Guest Commentary: Bioethics for Nurses from a Faith-Based Perspective
Hanford, Jack, Ethics & Medicine
Nurses are numerically the largest group of health practitioners in America. Their role is central for bioethics because they occupy the intersection between the physician-patient relationship. Nurses are the key health professionals involved in decisions for organ donation. Likewise, they have increasingly been utilized in genetic counseling.
Gwen Anderson, RN, PhD, of Stanford University is a leader in nursing education. She offers courses on genetic nursing from her website. Anderson describes the learning experience in the following way:
On my Genetic Nursing Resource web site, I have placed four conceptual models that represent a synthesis of the state of the science and art of socialpsychological research in genetic nursing. I have setup this aspect of the web site as an on-line discussion forum so that nurses/students could have a conversation about the utility of these models for practice, research, and education. I have an elaborate set of questions that I think would help students to think about and discuss genetic nursing and the practicality of our current genetic nursing knowledge as well as the gaps and future possible directions . . BSN students might want to use this web site and on line discussion forum to . learn about the state of genetic nursing as a practice, a theoretical and a research activity.
Also on the web site is a 600-item citation list of genetic nursing articles that could be used to create a custom bibliography that could be used to better understand the models and their practical use in nursing practice. . I'm about to put a redesigned version of this web site in place so it will look like an actual web site. As with the physicians, nurses also struggle with the machines of technology at the bedside and they are the main source of care for the elderly. And even in relation to pastoral care, nurses are working with pastors in a growing movement practicing effective care in the parish setting. (from personal correspondence, 24 May 2000)
Is Nursing a Profession?
Physicians have long been recognized as professionals in the technical sense of the term. Nurses less so. The main challenge for nursing in the 21st century is to establish the integrity and solidarity of their profession. Currently, nurses are viewed as quasi-professionals, somewhat similar to the status of clergy. Nurses are perceived as qualifying as one half of a profession because they have a clear and well articulated code of ethics and they fulfill the service or altruistic dimension of authentic professionalism.
In order to meet the model of the American Medical Association and be recognized as a bona fide profession, nursing will have to continue to cultivate professional standards. From about 1900, the AMA has endeavored to unite and standardized their profession by setting forth rigorous demands through higher education. Nurses have not yet taken charge of their profession in the same way and have not yet set forth academic demands similar to those of physicians. Appropriate requirements for nurses are careful selection of students, a standardized degree, and rigorous research. These are necessary to become fully professional.
The stakes for nurses are exceedingly high. Managed care will force nurses (and physicians) into its corporate mold if nurses do not take control of their profession. When managed care relies exclusively on the bottom line, it destroys the needed discretion of and erodes the patient's trust in nurses and doctors. These professional qualities (viz., discretion and trust) must be maintained if quality care is to be delivered. Patients fear that the one who pays the bill will decide the necessary treatment. Actually, patients provide the remuneration by paying the premiums for their insurance coverage. This point must be emphasized to counter the notion that health maintenance organizations and employers are paying the bills. The American public must deal with the fact that the insurance industry not only does not actually pay the bill but takes approximately 25% of the financial resources for its own operation and delivers no healthcare itself. …