BESIDES MY clinicals as a nursing student, I've completed internships on three different units: labor and delivery, pediatrics, and the ED. I've had opportunities to care for vulnerable patient populations within an urban hospital setting. By vulnerable patients, I mean those who encounter daily challenges beyond their specific health concerns. This includes, but isn't limited to, homeless individuals, patients with limited English proficiency, women undergoing difficult pregnancies, older adults, and severely compromised patients with systemic or chronic disorders. These circumstances are never just physical; they're accompanied by mental, spiritual, and ethical issues as well. The ability to make difficult decisions is a powerful measure of our freedom of choice.

I believe that knowledge is knowing the right answer; wisdom is asking the right questions. Instead of a right answer for every situation, there can be only a right process. I've created my own unofficial acronym to utilize when I encounter ethical dilemmas at work: CARE. It stands for compassion, action, reasoning, and education. These elements balance the ethical concerns of patients and healthcare staff.

Learn to CARE

I begin with compassion. Acknowledging someone else's values and beliefs doesn't require you to surrender your own. It's about focusing on the patient's end goal instead of judging a patient's preferred route. Empathy doesn't change the landscape, just the lens we view it through. It's pivotal to show that a problem is never more important than a person.

Next, we should consider what actions we can take to help meet our patients' needs. This is followed by reasoning, which is critical to understand how the CARE process aligns with both the patient's and your personal values and beliefs. The final element of CARE remains a call to educate. We don't make the ethical decision for our patients; we simply help them understand their choices. It's important to remember that the steps of CARE don't need to be implemented in any specific order and may overlap.

Taking CARE in practice

CARE has also been integral to my educational experiences as a nursing student. Compassion involves respecting seasoned educators and appreciating staff's patience for new nursing students. Many of my actions rely on teamwork, and my reasoning expands alongside growing responsibilities. To properly educate my patients, I'll need to first be willing to learn.

As healthcare professionals, we must collaborate to achieve goals to alleviate pain and maximize our patients' ability to pursue their definition of a quality life. Sometimes it isn't about pulling people in your direction, but rather supporting them where they are.