In her role as associate dean for DNP programs and assistant clinical professor at the University of Miami School of Nursing and Health Studies, Mary Hooshmand, PhD, MS, RN, helps UM nursing students understand the ethical challenges they may face as they enter the nursing workforce. Hooshmand has served as a nursing leader for more than 30 decades in a variety of settings in both the public and private spheres.
Q. How would you define ethical practice, in terms of how it is currently being applied in nursing?
Hooshmand: We are raised from childhood with values often impacted by our families, religion and the society around us. These values set the stage for how we manage ethical challenges in our day-to-day lives. There are formal definitions for ethics in nursing and healthcare, as well as major guidelines, including the American Nursing Association Code of Ethics and the International Council of Nursing Code of Ethics. Both documents provide a roadmap for nurses across all settings. Beauchamp and Childress, in their work “Principles of Biomedical Ethics,” identify four principles of bioethics, which provide a framework for moral reasoning as we deal with challenging ethical scenarios. The principles are as follows:
1. Respect for autonomy assures the autonomy and individual decision-making of a patient is voluntary and not done under duress. As healthcare professionals, we must respect, recognize and assure patients they are free to make informed decisions without controlling influences.
2. Nonmaleficence or first do no harm. We hear this often as we enter the healthcare professions but what does this mean? Of course, it means what is stated, but it says even more: Healthcare professionals should not intentionally inflict or create harm or injury through acts of commission or omission.
3. Beneficence ensures healthcare providers are helping or providing benefit to another individual and/or the good of a population.
4. Justice also is sometimes referenced as fairness. The benefits and risks should not only be considered, but fairly distributed. We have a responsibility to ask questions and raise concerns, if needed. We need to inquire and perhaps be that moral compass.
Q: How is the discussion of ethics shaping nursing today?
Hooshmand: In today’s healthcare arena, regardless of where we practice, nurses and other healthcare professionals face ethical issues on a daily basis. Nurses repeatedly have been identified as the most trusted profession and for good reason. Yet, with this trust, there comes further responsibility particularly as we face many challenges, such as those arising from new technologies including gene therapies, cloning, life extension and genetic engineering, to name a few.
Some of the many issues facing nurses today include safe staffing ratios, end-of-life care and the issue of health disparities among many of our communities. These all are issues of both individual and societal concern. We will encounter patients from all walks of life, many of them burdened by illness bringing unforeseen challenges and barriers. Very often, it is the nurse on the frontlines identifying and raising awareness to individual and societal issues.
Q: What ethical practice issues should mentors/preceptors address with young or less experienced nurses? How?
Hooshmand: It is most important for mentors and preceptors to develop our young and less experienced nurses as they first encounter ethical challenges in their practice settings. They may consider including new nurses on ethics committees within our hospitals so they can observe the process in a safe learning environment. This promotes interprofessional collaboration, as well as knowledge and skills using bioethical principles applied within their practice environments.
Simulation exercises using role play also may provide new nurses an opportunity to think through an ethical scenario. Case reviews also are n effective learning tool. Mentors should invite mentees to review cases and best practices within their clinical environments to provide them greater understanding of the issues and build their expertise in ethical practice.
It is critical we provide our new generations of nursing with the knowledge and skill to manage current and emerging ethical challenges in health care. We must certainly “first do no harm,” but, more importantly, we must protect and consider benefits, autonomy, and justice as we care for our individual patients and populations.