Why ethical standards? An introduction to the perianesthesia standards for ethical practice

perianesthesia standards for ethical practice Why Ethical Standards? An Introduction to the Perianesthesia Standards for Ethical Practice NANCY BURDEN, NANCY SAUFL, WHY ETHICAL STANDARDS?

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VER THE PAST several years, the ASPAN Board and Ethics Committee members have researched, discussed, developed, and revised an ethical framework for the organization and its members. This framework was approved by the Representative Assembly in April 2000. The resulting document, presented in this issue, is less of a short-term project than an evolution of many years as ASPAN leaders and members have long sought guidance for various concerns, issues, and situations faced both on an organizational level and within the workplace. Truly, the question is not, “Why Ethical Standards?” but rather, “How could we not provide an ASPAN guideline for ethical decision making?” Clearly, that goal has been on the minds of our leaders and members as our culture, our organization, and our challenges have evolved. The complexity of today’s society and of medical science demands introspection, decisions, and actions that were not even considered 20 years ago.

Nancy Burden, MS, RN, CPAN, CAPA, is a Director, Bardmoor and Trinity Outpatient Centers, Morton Plant Mease Health Care, Dunedin, FL; and Nancy Saufl, MS, RN, CPAN, CAPA, ASPAN President 2000-2001, is Manager, Port Orange Day Surgery, Halifax Medical Center, Daytona Beach, FL. Address correspondence to Nancy Burden, MS, RN, CPAN, CAPA, 1612 Crossvine Court, New Port Richey, FL 34655. © 2001 by American Society of PeriAnesthesia Nurses. 1089-9472/01/1601-0002$35.00/0 doi:10.1053/jpan.2001.22179 2

MS, RN, CPAN, CAPA MS, RN, CPAN, CAPA

As an organization, ASPAN has always embraced the philosophy that perianesthesia nursing care must be provided within the boundaries of ethical decision making. Our founding directors recognized the need for integrity both in the organization as a whole and throughout the clinical practice settings of its members. In those early years, dilemmas and discussions revolving around staffing ratios, nursing scope of practice, and individual nurses’ education and readiness indicated concern that perianesthesia settings throughout the country should provide care in an ethical and clinically superior manner. On an organizational level, the early directors developed bylaws and a method to ensure that all perianesthesia nurses had a mechanism for representation on the national level. The intelligence, diligence, and character of ASPAN leaders have enabled the organization to grow and flourish as the voice of perianesthesia nurses, even through some significant struggles. From promoting and protecting the organization’s reputation, to maintaining neutrality with other professional organizations embroiled in controversy, to recovering from financial struggles, the very essence of the Board of Directors has been one of ethical decision making in good and bad times. Through the past few decades, many issues and situations have arisen within clinical settings that have caused vigorous debates and demanded difficult decisions by frontline health care providers. Without a framework to guide decision making, we Journal of PeriAnesthesia Nursing, Vol 16, No 1 (February), 2001: pp 2-5

ETHICAL PRACTICE—PERIANESTHESIA would surely struggle to make the right decisions. Yes, our ethical behavior and thinking are and should be innate, driven by our personal backgrounds, standards, and character. However, the complex situations we encounter today demand that we consider many issues, arguments, rights, laws, and more. Consider the controversies in health care settings surrounding human immunodeficiency virus (HIV) infection, gay lifestyles, drug use, political and racial extremists, drunk drivers, and others. Setting standards for patient care that transcend personal attitudes is essential. Consider the following: ● The patient is in PACU after liver transplantation for ● ● ●

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advanced hepatic failure, but is known to have been drinking alcohol up until the time of his or her surgery. A patient is likely to die within hours or minutes, and the strict enforcement of no visitors in the PACU is expected of all nurses. A 15-year-old girl tells you preoperatively that she is using cocaine, but demands that you not tell her parents. You work in an institution that does not comply with the ASPAN standard of “two nurses in the PACU whenever one patient is recovering.” No matter what your approach, you cannot make changes happen. You need and love your PACU job, but can you continue in this situation? You are on call; when your patient arrives from surgery, you discover that in addition to an emergency appendectomy, she has asked for and been given an elective abor-

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tion. You have strong objections that you have shared with your manager about caring for patients having elective abortion, but you now have the patient in front of you without another PACU nurse to take over the care. ● You believe that the behavior of a peer, your best friend, may indicate drug use, and you suspect that she is substituting saline for medication used on her patients. You are not sure of your suspicions and your friend is a single mother of 3.

