A regional educational forum on nursing ethics that had a shaky start 17 years ago has transformed into a national exploration of professional values and patient advocacy issues. The first National Nursing Ethics Conference will be March 24-25 in Los Angeles.
Local Efforts Take Root
Katherine Brown-Saltzman, RN, MA, and Beverly Fairbairn, RN, CCRN, co-founded the nonprofit Ethics of Caring organization, which held its first conference in 1994 just after a 6.7-magnitude earthquake struck the L.A. basin region, killing 57 people, injuring 9,000 and causing extensive damage to some hospitals.
We werent sure we were going to survive the first year because of the downturn in the economy and the many nurses who were impacted, says Brown-Saltzman, co-chair of the Ethics Center at UCLA Health System. We not only survived, but went on to thrive.
The Ethics of Caring consortium is co-hositng the national event which encompasses and substitutes for the regional event this year in partnership with the American Nurses Association. Most of the 350 expected attendees are from the Los Angeles-area. The LA consortium will co-sponsor future annual national conferences to rotate between the east and west coasts but will also resume holding a separate regional Ethics of Caring conference in 2012 and beyond.Katherine Brown-Saltzman, RN
Sponsorship of the regional conference to provide ethics education for nurses and other health professionals has grown from five initial institutions to 17 organizations in L.A. and Orange counties that support the program today, Brown-Saltzman says.
Nurses are given an opportunity to step back from the pressures of daily practice when theyre not in the midst of chaos, and thoughtfully reflect on ethical issues and practices, she added.
Elissa Brown, RN, MSN, PMHCNS-BC, a Clinical Nurse Specialist in mental health for the VA Greater Los Angeles Health System, helped launch the initial Ethics of Caring event and took a leading role in building its network of supporting organizations. Other pioneer ethics leaders still active in the program are Linda Gorman, RN, MN, PMHCNS-BC, CHPN, OCN, who coordinates care in the Palliative Care unit at Cedars-Sinai Medical Center; and Marilyn Shirk, MN, RN, CNS-BC, Mental Health Nursing Liaison at Cedars-Sinai.
We built the consortium with no money by getting contributors to fund an educational program primarily for frontline staff nurses who deal with ethical dilemmas every minute of every day, says Brown, president of ANA-California. Its been a learning opportunity for everybody and a growth opportunity for everybody.
While nurses sometimes discuss their own issues, theres often a common thread that is shared with other conference participants, Brown said. This could be as simple a scenario as three patients asking for pain medication at the same time, she said. The decision of where to go first involves real critical thinking so one patient isnt favored over another. Nurses could discuss what they need to know about each patients condition and attitude, clinical effects of pain control, and even the patients familys value system regarding certain life-prolonging procedures, she said.
Brown says the national event is based on the Ethics of Caring model. For example, nurses can meet in small group sessions to role play an ethics situation such as working with multidisciplinary or peer teams to resolve patient care issues that occur in system changes, such as setting up medical homes or other health reform programs.
These are very useful, very meaningful exercises where nurses can take what they learn back to their work settings, Brown says. We want to make sure theres an ethics presence in the redesign of healthcare.Elissa Brown, RN
A keynote speaker, Carol Taylor, RN, PhD, professor and senior research scholar at the Center for Clinical Bioethics at Georgetown University, says nurses need to be empowered as competent, compassionate and collaborative advocates for patients and their families.
Patient outcomes are often dramatically different because RNs choose to get involved, said Taylor, whose talk is titled Rethinking Nursings Advocacy Obligations in 2011: Are We Measuring Up?
Nurses face distress and disengagement when theyre not provided the time, technology or resources to do what they feel is best for a patient, Taylor said. A moral residue occurs that can be forestalled by healthcare professionals working together to empower nurses.
Taylor says ethics care should be a primary element in tailoring treatment plans for patients as new research and genetic breakthroughs advance medical options. The national conference is an opportunity for nurses and others on the front lines of patient care to discuss the best ethical standards, support one another and celebrate the good work they do, she adds.
One plenary session being led by Brown-Saltzman will deal with how to respond to non-beneficial treatments.
Our technology has put us in situations where sometimes treatments are extended to the point theyre no longer beneficial and, indeed have become harmful, she says. As a result, conflicts can arise between the healthcare team that sees no positive outcome in continued aggressive therapy, but a patients family values compel them to continue treatment regardless of suffering.
In the conference evaluation process, nurses continue to request topics such as end of life care, futility, advocacy and cultural and spiritual dimensions of nursing practice.
Causes of moral distress for nurses and other health professionals can be shared and discussed at ethics conferences, Brown-Saltzman said. An example is when a surrogate decision maker wants a patient to be resuscitated even though it would prolong dying and suffering. Without DNR orders, nurses have a legal obligation to resuscitate and yet have a tremendous moral burden carrying out an action they believe is wrong. The national forum also will look at lateral violence and bullying in the workplace from an ethical perspective.
Were advocating for healthy work environments that are safe and provide good, open communications that translates to improved care for patients, Brown-Saltzman says.
In the breakout sessions, small group discussion focuses on a range of ethical issues experienced by nurses in different clinical settings. The goal is to generate fresh ideas and actions for individual practitioners and their institutions, she adds. Brown-Saltzman said that while technological changes have created demanding ethical situations, some of the same issues keep coming up. In the conference evaluation process, for example, nurses continue to request topics such as end-of-life care, futility, advocacy, and cultural and spiritual dimensions of nursing practice, she said.