Advocate for optimal outcomes
As a nurse working in the cardiac care ICU at Northwestern Memorial Hospital in Chicago for 12 years, Stephanie Seburn, BSN, RN, CCRN, won’t say she ran across morally distressing dilemmas every day. But they definitely were part of her nursing practice often enough, and continue to hold her attention years later.
Know the principles
Seburn advises nurses to be familiar with the principles of medical ethics, which she identified as autonomy, beneficence, justice and nonmaleficence. “We must remember that as healthcare providers, the patient’s right to decide what care to accept or reject is paramount and it is our responsibility to advocate for the patient, even when we don’t agree with the decision,” she said. To boost knowledge of these ethical principles, Seburn suggests nurses first investigate the resources available at their hospitals and other workplaces. At Northwestern, for instance, nurses might turn to the hospital’s ethics committee. All healthcare facilities accredited by The Joint Commission are required to have ethical resources on hand to help guide staff through potentially difficult ethical situations.
Step up, speak up
Often, nurses may run into situations in which they question a patient’s consent or ability to consent. Perhaps a nurse believes the patient has not been fully informed of the risks and benefits of a treatment. Or a nurse may not believe a patient is capable of understanding the situation and making decisions about his care, or is somehow being coerced by a relative or other close individual to make certain decisions. In any of those instances, Seburn said it is the duty of the nurse to advocate for the patient and help the patient obtain the proper information, evaluations or support they need from physicians and others to correct the imbalance.
EDITOR'S NOTE: Jonathan Bilyk is a freelance writer.
“As an ICU nurse, I encountered many situations in which families struggled with decisions regarding what care was in the patient’s best interest,” said Seburn, who now serves as a nurse education consultant at Northwestern Medicine. “RNs and MDs had to handle situations in which patients’ requests or refusals of treatment were incongruent with best medical practice. “These issues cause caregivers, including myself, to experience … moral distress.”
Mind the breach
While patient advocacy is paramount, nurses must simultaneously maintain their patients’ privacy, Seburn said. This, she said, encompasses all of the usual ways in which patient confidentiality might be violated. But the rule also includes trying to share it on the sly, such as posting interesting patient stories, or descriptions of patient conditions, on social media or other online resources, without specifically naming the patient or giving other particular identifying information. “In my institution, sharing information for any reason other than the patient’s necessary care is never appropriate,” Seburn said.
Respect to the end
Seburn said nurses should expect ethical issues to most often arise around end-of-life issues, as modern medical technology today “allow us to keep people alive … sometimes indefinitely.” For instance, how can nurses help families find the path to the right decision for a patient for whom an acceptable quality of life is difficult to ascertain, or for whom continuing life-supporting treatments may be painful, expensive and ultimately futile? Or, what should a nurse do if a patient decides to terminate or reject certain life-saving treatments because they violate a religious tenet? For Seburn, it returns to the principle of autonomy. “Even if we, as healthcare experts, know a treatment is beneficial or life-saving, we cannot override the patient’s decision to decline the treatment, provided the patient or decision-maker has been adequately informed of the risks and benefits,” she said. This principle, she said, holds true for those who cannot now speak for themselves, as caregivers should help families reach a decision based on the patient’s “past beliefs, ideas or expressed wishes.” “Ethically speaking, we can only offer options, information and support for their decisions,” Seburn said.
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Today, part of Seburn’s role is helping nurses process moral dilemmas in patient care.
“Ethics is all about having a discussion aimed at finding a solution that has the best possible outcome for the patient and is most aligned with the patient’s wishes,” she said. “To me, this means that what the patient wants for him or herself should be of paramount importance when a decision needs to be made.” Seburn said the goals of representing the patient and pushing for the best possible medical outcomes can often produce conflicting situations, requiring careful ethical consideration.
RNs and MDs had to handle situations in which patients’ requests or refusals of treatment were incongruent with best medical practice.”
— Stephanie Seburn, RN
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On the flip side, some nurses or caregivers may turn to online searches, such as those through Google, to learn more about their patients to aid in their care efforts. “However, there are ethical considerations involved in whether nurses should ‘Google’ patients on the Internet to learn more about them,” Seburn said. Because this information is publicly available, some would argue that it is not a violation of patient confidentiality. However, the concept of privacy relates to the patient’s right to be treated with dignity and respect. Therefore, if the information is not required for patient care, its use could violate this concept of privacy. I would counsel nurses to refer to their institution’s policy on patient rights and privacy or consult with their leadership regarding the ethical use of public information.”
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