Author addresses moral distress in nursing in new book

One nurse devotes her career to understanding and tackling ethics issues in nursing that threaten to undermine not only the profession, but also healthcare quality.

Cynda Hylton Rushton, RN

Meet Cynda Hylton Rushton, PhD, RN, FAAN, the Anne and George L. Bunting professor of clinical ethics at Johns Hopkins University who co-chairs the Johns Hopkins Medicine’s Ethics Consultation Service.

She co-led the first National Nursing Ethics Summit, which resulted in “A Blueprint for 21st Century Nursing Ethics.”

In her new book, “Moral Resilience: Transforming Moral Suffering in Healthcare,” Rushton takes a first-ever systematic look at moral resilience in nursing in the hope others use it as a catalyst to learn more. (Get a 30% discount on Rushton’s book by using code AMPROMD9 at checkout.)

We asked Rushton what fuels her work in ethics, how ethical issues might affect nurses professionally and personally and what nurses can do to help themselves and their profession.

You said the bedside experience has informed everything you have done professionally. What did you mean by that?

Rushton: I consider myself to be kind of a nurse’s nurse. I have always been committed to my clinical practice. And it has always been in that context that I’ve learned the most about myself and about what it means to be a nurse and … the moral adversity that comes with the role.

I started out in the pediatric ICU and often was confronted with questions about how we ought to be using our technology to sustain the lives of children who had life-threatening diseases or injuries. I worked with families to try to figure out what was the right thing to do for their children.

It was really through those roles that I became more and more interested in the ambiguity and uncertainty that was part of our work — especially as technology was expanding at a really rapid rate.

I do quite a bit of ethics consultation and, of course, that brings me right back to the bedside with patients, families and distressed staff. It’s clearly what keeps things current and real for me.

Do you have an example of an ethical dilemma in nursing?

Rushton: There are just so many. A lot of them have to do with end-of-life care.

One example is a child with a very complex congenital heart defect and the need for sometimes innovative and risky surgery that could leave the child with a high risk of death or disability and yet parents want to do everything possible to help their child.

Of course, we want every child to live well, but sometimes in our attempts what ends up happening is a very prolonged period of time where children are tethered to technology.

As a nurse, you witness how much the child is suffering, as well as people around the child — the family and often the clinicians. We struggle trying to figure out how far we should go and what amount of suffering is reasonable to endure to give a child a chance for life.

I think there are issues …read more

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