(or, why such a big topic for a DNP project instead of something “easy” like increasing STD screening or reducing inappropriate use of antibiotics?)
Well, the short answer is that it became very obvious to me that the ethics education I got in nursing school was not nearly enough to prepare me for the ethical problems I would face in practice. We had lectures on Karen Ann Quinlan and Terry Schiavo (and I am definitely old enough to remember when her story was all over the news) but we didn’t get to apply it to some of the situations we could expect when we started clinical rotations. A year into my master’s coursework, I took an ethics class taught by my advisor/mentor/2nd chair and my interest was sparked anew. One day in class we discussed a case study of a nurse practitioner whose 16 year old pt had sustained a serious concussion and who did not meet the clearance guidelines to return to football practice. In this case study, the parents are in the exam room with their son and the father is adamant that the son be cleared to play football and the mother is worried about her son but feels stuck in the middle. And the patient wants to resume practice and is hoping for a college football scholarship. In that moment, I felt like I saw into my future as an FNP and because I plan to go into primary care, I realized that this case study was likely a scenario I would someday face in practice. For real.
And sure enough, I did. I spent a week in the Central Valley with my cohort last summer and we did nothing but school and sports physicals for more than 800 students in 2 districts. The very first student I examined had experienced 3 concussions already at age 16 and had a history of heart palpitations not related to exertion. After I examined him and told him he would have to be signed off by his primary care provider, he tried to play of his symptoms and concussion history as no big deal but I knew he would need further evaluation. And so did my professors in attendance. We had been warned in advance that while the coaches were much better at screening the kids for concussions and sidelining them until they could be cleared to play, the kids might minimize their symptoms. And in such an impoverished area, a sports scholarship is likely the only way to go to college.
By this time I had already decided to build my DNP project on the foundation of work I did for my Masters of Behavioral Health capstone project around ethics education and case study discussion to mitigate moral distress in healthcare workers in the acute care setting. Only now I was going to focus on Advanced Practice RNs, physicians and Physician Assistants in the out-patient setting. While doing my lit review, I found a dearth of literature around ethics and moral distress among this group of providers in general but what literature I did find, was commonly based in the acute care setting. And once I figured out what I wanted to focus on for my DNP project, I had to decide how to provide the information to busy providers who see a minimum of 3-4 patients per hour and spend their lunchtime catching up on charting.
So I thought about making some short videos that could be watched during a few minutes of downtime or during a commute on the train or while waiting in line at the grocery store. And then I decided I needed more than just a You Tube page to host my videos since I needed to conduct surveys to determine if my interventions were helpful so I built a website to host all of the things I thought would be helpful to providers, as well as anyone else in healthcare who wants to learn more about ethics and moral distress. So here we are. Thanks for coming to my website and I hope you’ll join in on the discussion.
