Ethics in perioperative practice—advancing the profession

AORN Journal,  Oct, 2002  by Cecil A. King

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Editor's note: This is the seventh in a nine-port series that explores the effect the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements has on perioperative nurses. Each article in this series will deal with one of the nine provisions outlined in the ANA code, along with interpretations and examples for perioperative nurses. At the conclusion of this series, perioperative explications of the ANA code will be included in AORN's 2003 Standards, Recommended Practices, and Guidelines.

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 problem of the patient undergoing treatment. 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)

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 code expresses the moral commitment to uphold the goals, values, and distinct ethical obligations of all nurses. The code "... demonstrates accountability and responsibility to the public, other members of the health care (surgical) team, and the profession." (3) It articulates statements about the moral obligation of members of the nursing profession and addresses duties beyond individual nurse-patient relationships. In this way, professional standards are distinguished from standards imposed by external agencies (eg, regulatory agencies).

ADVANCING THE PROFESSION

Provision seven in the Code of Ethics for Nurses with Interpretive Statements says "The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development." (4) This provision addresses the obligation to be actively involved in professional associations and health care policy; develop, maintain, and implement standards of practice; and participate in the development and application of nursing knowledge.

Perioperative nurses have a personal obligation to contribute to the advancement of their profession by participating in some way with professional organizations. Perioperative nurses also can advance the profession by participating in various activities at their place of employment or participating on chapter, state, and national committees. Nurse researchers, for example, contribute to the advancement of nursing by contributing to the body of knowledge supporting professional nursing practice. Nurses who participate on AORN's Research Committee have an opportunity to provide input into research efforts to develop a scientific knowledge base related to perioperative nurse-sensitive outcomes. Individuals do not need to be a member of a committee, however, to actively participate. They also can provide feedback on proposed changes to AORN's recommended practices when they are posted for comment and send suggestions to the Recommended Practices Committee for developing future recommended practices.

Perioperative administrators and educators have an additional obligation as teachers, mentors, and role models to foster an environment conducive to advancing the nursing profession through professional development. Mentoring new nurses who are entering the perioperative arena is critical to their development as competent perioperative nurses, and it significantly improves retention. Advances in health care and technology result in even greater pressures on new perioperative nurses and present an opportunity for seasoned perioperative nurses to be mentors. Committed, competent nurses need support from educators, preceptors, supervisors, peers, and mentors.

Nurses can contribute to the health and safety of members of the public by participating in civic and legislative activities. Perioperative nurses should support and advance the welfare and safety of all people by sharing their knowledge and expertise about health care issues with elected officials (eg, civic leaders, health care policy makers, regulatory agencies). Participating in grassroots activities at local, state, and national levels, as well as state counsel membership, is an effective method to gain information, network with other perioperative nurses, and educate legislators about health-related legislative issues. Nurses can influence health care policy and enhance access further by exercising voting privileges and supporting political candidates who advance health care issues and nursing. Communication and collaboration with other health care professionals and maintaining membership in AORN all are ways individual nurses can participate in advancing the profession.