A Nurse Shares Her Experience

I have faced several ethical challenges in my career, but one in particular remains in the forefront. Several years ago, my husband and I suffered a miscarriage. When I returned to work, to my astonishment, my assignment for the day included a sweet baby born prematurely due to his mother's drug addiction.

I cared for the infant as I would any other baby. However, given my recent miscarriage, I wondered why this cocaine-addicted mother could have children and I couldn't. I distinctly remember the mother's words, "I did everything I could to have a healthy baby; I just do not understand."

My first thought wasn't professional, but I maintained my composure and practiced beneficence although it was difficult. Beneficence refers to doing good and acting in the best interest of the clients and their support persons (Blais, Erb, Hayes, & Kozier, 2006). I asked a colleague to watch the baby, then went into the bathroom and cried, asking God, "Why do I have to deal with this today after what I have been through?"

The mother remained at the baby's bedside most of the day. We established some rapport although I knew I was withholding emotional support from her. After several days, the child had a bowel obstruction (common with cocaine-addicted babies) and died. I felt guilty for my resentment toward the mother. She now was without a child just as I was.

My decisions to care for this child were by the book. However, my decisions for support of the mother were less than appropriate. Years later, I struggle with the guilt of my thoughts regarding the baby's mother and my lack of emotional support. I should have put my feelings aside and helped instead of giving in to self-pity, or asked for another assignment. I wonder if the mother sought help or had any more children.

Now, when faced with similar situations, I do things differently. Although my initial thought still may be, how could you?, I pause and recall this baby and his mother. Thanks to God's work in me and through his Word, the Bible, I am slowly becoming a nonjudgmental nurse.

Nonmalificence, or the duty to do no harm (Blais et al., 2006), is a principle to which I have always adhered. But harm isn't necessarily always physical harm. Emotional harm is just as bad. In this situation, I did not offer the emotional support I should have because of self-pity and internal conflict. I am dealing with these issues, and God is teaching me. He also has blessed me with children and given me the perspective that children are a miracle and a blessing regardless of circumstances, past or present.

THE JCN ETHICIST RESPONDS

Thanks Karen for your willingness to share your very personal experience and insights.

Karen's situation isn't one of those made-for-TV-news ethical dilemmas. Her dilemma was an inner, deeply personal struggle that no one would ever have known had Karen not chosen to confess it. In nursing ethics classes, we study headline issues but aren't prepared emotionally, intellectually, or professionally to handle the kind of issue Karen has shared.

So much of our moral distress as nurses is because we are afraid to admit our mistakes among colleagues. We all know how painful it is to make incident reports. At least we usually can recognize medication or treatment errors. But who reports ethical errors? Karen's story-her insight and her openness-shows us the importance of moral sensitivity, courage, and honesty in the face of our personal moral dilemmas, failures, and sinfulness.

I'm not suggesting that reporting "emotional errors" should become part of the incident tracking process. Hospital and agency systems aren't designed or equipped to cope with that degree of personal self-revelation. But what can we do when we have done the wrong thing, acting sinfully toward a patient or colleague?

The first step is recognition, moral sensitivity. Karen recognized that her feelings of anger, resentment, blame, and unforgiveness caused her to withhold emotional support from her patient who needed support and love in the midst of her crisis. Withholding emotional support is called "emotional blackmail," and we've all been guilty of doing it-to patients, colleagues, friends, and family. It's one of the most personally painful forms of punishment we can perpetrate or experience.

Thankfully, God, unlike our nursing systems, is equipped to handle all of our errors and human sinfulness. Karen's story helped me to see how often I try emotional blackmail in prayer, withholding my deepest feelings, to avoid admitting to God and myself how badly I need his forgiveness. Thank you again, Karen!!