Making Decisions at the Bedside - Everyday Ethics for Nurses
- : Sydney NSW 2001
Nurses experience challenging situations everyday that are likely to involve some sort of an ethical decision being made. You may not even realise that the decision you’re making involves ethical considerations as the focus of many nurses often turns to fearful legal consequences. It's time to look at how an understanding of ethics can assist you to feel more satisfied with the everyday decisions you are required to make. Topics include:
- The art of disclosure - what to share, to whom and how
- Managing family expectations when there is no hope of survival
- Who gets the shrinking resources?
- The use of restraints - whose need is being met?
- Dealing with unethical and incompetent behaviours of others
- It’s legal BUT is it ethical?
8:30AM REGISTRATION FOR DAY ONE
LINDA STARR TO PRESENT TODAY'S SESSIONS
9:00What is Ethics and What Is Ethics Not?
The concept of ‘ethics’ is often associated with being tedious and difficult to understand. Yet, debates around issues that involve ethics are lively and bring many opinions to the surface. As nurses, we have committed to being ethical and making ethical decisions everyday. The purpose of this opening session is to simplify this often misunderstood topic. Includes:
- Good, bad, right and wrong - what is ethics?
- What is ethics not?
- How can a Code of Ethics practically assist me?
- How is being ethical interconnected with being professional and legally sound?
9:45Who Am I? Moral Theories, Dilemmas and Courage
Morals and ethics are often used interchangeably yet they are two different concepts. Morals are seen as more subjective and therefore very person-centred whilst ethics are accepted widely as shared principles. In nursing, a challenging situation or decision to be made is likely to draw on your morals as well as ethics. As such, this session will explain the following:
- Deep diving into the difference between morals and ethics
- Moral theories and ethical principles explained
- Moral dilemmas versus ethical dilemmas
- What is moral courage and how will I know when to use it?
10:45 MORNING TEA
11:15Changing of the Guard - Patient-Directed Care
Modern healthcare has seen a shift, from the provider, towards the patient at the centre of care. This demands a new approach to thinking about practice and requires an increasing professional accountability. Now more than ever there is the pressure to meet measurable, high quality, safe patient outcomes. This session will challenge you to consider the following:
- Why are patient expectations changing and what does this mean for nurses?
- Are my actions being viewed differently and what does transparency in healthcare mean?
- How can I practically and realistically respond to greater personal responsibility?
12:15To Say or Not To Say... Truth Telling vs Trust Building
A great source of distress and discomfort for nurses often lies in disclosure. At the bedside nurses are huge sources of knowledge for patients and families. Questions are not just asked but encouraged. Yet everyday we are likely to have to make a decision as to what we should not say, how much we should say and to whom. Then comes the doubt as to whether what we said is right, wrong, appropriate or inappropriate. Our clinical expertise often guides us. The following considerations will be discussed:
- Must I reveal everything about a patient to a patient?
- What if I know what I will say will cause harm?
- 'Honesty and Right to Know' - how can I decide what information should be shared, when, how and to whom?
- Can a family wilfully decide to protect a patient from certain information?
1:15PM LUNCH BREAK
2:00Out in the Open - Bedside Handover
The practice of handover has been a long-standing cornerstone of nursing. Over time, the manner in which responsibility and accountability is transferred from shift to shift has changed. Bedside handover is now recognised and implemented as standard practice, and seen as a key feature of patient-directed care which improves quality and safety. In this session we consider:
- Why do nurses sometimes feel uncomfortable about giving handover in front of patients?
- What are the ethical challenges in this situation?
- Guidance for finding a method in which confidentiality and sensitive information can be protected and patient engagement maximised
3:15 AFTERNOON TEA
3:30The Use of Restraint - Whose Need is Being Met?
This final session will be based on highly relatable case studies and discuss the ethical, legal and moral ramifications for the use of restraint and will include:
- Why is the use of restraint so emotionally charged?
- What is the legal definition of restrictive practices?
- On whom can restraint be applied, in what circumstance and which types of restraint?
- An easy, ethical and practical approach to considering the need for using physical, chemical, mechanical, technological and psychological restraint
4:30 CLOSE OF DAY ONE OF PROGRAM
9:00AM COMMENCEMENT OF DAY TWO
LINDA STARR TO PRESENT MORNING SESSIONS
9:00Great Expectations - Families and Futility
A continued source of anguish and discomfort for nurses is continued treatment interventions in the face of futility. Traditionally this challenge has been somewhat limited to end of life and extreme situations in acute care environments. However, with our ageing population, scientific advancements, the shift towards more acutely unwell patients being cared for in general areas, as well as the expectations of the general public to ‘cure’, mean that all nurses must feel comfortable to communicate and advocate in these situations. This session will consider:
- Just because we can, does it mean we should?
