Nurses need to be empowered to express their moral judgment on issues relating to patient care, a lecturer on bioethics has said.
Speaking before the 10th International Philosophy of Nursing conference at Dublin City University, Dr Dolores Dooley said nurses were very aware of situations in hospitals and in community healthcare that were damaging to patients. "Unfortunately, they often don't feel that there is a place they can take their concerns," said Dr Dooley, who lectures on the Masters course in bioethics at the Royal College of Surgeons in Ireland.
It was a nurse who first blew the whistle on Dr Michael Neary, the obstetrician who performed a large number of unnecessary hysterectomies on women, following the birth of their babies at Our Lady of Lourdes Hospital in Drogheda, Co Louth.
"Nurses can be very aware that patients aren't 'in the know' about situations [ full diagnosis, prognosis and/or treatment options] and that clinical expertise is confused with moral judgment," said Dr Dooley.
Dr Dooley is the co-author with Dr Joan McCarthy of Nursing Ethics: Irish cases and concerns (Gill & Macmillan). Dr Dooley said whistleblowers needed to be encouraged and communication skills were the key to a more open culture. "Nurses need to be given a sense of confidence in their judgment and develop skills of fact gathering and reasoning," she said.
In her presentation , Dr Dooley focused on how nurses could be trained to show such moral leadership in their primary degree or at postgraduate level.
She spoke of the "elephant in the room situations in every institution, when everybody knows something is happening and nobody is talking about it".
She also discussed the idea of a "moral space", in which moral cover-ups are discouraged, a personal and institutional commitment to ethics is fostered and staff are encouraged to be aware of the ethical dimensions of care.
Other papers presented at the conference included I can find out myself - opportunities and challenges of diagnostic self-testing - an ethical perspective, by Dr Alan Kearns, lecturer in ethics at the Mater Dei Institute of Education, Dublin.
Dr Kearns examined the ethics of a range of home-based diagnostic devises being developed at the Biomedical Diagnostic Institute at DCU. "Such devices will give people more control over their healthcare in that they can take preventative steps once they have information about their risk of getting certain diseases."
However, Dr Kearns suggested that healthcare professionals should deliver the results of such home-testing units. He also spoke of people's perception of information. "To be told something is one thing, to understand it is often another step," he said.
