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Ethical Decision Making: Integral to the Role of the Advanced Practice Nurse

MUNRO, BARBARA HAZARD PhD, FAAN

Clinical Nurse Specialist: January 2001 - Volume 15 - Issue 1 - p 6
Nursing Practice: Editorial

BARBARA HAZARD MUNRO, Dean and Professor, Boston College School of Nursing, Boston, Massachusetts.

The two manuscripts contained in this section reinforce the need for a strong focus on ethics in nursing curricula. This is not a novel idea. At my own school, Boston College, nursing students, admitted in 1947 and were the first women undergraduates enrolled in this all-male school because the Archbishop of Boston, Richard Cardinal Cushing, believed that nursing education should be built on a liberal arts foundation with a strong ethics component. He recognized that leaders in nursing would be faced with ethical dilemmas for which they needed to be prepared. Inclusion of ethics content at the undergraduate level is not enough, however. Preparation for ethical decision making is crucial in the education of advanced practice nurses (APNs). The decisions APNs face are on a different level from those faced by staff nurses. As we can see in the article by Välimäki et al., the need for grounding in ethics to inform nursing decisions is international in scope.

The authors of the article on promoting autonomy in long-term care institutions come from Finland, Great Britain, Germany, Greece, and Spain. They are clear about the need for advanced practice nurses to apply ethical decision making in their practice. Their area of concern is the care of elderly clients in long-term care institutions. An understanding of the principle of autonomy and its relation to the care of the elderly underlies advanced practice in these institutions. The authors point out the need for clinical nurse specialists (CNSs) to work in the consultative role to assist the staff in identifying ethical and practical problems and to guide them in resolving the problems. Without a clear understanding and the ability to articulate the underlying ethical principles, the CNS could not fulfill this responsibility.

While they do not identify specific ethical principles, Larsen et al. provide an excellent example of a program initiated because of concerns about the level of care provided to a group of clients. A medical center's pain management review committee, which included a newly appointed CNS, became aware that adult patients with sickle cell disease (SCD) were receiving inadequate pain management. A thorough assessment determined that major areas of concern existed. As a result, changes were made at the medical center and at other institutions in the city. The CNS played a major role in identifying this problem and in developing and testing a plan for remediation.

As healthcare increases in complexity, the scope of practice changes, and more sophisticated technology evolves, there will be even more ethical dilemmas presented to APNs. It is essential, therefore, that consideration of ethical principles be part of every case presentation in our graduate programs and in our clinical practice. Our clients deserve excellent care based on sound ethical principles.

© 2001 Lippincott Williams & Wilkins, Inc.