National Nursing Ethics Conference Day One Release

This release was written for UCLA Health's National Nursing Ethics Conference. I produced a release for each day of the conference.

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KEYNOTE: Compassion is Key, for Yourself and Your Patients

The keynote opening to the National Nursing Ethics Conference (NNEC), given by Betty Ferrell, PhD, MA, CHPN, FAAN, FPCN, demonstrated the necessity of compassion and the importance of the little moments nurses have with their patients.

Ferrell said that even when nurses feel like they don’t have the space or time to care for a patient for hours, the smallest interactions and connections to patients mean more to them than they know. Sharing an anecdote from a patient, Ferrell said, “It’s the nurse who waited behind, came to the bed, and put a hand on my shoulder for one minute. At that moment, I knew I was not alone in this.”

By hearing and listening to patients’ stories and asking about their lives and who they were before they came to the hospital, nurses are accepting an invitation to be human and to create a community with their patients, according to Ferrell. “Yes, it’s chaotic, but just by being present for a patient, it's our presence in that sacred moment, the seconds and willingness to stare into the patient’s eyes, willingness to touch. You must be open to these moments.”

Seeking ways to create moments for your patients must begin with self-reflection. According to Ferrell, physical, psychological, and spiritual presence can only be there if nurses are aware of their full selves. She said reminders of the positive and profound things nurses do can improve presence for the self and the patient.

“You must refill before you go into a crazy shift again. We have to bring our full selves back to the bedside. We do that by caring for ourselves,” she said. “Take 30 seconds to pause and reflect on who you are and your intention today. Before you race off for the day, take 30 seconds to be reminded of the suffering you relieved today. That 30 seconds will make a difference.”

PLENARY: The Power of Moral Injury and Moral Goodness in Healthcare

William P. Nash, MD, spoke about the need to understand psychological stressors that lead to moral injury, how unexpected blows to our moral compass and other traumatic events can affect nurses, and solutions to moral injury in a healthcare setting.

Moral distress arises, Nash said when institutions make pursuing the morally right course of action impossible. According to Nash, moral injury is not dependent on the horror, fear, or grief witnessed during a traumatic event but on whether ‘what’s right’ has been violated.

“If you’ve had a significant moral injury and consequences are the weakening of sustaining attachments, if you lose those attachments for any reason, you not only lose that person in your life, but you also lose the part of self that existed in that relationship. On the flip side, moral injury can be inflicted on the self if you feel ashamed and guilty by something you've done, even if it wasn't your fault,” Nash said.

He said that the attachments and support systems nurses maintain to their colleagues, friends, family members, and the institutions they support can be damaged by traumatic and morally distressing events, which can further isolate people when they need help the most. When these attachments are lost, symptoms of trauma worsen, said Nash.

“We cannot stifle those deeper centers where those memories live and those painful centers. How can you lessen the pain enough so you can say you are cool with it and you can go on with life? How can this work so that you feel forgivable? You do some good stuff. Create goodness – and you’re going to know you are creating enough goodness when you are reminded, and suddenly those memories don’t hurt as much.”

Nash stressed the importance of giving and receiving compassion in healing from trauma and moral injury.

“In healthcare, when you’re charged with helping a particular patient to help them get through a particular situation, you have certain responsibilities, but you also have the option to go beyond the minimum and give the person extra value, love, and compassion and to reach out. That’s an act of goodness to say we’re going to set aside daily problem solving and talk about your value as a human being. Going out of your way to affirm that and the value, you get better at goodness, and you are healed by that. To me, that’s an awesome antidote.”

CLOSING REMARKS:
In closing, Connie M. Ulrich, PhD, MSN, RN, FAAN, reviewed the value of nurses throughout the COVID-19 pandemic and the pre-existing issues in health care that only became more apparent. She proposed solutions to increasing the awareness of nurses’ positive contributions to healthcare, including increased positive visibility, providing sufficient resources for care, and rethinking the responsibilities and care structure for nurses. Key values that nurses bring to health care are courage, compassion and commitment and need more visibility to bring about change.


Ulrich posed the question, does the job need to be rethought and referred to quotes by anonymous nurses who want transparency from leadership, verbal acknowledgment of hard work, streamlining of workflows to prevent wasted time, and adequate financial compensation for their work. She discussed the economic concerns of nurses and the solutions to implement, such as reimbursement models and the creation of incentives for those who are loyal to institutions.

“Let’s take the steps we know we need to care for our patients by ourselves. The eye of the beholder reminds us that the patient is the center of what we do, but there are challenges that we must overcome to care for patients,” Ulrich said. Dr. Ulrich addressed an additional four “C’s” that will help to deal with the challenges facing nurses today, Collaboration, Creativity, Conscientious (recognition of the obligation to patients, families and communities), and Currency (recognition of importance). She discussed the need for nurses to accept more leadership positions, and continue to provide the evidence of how nursing is linked to quality health care. And nurses need to insist that systems support mental health and wellbeing.

“We never fully appreciate how we touch others and how it remains with them,” wrote an attendee in the conference zoom chat.

In an interactive portion of the presentation, attendees highlighted the words that they felt captured the value of nursing. The most used words were “holistic,” “humanity,” “compassion,” “care,” “love,” and “impact.”

Dr. Ulrich reminds us, “Nursing’s voice needs to be more present in newspaper editorials, op-eds, and other avenues of public discourse, as nurses share their concerns about new technologies, policies, procedures, and emerging and reemerging diseases that impact the care they provide, as well as nurses’ overall mental and physical health.”