Pamela J Grace’s research while affiliated with Boston College and other places

In the current digital era, reliance on technology for communication and the gathering and dissemination of information is growing. However, the information disseminated can be misleading or false. Nurses tend to be trusted by the public, but not all information brought to the public forum is well-informed. Ill-informed discussions have resulted in harm to individuals who take such information as fact and act on it. As technology continues to evolve and fact versus fiction becomes more challenging to discern, it is critical that nurses recognize their ethical responsibility to the public in providing information for which sound evidence exists. This analysis will explore medical misinformation through concepts such as confirmation bias and the politicization of science. Also, the impact of nurses not recognizing the power and responsibility associated with using their credentials in public fora, even when the central motivator is that they believe they are helping other individuals. Using nursing goals and perspectives, we will discuss the ethical responsibility of nurses to be aware of the soundness of what they think they know. Utilizing ideas of professional responsibilities, as outlined by professional codes of ethics as well as the ethical principles of non-maleficence and veracity, we explore the problem of nurses propagating misinformation and suggest strategies to enhance nurse awareness of their ethical responsibilities for veracity and transparency regarding what is known and what is not.

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model of moral reasoning along with tenets of the International Council of Nursing’s (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action.

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings.

Since the 1960s, it has been recognized that “medical ethics,” the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one’s prior profession’s nomenclature as a prefix to “ethicist,” under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good.

In this chapter, we describe the origins of institutional healthcare ethics consultation services and the development of healthcare ethics committees in the US, Switzerland and elsewhere. We discuss some of the landmark situations, cases and macro-political and social frameworks that have contributed to their genesis. Next, we describe common models of ethical decision-making. While this list is not meant to be exhaustive, it covers approaches to ethical decision-making that are commonly used in clinical ethics, and which also can be found in the nursing ethics literature. We examine the roles that healthcare ethics committees fill in some hospitals in the US, including collaborative and consultative functions for clinical ethics issues and organizational ethics questions. We all note that in other countries ethics deliberations are not necessarily carried out only this way, for example in Switzerland. Also noted is the role that nurses with advanced education and ethical expertise can play in supporting and empowering point of care nurses and other clinicians to address moral distress as discussed in other chapters. Finally, we describe preventive ethics, and the critical role of nurses in the early recognition of emerging problems and calling attention to them before they escalate to intractable conflict.