Struggle_in_Nursing

Struggle in Nursing A hospital's main goal is to make people healthy. Their first priority is the patient, however, where does the line get drawn between patient and their family' When a situation ends in a way that would cause distress to anyone involved, their job should be to evaluate the situation and see if there is any flaw that could be fixed in order to prevent this situation from happening again. We see all parts of this exercised on Nurse.com;[i] including the nurses and the directors of various fields. In doing so, the people involved, brought about an evolution of moral responsibility in clinical practice. Before this evolution, a hospital had strict rules and regulations in place that restricted the comfort and the accommodating atmosphere of the hospital. If in some occasion they were broken, the entire situation would be better for all parties; the nurses, the surgeons, physicians, directors of various fields, and patients. The hospital staff's hands would be tied, they wouldn't be able to make the choices which would benefit the patients and their families the best. Fortunately, today the hospital staff can make those decisions and lighten a situation that would previous to the shift be a dark one. We will take a look at the evolution of moral responsibility in clinical practice by seeing through the eyes of the surgical liaison, director of ethics, a patient and an incident that happened at Boston Children's Hospital. A surgical liaison found herself caught in a dilemma between doing what is best for her patient and following the relentless rules of her operating room. A nurse's job includes duties extending far past that which are laid out in the job description. They will be put in a situation that will force them to take an ethical side to stand on; between the responsibilities to their patients, physician, hospitals, and their units. At Boston Children's Hospital, a surgical liaison was put in a situation where she was forced, by the strict rules governing her operating room, to make the patient and his family be under additional grief on top of the already stressful situation. The mother of a baby who was dying asked to be with her child in the operating room. The baby had unsuccessfully undergone heart surgery and could not be removed from the heart-lung machine. The mother wanted to go into the OR and be with her child when he died.[ii] She was told she could not go into the OR, same as anyone. However, some would argue that this situation should allow some leeway to that rule. For instance, it would affect the nurses because they would simply avoid the ethical questions; they simply did not know what nurses' responsibilities to patients when it came to discussing patients' diagnosis and prognosis. After the shift, the nurses know how to handle these situations. They make the decisions based on the ethical stand point of what is best for the entire situation. Previous to the shift, the staff would be talking about what they ought to be doing to help the situation. And that is where it stops, talking. This surgical liaison went to the director of ethics at Boston Children's Hospital and addressed the issue. The director of ethics scheduled a meeting with the Operation Room governance committee and the ethics advisory committee and the patient's parents. This initiated the shift. Now, if nurses see an ethical dilemma forming, they can talk to their fellow co-workers and ask what actions they would take to avoid the possible situation. When put in a situation where they would need to make the decision of what they ought to do. They simply ask themselves, “Are we doing the right thing'” Now they can alleviate the problem even before it becomes a problem by listening to their morals in which they live their lives. A director of ethics takes into account all the sides of all situations in a hospital and come to conclusion that is best for everyone: hospital staff and patients alike. They have to go through a grueling decision process to make changes if something is aloof, but it is their job to tunnel through the hierarchy of the hospital politics and make those changes happen. Upon hearing from the surgical liaison, Christine Mitchell, RN, MS, FAAN, director of ethics at Boston Children's Hospital and the associate director of clinical ethics at Harvard Medical School in Cambridge, Massachusetts[iii] told her story in her presentation of the “Evolution of Moral Responsibility in Clinical Practice[iv]” during the Massachusetts Association of Registered Nurses' annual spring conference. The conference was focused on ethics in nursing practice, so her presentation was well received. This presentation sparked the evolution in the moral standings of the nursing community, which caused positive things to happen within the hospital's atmosphere. Thusly, accomplishing her job as the director of ethics at the Boston Children's Hospital. Science and technology tend to drive the ethical issues faced by the hospital staff encounter in clinical practice, in part because “technology is often assumed to be beneficial to patient without hard evidence to prove it.”[v] As new technology is more readily available, it is assumed that it is good for patients before asking if it should be used and if it will actually help. So in conclusion, if a hospital conducts itself as an institution built around the comfort and well-being of the patient and their family members, positive things will be born from the dark situations that could use a little light shed on them. We have seen this through the nurses point of view and the director of ethics point of view of the example that has been provided. ----------------------- [i] http://news.nurse.com/article/20090525/NATIONAL01/90520001 [ii] Nurses Struggle with Ethical Dilemmas By Janet Boivin, Rn Monday May 25, 2009 [iii] Christine Mitchell, RN, MS, FAAN, director of ethics at Boston Children's Hospital, and associate director of clinical ethics at Harvard Medical School in Cambridge, Massachusetts [iv] “Evolution of Moral Responsibility in Clinical Practice” Presented by Christine Mitchell, RN, MS, FAAN, director of ethics at Boston Children's Hospital, and associate director of clinical ethics at Harvard Medical School in Cambridge, Massachusetts [v] Janet Boivin, RN