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Barriers to Innovation: Nurses' Risk Appraisal in Using a New Ethics Screening and Early Intervention Tool

Pavlish, Carol L. PhD, RN, FAAN; Hellyer, Joan Henriksen PhD, RN; Brown-Saltzman, Katherine MA, RN; Miers, Anne G. MSN, RN, ACNS, CNRN; Squire, Karina MPH, BS, RN

doi: 10.1097/ANS.0000000000000004
Original Articles

We developed and assessed feasibility of an Ethics Screening and Early Intervention Tool that identifies at-risk clinical situations and prompts early actions to mitigate conflict and moral distress. Despite intensive care unit and oncology nurses' reports of tool benefits, they noted some risk to themselves when initiating follow-up actions. The riskiest actions were discussing ethical concerns with physicians, calling for ethics consultation, and initiating patient conversations. When discussing why initiating action was risky, participants revealed themes such as “being the troublemaker” and “questioning myself.” To improve patient care and teamwork, all members of the health care team need to feel safe in raising ethics-related questions.

UCLA School of Nursing, Los Angeles, California (Dr Pavlish); Mayo Clinic, Rochester, Minnesota (Dr Henriksen Hellyer and Mss Miers and Squire); and Ethics Center, UCLA Health System, Los Angeles, California (Ms Brown-Saltzman).

Correspondence: Carol L. Pavlish, PhD, RN, FAAN, UCLA School of Nursing, 700 Tiverton Ave, Factor 4-238, Los Angeles, CA 90095 (

This study is funded by Sigma Theta Tau International.

The authors declare there are no conflicts of interest.

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