Ethical Competencies

Ethical competencies involve knowing what's right, making good choices, and treating others with fairness and honesty. They're like a guidebook for acting decently and responsibly in all kinds of situations. We were asked to evaluate and reflect on our own cultures and the ethical competencies within with the following 4 questions.

Which culture(s) do you belong to? Describe your culture in your own words, including the language, thoughts, communications, actions, customs, beliefs, values, and/or institutions of racial, ethnic, religious, and/or social groups. Use photos, videos, etc., to make the website more colorful!
How is autonomy perceived in your culture? Create a scenario and discuss how truthtelling may be processed in your culture/family.
Find an article / news / videos etc. describing a scenario that may cause moral distress. Describe the story in your own words and explain how/why it may cause moral distress. Alternatively, if you have personally encountered a situation that has caused you to experience moral distress, tell us the story and explain how/why it may cause moral distress.
Read the article by Dudzinski (2016) and construct the moral distress map for the case that you introduced in Question #3

Meg Blake

The culture that I identify with is the American culture with English being the only language I speak. While my family reigns from predominaetly England and Ireland, I have had the joys of marrying into a Dutch family in which my husband's maternal grandparents spoke Dutch. I have loved getting to learn more about their culture and can even stagger my way the Dutch Happy Birthday song! religiously I identify with the Christian religion, more specifically the non-denominal branch.
Autonomy in American culture is percieved as a fundemental right. Based on the American constitions first amendment of the right to freedom of religion, expression/speech, assembly, and to petition. Christianity is a religion that based on my American culture I am free to express and practice. I find this goes for all others as well, and based on my religion practicing love others above all else. While I may not agree with others personal choices, i find that being kind and respectful of others views is more important forcing my opinions on others and attemtping to argue.
I have personally worked in multiple institutions where patients were kept alive for years with making no signs of recovery, yet most were full code status. What made this even more distressing as a healthcare world is that often times this decision was made by family memebrs who had not seen their relative in months, sometimes years. One patient I still remeber vividly had developed a a pressure ulcer that was so severe it went all the way down to their tailbone.
Emotions: Unneasy, regret for breaking bones during CPR, and grief for seeing what once was a lively person absolutely helpless
1. - Source: Being forced to contunue life of someone who's quality of life was continually decreasing.
  - Constraints: Legally being bound to follow a patient's advanced directive
  - Conflicting Responsibility to "do no harm" to aptients and provide quality care
  - Possible actions: Discuss with management in hopes that they reach out to family and encourage conversation about quality of life vs quantity.
  - Final Action: Find new job where I was not put under moral distress working with such severely acute patients.

Family is very important in Christianity, my family takes anual trips together. This was our 2023 family vacation to Mexico.

This is the English Hawley Family Coat of arms. At the top with there is a goat with Holly leaves in his mouth

Sherwin Afable

While I’m not as privy to all of the specific beliefs and traditions of filipino culture, I am grateful to have grown up in a large extended family. The importance of family and community was emphasized frequently in my childhood. Large gatherings were held often so that we could each other’s company and to enjoy meals together. As a southeast asian country, the Philippines is also a collectivist culture that typically places higher weight to the voices of elders. As a filipino-american growing up in the more individualist America, there’s a cultural gap between the people in my generation of the family compared to our parents and grandparents who were 1st generation immigrants. Some of my more traditional family members think that it’s disrespectful for younger members of the family to disagree with decisions or opinions of the older generations. I think it’s both humorous and unfair that they often blame my generations “American-ness” whenever there’s any form of disagreement.
As I had mentioned before, the collectivist culture of the Philiipines means that older members of the family hold greater influence than younger members. Additionally, the emphasis of the importance of family and community also encourages an attitude of individuals making compromises for the sake of the whole. In my life I’ve seen this play out as people biting their tongues and withholding their opinions in order to avoid arguments even if their input would be valuable.
Some time ago I took care of a patient who had recently diagnosed stage IV cancer who had come in for acute hypoxic respiratory failure. While this patient was receiving care in the hospital, their spouse was at home on hospice. The patient’s oxygen saturation was stabilized and we were to send them home with home O2. What was initially supposed to be discharge at 10am was delayed up until 4pm because, on that day in particular, four out of the five RNs from the hospital’s home oxygen supplier had called out, leaving just a single person to deliver oxygen for all of the hospital's campuses. The patient’s spouse was imminent but the patient couldn’t go home without the necessary oxygen. I had asked the charge nurse if we could send the patient home with one of our oxygen tanks and have the home O2 RN meet them at the patient’s house but I was told that wouldn’t be possible and was told that the oxygen RN was supposedly on their way, which I had been told multiple times over the past few hours. The patient and their family members were clearly anxious and frustrated at the situation and I felt helpless as the time ticked away. Eventually a call from the hospice manager for the company called one of our unit managers to have the patient discharged with one of our oxygen tanks as the patient’s spouse’s passing was imminent. At the end of this, I felt upset at myself. Was I not advocating for my patient hard enough if the solution ended up being the one I proposed earlier? It took another facilities manager to call ours in order to enact a relatively simple solution.

