EP - Exemplary Professional Practice

EP23: Ethics, Privacy, Security, and Confidentiality-Describe and demonstrate how nurses use available resources, such as the ANA Code of Ethics for Nurses (American Nurses Association, 2001b), to address complex ethical issues. Provide examples from different practice settings.

The code of ethics at Jersey CityMedicalCenter is threaded throughout in our policies and procedures and most of all in our Values Commitment. All employees annually sign our Value Statement at the time of their yearly evaluation and at the time of hire. All employees are required to recommit to this value statement. The Rules of Behavior (OO20-A) outlines much of the ethical values that our employees embrace. These rules incorporate treating each other and members of the medical team with respect as well as insuring a level of customer-driven responsiveness. Our HIPPA policies, located on the Liberty Intranet, also insure the patient’s privacy during all aspects of care. Our Patients Bill of Rights, located in every room, provides further definition of our patients’ rights with respect to ethical considerations.

The ANA Code of Ethics for Nurses is a document that our nurses at the MedicalCenter embrace. All the tenets of this document are followed by our nursing staff, for example, compassion and commitment to patients, participating in the advancement of the profession, collaboration, advocacy for patients, and respecting the patients inherent rights as an individual. Please review (Appendix EP23-A) for a comparison of JCMC Code of Ethics and the Nursing Code of Ethics.

Another resource that nurses can use to address ethical issues is the Ethics Committee. This Committee is an interdisciplinary group (OO19) that provides advice and consultation to healthcare professionals, patients and families on ethical dilemmas which may arise in the course of medical decision-making. Consultations to the committee can be made by healthcare workers, patients or the patient surrogate and family members. Part of the role of the Ethics Committee is providing educational offerings to all physicians, staff members, and nursing personnel. The recent offerings are outlined on the table below:

EP23-Table 1

Our mission, …Enhancing Life insures alignment with the first three articles of the ANA Code of Ethics (American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, Silver Springs, MD: American Nurses Publishing, 2001):

  • The nurse practices with compassion and has respect for the inherent dignity, worth and uniqueness of every individual, unprejudiced by considerations of social or economic status, personal attributes, or the nature of health problems.
  • The nurse establishes relationships and delivers nursing services with respect for human needs and values
  • Nurses are leaders and vigilant advocates for the delivery of safe and dignified care

During interdisciplinary rounds, nurses can identify and respond to various issues relating to ethics. Issues frequently arise during rounding, which the team can discuss and resolve. Another method that nurses can utilize to respond to ethical dilemmas is through the Ethics Committee consultation. This committee will convene to resolve ethical issues and will present or clarify options to the primary care giver. Another very valuable resource for our nurses is our Advanced Practice Nurses. They frequently function as a support system for nursing staff when difficult ethical issues arise. They can offer valuable insight on how to proceed with complex ethical issues.

The nurse practices with compassion and has respect for the dignity and worth of each patient…” (ANA Code of Ethics)

A 66 year old woman with Diabetes Mellitus and on dialysis was found in her bed at home following a cardiac arrest, unknown down time, was intubated in the field and brought to the Cardiac Care Unit (CCU). The patient’s prognosis was poor, and was being kept alive by life-support. The family designated the eldest daughter to be their spokesperson and medical decision-maker. The daughter determined that she wanted aggressive treatment for her mother. The other family members were not in agreement. Analynn Bautista BSN, RN, Jill Avella BSN, RN and Geraldine Terry BSN, RN were the nurses in charge of her care. Nancy Pain APN-C, Pain and Palliative Care Coordinator and Pam Saporita, Case Manager, Raul Pamploma, Patient Advocate as well as Spiritual Support, met with the family as a unit and individually throughout the hospitalization. It remained difficult for the daughter to accept the fact that her mother was deteriorating rapidly. She wanted a tracheostomy and a PEG feeding tube placed in her mother. The team met together to strategize on how to proceed with this daughter and assist her with her decision.

Another meeting was arranged with the entire family. One of the questions the team asked was “If your mother was able to see herself now, what would she say?” The daughter stated clearly “I know my mother would not want this, but…I am her daughter, shouldn’t I keep trying?” The daughter went home with her family; they returned the next morning, including the daughter, and had the life support removed and stood by her side as she expired.

This team was able to assist the family, and particularly the daughter, with the death of their loved one. They helped the entire family get through this process in a caring and dignified manner.

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA Code of Ethics)

An elderly patient was admitted to 6 East, Medical-Surgical Unit, from a Nursing Home. She was diagnosed with Respiratory Failure and immediately after being admitted to the unit, developed a cardiac and respiratory arrest. She was successfully resuscitated and placed on mechanical support; however, she did not regain consciousness. She had no family and no Power of Attorney. It was clear to the team, which consisted of: Marilyn Sarnatora Ms, RN, BC, Nurse Manager, Janet Serylo RN, Case Manager, and Ditra Irving LCWS, Social Worker, as well as the Primary Physician, that her prognosis was bleak. The team had several meetings and determined that this particular case should be presented to the Ethics Committee. The recommendation from the Ethics Committee was that a Court Appointed Guardian would be appointed. The team had several meetings with the appointed guardian and arrived at the conclusion that respiratory support would be removed and comfort care provided.

Nurses must examine the conflicts arising between their own personal and professional values and interests of others who are also responsible for healthcare decisions (ANA Code of Ethics)

A 22 week female infant, weighing 1 pound was delivered at the MedicalCenter and admitted to the Newborn Intensive Care Unit (NICU). The infant was resuscitated and mechanical support was provided in the delivery room. Because of the extreme prematurity of the infant, ethical concerns arose about the outcomes for this infant. The initial team caring for this infant included: Dr. Arroyo MD, Fely Gonzales BSN, RN, Staff Nurse in the NICU, Nancy Floom LCWS, Social Worker, Michele Dickerson BSN, RN, NEA-NIC, Nurse Educator. The infant suffered an intracranial bleed and had been anoxic for a certain time period. The ethical issue was should they withdraw support or not. The team met with the family who decided that only comfort measures should be given at this point. Emotionally, the family stated that they were unable to cope with their infants death, and that they would prefer not to be present. The nursing staff had difficulty with this. Ms. Dickerson supported the staff through this process and helped them understand that the family was dealing with this terrible event in their own way. The staff did prepare a memory box for the family.