July 2015
Swank Health: Your monthly news from Swank HealthCare

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Did You Know?

Ethical Fitness

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Patient Experience
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Take this quiz to test your knowledge of three ethical principles.

Recommended Readings

Recommended Courses*
  • #44415 Legal and Ethical Issues Faced in Healthcare
  • #313214 Social Media and Ethical Concerns
  • #70414 Standards of Practice: Ethics
  • #17514 / #17614 Physical Therapy: Ethics Part 1 and Part 2
  • #66814 Code of Ethics for the Profession of Dietetics

* course numbers may vary by facility

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Did You Know?

Ethical Fitness

In a December Gallup poll, Americans rated nurses, pharmacists, and medical doctors as having the highest honesty and ethical standards among 21 various healthcare and non-healthcare professions. Nurses took the top spot with 85% of respondents ranking them with high or very high honesty and ethical standards. In fact, nurses have topped the list every year since 1999 with exception to 2001 when firefighters were included in response to their work during the 9/11 attacks. Pharmacists took second place in 2015 with a high rating of 68% by those surveyed and medical doctors ranked third with 67%. These three healthcare professions ranked above all other career fields in the survey, such as police officers with 56%, clergy with 45%, lawyers with 21%, and members of congress at 8%.

Society’s trust in the ethical standards of healthcare professionals comes with great responsibility. Clinicians routinely face complex issues in the workplace that test their ethical decision-making and ability to stand up for what is right. Ethical dilemmas occur when no matter what course of action is taken, some ethical principle must be compromised – in other words, there is no perfect solution. In other situations, doing the right thing is not easy and may require strong moral courage. Ethical fitness is the capacity to recognize the nature of ethical challenges, choose a course of action, and act in a manner consistent with a thoughtful understanding of ethical principles applied through a systematic process. Like physical fitness, ethical fitness requires ongoing exercise to strengthen an individual’s competencies in challenging situations. This requires dedication to professional development through literature, continuing education, discussions with professional and inter-professional colleagues, and other resources that aid in a robust understanding of:

  • One’s own personal values and beliefs. Self-reflection is a process of identifying, exploring, and resolving areas where conflicts or biases may exist between personal and professional values. Resolution may come from a change in personal beliefs or from understanding ways to uphold principles of professional practice despite conflicting beliefs.
  • Professional ethical principles and duties. A professional code of ethics is a guide for carrying out the ethical obligations of a profession. Inherent in the obligation is an understanding of the principles that make up the ethical practice standards by all members of the profession. Although differences in codes of ethics for healthcare professionals exist, some common themes among many of them require practitioners to:
    • Protect the autonomy and dignity of patients
    • Practice with honesty and integrity
    • Maintain confidentiality
    • Place patient’s interests before personal interests
    • Maintain competence
    • Respect for others, including colleagues and other professionals
    • Practice in a non-discriminatory fashion
  • Organizational values and code of conduct. The core values of a healthcare organization should be reflected in policies and practices, codes of conduct, and in relationships with patients, staff, and the community.
  • Complex ethical issues often encountered within an area of practice. Within each healthcare field, area of practice, and setting, some common ethical challenges are known to occur. Professionals should be prepared to face them by having a robust understanding of the conflicting principles and factors to consider when seeking to resolve them.
  • Systems for resolving ethical dilemmas. When ethical dilemmas arise, use of a systematic approach or process aids in gathering, organizing, and analyzing key information in a step-by-step fashion to help arrive at the best possible decisions. There are several available frameworks, but most include the same concepts, which are: defining the problem/s; collecting key information; including the right people (patient, family, and staff members); identifying decision choices, their relationship to ethical principles and anticipated outcomes; identifying the best option; developing and implementing a plan of action; and evaluating and monitoring the decision.
  • Patient cultures, preferences and how they may affect ethical decision-making. Patients have diverse cultural, religious and ideological beliefs that often impact their health-related preferences. It is important for personnel to study groups that share common sets of values that often impact healthcare choices, explore individual patient beliefs, and respect individual preferences.

The Patient Experience

A 2014 study published in Health Services Research found that hospitals that explicitly reward compassionate acts performed by staff and support staff during tough times are associated with patients more highly rating the care experience and being more likely to recommend the hospital to others. In addition, when patients who are dissatisfied with their care are interviewed, they frequently point to a lack of compassion given by healthcare staff.

Compassion is an ethical virtue and the foundation to quality caregiving in all healthcare roles and professions. It means addressing patients’ emotional and psychological needs associated with distress and suffering through human connection and caring relationships. At its core are active listening, empathy, communication, and respect for individual perspectives and preferences. However, the challenges of today’s healthcare environment often lead to stress and burnout experienced by healthcare personnel, decreasing the ability to feel connected to others and express compassion. Ironically, studies show that compassion is not only important for quality patient care, but healthcare personnel who engage in acts of compassion show improved health and resilience to stress.

