Ethics in Nursing - An Interview with Alethea Sment

[traumaRUs, MSN, APRN]

Nurses face ethical dilemmas on a daily basis. allnurses.com wanted to explore this topic more deeply.

allnurses.com recently interviewed Alethea Sment, MSN, RN, ACCNS-AG, CCRN-CSC after her presentation on ethical dilemmas versus moral distress at AACN's NTI 2019 conference in Orlando. She was interviewed by Mary Watts, BSN, RN, allnurses.com Content and Community Director.

They discussed Alethea's background and she stated, "I started in critical care as a new grad resident at a VA hospital. I fell in love with ICU and never left it.” She notes there were many ethical dilemmas in the ICU and she got involved in the ethics committee where she was invited to be part of a case. It involved a patient who had a very large surgery; a Whipple procedure and recovery was very rough and prolonged. The patient's daughter kept saying, "My Dad would never want this.” The outcome was that the ethics committee decided that the daughter was correct and the patient was placed on comfort measures. This was the impetus to Alethea going back to school for an MSN. She also got a certification in ethics which afforded her a greater knowledge base and her ethics career progressed.

Research

Moral Distress and Ethical Decision-Making shows that the leading cause of moral distress for nurses involves end-of-life care. We still aggressively treat too many terminally ill patients when a referral to hospice for comfort care is needed. Hospice is underutilized and often only called in when death is imminent. Caring for terminally ill patients who are suffering from both physical and emotional pain at the end of life increases moral distress in nurses. Research shows that the longer nurses care for terminally ill patients, the greater they experience moral distress.

Work Load

Staffing is yet another ethical dilemma faced by nurses today. Texts, phone calls that are constant reminders of short staffing. Some nurses have even received texts asking them to work while they are attending conferences! This situation also causes moral distress because nurses are pulled in so many different directions.

Coping

Mary asked Alethea about coping with ethical dilemmas and moral distress and Alethea answered, "This is a very stressful job and difficult to juggle all these massive responsibilities. It's extremely important that we recognize that we are all in this together.” She further stated that it is important to realize that physicians and our other colleagues also face ethical dilemmas.

They also discussed how to decrease ethical dilemmas and Alethea suggested that everyone think about advanced directives and that she hopes it will someday become an easy discussion for everyone. Appointing a health care power of attorney (HCPOA) should be something everyone should consider doing NOW. It doesn't have to be a relative. In fact, Alethea discussed that the best HCPOA is someone that will abide by YOUR wishes, not theirs and that often family members have a very difficult time separating their feelings. The HCPOA must speak for the patient when the patient can't.

Mary and Alethea recognized that ethical dilemmas increase moral distress and can drive nurses out of the workforce. Nurses can often be overwhelmed by their responsibilities. There are many other "easier" jobs. However, by using tools such as sharing experiences with other nurses and participating in ethics committees, nurses can reduce this stress.