Magnet Moment: Winning Essays - Crozer-Keystone Health System - PA

Magnet Moment: Winning Essays

CKHS Nurses Share Perspective on Code of Ethics for Nurses

Initiated by the ANA Board of Directors and the Congress on Nursing Practice in 1995, “the Code of Ethics is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It is the profession’s nonnegotiable ethical standard. It is an expression of nursing’s own understanding of its commitment to society.”

This year, CKHS Magnet Ambassadors embarked on four educational initiatives which included the Code of Ethics for Nurses. As part of this effort, they organized an essay contest in which nurses were encouraged to write about their personal experiences in carrying out the ethical duties and obligations of the Code in their nursing practice. These winning essays are a testament to the dedication and commitment of these nurses as well as a reflection of the Magnet values to which we aspire as a health system.

Winning Essay

by Annette Turnbull, RN, Emergency Department

Taylor Hospital

The following story illustrates the first three points of the Nurses Code of Ethics:

  1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
  2. The nurse’s primary commitment is to the patient, whether an individual, family, group or community.
  3. The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient.

We got a call for an unresponsive person and the next thing we knew we were babysitters. A diabetic patient had a hypoglycemic episode after she had picked up her 10-year-old son at school. The patient was now responsive but disoriented and her son was giving us his mother’s history. He was much too knowledgeable about his mother’s condition for his age, and yet he was very immature for age 10.

Mom was slightly combative and insistent upon taking her son and herself home. Her speech remained slurred, she was still confused as to place and time but “she was going home!’ Finally we realized why she wanted to leave even though it was unsafe for her and her son. She kept saying there was no one else the child could go home with. She was frantic about us calling the child’s father (her ex- husband) and she said he would hurt them. Her stories were confusing and kept changing and no one was sure what the truth was. Finally I called the school where the child went and spoke with the principal to find out if a protective order was in place for the child. Indeed he confirmed the situation. There was a court order in place and there was a flight risk out of the country. During all this, the child was kept occupied and fed by the staff. Social Service got involved as did CYS and finally twelve hours later a brother (uncle) was found to take the child home.

All of the nurses and staff that were involved showed compassion and commitment to this patient and child. We advocated for the patient while she was disoriented. We advocated for her son to keep him from being placed in a temporary foster home or worse, in a potentially harmful family situation. Our compassion and respect was challenged many times that day. I’m so proud to say our commitment was to the patient and her family unrestricted by her social or personal attributes. We were able to preserve the integrity and safety of her family.

Winning Essay:  Patient Teaching

Submitted anonymously

This nurse and her preceptor illustrate points 5 and 7 as they work on orientation competencies:

5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.

7. The nurse participates in the advancement of the profession through contributions to practice, education, administration and knowledge development.

Many years ago when I was a new nurse, I was given a unique patient teaching job by my preceptor. This was back in the day when there were no diabetic teaching classes and blood sugar meters for home and hospital use were years away from being available. Blood sugars were done by the lab and testing was done with urine strips. The only types of insulin were NPH and regular. An insulin pump was only in the testing stages. Now anyone reading this who is a veteran nurse remembers those days and anyone who is a beginner nurse is probably horrified by this type of diabetic care. This was not so long ago – so as they say, “We have come a long way baby!”

My preceptor took me aside after report and said, “I have a nursing challenge for you. The patient and her husband in bed 15 need diabetic teaching.” Well, I figured this was a good time to show off my teaching skills and get it checked off on my orientation skills list. So to the chart I go to get the history on the patient. The patient is a 70 year old newly diagnosed diabetic with a history of left sided CVA and right sided paralysis, bed ridden with expressive aphasia. And her primary care person is her devoted husband who is blind. Talk about a nursing challenge. 

How was I going to teach a blind man to give injections to his wife who communicates by aphasic noises? I was perplexed until I met the couple. The husband had been taking care of his chair- and bed-ridden wife for five years. Her skin was beautiful -- no breakdown anywhere. He knew what she needed by her unique communication. They had someone who shopped for them, but he did all the cooking and care. Their niece had agreed to come over once a week to fill the syringes with insulin so all the husband needed to know was how to give an injection using sterile technique. I am thinking, “How am I going to do this?” But after meeting with the husband and discussing meals, skin care and signs and symptoms of hypoglycemia and hyperglycemia, I realized he was very knowledgeable. Since his wife was diagnosed, he had been reading everything he could get out of the library and was teaching me a few things.

Still, how do you teach a blind man to give injections using aseptic technique? I got an orange, a few sterile needles and a box of alcohol wipes. I taught him how to wipe the area with alcohol and pinch the skin slightly and take the cap off without touching the needle. I decided not to try to teach him to pull back on the plunger to assess for blood and to just put the needle in and give the shot. This man was determined and, although he had a few false attempts, he did great. I was even brave and let him practice on me with sterile water to get the feel of real skin.

Before this couple was discharged to home, the husband was doing all of the insulin injections. He rotated sites every time and he had follow-up checks by visiting nurses, but for the most part he did all the care himself. I learned never to underestimate a person who is willing to do anything for their partner, and that nursing is always a challenge. This is an example of the uniqueness of every patient.

Winning Essay                         

by Semande Oladosu, RN

Delaware County Memorial Hospital

This nurse exemplifies point 1 and, in her work as a school nurse, she also incorporates point #8 of the Nurses Code of Ethics in her practice:

8. The nurse collaborates with other health professionals and the public in promoting community, national and international efforts to meet health needs.

My name is Semande Oladosu. I work at DCMH on the rehab floor and also as a school nurse with the Philadelphia School District. I believe school nurses are valued members of the educational team because we work in collaboration with familiar schools and the communities.

We play a vital role in improving the health and well being of our students by promoting health and safety, assisting to design and implement accommodations for children with special health needs by linking these students and their parents with health resources available in their school communities. We also provide on-site healthcare so that students can remain in school.

We screen all the students for vision, hearing, height and weight every year. Any students that failed these screenings are referred to the appropriate health services. For instance, students that failed vision screening are referred to the eye doctor. Unfortunately, parents might not follow up because the student does not have health insurance, or might not know the importance of why their children need to see an eye doctor.

Fortunately we work in collaboration with EAGLE Vision. They will bring their van to the school, re-evaluate these students and give them two free (pairs of) eyeglasses. The EAGLE Vision is a non-profit organization founded by the Philadelphia EAGLES and they provide services to all public schools.

Another example was that a student came to me wheezing, and mom was asked to take the student to see the doctor. Two days later, the student came back with the prescription not filled. I called mom and referred her to the public health centers to fill the prescription. I realized that the student has no health insurance. I referred mom to CHIPS and I also called CHIPS. Fortunately someone called me from CHIPS when the student got her insurance card.

We also work in collaboration with The University of Pennsylvania Dental School. They will bring their van to the school to evaluate and treat the students (they do tooth fillings, cleaning, etc.). They saw a 5-year-old kindergarten student who has five cavities in her mouth (five big holes, bad-looking decayed teeth). I called mom and referred her to the appropriate dentist. Mom said she took the student to a dentist. The dentist wanted to pull her tooth but she said “no.” Unfortunately, Penn Dental Van does not do treatment on children and does not perform tooth extraction in the van. I could not locate the dentist mom mentioned; therefore I had to call DHS (Department of Health Services) to follow up with this student.