to seven members who collaborate throughout the semester to work through activities that build on ethics concepts introduced through reading and lectures. Nurse educators are challenged to develop educational approaches that will engage students and help them to apply what they learn from the study of ethics to the lived experience of clinical practice. The ultimate goal is to help students to develop into morally sensitive and competent professionals. Team-based learning represents a novel way to teach these skills to undergraduate nursing students.

Nurse Ethicist: Innovative Resource for Nurses

Nurses are challenged with ethical problems on a daily basis, yet when they are students, nurses may have never had an opportunity to explore the complexities of how ethics will influence every facet of their nursing practice. This article describes how a large health care system, through collaboration between academic and clinical partners, developed a nurse ethicist role to serve both the patient care environment and students in academic programs. The nurse ethicist is charged with creating and sustaining programs in ethics and nursing ethics education with the goal of improving the capacity of nurses to manage the ethical issues inherent in the care of patients in a contemporary, technology-driven health care system. The Program in Nursing Ethics includes staff education, consultation and support, and research. The addition to the faculty of a nurse ethicist who is active in clinical ethics consultation has strengthened the baccalaureate nursing curriculum by providing an instructor who creates and shares a clear vision for how ethics is central to quality nursing care. This article describes the central role of a nurse ethicist in promoting ethical nursing practice.

An Urgent Call for Ethics Education

The target article by Grady and colleagues (2008) is a valuable and exciting contribution to the debate about the importance of ethics education for nurses. The findings indicated that ethics education, especially continuing education or in-house training positively influences confidence, use of ethics resources, and moral action. Yet one in five nurses in this study reported having no ethics education at all. It should come as no surprise then that nurses tended more often than social workers to choose “feel concerned but take no further action” (Grady et al. 2008, 4) on moral action items. Nurses’ evident lack of moral action, despite feeling concern is consistent with the classic definition of moral distress: a phenomenon that occurs when a nurse believes that she or he knows what is the correct action to take, but feels constrained from performing that action (Gordon and Hamric 2006). It seems that moral distress is a failure of the advocacy role. It is important then to consider the link to advocacy in more depth.

Futility Disputes: A Review of the Literature and Proposed Model for Dispute Navigation Through Trust Building

Futility disputes in the intensive care unit setting have received significant attention in the literature over the past several years. Although the idea of improving communication in an attempt to resolve these challenging situations has been regularly discussed, the concept and role of trust building as the means by which communication improves and disputes are best navigated is largely absent. We take this opportunity to review the current literature on futility disputes and argue the important role of broken trust in these encounters, highlighting current evidence establishing the necessity and utility of trust in both medical decision-making and effective communication. Finally, we propose a futility dispute navigation model built upon improved communication through trust building.

A Misunderstanding of Moral Distress

in general). As we have argued in the preceding, the relationship between MS and MD seems to be complicated. It seems plausible to assume that an enhancement of MS would—at least temporarily—lead to higher levels of MD. However, these negative emotions should ideally motivate people, such as medical practitioners, to change their own behaviors or to challenge how things are done in their contexts. After all, nobody would argue that a bad conscience is a bad thing—as long as we “deserve” to feel bad about something. The challenge here is to additionally equip medical practitioners with adequate attitudes, skills, and strategies to deal with the ethical features of their work in a constructive way—only promoting moral sensitivity may fall too short. Therefore, both trainings for and assessments of MS should also investigate other resources and outcomes, including moral distress.

CEASE: A Guide for Clinicians on How to Stop Resuscitation Efforts

Resuscitation programs such as Advanced Cardiac Life Support, Cardiac Life Support, Pediatric Advanced Life Support, and the Neonatal Resuscitation Program offer inadequate guidance to physicians who must ultimately decide when to stop resuscitation efforts. These decisions involve clinical and ethical judgments and are complicated by communication challenges, group dynamics, and family considerations. This article presents a framework, summarized in a mnemonic (CEASE: Clinical Features, Effectiveness, Ask, Stop, Explain), for how to stop resuscitation efforts and communicate that decision to clinicians and ultimately the patients family. Rather than a decision rule, this mnemonic represents a framework based on best evidence for when physicians are considering stopping resuscitation efforts and provides guidance on how to communicate that decision.

