Collaborative decision-making through shared governance alludes to a nursing practice design outlined to integrate various beliefs and fundamental values accepted by professional practice as means of providing quality care (Coyne & Gallagher 2011 pg. 2334). Collaborative decision-making aids in enhancing the nurse’s workplace environment, satisfaction and retention (Graham-Dickerson et al. 2013 pg. 286). Getting an opportunity to attend the hospital’s ethics committee meeting permitted me to be part of the employees in attendance and observe how the committee conducts its business, the collaborative efforts between members how they make significant decisions, functions, and roles of each committee member.
The ethics committee meeting comprises of doctors, social workers, nurses, a chaplain, an educator and an attorney. The main mandate of the committee is to advocate for patient’s bioethical issues, develop hospital’s policies that describe principles of conduct, give advice and review cases where ethical dilemmas are perceived. At the meeting, I understood that running a hospital is a collective approach that needs stakeholders to embrace a collaborative approach. The Health Ethics Committee (HEC) main mandate is creating awareness among its members, hospital staff, and patients about ethical issues. Secondly, the HEC is to cooperate with the development and emendation of hospital policies and guidelines to improve service provision by hospital staff. The final mandate of the HEC is the job of ethical cases analysis.
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A chairperson appointed by the hospital board heads the committee. The committee has the reporting responsibility to make appropriate recommendations to the Board or any area of improvement where action in needed. The secretary who is a nominee of the board minutes the proceedings of all the committee meetings including a record of the individuals in attendance. Other roles of the secretary include ascertaining the existence of conflicts of interest at the start of each meeting and minute them appropriately. The secretary of the committee convenes the meetings at the request of the chairperson.
The main role of the attorney is explaining what the law allows, dispelling common myths and to educate the committee members about the legal and ethical aspects of patient care. Lawyers play critical roles in policy formulation; although committees make policies for review by hospital administrations, lawyers come in handy when scrutinizing words and alerting members to ambiguities and uncertainties. The main role of the chaplain of HEC is to determine and clarify the patient’s spiritual and moral views and crucial ingredients to the process of patient care ethics reflection. The educator’s role is a more obvious one in the committee; at the meeting, she was allocated a few minutes to remind members of the ethical policies at the hospital.
The hospital’s ethical committee uses the collaborative decision making approach to make crucial decisions. That means that they reach at decisions by means of consensus, democratic process or a combination of both. For instance, the committee had to make a decision on an emerging issue where some doctors and nurses resented the idea that third parties were invading on an area, which was previously their main domain. Additionally, some physicians may not be aware of the services available or recognize that a health care issue was ethical. The committee used consensus and straw polling to make a decision on the way forward to deal with the two problems.
Regarding the decision where physicians resented the idea that a third, party was watching how they made patient-care decisions the committee members proposed the idea of creating awareness on the importance of ethical considerations. The consensus method used allowed all members to be heard and participate in decision-making. The goal of consensus is to find common ground, probe issues until everyone’s opinions are heard and understood (Graham-Dickerson et al. 2013 pg. 286). Consensus does not require unanimity rather; members have to agree that they can live with their decisions. Although the committee educator had been creating awareness among the hospital staff it was decided that more time be dedicated to educator classes; members of the committee were also asked to be ambassadors of the initiative among their colleagues.
Three members were opposed to the idea; they argued that the physicians’ schedules were already busy as it were and more educator classes would strain their time. The committee discussed the concerns with the disagreeing members and eventually, they reached a consensus with agreement that educator classes would be scheduled according to the physicians’ shifts. Additionally, the committee agreed to involve the physicians in the decision according to shared governance principals. Brochures would be left at the nurses’ station and break rooms; the brochures would contain the importance of ethical considerations during patient care and consequences of failing to adhere. Straw polling was utilized to know how many committee members agreed; by the show of hands, all members seemed to agree eventually.
Shared governance provides a construct in that quality enhancement is the chief goal and career advancement an added advantage (Ott & Ross 2014 pg. 761). The approach allows managers to listen to staff concerns directly; it also empowers the nurses to provide excellent patient care autonomously and collaboratively as equals of the healthcare team. The committee agreed that they would make the nurses and doctors participate in the education programs willingly. A poster would be displayed in the break rooms and nurse stations asking three questions; Zealous about quality patient care? Keen about improving patient care? Want to have a voice? The staff was asked to reply through email and was asked to attend educator classes, the motive of which was to rally them to consider ethics in delivering patient care.
References
Coyne, I., & Gallagher, P. (2011). Participation in communication and decision ‐ making: children and young people’s experiences in a hospital setting: Journal of clinical nursing , 20 (15 ‐ 16), and 2334-2343.
Graham-Dickerson, P., Houser, J., Thomas, E., Casper, C., ErkenBrack, L., Wenzel, M., & Siegrist, M. (2013). The value of staff nurse involvement in decision making: Journal of Nursing Administration , 43 (5), 286-292.
Ott, J., & Ross, C. (2014). The journey toward shared governance: the lived experience of nurse managers and staff nurses: Journal of nursing management , 22 (6), 761-768.
