Mike Czechowskyj Ferris State University Nursing Ethics Education and Support Mike Czechowskyj Ferris State University

Ethics Rules of behaviors based on ideas about what is morally good and bad. (Merrium & Webster, 2014) Health care professionals encounter ethical situations on a constant basis. For the best patient outcomes nurses need to be able to identify these situations and react appropriately.

The gap What is the current state of ethics in the continuing care setting? How are nurses involved? What is the future state the CNO would like to see?

The Proposed Plan What is the root cause and the barriers related to a lack of recognizing ethical situations? A fishbone diagram was used to visually identify the issues.

Fishbone for Unrecognized Ethical Situations Physicians Health System Resources Money Infrastructure Capacity to help Ethicist Knowledge of problem Unable to act on ethical concerns Identify the need Provide finances Prioritize the project Education How to get support Baseline knowledge Administration Nursing Staff

The Proposed Plan The plan starts by working with key stakeholders to develop a survey, education presentation and algorithm. The survey will be given to nurses in the facility identified The same nurses will then be taught using the education presentation. They will also be taught the algorithm they can use when ethical situations are identified. There will then be a post survey to validate that the nurses understand the new plan.

Change Theory Used Influencer Model (Patterson, Grenny, Maxield, McMillan, & Switzler, 2008) Change the environment Harness peer pressure Find strength in numbers Designing rewards and demand accountability

Leadership Theory Used Authentic Leadership (Waite, Mckinney, Smith-Glasgow, & Meloy, 2014). Understands sense of one’s self Perceived as open, optimistic, and resilient. Genuine

Evidence to Support This Plan In the current environment the CNO has identified a lack of ethical awareness. Lack of good ethical education in nursing school (Vynckier, Gastmans, Cannaerts, & Dierckx de Casterle, 2014). No continuing education currently in the workplace at Spectrum Health Continuing Care. Having an algorithm will help with decision making. Better ethical identification would lead to less burnout and turnover (Blacking, 2011).

Implementation Support Using QSEN competencies (QSEN Institute, 2014) Teamwork and Collaboration Safety ANA Scope & Standards (American Nurses Association 2009) Collaboration Ethics Resource Utilization

Facility Identified Spectrum Health Continuing Care Hospice Why this unit? Who will be educated?

Preceptor Deb Cress, MSN, RN, NE-BC. CNO Why is she qualified to oversee this project? Years of experience Access to resources Ability to break down barriers

Evaluation Two different result evaluations Survey results Number of ethics consults

Conclusion This plan should set up Spectrum Health Continuing Care for… Better recognition of ethical situations Improved support for the patients Added support for the nursing staff Less burnout and frustration

References American Nurses Association. (2009). Nursing Administration: Scope and standards of practice. Silver Spring, MD: Nursebooks.org. Blacking, C. (2011). Empowering nurses to participate in ethical-decision making at the bedside. Journal of Continuing Education in Nursing, 42(1), 19-24. dio: 10.3928/00220124-20100601-03. Merriam- Websters. (2014). Ethics. Retrieved from http://www.merriam-webster.com/dictionary/ethics Patterson, K., Grenny, J., Maxield, D., McMillan, R., & Switzler, A. (2008). Influencer: The Power to Change Anything, New York, NY: McGraw-Hill. QSEN institute, (2014). Graduate KSAS. Retrieved from http://qsen.org/competencies/graduate-ksas/ Vynckier, T., Gastmans, C., Cannaerts, N., & Dierckx de Casterle, B. (2014). Effectiveness of ethics education as perceived by nursing students: development and testing of a novel assessment instrument. Nursing Ethics. dio: 10.1177/0969733014538888. Waite, R., Mckinney, N., Smith-Glasgow, M. E., & Meloy, F. A. (2014). The embodiment of authentic leadership. Journal of Professional Nursing, 30(4), 282-291. dio: 10.1016.j.profnurs. 2013.11.004.