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Industry: Email Alert RSS FeedEthics in perioperative practice—duty to foster an ethical environment
AORN Journal, Sept, 2002 by Patricia C. Seifert
Perioperative nurses often find ethical decisions difficult to make, but necessary when caring for surgical patients in practice. Perioperative nurses need to be able to recognize ethical dilemmas and take appropriate action as warranted. They are responsible for nursing decisions that are not only clinically and technically sound but also morally appropriate and suitable for the specific problems of the particular patient being treated. The technical or medical aspects of nursing practice answer the question, "What can be done for the patient?" The moral component involves the patient's wishes and answers the question, "What ought to be done for the patient?" (1)
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AORN's Ethics Task Force has detailed specific perioperative nursing explications that correspond to the nine provisions in the American Nurses Association's (ANA's) Code of Ethics .for Nurses with Interpretive Statements. (2) The ANA's code of ethics expresses the moral commitment to uphold the goals, values, and distinct ethical obligations of all nurses. The ANA code and AORN's explications for perioperative nurses provide the framework in which perioperative nurses can make ethical decisions. (3) The code establishes a nonnegotiable ethical standard for the nursing profession. It demonstrates accountability and responsibility to the public, other members of the health care team, and the profession overall. This series of articles will help perioperative nurses relate the ANA code to their own area of practice and provide examples of behaviors that reflect the ethical obligations of perioperative nurses.
FOSTERING AN ETHICAL ENVIRONMENT
Provision six in the ANA's Code of Ethics for Nurses with Interpretive Statements says
The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. (4)
This provision addresses the commitment by all nurses to the patient; whereas the 1985 code was directed primarily at clinicians. (5) The new code reflects the influence of educators, researchers, and administrators, as well as clinicians, in creating a moral climate. (6) For example, educators help clinicians achieve a skill level that fosters competent patient care, researchers contribute to the body of knowledge that can improve practice and patient outcomes, and administrators help clinicians and others create and maintain an ethical environment where caregivers and patients both can thrive. Provision six directs all nurses, regardless of their role, to create an environment that fosters ethical behavior.
ENVIRONMENTAL FACTORS AFFECTING MORAL AND ETHICAL BEHAVIOR
Nurses' duty to self, which is articulated in provision five of the code of ethics and is exemplified by engaging in life-long learning, maintaining competence, and promoting personal and professional values, supports the establishment and maintenance of an ethical workplace. (7) To establish, maintain, and improve the work environment, nurses first must be secure in their ability to preserve their integrity and moral self respect. Individual virtues and excellences (ie, habits of character) further promote nurses' abilities to fulfill moral obligations. (8) The virtues of wisdom, honesty, loyalty, and courage often are cited as exemplary qualities of the moral person. Excellence refers to the formation of habits (eg, compassion, patience, skill) that also promote nurses' abilities to behave in an ethical manner. An individual nurse's virtues and excellences support nursing's core values of health, wellness, personal dignity, and independence. (9)
The practice environment strongly influences the expression of nurses' virtues and excellences and can support or impede ethical behavior. Administrative activities affecting policies and procedures, position descriptions, and working conditions, for example,. influence an employee's behavior, which can affect the delivery of patient care. When policies are implemented inconsistently or working conditions become intolerable (eg, consistent mandatory overtime), the work environment can become an impediment to ethical performance.
CREATING AN ETHICAL ENVIRONMENT
Administrators, clinicians, educators, and researchers recognize the impact of environmental influences, and many have developed programs that promote a nurturing, therapeutic, and ethical environment. One of the best known of these programs is the magnet hospital program, which was conceived by the American Academy of Nursing (AAN). Magnet hospitals successfully recruit and retain nurses and promote a work environment that provides sufficient RN staffing, RN autonomy and control of nursing practice, recognition of RNs' contributions, adequate support services, powerful nurse executives, and collegial multidisciplinary working relationships. (10) These magnet hospital attributes reflect not only the establishment of a therapeutic work setting, but they also attest to the recognition of nurses as moral agents with rights and duties to provide quality patient care. Currently, the magnet hospital program is directed by the American Nurses Credentialing Center of the ANA, http://www.nursingworld.org/ancc/magnet.htm, and it is the subject of studies linking the quality of the practice environment, as evidenced by nursing staff levels, recruitment, and retention data, with patient outcomes. (11)
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