Work That Matters

Supporting Nurses Through Ethical Dilemmas

As a lead nurse in the Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit (NICCU), Brenda Barnum, MA, RN, knows all too well the ethical challenges that bedside nurses face as they care for critically ill newborns and infants.

Dealing with life-and-death situations on a daily basis, they grapple with providing compassionate care to patients and families where there may be conflicting interests, lifesaving treatments that can cause suffering and profound side effects, and more.

The biggest dilemma nurses face is an ethical one, according to Barnum, a 24-year CHLA veteran who has worked in the NICCU for 23 years. “Because they spend so much time at the bedside, they get a holistic view of patients’ needs and are privy to conversations and requests for certain types of treatment and care,” Barnum says. “They bear witness to patient suffering and that can cause a lot of moral distress.” She defines moral distress as a situation in which nurses feel a responsibility or obligation to act, but they also feel powerless or afraid to respond.

Barnum, who has a master’s degree in bioethics and health policy from Loyola University of Chicago, is passionate about educating and supporting nursing staff in the area of ethics. She’s involved in numerous activities at CHLA, including representing Critical Care Services on the Ethics Resource Committee, teaching ethics to new nurses in the RN Residency in Pediatrics Program and providing support to intensive care nursing staff on issues of ethics and moral distress.

Barnum is also a board member of Ethics of Caring, a nonprofit organization comprised of leaders in nursing and ethics at 17 Los Angeles- area health care facilities with the goal of promoting ethical discussion and ethics education for nurses and others through its annual National Nursing Ethics Conference. CHLA has been a sponsor of the conference for 15 years.

“It has always been our goal to create conferences with topics and themes that are appealing for frontline clinical bedside nurses,” says Barnum, who is on the conference planning committee.

The conference has addressed such topics as vulnerability, end-of-life care, having a voice at the table when trying to lead from the bedside, communicating ethical concerns for patients, addressing treatment that has little benefit to patients and cultivating compassion and caring for difficult patients and families.

“Our work has impacted a lot of bedside nurses,” Barnum says. “It allows them to take time away from work and think about why we do the things we do, reflect and take time to heal.

“It makes us a better institution,” she adds, “to have nurses who want to practice in an ethical manner, have healthy relationships with patients and team members, and have open dialogue. If we have nurses who feel empowered to have those conversations, we can provide the best care possible.”

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