A structured mapping process can help nurses and other healthcare professionals identify patterns behind ethical challenges and reveal new approaches to guide communication and decision-making, according to an article in AACN Advanced Critical Care, a journal of the American Association of Critical-Care Nurses (AACN).
The four-step process is outlined in “Suspending Our Agenda: Considering What Will Serve When Confronting Ethical Challenges” as the subject of the journal’s Ethics in Critical Care column. It’s designed to help clinicians pause, focus and connect to their professional values, ethical commitments and responsibilities. It allows them to recognize patterns and habitual responses within others, the broader healthcare system and themselves.
Cynda Hylton Rushton, PhD, RN, and Kathleen Turner, RN, CHPN, CCRN-CMC, are co-authors of the article. Turner is clinical nurse III in the medical-surgical intensive care unit at University of California San Francisco Medical Center. Rushton is Anne and George L. Bunting Professor of Clinical Ethics, School of Nursing and Berman Institute of Bioethics at Johns Hopkins University, Baltimore. In addition, she serves as one of the ethics department editors for the journal.
“Although many of the ethical challenges that critical care clinicians confront will have a moral remainder, it is possible not only to shift our perspectives but to shift our relationship to the realities we find ourselves in,” Rushton said. “A process that cultivates self-awareness, self-regulation and compassion is vital for creating a foundation that fosters mindfulness and insight.”
The process focuses on the “four Rs”:
· Recognize: Understanding what fuels ineffective patterns of communication and decision-making opens up the possibility of changing them.
· Release: Existing agendas and underlying attitudes often hinder resolution of ethical challenges. Releasing what no longer serves may create conditions for new awareness and possibilities to emerge.
· Reconsider: Being open to new approaches invites clinicians to understand the perspectives of others and rebuild trust and rapport with the patient, their family and the team.
· Restart: New questions, empathy and a fresh focus can help the team and the family move from their positions to a place of greater understanding and engagement.
If answers come too readily or are contaminated rather than informed by past experiences with similar situations, the authors suggest clinicians continue working through the process until they are able to arrive at actions that embody their stated values.
The authors also urge healthcare leaders to identify situations that create conditions for threats to clinician integrity and that undermine the quality of patient care. Organizations must support individual members of the clinical team in sustaining newfound insights and shifts in perspectives and actions. Together, critical care clinicians and leaders can design healthy work environments that reflect the core values of all healthcare professions.