ASPAN proudly presents these Perianesthesia Standards for Ethical Practice as a framework for individual nurses and the organization to use to guide decisions, philosophy, discussions, and actions in an effort to protect our organization, our members, and our customers—patients, physicians, and peers— from variations in standards of care, bigotry, breeches of confidentiality, and other offenses. This document should serve as a wonderful tool for providing the best that is possible in ethical practice. ACKNOWLEDGMENT Special thanks and recognition go to the 1999-2000 Ethics Committee for their dedication to this project. The members of the committee were Nancy Saufl, Chair; Nancy Burden; Phoebe Conklin; Sally Foix; Mary Mulkay; and Lois Schick. Our appreciation also goes to Myrna Mamaril, ASPAN Immediate Past President, and our consulting ethicists, Dr Catherine Green, Kansas City, MO, and Dr Frank Forrest, Daytona Beach, FL.

PERIANESTHESIA STANDARDS FOR ETHICAL PRACTICE American Society of PeriAnesthesia Nurses PREAMBLE

ASPAN exists to promote quality and costeffective care of patients, their families, and the community through public and professional education, research, and standards of practice. The American Nurses Association (ANA) Code for Nurses was first published in 1950 and serves to inform the nurse and society of the profession’s expectations and requirements in ethical matters. It provides a framework for nurses to make ethical decisions. ASPAN formally endorses the ANA Code for Nurses. Perianesthesia nurses share a commitment to these principles and a desire to incorporate them into daily practice. The ANA Code for Nurses is reprinted with permission in ASPAN’s Standards of Perianesthesia Nursing Practice under Resource 2. ASPAN’s Perianesthe-

sia Standards for Ethical Practice provides a specific context for applying the Code for Nurses to perianesthesia practice and serves as a resource to develop ethically sound practices. The perianesthesia nurse practices by providing nursing care to preanesthesia and postanesthesia patients. The perianesthesia nurse accepts the responsibility bestowed on him or her by the state, the profession, and society. This document shows accountability to the public and to the profession. It should assist the perianesthesia nurse to relate the ANA Code for Nurses to his or her own area of practice and use appropriate mechanisms to identify and resolve ethical dilemmas. INTERPRETATION

The ANA Code for Nurses expresses the moral commitment to uphold the values and ethical ob-

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ligations of all nurses. The perianesthesia nurse faces unique situations in the care of patients undergoing surgery and anesthesia. The perianesthesia nurse’s decisions and actions are determined in an ethical manner and are guided by the ANA Code. ASPAN developed the Perianesthesia Standards for Ethical Practice document to assist in recognizing our obligations to patients, the society, other health care professionals, and to the self. ASPAN and perianesthesia nurses strive to ensure the following:

● maintains patient confidentiality, modesty,

Competency Perianesthesia nursing is a specialty area that takes pride in developing and maintaining the highest standards of care. Competency based practice integrates knowledge, attitudes, skills, and behaviors to maintain consistent standards of care. The perianesthesia nurse

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and privacy;

● participates in perianesthesia patient teaching; ● answers questions honestly and accurately; ● communicates pertinent information as the ● ● ●

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● identifies personal competency and partici● ● ● ● ● ● ●

pates in professional continuing educational activities; adheres to ASPAN’s Standards of Perianesthesia Nursing Practice; complies with institutional policies and procedures regarding competence; accepts responsibility and accountability for perianesthesia nursing practice; participates in performance improvement activities; uses competency-based orientation and annual review processes; remains current on new products and procedures affecting practice; and maintains a kind and caring demeanor.

