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Giving nurses a stronger voice in ethical quandaries

Cynda Rushton’s research informs a new Berman Institute/School of Nursing program that arms nurses with skills to manage "moral distress"
Posted June 15, 2017

Years ago, Cynda Rushton — then a bedside nurse in a pediatric intensive care unit — served with a medical team caring for a child who suffered a traumatic brain injury. The parents of the child, who was in a persistent vegetative state, wanted to discontinue life support, but the doctors disagreed. Rushton remembers the palpable stress she felt, struggling to understand why her team continued with treatment, against the parents' wishes, while she was powerless to affect the situation.

Looking back on that moment, Rushton cites ethicist Andrew Jameton's name for her precarious position — moral distress — and theorizes it's a top reason for an alarming statistic: a third of newly licensed registered nurses leave the field after just two years.

"Data suggest that moral distress is increasing in many disciplines, not just nursing, yet despite three decades of research about the topic, we have very few solutions," Rushton says.

As the Anne and George L. Bunting Professor of Clinical Ethics in the School of Nursing and the Berman Institute of Bioethics, Rushton has the time and resources to address that need. Drawing on literature from social psychology and neuroscience and infusing the practice of mindfulness, Rushton developed the Mindful Ethical Practice and Resilience Academy (MEPRA) for Hopkins nurses. Launched in the spring of 2016, the six-session program teaches nurses how to stabilize their nervous systems through meditation, discern and analyze ethical challenges, and confidently communicate when discussing an ethical issue with a physician or patient. Then, MEPRA puts those lessons into practice in the School of Medicine's Simulation Center with trained actors. The experience is recorded, so participants can assess their strengths and where they can improve.

"I don't feel like I'm bringing home the weight of the world with me at the end of every day anymore.”
Jen Simmons, Johns Hopkins Hospital surgical ICU nurse

Jen Simmons, a nurse in Johns Hopkins Hospital's surgical intensive care unit for 11 years, was at first skeptical of MEPRA's emphasis on meditation and mindfulness. But after completing the course, she recognizes the practices' benefits.

"This program gives you the skills you need to create a healthy space between your patients' suffering and your own," Simmons says. "I don't feel like I'm bringing home the weight of the world with me at the end of every day anymore."

Rushton has infused aspects of MEPRA into a core course she teaches in the Master of Science in Nursing: Entry into Nursing Practice program and hopes to expand the program to reach more nurses, as well as medical students and doctors. For Renee Boss, an associate professor specializing in pediatric neonatology, teaching staff at all levels to manage moral distress can head off problems that impact the quality of patient care.

"We know from data that one of the factors protecting against staff burnout is having an education and support program," Boss says. "It's not enough for nurses and doctors to go to their families and friends to vent outside of work — there needs to be an investment inside the workplace to help staff navigate these issues."

Rushton's sights aren’t limited to medical professionals at Johns Hopkins. Her forthcoming book, Moral Resilience: An Antidote to Moral Distress, includes many of MEPRA's founding principles, and MEPRA's strategies were topics of discussion at the "State of the Science Symposium: Transforming Moral Distress to Moral Resiliency in Nursing," a workshop co-hosted by the School of Nursing, the Berman Institute, and the American Journal of Nursing last August. The conference produced several recommendations for practice, education, research, and policy; a full report will be published in February 2017.

"One of the gifts of the Bunting Professorship — and being associated with the School of Nursing and the Berman Institute — is that I can leverage those platforms for the good of our profession, our patients, and the families we serve," Rushton says. "That's what the workshop and the book are all about. We can be a convener of these important conversations."

To learn more about how you can support professorships and programs at the School of Nursing and Berman Institute, please contact Joshua Else, associate vice president for development.