Application: Taking a Stand
In Leadership Roles and Management Functions in Nursing, Marquis and Huston
discuss the opportunities nay, the imperative for a nurse to advocate on behalf of him-
or herself, others, and the environment. No doubt, at some point in your career, you will
encounter an ethical or moral dilemma that requires you to take a stand and defend
your position.
For this Assignment, you evaluate an issue and consider how you could act as a moral
agent or advocate, facilitating the resolution of the issue for a positive outcome.
To prepare:
� Consider the examples of leadership demonstrated in this week’s media presentation
and the other Learning Resources. (Will attach this separately for your use if you need
it see below)
� Mentally survey your work environment, or one with which you are familiar, and
identify a timely issue that requires you to perform the role of moral agent or advocate
to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the
need for appropriate staffing, a colleague being treated unfairly).
� What are the potential outcomes if you do not execute that role?
� What skills, dispositions, and/or strategies would help you to fulfill this role?
� Finally, consider the values and principles that guide the nursing profession; the
organization’s mission, vision, and values; the leadership and management
competencies addressed in this course; and your own values and reasons for entering
the profession. What motivation do you see for taking a stand on an important issue
even when it is difficult to do so?
To complete:
Write a 3- to 4-page paper that addresses the following:
� Describe your role as a moral agent or advocate for a specific issue in your work
environment or an organization with which you are familiar.
� Explain one or more negative outcomes that may result if this role is not fulfilled.
� Analyze the skills, dispositions, and/or strategies that would help you to fulfill this
role.
� Explain your motivation for taking a stand even when it is difficult to do so.
Application: Taking a Stand
Describe your role as a moral agent or advocate for a specific issue in your work environment
or an organization with which you are familiar.
One of the ethical issues in nursing arises from the pro- choice versus pro- life
dilemma. Nurses face the challenge when caring for patients who procure abortion when the
nurses consider it murder. They also face the issue when caring for palliative care patients
who consider euthanasia when the nurses may also consider it murder (Fernades & Moreira,
2013). As an intensive care nurse, ethical issues are complicated by the complex clinical
situation of intensive care unit (ICU) care inpatients and the technological advances in the
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settings. Clinical decision in the setting requires using different types of knowledge to protect
and respect the dignity of the human being (Fernades & Moreira, 2013).
Nurses in the ICUs make end of life decisions when faced with issues related to
euthanasia and do-not-resuscitate (DNR) orders. Other decisions for patients are often arrived
at within a short period of time and with limited knowledge of the clinical situation. The
physician may not consider the benefits of medium and long-term therapeutics because they
focus on the immediate situation. Physicians do not always follow common orientation and
comply with consistent standards (Fernades & Moreira, 2013). The decisions are made
without an overall analysis of the situation and without a broad discussion involving other
professionals and family members (Halvorsen, Ferde, & Nortvedt, 2008).
Care is the central part of the nursing profession and a direct or indirect request for
euthanasia from a patient or order by a physician may change the interpersonal and
professional relationship between health care professionals and the patient and the family.
Reports show that there are mixed perceptions about acceptability of euthanasia among
nurses. Some actively perform euthanasia sometimes even without a patient’s explicit request
(Brzostek, dekkers, Zalewski, Januszewska, & Gorkiewicz, 2008). In making decisions on
euthanasia, there are several factors to consider. They include having a philosophy of life,
experience and knowledge, adhering to a professional deontological code and abiding by the
law (Brzostek, dekkers, Zalewski, Januszewska, & Gorkiewicz, 2008). In as much as it is
essential to involve all the necessary healthcare professionals, the family and the patient in
euthanasia decision making, euthanasia remains a violation of the Hippocratic Oath as well as
a violation of my religious beliefs. This thus necessitates adopting a pro-life stand based on
personal philosophy of life that is informed by religious beliefs about the sanctity of life.
Faced with the euthanasia ethical issue, it would be necessary to make effort in
changing the organizational culture to accommodate varying nurse’s perceptions. This would
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remove the blanket obligation of all nurses to perform euthanasia. It would also remove the
burden of guilt among the nurses that are opposed to euthanasia but would be forced to
administer it as a matter of procedure or duty. It is reported that older and more experienced
nurses adopt a psychosocial focus in their decision making while the younger nurses focus
more on the physical aspects of work. Thus, older nurses’ ethical conscience, experience,
courage to work and a sense of personal empowerment inform their effort in trying to change
organizational values (Leino-Kilpi, Souminen, & Makela, 2002).
Borrowing from these older nurses’ tendencies, advocacy on organizational change
would promote aspects of personal choice in nurses’ participation in Euthanasia. It would
also advocate for involvement of all the interested parties before euthanasia and DNR
procedures can be allowed. The patient, the patient’s family and all relevant health care
professionals require being involved in euthanasia decision making. Most importantly, the
policy change would indicate that only nurses agreeable to euthanasia would be tasked to
administer the procedure.
What are the potential outcomes if you do not execute that role?
Failure to advocate for change would sustain the lack of an overall analysis that
prevents decision making from focusing on a holistic view of the situation. It sometimes
results in lack of concern for what would be significant to the patient. These situations cause
restlessness and discomfort in nurses as they result from the perception that some of their
decisions and applications has led to more suffering for the patient. The nurses concern lies in
providing a dignified death and feeling that they are able to respect their autonomous area of
intervention in terms of preparing the family for what is happening to their family member
(Beca, Koppmann, & Chavez, 2010). Decisions to administer or not to administer euthanasia
and other interventions require both the patients consent and the nurse’s willingness to
practice. Additionally, patient preferences should prevail over family wishes or the healthcare
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team values. Physicians should not bypass the patient’s clearly stated end of life wishes. This
honors the patient’s dignity and rights.
