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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.
AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles and columns of interest to critical and progressive care clinicians. The American Association of Critical-Care Nurses (AACN) publishes the journal.
Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.
About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses, the journal has a circulation of 4,845 and can be accessed at http://acc.aacnjournals.org/.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 120,000 members and over 200 chapters in the United States.
American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme
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