Ethical Issues Related to New Cellular Therapies and the IMPACT on Nursing Practice

Abstract

Topic Significance & Study Purpose/Background/Rationale Nursing care for hematopoietic stem cell transplantation (HSCT) patients has always presented ethical challenges throughout the care continuum. Recent research indicates HSCT nurses frequently experiencing moral distress in situation related to diminished patient care quality due to poor team communication; provider giving false hope to patient or family; following family wishes to continue life support even when not in best interest of patient; patient care suffering due to lack of provider continuity; and initiating extensive life-saving actions when it is likely to only prolong death. With the addition of new cellular therapies, HSCT nurses find themselves caring for patients with hematologic and solid tumor malignancies with advanced or progressive disease. The promise of these new therapies with possible profound adverse effects promotes nursing concerns of unrealistic or uncertain patient expectations; questionable benefit versus harm in view of adverse events which have occurred in early clinical trials; and questionable patient understanding of the efficacy of phase 1 trials. Unresolved ethical issues may also contribute to team members’ burnout, compassion fatigue, and moral distress affecting recruitment and retention of healthcare team members. Methods, Intervention, & Analysis To assist nurses managing with these additional challenges the nursing leadership teams on the HSCT, leukemia and lymphoma units requested regular nursing ethics rounds to provide clinical nurses the opportunities to openly discuss their experience and distress with difficult patient situations. Nursing ethics rounds have been conducted monthly or every other month on different units for both days and night shift nurses. Clinical nurses have discussed concerns about patient selection, patient preparation for all possible outcomes, and their participation in administering treatment with uncertain or adverse outcomes. Current literature is presented on a relevant topic and continued education units are provided. Nurses are reminded of the resources available for immediate situational assistance (ethics consult) and individual assistance (employee assistance program). Findings & Interpretation Clinical nurses have discussed concerns about patient selection, patient preparation for all possible outcomes, and their participation in administering treatment with uncertain or adverse outcomes. Current literature is presented on a relevant topic and continued education units are provided. Nurses are reminded of the resources available for immediate situational assistance (ethics consult) and individual assistance (employee assistance program). Discussion & Implications Informal feedback has been positive and nurses have expressed appreciation for the opportunity to discuss their feelings about these new challenges.