dharmadoctors.org

AACN Advanced Critical Care
Volume 20, Number 1, pp.108–111

Cynda Hylton Rushton, RN, PhD, FAAN

Do you ever notice how difficult it becomes when you are embroiled in an
ethical conflict to stop long enough to reflect on your own motivations,
much less the motivations of others? Or how easily we begin to create our own
story about the situation, often projecting meanings and understandings
through our own filters? Sometimes the most difficult thing to do is to create
enough space for something new to emerge. Often we are busy justifying our
own position, searching for the reasons the other person is wrong, and working
hard to manipulate the outcome to the one we desire. Sound familiar? This
dynamic becomes intensified when we are in situations where deeply held values
are at stake, where outcomes are irreversible, and where human beings’ lives
hang in the balance. Creating a space to pause and reflect can be an important
intervention for critical care nursing leaders. Many benefits are described below
for creating a space for a pause.

Exploring Urgency
When an ethical conflict arises, it is often accompanied by heightened emotions,
strained communication and relationships, and a sense of urgency to do something
to relieve the conflict or discomfort. In the space created by a pause, there
is an opportunity to slow down the urgency of the situation. Often urgency is
created in response to one’s own anxiety or fear. Anxiety may be generated in
response to continuing to do things you think are harmful or with marginal
benefit, or the fear that prolonging the dying process will undermine important
values or the feelings of guilt about not being able to “fix” the situation that
arises when treatment options have been exhausted. Being aware of what is instigating
the sense of urgency can help name it and begin to ascertain whether it is
real or imagined. Questions that may help illuminate this include the following:
What has happened that has created this sense of urgency? What is different now
compared to yesterday or last week? These questions become essential when an
ethical conflict arises. Slowing down the process can help create an environment
in which mindful and intentional decision making can occur.