Another negative outcome of failing to develop clear policy on end of life procedures
is hopelessness, helplessness and burnout among the nurses that are comfortable with
euthanasia. The nurses suffer emotional trauma caused by regrets about being unable to be
better advocate for the patient. They regret not adequately preparing the patient and the
patients’ family for impending death and administering life extending aggressive treatments
that increases patient’s suffering and lowers their quality of life. Essentially, failure to
advocate for change leave nurses in the middle of situations created by others and without
power to change the situations (Pavlish, Brown-Saltzman, Hersh, Shirk, & Rounkle, 2011).
What skills, dispositions and or strategies would help to fulfill this role?
My personal stand against euthanasia is based on my philosophical predisposition
about sanctity of life and the Hippocratic Oath on preservation of life. However, this stance
does not bar nurses that are pro-choice from administering euthanasia on the basis of ensuring
quality of life. The stance advocates for the development of a policy that considers that not all
nurses are comfortable in practicing euthanasia procedures. It also advocates for
consideration of the patient’s wishes, involvement of the patient family and the relevant
health care professionals in decision making for euthanasia.
Advocating for development of a policy for end of life procedures for nurses would be
guided the strategy to reducing high turnover rates and underperformance caused by moral
distress. Moral distress is associated with ethical dimensions of nursing practice and concerns
related to difficulties in navigating practices while upholding professional values,
responsibilities and duties. Moral distress has been shown to contribute to emotional distress,
withdrawal from patients, unsafe or poor quality patient care, decreasing job satisfaction and
attrition in nursing (Paully, Varcoe, & Storch, 2012). To keep nurses from leaving the
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profession persistent lobbying with health care leaders is required. Advocacy and lobbying
skills would be essential in convincing the nursing fraternity to support the move for
establishing a clear policy outlining the roles and liberties of nurses in end of life procedures.
The ICN code of ethics that provides guidance for nurses and supports their refusal to
participate in activities that are contrary to caring and healing would also form a strong tenet
for lobbying for the policy. Additionally, Provision 1 of the ANA Code of ethics that
mandates that nurse’s practice with compassion and respect for patients’ inherent dignity and
right to self-determination would inform the lobbying activities (Pavlish, Brown-Saltzman,
Hersh, Shirk, & Rounkle, 2011). Lobbying would advocate the importance of prioritizing
patient’s suffering and autonomy in exploring patient’s preferences for treatments and
advocate for their care in a non-paternalistic way. It would indicate values that require nurses
to query gently and empathically listen to patient’s preferences (Pavlish, Brown-Saltzman,
Hersh, Shirk, & Rounkle, 2011).
What motivation do you see for taking a stand on an important issue even when it is difficult
to do so?
It is difficult to take a stance that allows patients preference to override that of nurses
and other healthcare professionals particularly where it concerns requesting euthanasia.
However based on the professional obligation to improve the quality of life of patients with
uncontrollable pain and those with poor quality of life, euthanasia would be permissible albeit
practiced by nurses comfortable with practicing euthanasia procedures. Research has
indicated that physicians are favorable towards legalization of euthanasia in the US but show
little enthusiasm when asked to perform it (Dickinson, Clark, Winslow, & Marples, 2005).
This indicates that physicians would not misuse the policy. This is because research has
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shown that even if euthanasia were to be made legal, an overwhelming majority would not
practice it. Therefore, my support for its practice by other nurses would not lead to a large
increase in the willingness to hasten death unnecessarily.
This role in advocating for change of policy would also allow for proactive counsel
for patients and families on end-of life values and preferences. Additionally, the possibility of
discussing pain control and the sharing of values between the patient and physician would
assist in obviating end of life care conflicts while being respectful of both parties (Dickinson,
Clark, Winslow, & Marples, 2005). Essentially, this change in organizational policy would
ensure more accuracy and fairness because the decisions would be made only after sufficient
consultation with all interested parties.
References
Beca, J., Koppmann, A., & Chavez, P. (2010). Analysis of a Clinical Ethics Consultation
Experience in Intensive Care. Rev Med Chil, 815-820.
Brzostek, T., dekkers, W., Zalewski, Z., Januszewska, A., & Gorkiewicz, m. (2008).
Perception of Palliative Care and Euthanasia Among Recently Graduated and
experienced Nurses. Nursing Ethics, 15(6), 762-774.
Dickinson, G. E., Clark, D., Winslow, M., & Marples, R. (2005). US Physicians’ Attitudes
Concerning Euthanasia and Physician-assisted Death: A Systematic Literature
Review. Mortality, 10(1), 43-52.
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Fernades, M. I., & Moreira, I. M. (2013). Ethical Issues experienced by Intensive Care Unit
Nurses in Everyday Practice. Nursing Ethics, 20(1), 72-82.
Halvorsen, K., Ferde, R., & Nortvedt, P. (2008). Professional Challenges of Bedside
rationing in Intensive Care. Nurs Ethics, 15, 715-728.
Leino-Kilpi, H., Souminen, T., & Makela, M. (2002). Organizational Ethics in Finnish
Intensive Care Units. Nurse Ethics, 9, 126-136.
Paully, B. M., Varcoe, C., & Storch, J. (2012). Framing the Issues: Moral Distress in Health
Care. HEC Forum, 24, 1-11.
Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Rounkle, A.-M. (2011). Nursing
Priorities, Actions and Regrets in Ethical Situations in Clinical Practice. Journal of
Nursing, 43(4), 385-395.