4. Emotions:

Anxiety, unease, powerlessness

Source of Moral Distress:

When initially told my solution was viable, should I have pressed more? Should I also have gotten management involved. Due to my lack of experience I felt as though I had no choice but to sit and wait.

Constraints:

Internal constraints: Hesitation
External constraints: Hospital Policy

Conflicting Responsibilities:

Responsibility to ensure that patient is safe for discharge, meaning that they have the resources they need at home.
Prioritizing patient discharge planning so that patient can see their dying spouse.

Possible actions:

Take a step back to recenter and recognize the stress in the situation.
If following the initial plan to wait for the O2 to arrive bears no progress, revisit obstacles that are preventing discharge and include management to help coordinate interdisciplinary teams.

Final Action:

Patient eventually did leave the unit with an oxygen container from the unit.

My son Jason and I at military base at Christmastime

Beverly Sumanti

The culture that I identify with is American culture. The language in my culture is English. I tend to be direct in my communication. My ancestors are from Scotland and Wales. My ancestors immigrated to the United States in the beginning of the twentieth century and adopted many American customs. I identify with the Christian religion. Some values that are important in my culture are family, freedom, education, individualism and equality.
Autonomy is perceived in my culture in a positive manner. It is when a person is independent and free to make their own decisions with their body and life. Some of these decisions must be made by an adult or parent until they are eighteen. When my son graduated high school, I wanted him to attend college. He expressed the desire to join the Marines. I felt like I had to support his autonomy and respect his decision.
A topic which has caused me moral distress as a nurse is continuing life support when it may not be in the best interest of the individual. I have worked in a setting where the patients are kept alive on ventilators, with tracheostomies and feeding tubes for several years in a vegetative state. Some of the patients were suicide attempts, drug overdoses or experienced car accidents. The patient might not have completed an advanced directive and the family and/or guardian was left to make decisions on their care. The patients would frequently develop sepsis and pressure ulcers. Seeing the patients in this condition left me feeling psychological uneasy.
Emotions: Sadness, uneasiness, feelings of helplessness. Source: Decreased quality of life for patients and prolonged suffering. Constraints: Staffing ratios, lack of funding for long term complex patient care. Possible Actions: Discuss with management concerns, involve social services, provide education to family. Final Actions: Work in a different setting, advocate for patients, provide education to patients and to families on advanced directives and end of life care.

Robel Anshebo

I was born in Ethiopia but was primarily raised in the United States. I still identify with my Ethiopian culture mostly, but I acknowledge the American influence on my identity. I speak Amharic, one of the national languages of Ethiopia, and English. With family, I primarily speak Amharic and use English in other settings. Ethiopia is a largely religious and conservative country. Its religious demographics mainly consist of Pentecostal Christians, Orthodox Christians, and Muslims. Numerous ethnic groups exist within Ethiopia, with most people identifying as Amhara, Oromo, and Tigray.
As mentioned above, Ethiopia is a religiously occupied country. This impacts how people act towards each other, with truth-telling being an important factor in faith-based practices and interpersonal interactions. On the other hand, the idea of autonomy isn't as integral in Ethiopia compared to the US. People are more reliant on each other and maintain close synergistic ties to their community, making Ethiopians much less individualistic than Americans.
Almost a year ago, I was caring for a patient on the organ transplant waitlist for a liver. This particular patient was diagnosed with ETOH cirrhosis and was recently rehospitalized for decompensation. Labs were drawn and the patient's blood alcohol levels were elevated, indicating that the patient had recently returned to drinking. This was a major conflict to their qualification for a liver, and one of the factors used to decide transplant candidates is any recent history of alcohol consumption. The patient also had a high MELD score, indicating that their chances of survival for the next few months are small. Consequently, the patient wasn't considered as a primary candidate for a liver and soon after passed away surrounded by family. I didn't care for them on their last day, but I remember feeling distressed at the utilitarian process used to afford an individual with a transplant.
Moral distress map:

Emotions: inadequacy, frustration, disbelief

Source: inability to change the tragectory of the patient's health

Constraints: bureaucratic process of organ transplantation

Conflicting responsibilities: duty to patient safety and ensuring they have the highest chance for survival until transplantation

Possible actions: familirizing myself with the MELD score factors and transplant qualifications then answering patient's/family's questions. Monitoring closely for further decompensations and responding/reporting accordingly

Final action: promote comfrot measures for the patient and their family. Ask floor managers for change of patient assignement if feeling profound distress.

Conclusion-

Each member of our team has a culture that is riddled with different ethical competencies that guide the decisons we make and how we view the world. To better breakdwon ethical concerns that cause moral distress, a moral distress map can be used to determine the emotions, constraints, conflicting repsonsibilities, and possible actions taken.

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