The Role of Nurses in Ethical Medicine: Commentary on Ersoy, Altun and Beser

- Frank J. Leavitt, Ph.D.
The Jakobovits Centre of Jewish Medical Ethics
Faculty of Health Sciences, Ben Gurion University of the Negev,
Beer Sheva, ISRAEL (Home Tel/FAX: +972-2-9963048)

Eubios Journal of Asian and International Bioethics 7 (1997), 170-1.

The paper by Ersoy et al. is a sign of the future. As medicine gets more molecular and epidemiological nurses will have more and more of a role in relating to patients as thinking, feeling and spiritual individuals, and in making sure that patients feelings and thoughts get heard.

A number of things can help nurses assume this role:

1. We should encourage academic nursing, encouraging practical nurses to become RNs, and RNs to Bachelor's go on to the Masters and the Ph.D. in nursing or in related medical sciences. These educational syllabi must include not only basic biological sciences but also bioethically important subjects like anthropology, philosophy, communications skills, and of course ethics.

2. At the same time we must be aware of the danger that the academic nurse might get too academic for nursing, leaving the bedside for more prestigious and high-paying positions. We need the academic nurses right there in the wards with the patients.

3. Ethical medicine requires mutual respect between physicians and nurses and a willingness to listen to one another. But I don't think there is any point in preaching this to people who are already professionals. It probably makes more sense to begin with students in the first year of medical or nursing school. During the past academic year (5757) in Beer Sheva, therefore, we began an experiment, teaching ethics to mixed groups : medical and nursing students together. We began with discussion sessions in the obstetrics clinical round, focusing on Ethics in Healthy Childbirth. Young nursing and medical students discussed ethical problems which they actually experienced in the delivery room, such as whether a signature on an informed consent form for an epidural injection by an apprehensive woman during intense labour pain is really an expression of autonomy, and whether real autonomy in obstetrics might better be served by explaining, shortly after a positive pregnancy test, about natural methods of dealing with pain without analgesics.

Just as the students were interdisciplinary, from nursing and medicine, so were the teachers, representing nursing-midwifery, neonatology and philosophical bioethics. We hope to expand the program into other clinical rounds (perhaps next will come internal medicine and various kinds of intensive care units) during the coming academic year, gradually building, over four years of nursing education and six years of medical education, mutual openness and respect between the two professions for bioethical medicine.

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