AACN News—September 2005—Practice

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Vol. 22, No. 9, SEPTEMBER 2005

Code Encourages Nurses to Collaborate on Multilevels

Editor’s note: The American Nurses Association’s Code of Ethics for Nurses contains nine provisions that are the foundation of nursing care. The purpose of the code is to provide concise statements of ethical obligations and duties to all nursing professionals.1 It is the profession’s ethical standard and commitment to society, and all acute and critical care nurses should practice in accordance with this code. Following is the sixth in a series of articles applying the provisions of the ANA Code of Ethics to critical care nursing practice. This article highlights the eighth provision and its underlying principles. Correlations with the AACN Synergy Model for Patient Care will also be discussed.2

By Rebecca E. Long, RN, MS, CCRN, CMSRN
AACN Certification Corporation

The Eighth provision in the ANA Code of Ethics states:

The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.

Collaboration is not new to nurses. We understand that it is the best way to meet a patient’s needs. In fact, true collaboration is one of the six crucial standards listed in the AACN Standards for Establishing and Sustaining Healthy Work Environments.3

True collaboration supports nurses to use their skills, resources and authority to make decisions that contribute to optimal patient care. Applying this skill and teamwork to a larger world implies that nurses are informed and involved in addressing the greater health needs of their communities, the nation and the world.

Health Needs and Concerns
This code speaks to nurses’ duty to concern themselves with health and societal issues beyond their day-to-day world. This concern and collaboration can be manifested in many forms: staying abreast of broader health concerns, financial contributions, advocacy in legislative arenas and facilitation of others’ understanding of important health issues.

Volunteering time and valuable skills is a wonderful way to impact the world beyond the bedside. I know of one nurse who volunteers two weeks each summer to teach basic nursing in a school with predominantly Native American students. Another colleague dedicates two weeks a year for medical missionary work in Mexico. She works with an interpreter in remote villages to teach basic hygiene education. Creativity is essential, because basics such as running water and sterile supplies are rarely present. This type of volunteerism exemplifies this eighth provision and captures the 2005 AACN “Engage and Transform” presidential theme. These nurses not only contribute to transforming the places they visit, but also are transformed individually by their unique experiences.

A clinical nurse specialist advocating for legislation that impacts those who are underserved is another example of this eighth provision. The CNS is working closely with a congressional representative to change legislation to support the reimbursement of clinical nurse specialists by Medicaid programs. Efforts surrounding this bill to amend Title XIX of the Social Security Act are an example of this eighth provision because they use skills in the public policy arena to impact access and collaboration and ultimately promote national health objectives.

Responsibility to the Public
The Synergy Model has both patient and nurse characteristics that are in sync with aspects of this eighth provision. In particular, patient characteristics such as vulnerability, complexity, participation in care and participation in decision making apply to the populations that nurses serve. Many of the health populations that are underserved both nationally and internationally are susceptible to ravages of their illness or disease as well as system gaps that prevent them from obtaining both preventative and necessary care. In addition, family and cultural dynamics add to their level of complexity. Participation in care and participation in decision making are two additional characteristics that are consistent with tenets of this provision. Cultural and familial traditions can impact the role that the patient and family may have in making decisions about their healthcare as well as the family or significant others’ participation in that healthcare.

Victims of the 2004 tsunami, who represented many of the above traits, provided unique opportunities for nurses to intervene. Certainly, patients were vulnerable and complex in their needs as homes, families and the basics of daily living were stripped from their lives. Because of the destruction of entire family units, cultural influences and the severity of injuries, some were unable to participate in their care or the care of their family members.

Synergy Model nurse characteristics that relate to this provision include advocacy and moral agency, systems thinking, response to diversity and facilitator of learning. Advocacy involves helping the patient and family resolve ethical and clinical dilemmas. Intervening on behalf of the patient is one of the most important roles that nurses must play. Systems thinking involves using a variety of strategies to meet the needs of the patient and seeing the patient in a holistic manner. Kritek addresses this need for systems thinking and adept strategizing in the statement: “Creating healing environments is a system question, and their creation is a system negotiation. Neither demand nor despair will work, and to negotiate effectively, we must first think through what we have now.”4

Differences in Care
Response to diversity speaks to the need for the nurse to appreciate and incorporate differences into care. A recent example in the media is that of a United States military nurse in Iraq. Her duty to care for the Americans wounded alongside those who wounded them demonstrates the difficulty in applying ethical principles to real world situations. Facilitation of learning addresses assisting the patient and family to receive interdisciplinary education. Creativity may be needed to modify the program for the individual or population served.

In summary, the eighth provision of the ANA Code of Ethics is about nurses extending themselves beyond the bedside into their communities and nation. It is a call to action for nurses to individually and collectively contribute in unique ways to a cause beyond their immediate world.

1. ANA Code of Ethics for Nursing with Interpretive Statements/. Available at http://www.nursingworld.org/ethics/code/ethicscode150.htm. Accessed Aug 1, 2005.
2. The AACN Synergy Model for Patient Care. Available at http://www.aacn.org. Accessed Aug 1, 2005.
3. AACN Standards for Establishing and Sustaining Healthy Work Environments. Available at http://www.aacn.org. Accessed Aug 8, 2005.
4. Kritek P. (2001). Rethinking the Critical Care Environment: Luxury or Necessity? AACN Clinical Issues. 2001;12(3):336-344.


Sponsored by Philips Medical Systems
New Grants Support Studies Relevant to Bedside Practice

Beginning in January 2006, three AACN grants of up to $10,000 each sponsored by Philips Medical Systems will be awarded to qualified proposals relevant to bedside clinical practice. Each grant supports a nurse who is experienced in research in conducting a clearly articulated study relevant to clinical nursing practice in acute or critical care. Funds may be used for original research or replication of existing research.

