Unit-Based Ethics Rounds
The nursing staff on 9C (medical ICU) has a long history of providing regularly scheduled forums for talking about and dealing with ethical issues. For more than 10 years, the nursing staff has been working with the physicians on the unit to make sure time was set aside once a month to discuss a challenging case.
“So much of the early case discussions were the result of needing a place to talk openly and together about the differences of opinion people had on what we were doing with a particular case,” said Bonnie Grady, staff nurse on 9C since 1979.
The need for the rounds evolved from technology development and use, a strong nursing role of patient advocacy, and our teaching and research focus. These factors often led to situations in which staff were asking “Why are we doing this? What will this accomplish?”
The staff sought a forum for bringing together all the involved team members at the same place and time to talk about the facts of the case, the prognosis of the patient, and the different outcomes. The designated monthly rounds have come to build cohesiveness among the nurses and physicians.
“It helped us see and respect other colleague’s perspectives—and helped us support one another with the difficult cases” said Grady.
“One of the things we learned early on was the importance of presenting a ‘team decision’ to families,” remembers 9C staff nurse Helen Anagnos. “Of course it happens that all clinicians can have different perspectives on patient treatment and reach different conclusions on what is ‘best’ for the patient, but the rounds have clarified the value of communication. The rounds are multidisciplinary and have had strong support from social work, chaplaincy, and psychiatry,” added Anagnos.
The ethics rounds on 9C have led to some practice changes that benefit patients and their families. A discussion with the physician, nurse and family is now a regular part of the admission process on 9C. The importance of the rounds and subsequent follow-up discussions was supported in a recently published study by the medical ICU’s director, Craig Lilly, MD.
Many of the nurses involved in the original development of ethics rounds are still working on 9C and they include (in addition to Grady and Anagnos) Jean Cabral, Sue Glennon, Kathy Mazza, and Audrey Minsky. The rounds continue on a monthly basis, providing stimulating discussion and team resolutions to conflicts.
—submitted by Martha Jurchak, RN, PhD