A number of studies show it is possible to improve compassion through meditation, journaling, and practice. Below are tips for building compassion among staff and providers.

  • Patient stories illustrating the positive impact of compassionate acts by personnel are a powerful resource. Share them in staff meetings, daily huddles, and individual interactions. Reward staff who make a difference in the patient experience through acts of compassion.
  • Role-playing in which staff play the role of the patient is another useful exercise. Create challenging scenarios that help staff explore the types of compassionate acts needed to reflect empathy and relieve suffering.
  • Forums that allow practitioners to have open and honest dialogue about challenges, frustrations, and feelings of delivering care is useful in developing compassion when the environment is free of judgment and criticism.
  • Exercises to improve teamwork are known to make a difference in compassion. When staff support one another in positive, meaningful ways, they’re less likely to experience high levels of stress and burnout that often lead to a lack of compassionate caregiving.
  • When leaders model compassionate behaviors toward staff and patients, personnel are more likely to exhibit similar behavior to co-workers and patients.
  • Exercises in kindness are useful for developing compassionate behaviors. Make a commitment to each of the following acts every day and keep a diary of your progress. Building acts of kindness leads to positive habits and trains the mind to think with more compassion.
    • Perform at least one spontaneous act of kindness.
    • Use active listening to discover something about a patient or co-worker that you didn’t know before.
    • Practice at least one act of forgiveness, no matter how small, especially if you tried and haven’t been as successful as you wanted or if you had a relapse of some kind.
    • Do one thing, even something small, that is enjoyable to you.
    • Spend five minutes reflecting on an act or acts of kindness you performed or witnessed someone else performing that day.

Loving-kindness meditation: A tool to improve healthcare provider compassion, resilience, and patient care

McClelland, L. E., & Vogus, T. J. (2014). Compassion Practices and HCAHPS: Does Rewarding and Supporting Workplace Compassion Influence Patient Perceptions? Heatlh Services Research, 1670-1683.

Recommended Readings

Top List

Here are eight of the most common ethical dilemmas in healthcare.

  1. Futility of continued treatment and end-of-life care – Dilemmas can occur when modern medicine is capable of prolonging a person’s life despite the likelihood of meaningful recovery or quality of life.
  2. Staffing issues – Today’s healthcare environment of ever-increasing patient populations, along with shortages of nurses and other professionals to care for them, has resulted in an often overwhelming workload with more tasks to perform and less time to complete them. Ethical and legal challenges can occur when prioritizing the workload.
  3. Benevolent deception – The principle of fidelity requires one to perform their duties with loyalty and truth, but this sometimes conflicts with the principle of beneficence – promoting and contributing to health and well-being – when withholding information from a patient could protect him/her from emotional or mental stress.
  4. Surrogate decision-makers – When an advance directive or durable power of attorney has not been prepared, the role of decision-maker can sometimes be unclear. Most states provide for a default surrogate decision-maker, but some do not. This can create especially challenging situations when family members disagree about care options.
  5. Pain management – Healthcare professionals have a duty to relieve pain and suffering and to respect patients’ autonomy by allowing them to make decisions about how they want their pain to be treated. On the other hand, duties to support health and well-being and to refrain from doing harm could conflict with those principles when patients have a history of substance abuse.
  6. Social media – Participation in social media provides healthcare professionals with tools to share information, promote health behaviors, and interact with patients and colleagues. However, ethical concerns arise when this participation blurs the lines of professional relationships and when the security of patient information could be compromised.
  7. Disclosing medical errors – Certainly, there is a duty to disclose medical errors resulting in patient harm, but should a disclosure be made when an error causes no harm or minimal temporary harm? Would a disclosure cause greater harm by damaging a patient’s confidence in their provider or cause unnecessary worry or fear?
  8. Confidentiality – To provide quality care, it is often necessary to share patient information with members of the healthcare team. Patients have a right to privacy and healthcare providers have a duty to protect personal health information. Although there are legal exceptions to duties of confidentiality in some cases, the boundaries of acceptable information sharing are sometimes difficult to distinguish.

Now Trending

Take this quiz to test your knowledge of three ethical principles.

Respect for a patient’s right to make their own decisions about healthcare is the ethical principle of _____.

A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice

What are attitudes of respect for human dignity?

A. Self-direction and self-discipline
B. Creativity and appreciation
C. Empathy, kindness, trust
D. Commitment, generosity, perseverance

Acting as a patient advocate, allocating resources fairly, and reporting unethical, illegal, or incompetent conduct are professional behaviors of _____.

A. Truth
B. Utility
C. Altruism
D. Justice

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A - Autonomy



C – Empathy, kindness, trust



D - Justice