Palliative Medicine

Karla Schroeder, DNP, MHS, ANP-BC, Heather Shaw, MSN, GNP-BC, and Lynn Hutton, LCSW from Palliative Medicine recently collaborated with Casey Miller, MSN, ANP-BC from the Mechanical Circulatory Support Program to discuss ethical decision making and moral distress related to caring for a complex patient situation.

Ethical Decision Making and Moral Distress

Each year The Journal of Hospice and Palliative Nursing presents an ethics series on challenging healthcare situations.  The series elicits case-based situations which provide a foundation for translational science.  These articles are written in efforts to provide evidence-based practice tools for nurses.  Karla Schroeder, DNP, MHS, ANP-BC, Heather Shaw, MSN, GNP-BC, and Lynn Hutton, LCSW from Palliative Medicine recently collaborated with Casey Miller, MSN, ANP-BC from the Mechanical Circulatory Support Program to discuss ethical decision making and moral distress related to caring for a complex patient situation.

The intention of the article was to address the complexity of ethical decision making in healthcare and the ensuing moral distress for the providers who are immersed in difficult decisions. It addresses the internal battle a nurse may face when tensions exist between values, goals, or ethical ideals. A literature review was utilized to gain insights, best practices, and implications of ethical decision making. Many interactions with nurses in complex situations revealed they did not feel equipped, lacked guidance, and did not have the tools needed to work through ethical decisions and the resulting moral distress.

The nurses made it clear some cases were more ethically challenging and thus, created an increased presence of moral distress. Through professional experiences and interactions, the interdisciplinary group of authors noted that pregnancy in the presence of serious illness heightened the sense of difficulty in ethical decision making and moral distress.

The article presented a complex case scenario and used an evidence-based ethical decision-making model. The 4-box methodological framework was used to provide a structure for evaluation of this complex case. This framework allowed translation of this model into a practice scenario and offers nurses insight into the application of the 4-box method in ethical decision making. The article also addresses moral distress from the patient, family and clinical perspective and provides guidance for the nurse who may encounter moral distress. Nurses may be able to use the tools, examples and information provided to help guide ongoing and future approaches to ethical decision making and moral distress.

Pregnancy in Serious Illness: It’s Not Just Medical Decision Making.

Schroeder, Karla, DNP, MHA, RN, ANP-BC, NE-BC; Miller, Casey, MSN, RN, ANP-BC; Shaw, Heather, GNP-BC; Hutton, Lynn, LCSW

Journal of Hospice & Palliative Nursing: June 2018 – Volume 20 – Issue 3 – p 212–216

doi: 10.1097/NJH.0000000000000422

Ethics Series

Article By: Karla Schroeder

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