title: Barriers to innovation: nurses' risk appraisal in using a new ethics screening and early intervention tool.
abstract: We developed and assessed feasibility of an Ethics Screening and Early Intervention Tool that identifies at-risk clinical situations and prompts early actions to mitigate conflict and moral distress. Despite intensive care unit and oncology nurses' reports of tool benefits, they noted some risk to themselves when initiating follow-up actions. The riskiest actions were discussing ethical concerns with physicians, calling for ethics consultation, and initiating patient conversations. When discussing why initiating action was risky, participants revealed themes such as "being the troublemaker" and "questioning myself." To improve patient care and teamwork, all members of the health care team need to feel safe in raising ethics-related questions.
authors.affiliation: UCLA School of Nursing, Los Angeles, California (Dr Pavlish); Mayo Clinic, Rochester, Minnesota (Dr Henriksen Hellyer and Mss Miers and Squire); and Ethics Center, UCLA Health System, Los Angeles, California (Ms Brown-Saltzman).
authors.forename: Carol L
authors.initials: CL
authors.lastname: Pavlish
authors.forename: Joan Henriksen
authors.initials: JH
authors.lastname: Hellyer
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown-Saltzman
authors.forename: Anne G
authors.initials: AG
authors.lastname: Miers
authors.forename: Karina
authors.initials: K
authors.lastname: Squire
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D004993:Ethics, Nursing; D005240:Feasibility Studies; D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units; D008962:Models, Theoretical; D009014:Morals; D009741:Nursing Staff, Hospital / Q000941:ethics* / Q000523:psychology; D016522:Oncology Service, Hospital; D015279:Organizational Culture; D019555:Physician-Nurse Relations; D036301:Qualitative Research; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics*