Ethics Commentary
By Martha Jurchak, PhD, RN
Director, Ethics Service
The ANA Code of Ethics for Nurses and Interpretive Statements says: “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.” This revision in 2002 was made to reinforce the personal responsibility of nurses’ independent practice, which allows us to be accountable for our decisions, judgments and actions.
Mary Beth’s narrative illustrates several aspects of this expectation. First, Mary Beth needed to face her self and the questions she had about the treatment decisions made by Angel’s parents. As an advocate for Angel and her family, Mary Beth recognized that she needed to be the advocate and voice for Angel’s parents across the complex treatment team caring for her. True advocacy requires knowing what the patient or surrogate speaking for the patient would want based on their values, beliefs and prior decisions. Caring is the foundation of advocacy, but advocacy is rooted in the patient’s choices and goals, not what the nurse thinks might be “best.”
Another illustration of this expectation is the way in which Mary Beth and the other nurses working with her met the need to develop new knowledge to keep up with the medical teams’ work at diagnosing her problem and managing her condition in the face of uncertain diagnosis. The strongest impact was the decision to create “primary nursing care team” to develop and maintain a relationship to support the family, to keep the information circle “tight” so that there would be coverage and consistency from the same group of nurses—who knew Angel’s story, who remembered her clinical course and were able to say “three weeks ago, this was tried and the result was this.” These nurses shared with one another the challenge of uncertainty, devastation and hope for this young woman and her family. Just as consistency is important, so is Mary Beth realizing when she needed a break from care giving. It is crucial aspect of good care to know when one needs to step back and care for, replenish oneself. It is only in caring for ourselves—having the same duty to self as others—that we have the ability to connect with and care for our patients and their families.