by Robert Gardner
Nursing students at Montgomery County Community College, as part of their professional growth and development, must learn to deal with real-life scenarios in the classroom before experiencing these with patients and families. In Professional Issues in Nursing (NUR 213), students consider a multitude of ethical dilemmas they will face during their careers. In August, they presented their findings to the public in the lobby of the Science Center.
Technology played a significant role in the semester-long project. Once the students formed groups and chose an ethical situation to explore, they communicated through emails, text messages, even social networking. In order to conduct their research, students were encouraged to use an online tool known as a “wiki.” Available on Blackboard, a wiki allows users to create and share content in a collaborative forum. The groups also examined cases in the College library, making particular use of nursing journals and newspaper articles.
The poster presentation topics ranged, among others, from end-of-life care to patients’ rights. They gathered information from both sides of the moral divide. Since many of the topics involved cultural and/or religious factors, the students had to remain sensitive to established medical fact as well as to the practices and beliefs of the patients and their families.
According to instructor Connie Fiorentino, the project helped students identify their personal perspective while weighing pros-versus-cons and presenting solutions in a “manner for a lay person to understand.”
“It’s good to see it outside the classroom and shared with the community,” said Fiorentino as she surveyed her students’ work. “This is the first time we’ve presented ethical dilemmas in [Nursing] 213. So far, I’m very impressed.”
Monday’s event marks the first time nursing students have presented their research to the public; previously, all projects had remained in the classrooms. In addition to visual presentations, the students capably explained their findings to those in attendance.
“Nursing is very holistic,” said Jeff Newman who, along with Christopher Schulz, based his research on a case study involving a non-compliant diabetic. Their topic—Respecting Patient Autonomy While Maintaining Patient Advocacy in the Non-Compliant Patient—comes up often in health care. Nurses walk a fine line when advising a patient. “It’s difficult to maintain empathy for a non-compliant patient,” Newman said. However, “one of the main causes [of non-compliance] is financial.”
“We must see the whole picture, make the best assessment,” Schulz added. “It’s all about empowerment.”
That was the prevailing sentiment among all the groups. In many situations, a nurse acts as both caregiver and social worker. As such, he or she must provide as much information to the patient/family as possible before any treatment is suggested. Clouding the waters, laws which define patients’ rights exist at both the state and federal levels which address these scenarios.
“As nurses, we have to follow the law,” said Patrice Smith. Her group, which included Parris Janusek and Matt Deleskiewicz, addressed Emergency Contraception (for minors, without a prescription). “We don’t give our opinion, we try to give information.”
Jessica Eisenberg, Heather Curran, and Seth Rotman explored Parental Rights Vs. Rights of the Child where religion is a determining factor. Most notably, Jehovah’s Witnesses and Christian Scientists refuse treatment based on their beliefs. While the First Amendment protects the right to practice any religion, states have yet to define the decisions parents can make regarding their children’s health care. The group proposed the passage of “a federal law in accordance with UN Children’s Convention and family protection laws that define limitations of parental rights regarding healthcare decisions of children.”
According to Angel Osborn, an ethical dilemma could involve more than the rights of patients; a nurse must make moral decisions involving colleagues. She and Robert Matthews addressed the Addiction-Impaired Nurse. Of the 2.5 million nurses in the United States, as many as 10% of these are dependent upon drugs or alcohol.
“Impaired nurses are less-capable of providing quality care,” Osborn said matter-of-factly. “As a colleague, I have to determine what’s ethical. Can I allow a friendship interfere with treatment?”
Many states have systems in place to handle such scenarios, including Peer Advocacy groups. Further, Chapter N7 of the Nurse Practice Act states that an RN or LPN has a “duty to report” any violation of the rules of conduct. This includes knowledge of impaired practice.
The students of NUR 213 completed the Nursing program in late August. Many intend to continue their education; some will begin their careers. All will encounter situations which involve ethical questions. Based on their performances at the poster session, the future of ethical health care looks bright.
Photos by Alana J. Mauger