- Caught in the middle - requests for treatment and medical willingness to act
- Should we give ‘fake’ hope until a family is ready to accept?
- How do we ensure our instincts and clinical expertise are not imposed on families making decisions under duress?
10:00Greater Expectations - Resource Pressures from Above and Below
Prioritisation has always been a key feature of being a safe and efficient nurse. We are taught to prioritise nursing care and are constantly required to think about what needs to be done now and what can wait. At a time where budgets are shrinking, beds are closing and nursing staff are sometimes scarce, how do we meet these challenges and feel comfortable doing so? Let’s look at:
- Who gets the shrinking resources?
- When patients think nursing assistants are the same as nurses
- When nursing staff are scarce do you prioritise care or ration nursing care?
- The question of time and money versus what we perceive is best for the patient
- is the time coming where we have to admit and discharge patients based on age?
10:45 MORNING TEA
11:15It May be Legal BUT is it Ethical? Policing Pregnancy and Parenting
The clinical expertise of nurses and midwives often allows us to view an action as it happens, and visualise the real consequences on health in the years to come. Refraining from judgment is tough particularly when the effect on a young life is potentially dangerous. What are we ethically, legally and morally supposed and allowed to do in these situations? This session takes a look at:
- Drinking, drugs and damage during pregnancy
- Families who choose not to vaccinate their children
- To what extent can we, and should we, impose our own values?
- Where should we draw the line with offering health advice?
12:15Shining a SPOTLIGHT on CPD - What’s Acceptable?
Whilst nurses have always learnt and engaged in ongoing education, the shift towards mandatory requirements of continuing professional development (CPD) has forced the profession to examine the type of formal ongoing education they undertake. Now that there is a degree of acceptance and familiarity with mandatory CPD, it’s time to consider if ethics plays a role in the CPD you choose to do. includes:
- What CPD is deemed acceptable and how does this compare to international standards?
- Conflict of Interest - should education provided by companies who profit from products used on patients be considered CPD?
- What impact could unregulated CPD be having on your patients?
- How can you ensure the education you undertake is properly evidence-based and free from commercial bias?
1:00PM LUNCH BREAK
DR MICHAEL NANCARROW TO PRESENT THE AFTERNOON SESSIONS
1:45Incompetence and Unethical Behaviours of Others
Most people can give examples of working with someone whose behaviour was considered unethical, incompetent and/or unacceptable. Invariably, such behaviours create turmoil in the workplace, leave you feeling uneasy and ultimately impact patient outcomes. This session will challenge you to look at what happens when the work setting is not aligned with the Code of Ethics, and how you can remain ethical in these situations. Includes:
- Reflect again on what exactly are unethical behaviours and what they are not
- Calling it out - ethically managing incompetence and ineffectiveness
- What happens if you do not act in accordance with ethical principles?
- Learning how to recognise and integrate choice and judgement in professional decision-making
- When bad things happen because good people do nothing...
2:45 AFTERNOON TEA
3:00Creating a Spirit of Inquiry
What is the solution to a world of constant change and turmoil? Is it time to continually ask - ‘but why?’. This final session will look at the power of creating a ‘Spirit of Enquiry’ and how this may just be your secret weapon for dealing with the everyday changes and challenges faced by nurses today.You will be asked to explore your own ethical woundedness and appreciate the power of telling your story in helping to build a more ethical robust nursing culture.
4:30 FINAL DISCUSSION, CLOSE OF DAY TWO OF PROGRAMThe Goal Need for Program
Nurses will experience many ethical issues during the course of their day-to-day work – ranging from protecting patient dignity, to dealing with inadequate staffing levels, to the use of restraints. Ongoing access to information that discusses the role of ethics in what may appear on the surface to be a legal issue and, to explore the ramifications of this to practice will assist in guiding nurses to manage difficult challenges and make clearer decisions whenever they occur.Purpose of Program
By using realistic, everyday case studies, nurses and midwives will gain practical knowledge on how ethics can assist with decision-making and resolving clinical scenarios, and in so doing improve patient and family outcomes.Your learning outcomes:
Patients in your care will experience highly ethical nursing care at all times
You will respond with greater confidence to common clinical situations that may require a decision to be made based on an ethical framework
Patients and families in your care will be empowered by your ability to advocate for them and comfortably discuss with them challenging ethical situations
Realistic case studies and engaging discussion will enable you to ‘unpack’ common workplace clinical scenarios and hence be able to more clearly approach and resolve these tasks in an ethical mannerPresenters
Linda Starr is a qualified general and psychiatric nurse, lawyer and associate professor in the School of Nursing and Midwifery ... Read More
Michael Nancarrow holds degrees in economics and law. He has studied economics, law and political theory at Macquarie University, the ... Read More