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Ethics and Mistake Making in Nursing: A Transformational Ethical Framework for Nurses


Learn how to use a transformational ethical ... nursing standards of practice, ethical ... Balance between protecting the public--and human kindness and consideration. – PowerPoint PPT presentation

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Title: Ethics and Mistake Making in Nursing: A Transformational Ethical Framework for Nurses

Ethics and Mistake Making in Nursing A
Transformational Ethical Framework for Nurses
  • Nelda Godfrey, PhD, RN, ACNS-BC, FAAN

  • Describe the role and process of discipline in
    nursing regulation
  • Apply a patient safety pathway for discussion and
    evaluation of nursing practice errors and
    professional conduct
  • Describe current guidelines and programs for
    evaluating, treating and managing nurses with a
    substance use disorder (SUD)
  • Learn how to use a transformational ethical
    approach when assessing practice errors in
    nursing and
  • Develop skills to interpret body language.

(No Transcript)
We Live in Innovative Times
  • Two obvious truths in our professions future
  • Change
  • A growing complexity of practice
  • (Benner, et al., 2009)

Professional Nurse, or Nurse Professional?
  • Professional Nurse validation by examination or
    institutional verification
  • Nurse Professional a person who professes to be
    a member of the discipline and has individual
    qualities or characteristics that inform and
    motivate him to make good moral choices.

Safe PracticeCulture of SafetyJust Culture
  • Yet humans make mistakes. . .

A Quick Primer on Discipline Within a Profession
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Case Study A
  • Nurse M is caring for Mr. J., a patient in the
    Neurological Intensive Care Unit, who has been
    diagnosed with a meningioma and was recently
    returned to the NICU after resection of the
    tumor. She knows that the family is anxious to
    be with Mr. J., and have waited for hours. But,
    Nurse M decides to finish her nursing tasks with
    Mr. J. while the family waits. Besides, I need
    to get my work done first, Nurse M. justifies.
    There is no rule to say that I should allow the
    family in right at this moment.

Three Areas of Professional Ethics
Principle-Based Ethics Rules, codes, standards
Professional Ethics
Consequences-based Ethics Outcomes
Virtue (ideal)-based Ethics Character
(No Transcript)
Case Study B
  • Nurse K is the next professional nurse to care
    for Mr. R. Nurse K is taking courses for
    graduate school and has a family of younger age
    children for whom she is responsible. She views
    work as a necessary evil. Without work, I dont
    support my family. Lets see, here is my list of
    tasks. May as well start with Mr. R. Hurry,
    hurry! Here is the care plan. If I work hard to
    do all the duties then I can be done by 930. I
    can break then and call Michaels school. I also
    need to get online and email the cable company.
    Lunch. I may have time to run to the store and
    back. Laura can probably cover for me.

(No Transcript)
Stairstep Model of Professional Transformation
Crigger , N. Godfrey, N (2011). The Making of
Nurse Professionals A Transformational, Ethical
Approach. Sudbury, MA Jones Bartlett.
How could a Transformational, Ethical Approach
make a difference in mistake making and
professional practice?
Professional Discipline/Regulation
  • Peer review
  • Due process
  • Interests of the public/person/profession
  • Formalized
  • To some extent, an individual rights/privileges
    are subrogated to the rights/interests of the
    public or the person that is harmed

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Case Study C
  • Nurse S has been assigned to a patient who is
    unresponsive. The patient, Mr. L., is ventilator
    dependent and is to receive oral care as part of
    the hospital policy to reduce the risk of
    ventilator-dependent pneumonia. Nurse S knows
    that no one will know the level of care that is
    given and does a cursory job of oral care to Mr.
    L. After all, Nurse S rationalizes, he should
    put his efforts toward patients who can
    acknowledge and understand that he has done
    something good for them. Unconscious patients
    can neither complain or praise.

Substance Use Disorder State of the Science 
(No Transcript)
Case Study D
  • Each nurse at Bayview Medical Center must
    complete mandatory LMS testing/standards
    annually. Each module is accompanied by an exam,
    which must be passed at 90. Each time Nurse R
    is asked to complete these modules, she skips the
    prep modules and takes the test over and over,
    marking the option she selects on another piece
    of paper, and by the process of elimination, gets
    to 90 after several trieswithout ever reading
    the accompanying module.
  • You know that Nurse R has done her mandatories
    this way for several years now. You just heard
    yesterday that she was boasting of her method
    to others.

What we know
  • Substance Use Disorder
  • Substance abuse and substance dependence
  • Complex
  • Drug specific
  • Efficacy is a central theme

(No Transcript)
Case Study E
  • Nurse P consistently fails to complete compliance
    requirements on time, including immunization and
    routine employment followup (TB Skin test, etc).
    The unit educator is frustrated about the amount
    of time it takes to follow up with one employee.
    Recently, Nurse P was part of a QI peer review
    assessment for clinical handoff (from one shift
    to another). In this project, all nurses receive
    feedback about their handoffs, and are asked to
    make changes and improvements in how
    communication is done from one shift to another.

