There’s No Charge to Check Ethics Baggage

There’s No Charge to Check Ethics Baggage

08/17/2010

  I am an ethics geek. I believe consulting with someone who is an expert in identifying ethical issues in complex patient situations and who has n[...]

  I am an ethics geek. I believe consulting with someone who is an expert in identifying ethical issues in complex patient situations and who has negotiation skills helps patients and helps the people who care for patients. So why is it so hard for people to ask for help in ethically challenging situations?
 
“Ethics” comes with baggage. In the old days, people would call ethics when someone was behaving badly. Physicians in particular were naturally defensive when they would hear “We’ve called ethics” because that translated into “You are behaving badly” or worse “You are unethical.”
 
Ethics is personal and when someone says, “We need help from ethics” it feels like hearing someone say, “Your morals are not good enough!” Ethics may be personal, but ethics consultation is professional. So how does one overcome this attitude on top of so much baggage from the past?
 
At Clarian, we’ve adopted a policy for ethics consultation. It describes what an ethics consultation is, namely a service meant to help patients, families and health care providers address ethical dilemmas. The goal of an ethics consultation is to promote and support sound ethical reasoning and thoughtful problem-solving in clinical practice.
 
Perhaps the most significant challenge to requesting an ethics consultation is the fear that asking for help will get someone in trouble. Intimidation and or reprisals (retaliation) for seeking help are inconsistent with Clarian’s core value of a community of trust and respect. Retaliation comes in many forms: cold shoulder, questioning judgment, changing an assignment, even yelling at someone. None of these responses, from anyone, is appropriate when an ethics consultation has been requested.
 
Clarian has an open access ethics consultation policy, meaning anyone involved in the care of a patient may request assistance from ethics. It takes a great deal of courage to seek help in a situation where you feel more than one choice may be right, and it is unclear what is best for a patient.
 
Lucia D. Wocial, PhD, RN
Clarian Health Nurse Ethicist
 
To be a registered nurse at Clarian, visit Registered Nursing Position Indiana. 

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Tue, 17 Aug 2010 17:37:13 +0100

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Teamwork Promotes Safe and Ethical Behavior

Teamwork Promotes Safe and Ethical Behavior

07/17/2010

When was the last time you tried to name Disney’s Seven Dwarfs? (Doc, Grumpy, Dopey, Sneezy, Sleepy, Bashful and Happy.) It’s a safe bet t[...]

When was the last time you tried to name Disney’s Seven Dwarfs? (Doc, Grumpy, Dopey, Sneezy, Sleepy, Bashful and Happy.) It’s a safe bet the Seven Dwarfs knew each other’s names, and Snow White learned them pretty quickly. The dwarfs had to rely on each other, and Snow White had to rely on them. They were, in essence, a team, in part because of established obligations of fidelity.

Like the fictional world of Disney, our very real world of health care involves obligations of fidelity. These obligations arise whenever a health care professional establishes a significant relationship with someone else, usually a patient. Fidelity establishes a commitment to another person, a promise to be faithful and loyal. Obviously we need to establish this relationship with patients, but what about establishing one with our teammates?

We all know that our teams look different this time of year. July is a difficult time. The hospital is flooded with new interns and residents typically just after an influx of newly graduated nurses. We haven’t had a chance to get to know each other or establish relationships. A recent study reviewed deaths from medication errors and found a 10 percent spike in these events in teaching hospitals in July. The authors of the study hypothesized that part of the explanation for this was that medical residents operate more independently than on a team.

Anyone who has ever been involved in a medication error knows that an entire team is involved in the administration of medication, not just the physician. An intervention to improve patient safety offers a simple, reasonable opportunity for us to address the “July effect.” It’s called the activation phenomenon.

Better teamwork is observed when people on a team take the time to introduce themselves to each other. When people know the names of others on the team, they are more likely to speak up if they see a problem.

Take the time to establish a relationship with members of your new team. Introduce yourself and make sure your teammates know you are committed not just to patients, but also to the success of the team. Formally establishing fiduciary relationships with each other in support of safe, quality patient care promotes ethical practice.

Lucia D. Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

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Sat, 17 Jul 2010 03:58:27 +0100

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