Moral Distress: Although a good deal of empirical and theoretical research has identified the problem of moral distress among nurses as causing significant professional turmoil and leading to nursing burnout and intent to leave the profession, no organization has developed, implemented, and evaluated workable strategies for managing this important ethical problem. The Fairbanks Program in Nursing Ethics focuses research efforts to identify interventions that diminish moral distress for nurses.
Unit Based Ethics Conversations: In 2005, FCME developed a program of clinical Unit-Based Ethics Conversations which provide a forum for nurses to share and discuss their ethical concerns. Preliminary efforts to evaluate this growing program suggest that it is improving moral distress for nurses who participate. UBECs have identified areas which require further empirical research (e.g. Does framing the nurses’ described turmoil as an ethical issue help to diminish moral distress?). Issues identified in UBECs have been adopted for further study by participants in the Clinical Ethics Fellowship and targeted for novel interventions by the Fairbanks Center’s Program on Translational Ethics of Applied Health and Medical Communication (TEAMc).
Evaluating Organizational Ethical Climate: The Fairbanks Program in Nursing Ethics sits in the midst of a large, vertically-integrated healthcare system (Clarian Health Partners) with more than 5000 nurses working within the three downtown Indianapolis hospitals, and thousands more in Clarian’s affiliated hospitals in suburban Indianapolis and throughout Indiana. The Program in Nursing Ethics is conducting a Clarian-wide assessment of the “ethical health” of nursing practice within the organization. Initially the assessment uses published tools to measure perceptions of healthy work environment and moral distress. A segment of this project evaluates the validity of a “quick” assessment tool that may be used by nurses in real time to identify their level of distress.
ICU Demonstration Project: The Fairbanks Program in Nursing Ethics is evaluating the impact of integrating a Nurse Ethicist into routine patient care rounds. Initial sites for a “demonstration project” will be intensive care units at each of Clarian’s three downtown Indianapolis hospitals. The project includes introduction of a communication tool and integration of the Nurse Ethicist into regular nurse-to-nurse patient report to provide individual ethics mentoring for nurses. Patient outcome measures and nurse self-reports of behaviors and attitudes will determine the success of this program.