Using the STOP Model to Make Better Decisions S
is for standards and reminds you to consider the
nurse practice act, nursing standards of
practice, ethical codes, and institutional
policies to make the best decision. T is for
thorough and reminds you to consider the context
of your decision, including relevant history,
unspoken rules, personalities, and other elements
in addition to the facts. O is for outcomes and
reminds you to consider whether your decision is
in the best interest of the patient and shows
respect for all concerned parties and society. P
is for personal values and ideals and reminds you
to make sure your decision is consistent with
your character and personal values.
If a nurse is still unable to decide
after completing the STOP model, he or she should
consult other resources, such as the hospital
ethics committee.
Assessment techniques and considerations in
mistake-making situations
Assessment and considerations
  • Assessment
  • Body Languagewhat do we know?
  • Analysis
  • Old mental models
  • Outcome orientation?
  • Balance between protecting the public--and human
    kindness and consideration
  • Self-criticism vs. self reassurance
  • Perfectionism

  • Bashaw, E. Lounsbury, K. (2012). Forging a new
    culture Blending magnet principles with Just
    Culture. Nursing Management, October 2012.
  • Buerhaus, P., DesRoches, C., Donelan, K. Hess,
    R. (2009). Still making progress to improve the
    hospital work environment? Results from the 2008
    National Survey of Registered Nurses. Nursing
    Economics, 27 (5), 289-301.
  • Cigularov, K.P., Chen, P.Y., Stallones, L.
    (2009). Error communication in young farm
    workers Its relationship to safety climate and
    safety locus of control. Work and Stress, 23
    (4), 297-312.
  • Crigger, N. Godfrey, N. (2011). The making of
    nurse professionals A transformational, ethical
    approach. Sudbury, MA Jones Bartlett.
  • Crigger, N.J. Meek, V.L. (2007). Toward a
    theory of self-reconciliation following mistakes
    in nursing practice. Journal of Nursing
    Scholarship, 39 (2), 177-183.
  • Drenkard, K. (2011). Magnet momentum Creating a
    culture of safety. Nurse Leader, 9 (40), 26-31,
  • Gilbert, P., Clarke, M., Hempel, S., Miles, JNV.
    Irons, C. (2004). Criticizing and reassuring
    oneself an exploration of forms, styles and
    reasons in female students. British Journal of
    Clinical Psychology, 43, 31-50.
  • Godfrey, N. Crigger, N. (2012). Ethics and
    professional conduct Striving for a
    professional ideal. Journal of Professional
    Regulation, 3, 910, 32-7.
  •  Haerkens, M., Jenkins, D., Van der Hoeven, J.
    (2012). Crew resource management in the ICU
    The need for culture change. Annals of Intensive
    Care, 2, 39.
  • Hawkins, C., Watt, HMG, Sinclair, KE. (2006).
    Psychometric properties of the Frost
    Multidimensional Perfectionism Scale with
    Australian adolescent girls clarification of
    multidimensionality and perfectionist typology.
    Educational and Psychological Measurement, 66
    (6), 1001-22.
  • Johnstone, M. (2005). Processes for disciplining
    nurses for unprofessional conduct of a serious
    nature a critique. Journal of Advanced
    Nursing, 50 (4), 363-371.
  • Leroy, H., Dierynck, B., Anseel, F., Simons, T.
    Halbesleben, JR, MCCaughey, D. Savage, GT, Sels,
    L. (2012). Behavioral integrity for safety,
    priority of safety, psychological safety, and
    patient safety A team-level study. Journal of
    Applied Psychology, 97 (6), 1273-81.
  • Meade, D.M. (1999). Mixed messages Interpreting
    body language. Emergency Medical Services, Sept
    28 (9), 59-62 73.
  • National Institute on Drug Abuse. (2009). Drug
    Facts Treatment approaches for drug addiction.
    -approaches-drug-addiction. Retrieved 1-5-13

References (cont)
  • Schmidt, L.A., Rieckmann, T., Abraham, A. ,
    Molfenter, T., Capoccia, V., Roman, P.,
    Gustafson, D.H., McCarty, D. (2012). Advancing
    recovery Implementing evidence-based treatment
    for substance abuse Vdisorders at the system
    level. Journal of the Study of Alcohol and
    Drugs, 73 (3), 413-22.
  • Shepherd, L. (2011). Creating a foundation for a
    just culture workplace. Nursing, 41 (8), 46-48.
  • Simpson, D. (2003). Special section 5 year
    follow up treatment outcomes studies from DATOS.
    Journal of Substance Abuse Treatment, 25 (3),
  • Sorra, J., Nieva, V., Fastman, B., Kaplan, H.,
    Schreiber, G. King, M. (2008). Staff attitudes
    about event reporting and patient safety culture
    in hospital transfusion services. Transfusion,
    48, 1934-1942.
  • Stavrianopoulos, T. (2012). The development of
    patient safety culture. Health Science Journal,
    6 (2), 201-211.
  • Sullivan, KM, Such, S., Monk, H., Chup, J.
    (2012). Personalized performance feedback reduces
    narcotic prescription errors in NICU. British
    Medical Journal of Quality and Safety, Oct 4,
    2012. abstract.
  • Tidwell, S. (2002). Processing complaints and
    disciplining nurses An overview of the
    investigative process b the Kansas State Board of
    Nursing. Kansas Nurse, 77 (1).
  • Vogelsmeier, A. Scott-Cawiezell, J. (2007). A
    just culture The role of nursing leadership.
    Journal of Nursing Care and Quality, 22 (3),
  • Woodgett, J. (06 September 2012). We must be
    open about our mistakes. Nature. Doi