Proposals for the first round of funding must be received no later than Jan. 1, 2006. Studies selected should be completed in time for oral and poster presentations at the National Teaching Institute and Critical Care Exposition in May 2007 in Atlanta, Ga. The principal investigator will receive funding for travel, two nights lodging and complimentary registration for the NTI.

Areas of inquiry, selection criteria and submission instructions are available online at www.aacn.org.

Public Policy Update

Advanced Practice Nurses Act Would Expand Medicaid Coverage
AACN joins the American Nurses Association in commending Sen. Daniel Inouye (D-Hawaii) for his efforts to expand Medicaid coverage of advanced practice nursing services through the introduction of the Medicaid Advanced Practice Nurses and Physician Assistants Access Act (S.1515).

The proposed legislation would increase patients’ access to essential healthcare services, especially needed in rural and underserved areas. A companion bill, H.R. 2716, was introduced in the U.S. House of Representatives in May by Reps. John Olver (D-MA), Sherwood Boehlert (R-N.Y.), Lois Capps, RN (D-Calif.) and Steven LaTourette (R-Ohio).

To support this legislation, contact your congressional representatives. For more information, go to http://capwiz.com/criticalcare/issues/bills/?billtype=S.&billnumb=1515&congress=109.

State Department Releases Visas
The State Department has released 50,000 visas that were not used in the past four years for use by nurses and physical therapists in this and future years. The move will allow U.S. hospitals struggling with a critical shortage of nurses to resume recruitment of nurses from the Philippines, India, China and other countries that have exceeded their visa quotas. Previously, hospitals faced a three-year wait for visas.

Report Documents Deficiencies
Despite the high quality of the U.S. healthcare delivery system, many Americans do not get all the healthcare that they need, according to the 2004 National Healthcare Quality Report and National Healthcare Disparities Report. The report documents continuing deficiencies in care, particularly for poor and minority women.

Selected findings related to women’s health are available online in a fact sheet titled “Women’s Health Care in the United States” at http://www.ahrq.gov/qual/nhqrwomen/nhqrwomen.htm.
U.S. News & World Report Ranks Hospitals
U.S. News & World Report has published its annual America’s Best Hospitals edition. Of the 176 medical centers that are included, 16 earned Honor Roll status by achieving high rankings in at least six specialty areas. To view the full report, go to http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm.

Spanish Version of Patient Safety Culture Survey Now Available
A Spanish version of the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture survey tool is now available. When combined with a new, customized data tool for easy entry and rapid display of survey results, these tools complement other resources from AHRQ for implementing the survey as well as analysis and benchmarking of results. To access these resources, go to http://www.premierinc.com/all/safety/culture/.

Medical Errors Bill Paves Way for Confidential Reports
Legislation to create a network for reporting and analyzing medical errors has been approved by Congress and signed by President Bush.

Under the new law, hospitals could report mistakes through a confidential system shielding the information from malpractice suits. The reports would be made to a new patient safety organization that would recommend steps to prevent future errors. Additional information about the Patient Safety and Quality Improvement Act of 2005 (S.544) is available at http://capwiz.com/criticalcare/issues/bills/?bill=7499426.

For more information about these and other issues, visit the AACN Web site.

Congratulations Beacon Award Winners! Units Embrace Excellence in Critical Care

Pictured here are staff representatives of units that were awarded the AACN Beacon Award for Critical Care Excellence in the past year. All were recognized during Network Night at AACN’s National Teaching Institute and Critical Care Exposition in May in New Orleans, La., where then AACN President-elect Debbie Brinker was on hand to offer congratulations. Beacon Award units attain high standards for quality, exceptional care of patients, and healthy, humane and healing work environments. Applications are accepted year-round. For more information about the award and to access the Web-based application process, visit the AACN Web site at www.aacn.org.

Fall 2004 Winner—Cardiovascular Recovery Unit, Lynchburg General Hospital, Lynchburg, Va.

Fall 2004 Winner—Intensive Care Unit/Cardiac Care Unit, Norwalk Hospital, Norwalk, Conn.

Fall 2004 Winner—Medical Intensive Care Unit, Methodist Hospital, Houston, Texas

Fall 2004 Winner—Cardiovascular Care Unit, Mount Carmel West, Columbus, Ohio

Fall 2004 Winner—Surgical/Trauma Intensive Care Unit, Tampa General Hospital, Tampa, Fla.

Spring 2005 Winner—Adult Medical Surgical ICU, Baystate Medical Center, Springfield, Mass.

Spring 2005 Winner—Neuro-Medical ICU, North Broward Medical Center, Pompano Beach, Fla.

Spring 2005 Winner—Intensive Care Unit, Mercy Hospital, Coon Rapids, Minn.

Spring 2005 Winner—7 & South 1 & 2 ICU, St. Luke’s Episcopal Hospital, Houston, Texas

Spring 2005 Winner—Bliss 10 I Coronary Care Unit, Hartford Hospital, Hartford, Conn.

Spring 2005 Winner—Neurotrauma ICU C9WI, Hartford Hospital, Hartford, Conn.

Spring 2005 Winner—Cardiac ICU, Utah Valley Regional Medical Center, Provo, Utah

Spring 2005 Winner—CCU, Oklahoma Heart Hospital, Oklahoma City, Okla.

Spring 2005 Winner—Intensive Care Unit, Eastern Idaho Regional Medical Center, Idaho Falls, Idaho.

Spring 2005 Winner—Medical-Surgical Intensive Care Unit, Overlook Hospital, Summit, N.J.
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