Image is more than a uniform: the promise of assurance.

OBJECTIVE: The purpose of this qualitative study was to explore the meaning of the phrase “image of the nurse” in the context of the desired brand experience of assurance. BACKGROUND: A brand is a promise that lives in the minds of consumers. Nurses play a key role in delivering on the brand promise of a hospital. METHODS: Using focus groups, the authors applied a deductive approach to generate data. Discussion transcripts were analyzed by establishing codes and identifying themes. RESULTS: The most frequent comment from participants was that for nurses to communicate assurance, they must 1st be clean, well groomed, and understated in overall appearance. Nurse behaviors that reassure patients include being present with patients, helping patients know what to expect, and demonstrating a consistent team approach. CONCLUSIONS: Overall appearance and behaviors define the image of nurses and contribute significantly to the brand of assurance.

An Ethical Analysis of Opt-Out HIV Screening for Pregnant Women

Critical advances in prevention of mother-to-child-transmission (MTCT) of the HIV in the perinatal period have changed practice recommendations for HIV screening for pregnant women. Using case studies we illustrate the ethical complexities and implications of opt-out HIV testing for pregnant women. Despite the potential for compromised informed consent, an opt-out HIV screening approach is ethically defensible.

Commentary: Courage is the only ethical choice

M ohr makes a strong argument for the need for action from nurse leaders in response to revelations of health care providers’ involvement in unethical treatment of ‘‘enemy combatants’’ in the ‘‘war on terror.’’ Although the evidence for nurse involvement may be less well publicized or documented, dual loyalties and sometimes conflicting obligations embedded within the nursing role, particularly within a military hierarchy, make nurses vulnerable to losing their moral compass in these types of circumstances. Experiments in social psychology indicate that when placed in certain situations, ordinary people fulfill orders to cause harm to others, and in some cases inflict unnecessary suffering on others. Unlike military nurses in a war zone, subjects in these studies faced no real risk to their own safety if they questioned the orders to perform harmful acts. This behavior may be explained by learned helplessness, obedience to authority, or cognitive dissonance. With no clear explanation or rationale for such behavior, we must find a way to inoculate nurses against the moral compromise inherent in participation in torture. The ethical arguments against mistreatment in any form are overwhelming, even in circumstances of public emergency or when mistreatment may be used as a means to achieve a good, such as preventing the deaths of innocents. The principle of beneficence, one of the central principles of bioethics, requires that we take steps to help others. The moral obligations for reporting mistreatment (a positive duty) stems from beneficence. Alhough establishing precise conditions of an obligation of beneficence (a positive duty) is difficult, they can be established in special circumstances, such as when individuals accept the role and responsibilities inherent in being a nurse. In this circumstance, knowledge of mistreatment but failure to report it constitutes participation in it and suggests some moral compromise of those involved. Before we become nurses, we are citizens of the world. The United Nations Declaration on Human

Moral Distress in Rehabilitation

About a dozen years ago, I took the lead on surveying clinical and nonclinical staff members at the Rehabilitation Institute of Chicago (now the Shirley Ryan AbilityLab) about their perceived moral distress [1]. My colleagues and I asked, “We are interested in learning about the issues that create a sense of moral distress in your daily professional life. What types of situations are troubling for you because of your beliefs about what is right and wrong? What is troubling to you because of conflicts of values?” The results were published in this Journal in 2009 and for many years the data guided the priorities and focus of our ethics initiatives. The literature on moral distress has continued to grow since then and is relevant for all of us working in health care. For this column, I have invited Andy Kondrat, PhD, to be a guest editor. Dr Kondrat’s