Name(s) / Paula Goodman-Crews
Anne Marie Watkins
Erica Garcia
Email(s) /


Region / SCAL
Affiliation/Site / San Diego

BREAKOUT EXECUTIVE SUMMARY

TITLE / The Moral Experiences of Nurses: How One Medical Center Utilized the VON Framework to Promote Moral Resilience and Enhance Ethical Practice
PROJECT PURPOSE/OBJECTIVE / Why did/your team do this work? What were you trying to change/improve?
Our team, consisting of the Medical Center CNE, an ICU nurse who Chaired the Nurse Quality and Patient Safety Council, and the Medical Center Bioethics Director, identified opportunities within the framework of the Voice of Nursing Professional Practice Model, to promote nursing ethical practice. There is ample literature that describes the phenomenon of “Moral Distress” as it is experienced by nursing as a profession – from the nurse at the bedside, to the Chief Nurse Executive. Nurses make moral decisions daily, of which many are not fraught with distress, conflict, or uncertainty. When these decisions create disequilibrium, and are experienced as threats to one’s personal integrity, the nurse needs to have access to internal and external/organizational resources to address, remediate, and promote moral resilience.
Our team believed that offering opportunities for reflective practice to nurses would improve core competencies to regulate responses to moral distress, and enable nurses to utilize an ethical framework when they experience moral conflict or uncertainty. A panoply of resources, including by not limited to the ANA Revised Code of Ethics, evidence based research and guidelines proffered by the ANA and American Association of Critical Care Nurses, and conversations with national nurse ethicists were utilized.
Objectives:
  • Identify ethical challenges experienced by frontline and nurse leaders
  • Propose infrastructure that support reflective practice
  • Call to action for nurse leaders to recognize the impact of moral distress, identify strategies that strengthen moral resilience

PROCESS / What steps did you take?
  1. CNE and Bioethics collaboration which resulted in identification ofstrategies where Bioethics interface with VON could:
  2. help facilitate reflective practice discussions on professional nursing ethics issues
  3. advocate for staff nurses and nurse leaders to serve as members of the institutional Bioethics Committee
  4. serve as champions and collaborators for ethics quality projects that foster nurse ethical standards of practice, and the ethical environment, in general
  5. collaborate with UNAC to assist in planning off-site CEU Conferences with ethical themes
  6. serve as thought partners in fostering an ethical environment of care
  7. offer guidance on specific ethics topics and themes
  8. Outreach to nationally known nurse ethicists and professional organizations for evidence based approaches for addressing moral distress, including utilization of the ANA Revised Code of Ethics Faculty manual
  9. Utilization of existing infrastructure to support nurse reflective practice and case-based learning on ethical issues
  10. Quality and Patient Safety Council Monthly Meetings
  11. Charge Nurse Monthly Meetings
  12. Bioethics Committee
  13. VON Summit
  14. Schwartz Center Rounds
  15. Creation of case-based curriculum based upon the ANA Code of Ethics Provisions, to be utilized for nurse reflective practice in various forums

RESULTS / What were the results of your project?
Highlights include:
  1. Quality and Patient Safety Committee Members:
This was a quality improvement project. Direct verbal feedback from the nurses who were on the committee:
  • Content of the ANA Code of Ethics for Nurses very useful and effective.
  • Found Value in the provisions, as it offered the opportunity to learn an ethical framework in which to practice
  • A voice to promote individual and collective moral agency, and the moral authenticity for compassionate quality care.
  1. Survey evaluation themes from the Voice of Nursing Kickoff Fair:
  2. Opportunity to learn an ethical framework to practice by
  3. Voice to promote individual and collective moral agency
  4. Moral authenticity for compassionate quality care
  5. Protected by the ANA code of ethics when doing the right thing for the patient
  6. Nursing feeling empowered to request ethics consultations
  1. Survey Data Results from the Voice of Nursing Summit :
  2. Total Surveys Collected: 379
  3. 92% Evaluated content of ethics booth as “Excellent”
  4. 6% Evaluated content of ethics booth as “Good”
  5. 2% Evaluated content of ethics booth as “Fair”

CONCLUSION / What did you learn? What advice would you give to others who would like to do the same or similar efforts?
The ANA Code of Ethics for nurses articulates professional obligations for nurses by nurses to promote the ethical environment needed to provide quality compassionate care in our complex, nuanced, and sometimes volatile healthcare system. By utilizing the infrastructure of the nursing hospital committees and nursing fairs, the Council could advocate for the allocation of time and resources to educate, promote ethical practice, and disseminate the teachings to frontline nurses on the ANA Code of Ethics. This approach in educating and applying the ANA Code of Ethics in nursing practice was successful at Kaiser San Diego Medical Center. The process of ethics education thereby led to the promotion of ethical practice at the bedside.
FUTURE PLANS / What are your next steps?
  1. Continue to integrate the professional nurse practice model, “The Voice of Nursing” and the ANA code of ethics within existing nursing hospital committees
  2. Develop frontline nurse ethics champions throughout the medical centers for further integration of the ANA Code of Ethics into daily practice
  3. Participate in orientation of new nurses, student nurses regarding professional ethics practice
  4. Develop system-wide policies that address moral distress