Responsibility to Patients The perianesthesia nurse provides care to each patient while preserving human dignity, autonomy, confidentiality, and worth; protecting patient rights; and supporting the well-being of the patient. The perianesthesia nurse

● provides quality care to all patients regardless of race, religion, sex, age, disability, social or economic status, gender orientation, and the patient’s care decisions; ● confirms that informed consent for surgery has been obtained; ● explains procedures before initiating care;

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patient progresses through the continuum of perianesthesia care; respects advance directives; provides communication aides (charts, voice boxes, language interpreters, etc) when needed; advocates for the spiritual comfort of patients and significant others; respects the patient’s decision for or against surgery; protects and removes the patient from harm; advocates for patient welfare; aggressively provides pain control and other comfort measures; includes the patient’s family and/or social support system in the plan of care as appropriate and as desired by the patient; evaluates patient environment for safety and addresses deficiencies; and ensures that all patients are cared for by a professional nurse.*

(* Where the perianesthesia nurse’s personal convictions prohibit participation, that nurse may remove himself or herself from a patient care situation as long as such removal does not harm the patient or constitute a breach of duty. The professional nurse should provide his or her manager with information about the specific situations that would be difficult to participate in so the manager is better able to plan for patient needs. If an unplanned situation arises in which no other professional nurse is available to care for the patient, however, then the objecting nurse must ensure that the care needs of the patient are met.) Professional Responsibility In fulfilling obligations as a professional, the perianesthesia nurse is responsible and accountable for the care provided and for maintaining compliance with regulatory and professional agencies. The perianesthesia nurse recognizes the importance of achieving the highest standards of nursing practice. The perianesthesia nurse

● adheres to ASPAN, Joint Commission on Accreditation of Healthcare Organizations

ETHICAL PRACTICE—PERIANESTHESIA

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(JCAHO), Accreditation Association of Ambulatory Health Care, and other national, state, local, institutional, or agency policies, procedures, and standards; provides a comparable level of care regardless of physical setting (ie, outpatient, inpatient, emergency department, endoscopy, obstetrics); discusses patient information with appropriate health care providers as needed to ensure optimum care; maintains accurate, objective patient records; safeguards the highest confidentiality of written and electronic patient information; participates in activities that contribute to the ongoing development of the perianesthesia nursing profession; promotes certification for perianesthesia nurses (CPAN) and ambulatory perianesthesia nurses (CAPA); acts as a mentor and/or preceptor; shows stewardship through fair and responsible management of all resources; maintains an awareness of changing perianesthesia practice issues; recognizes a need to care for one’s self and to maintain professional boundaries; and follows policies, procedures, and laws to protect the patient from incompetent, unethical, or illegal practice and is able to identify and appropriately report a health care provider exhibiting questionable practice.

Collegiality The perianesthesia nurse is a member of a multidisciplinary health care team providing care to

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patients undergoing invasive and/or noninvasive procedures. The perianesthesia nurse

● consults, collaborates, and cooperates with colleagues, peers, supervisors, and other health care providers to improve the quality, effectiveness, and efficiency of patient care; ● and promotes respectful relationships with colleagues. Research The perianesthesia nurse participates in research to improve practice and education. The perianesthesia nurse

● obtains appropriate Institutional Review Board approvals;

● protects patient confidentiality when collecting data;

● uses research findings to support clinical practice;

● identifies problems to be considered for the research process;

● and protects the rights of all research participants and staff throughout the research process. CONCLUSION

ASPAN’s Perianesthesia Standards for Ethical Practice recognizes the matrix of relationships among individuals, society, and systems. Our goal is to guide the perianesthesia nurse in providing care that encompasses compassion, collaboration, and trust. The principles of the Perianesthesia Standards for Ethical Practice include a moral obligation to promote the welfare, health, and safety of the patients we serve and to advocate on the patient’s behalf whenever necessary.