Leadership for Ethical Policy and Practice

by Janet Storch, Patricia Rodney | Nov 09, 2009

Main Messages

WHAT DO ETHICS HAVE TO DO WITH THE WELL-BEING OF NURSES AND PATIENTS?

Current healthcare work environments are not always conducive to safe, competent and ethical practice. Poor working conditions lead to poor health outcomes for patients and poor health for workers. Being able to practice ethically is a key aspect of healthy work environments and of ensuring better health outcomes for patients.

Our program of research suggests that action is needed to strengthen ethical practice in healthcare and provides guidelines for strategies that will build positive moral climates to promote ethical practice. We have learned that:

  • Nurses and other healthcare providers welcome the opportunity to discuss ethical concerns and perspectives.
  • In sharing their concerns, these caregivers find strong support in solving ethical issues and in strategizing to make changes to support safe, competent and ethical practice.
  • Ethics projects provide a chance to talk and act on goals chosen with peers.
  • In each workplace, action projects must be tailored to the unique histories and clinical challenges of the area.
  • Key ingredients for success include interest, trust, leadership/manager support, access to resources, and the ability to see action/change.
  • A staff member serving as a champion/coordinator is critical to the effectiveness of an ongoing project.
  • An outside facilitator at the beginning of a project can help group members feel safe to speak openly and thereby build trust amongst the team.
  • As each project develops in a particular context, unique approaches will emerge to enhance ethical practice and improve care.
  • Other healthcare providers are beginning to join nurses in these projects and welcome the opportunities for the ethical dialogue and action they provide.

WHAT YOU CAN DO?

Regional Health Authority Boards. Recognize the importance of ethics to “good” healthcare practice. Support efforts to strengthen ethical practice in healthcare.

Chief Executive Officers. Create opportunities for interdisciplinary ethical dialogue, recognizing its positive impact on patient care.

Chief Nursing Officers. Develop and implement a multi-faceted approach to support nurses and other healthcare professionals to incorporate ethics in their practice.

Canadian Nurses Association/College of Registered Nurses of British Columbia. Recognize ethics as foundational to healthcare. Support developing practice environments that permit full implementation of the CNA Code of Ethics.

CIHR/CHSRF/CCHSE. Foster knowledge translation of research findings, including both qualitative and quantitative studies of work environments. Develop strategies to support the potential of ethics to change the quality of care provided to patients/clients and their families.

Executive Summary

WHAT WAS ACCOMPLISHED IN THIS STUDY?

The research study described in this report is focused on how the ethical/moral climate in healthcare delivery can be improved, and how the use of democratic participation methods can lead to ongoing improvements and lasting changes in healthcare delivery.

HOW DID WE CONDUCT THE STUDY?

Our goal was to develop strategies (templates or designs) for taking action involving nurses and other healthcare providers in direct care, and those in key leadership positions (Chief Nursing Officers and decision makers). This action was directed at improving the quality of the work environment, including working towards a good moral climate, for nurses and healthcare providers. Strategies were developed by participants involved in this study and were tested in various sites across the province. We also sought clarity about the relationship between an ethical climate and moral distress.

WHAT DID WE LEARN IN THIS STUDY?

  • Nurses and other healthcare providers welcome the opportunity to discuss ethical concerns and perspectives.
  • Key ingredients for success include interest, trust, leadership/manager support, access to resources and the ability to see action/change.
  • A staff member serving as a champion/coordinator is critical to the effectiveness of an ongoing project.
  • Most projects begin with conversations with an outside facilitator, who can help group members feel safe to speak up with each other, followed by group decisions regarding ideas for further learning and action. As agency staff becomes more confident in taking the lead, they will not need outside facilitation.
  • Ethics projects provide opportunities to talk (debrief situations) andto act on short-term and long-term goals. Regular re-evaluation of progress is essential.
  • No one approach works best in all settings. Action approaches must be tailored to the unique histories and clinical challenges of each workplace.
  • As each project develops in a particular context, unique approaches will emerge to enhance ethical practice and improve care. Nurses and other healthcare providers report outcomes such as a renewed commitment to their work, better relationships with colleagues, and more conscious ethical decision-making.
  • Other healthcare providers are beginning to join nurses in these projects, identifying similar ethical concerns. They welcome the opportunities for dialogue and action that the projects provide.
  • The meaning of moral distress and ethical climate is complex, as is its measurement.

WHY IS THIS STUDY IMPORTANT?

Current healthcare work environments are not consistently conducive to safe, competent and ethical practice. Researchers examining the impact of work environments on patient/client care and on healthcare providers have shown that poor working conditions lead to poor health outcomes for patients and poor health for workers. Being able to practice ethically is a key aspect of healthy work environments and of ensuring better health outcomes for patients. Environments or climates that are not supportive of ethical practice contribute to moral distress for nurses and other healthcare providers, influence retention of nurses and negatively impact patient care.

WHAT IS THE BACKGROUND TO THIS STUDY?

In many studies, nurses and other healthcare providers have indicated they want safe and legitimate forums to discuss the ethical concerns they encounter in their daily practice. Nurses have led the way among healthcare providers in distilling the everyday ethics pertinent to practice. This approach to ethics complements but goes beyond application of ethical principles to selected issues in bioethics. Over the past nine years, the research conducted by our UVic-UBC team of academic nurses has focused on everyday nursing ethics. Our research team has been involved in extending this research and our findings to all health regions in British Columbia, through implementation of ethics in action studies. Our program of research suggests that action is needed to strengthen ethical practice in healthcare, and provides guidelines for strategies that will build positive moral climates to promote ethical practice.

WHAT YOU CAN DO

Regional Health Authority Boards

  • Recognize the importance of ethics to good healthcare.
  • Support efforts to strengthen ethical practice in healthcare.

Chief Executive Officers

  • Support efforts to strengthen ethical practice in healthcare.
  • Foster opportunities for nurses and all healthcare providers to participate in the creation of positive ethical climates through identifying areas of ethical concern and generating directions for action.
  • Create opportunities for interdisciplinary dialogue about ethics in healthcare, recognizing its positive impact on patient care.

Chief Nursing Officers

  • Promote the development of opportunities for ethics education and debriefing, i.e. ensure there is a place and moral space where nurses and other healthcare providers can speak freely and openly to address ethical concerns.
  • Identify a forum at which nurses and other healthcare providers can discuss actual ethical situations using a consistent ethical approach framework.
  • Keep up to date on the evidence related to ethical climates/healthy workplaces. Advance initiatives to establish and sustain the attributes of a healthy workplace with a positive ethical climate.

Canadian Nurses Association/College of Registered Nurses of British Columbia

  • Recognize ethics as foundational to healthcare.
  • Recognize diverse value systems in healthcare that influence the ability of nurses to provide safe, competent and ethical care.
  • Develop strategies to support the development of practice environments that permit full and consistent implementation of the CNA Code of Ethics.

CIHR/CHSRF/CCHSE

  • Foster knowledge translation of research findings, including both qualitative and quantitative studies of work environments.
  • Develop strategies to support the potential of ethics to change the quality of care provided to patients/clients and their families.