Keywords: ethics, code of ethics, collaboration
Nurses today often face many ethical dilemmas including, but not limited to, informed consent versus a patient’s right to refuse treatment, quality of life versus length of life, active euthanasia versus passive euthanasia, adult stem cell use versus embryonic stem cell use, and maintaining treatment versus withdrawing treatment. The nurse’s ability to collaborate with patients, families, and multi- and intra-disciplinary health care professionals in the successful resolution of such dilemmas can affect the quality of health care. The authors of the articles in the Online Journal of Issues in Nursing (OJIN) that are collectively called Partnerships and Collaboration: What Skills are Needed? discuss and give examples and guidelines for developing collaborative skills. Nurses may find the 2001 American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (hereafter referred to as the Code) a thoughtful framework for evaluating their own collaborative skills. The Code also provides the "nonnegotiable ethical standard" (ANA, 2001, p. 5) that calls each of us to act ethically, including acts of collaboration. Thus, this column will focus on how collaboration is addressed both implicitly and explicitly in three of the Code’s provisions and interpretive statements.
These provisions and interpretive statements of the Code not only illustrate ways to guide us individually and collectively in our collaboration but also substantiate how important collaboration is to health care, patient care, and social justice. Collaboration is first mentioned in provision 1 of the Code, interpretive statement 1.5 entitled "relationships with colleagues and others." This part of the Code states that "the nurse values the distinctive contribution of individuals or groups, and collaborates [italics added] to meet the shared goal of providing quality health services" (ANA, 2001, p. 9). Implicit in this sentence is that collaboration and quality care are related; that is, collaboration is essential for shared goals that result in quality health care.
Collaboration is next mentioned in the Code in provision 2, interpretive statement 2.3. This interpretive statement consists of two paragraphs about collaboration and its central role in patient care. The first paragraph focuses on how multi-disciplinary collaboration, and not just cooperation, is critical when the goal is shared decision making related to the health care needs of individuals, families, groups, and communities. The second paragraph focuses on intra-professional collaboration and the shared contributions of all nurses, including nonclinical nurses, to health care.
Thus, collaboration is central to the care nurses deliver and to their ethical commitment to patients. Even though issues in collaboration are addressed directly and early in the Code, the articles on collaboration in OJIN challenge us to expand on these and other issues. The overview by Baggs (2005) provides a brief history of collaboration, citing select evidence from literature that supports the effectiveness of collaboration in health care. Gardner (2005, para. 2), in the first article, asserts that "Unfortunately, interdisciplinary collaboration . . . is rare." Gardner then discusses 10 lessons that give concrete suggestions for ways nurses can increase their collaborative skills. We recommend an 11th lesson: Read and reflect on the entire Code. One example of this can be found in provision 1 of the Code, interpretive statement 1.5 that states "the nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise, and to resolving conflict" (ANA, 2001, p. 9). Further, provision 2 of the Code, interpretive statement 2.2 indicates that "nurses must examine the conflicts arising between their own personal and professional values, the values and interests of others who are also responsible for patient care and health care decisions, as well as those of patients" (ANA, 2001, p. 10). Both quotes implicitly address the importance of collaboration.
The Code is explicit about collaboration in provision 8. The entire provision and subsequent interpretative statements assert the need for collaboration to support ". . . community, national, and international efforts to meet health needs" (ANA, 2001, p. 23). Interpretive statements 8.1 and 8.2 discuss the need for nurses to look beyond individual practices and to examine issues that we face as citizens of a global community. These are difficult issues like violence, homelessness, hunger, and disrespect for human rights, all of which require us to work collaboratively within and across disciplines and countries to solve these problems.
The OJIN topic, Partnerships and Collaboration: What Skills are Needed?, further illustrates how provisions 1, 2 and 8 embody nurses’ collaboration with others. Hinton Walker and Elberson (2005) build on these provisions by outlining an approach to working collaboratively with any organization in a technological global environment. Boswell and Cannon (2005) give examples of how collaboration can be used to help meet communities’ needs. Ross, King and Firth (2005) demonstrate how they developed a reflective exercise to help nurses improve their collaboration and, thus, their working relationships with other health team members. Lindeke and Sieckert (2005) discuss a variety of strategies that enhance nurse-physician collaboration.
To summarize, we have shown how the ANA (2001) Code of Ethics for Nurses with Interpretive Statements is alive and well in its application to collaboration, in particular, the OJIN topic on Partnerships and Collaboration: What Skills are Needed?. The Code and the OJIN articles challenge us not only to reflect on and act collaboratively to meet health needs of individuals and communities locally, but also internationally. We believe that nurses are up to this challenge.
Joan Garity, EdD, RN
College of Nursing and Health Sciences
University of Massachusetts, Boston
Article published July 26, 2005