ICN Durban 2009
International Council of Nurses 24th Quadrennial Conference Report
Durban, South Africa
27th June to 4th July 2009
The theme of the 24th ICN Quadrennial conference was ‘Leading Change; Building Healthier Nations’. The conference brought together approximately 5,600 nurses from 129 countries. Ethics was a core theme in many of the main sessions as keynote speakers emphasised the inter-relationship between health and social justice, the impact of professional migration and the challenges of maintaining professionalism in very difficult circumstances.
Other sessions debated the ethics of industrial action and reported on a wide range of ethics-related research initiatives. Samantha Pang from Hong Kong and colleagues from Japan and Taiwan shared findings from their ‘good nurse/bad nurse’ studies in the Far East and discussed the impact of ‘good nurses’ and ‘bad nurses’. Jan Storch and colleagues from Canada shared findings from their research relating to the moral climate of healthcare organisations and the moral distress of nurses. Joan Miller, Verena Tschudin and Samantha Pang discussed the significance of ‘good work’ in nursing. Good work is work that is excellent, ethical and engaging and has four constituents: personal standards; professional standards; forces of the field; and forces of society. Research in this area has suggested factors that compromise good work such as nursing shortages, lack of time, conflicting values, lack of autonomy and insufficient resources (see www.goodworkproject.org).
The Ethics\human rights strand of the ICN Congress was well attended and included a wide range of presentations on topics such as: the development of professional codes; patient perceptions of privacy; the relationship between ethics and cultural safety; dignity in care; the development of clinical ethics committee; and the relationship between religion, culture and professional ethics.
Pre-ICN Nursing Ethics Conference – 28th June 2009
Prior to the ICN conference the International Centre for Nursing Ethics collaborated with colleagues at the School of Nursing at the Kwa-Zulu Natal University to run a one-day conference on the theme of ‘Transcultural Ethics: Learning from Each Other’. There were four keynote speakers:
Ebin Arries from the University of Johannesburg, South Africa – ‘An African ethic: humanisation of a dehumanised workplace?’
Margaret Pharris from The College of St Catherine’s, Minneapolis, USA – ‘Critical Multiculturalism: creating inclusive nursing education environments’
Anita van der Merwe from the University of the Free State, South Africa – Nurse leadership and ethics in Africa’ and
Paul Wainwright from Kingston University and St George’s University of London, UK – ‘Is a transcultural ethics viable?’
In the course of the day there was discussion of differences and similarities in our cultural, political, health and social contexts. We examined our different histories and biographies and considered how this may impact on our professional lives. The relationship between ethical practice, ethical theory and the climate or culture of healthcare and educational organisations was explored. Participants discussed the importance of history to nursing identity. One participant said that if nurses lose their nursing history they may also lose their identity as nurses.
There was also a good deal of discussion relating to the role and transcultural potential of values such as dignity, autonomy, respect and the African value, ubuntu. It was suggested that we need to discern amongst the concepts of race, culture and ethnicity and also to acknowledge differences amongst tribes within the same region. Translating cultural diversity into ‘meaningful experience’ requires, according to participants, resources and needs to be addressed at different levels. Challenges relating to language and different dialects were also discussed. It was suggested that nurses need to also consider the significance of non-verbal communication.
Key messages of this conference suggest that the development of a transcultural ethics will be advanced by:
- listening to and learning from each other;
- ‘bold conversations’ (Pharris) – where nurse ethicists and others can share and explore challenging experiences and perspectives;
- engaging in theoretical work examining the transcultural potential of ethical concepts and theories;
- undertaking empirical work to explore the perspectives of nurses and patients in different cultural contexts;
- nurse leadership demonstrating qualities such as resilience, compassion and pride;
- nurse educators providing spaces for reflection on issues of diversity; and
- nurses engaging in critical reflection in relation to culture, gender, sexual orientation, age and class – courage may be required to engage in reflection and discussion, to walk across what might a times feel like a precarious ‘suspension bridge’ (van der Merwe).
- storytelling – nurses and others sharing their perspectives and experiences as stories or narratives so that we can learn from each other.
Ethicists’ network meeting at ICN Congress on Tuesday 30th June
This meeting provided an opportunity for those interested in ethics to come together the share their experiences and ideas. Participants discussed many of the threats to ethical practice they encounter in their everyday work and suggested how such challenges might be responded to. These included:
- Concern about ‘moonlighting’ – nurses were taking second jobs as they are underpaid. This raises ethical and professional issues and may contribute to the neglect of patients.
- A member of a nursing council expressed concern about the attitudes of nurses who appear to ‘justify wrongdoing’ and who lack a sense of accountability. It was suggested that a reason for this may be poor staffing.
- Participants talked about other pressures on nurses, for example, being on call on days off and enduring a ‘perpetual absence of resources’;
- Concern was expressed about nurses ‘losing their ethics’ and that ‘accountability is fading’. A view was expressed that nurse managers get blamed for the unethical practice of nurses and that this takes away individual responsibility;
- Nurses have to fund their own education;
- Nurses sometimes leave work early and ‘forget about ethics’ – this is because they fear going home in the dark and some don’t have cars;
- There was experience of nurses leaving work ‘to the next shift’, putting their feet up and saying ‘I’m not going to do it’. The participant said: ’we have a problem and the patient suffers’;
- Impact of the development of nurses’ rights and unionisation seems to have a negative impact on care putting professionals ‘first and patients second’. It was pointed out that doctors are currently on strike in South Africa;
- A student nurse shared her experience of being ‘taught shortcuts’ and having three different perspectives on practice – from books, from lecturers and from nurses in practice.
Responses to concerns and strategies to promote ethical practice
- There is a role for professional codes providing guidance for individual practice but it is also important that organisations support individuals – ‘if you don’t look after your staff, staff won’t look after patients’;
- The importance of nurses understanding their duty of care and of understanding ethical principles that underpin decision-making;
- Need for ethics education and time to discuss ethical issues;
- Nurses need to role model accountability and ethical practice;
- Employers need to also engage with the ethics of management and prevent ‘toxic management’;
- Nurses need to contribute to the development of ethical institutions;
- Educators and practitioners need to take the development of character seriously and to consider nurses’ rights in relation to patients’ rights;
- All nurses need to be good mentors and role models;
- Nursing councils have a role in reinforcing ethical practice – one participant suggested that all nurses and students should attend and learn from professional conduct/fitness to practice hearings. This should contribute to their being more ‘vigilant’;
- Student nurses should aspire to be ‘pacesetters’;
- Nurses need to develop confidence to challenge unethical practice and reflect on what doing the right thing means;
- Educators need to develop approaches to ethics and leadership that are meaningful and engaged with practice;
- Nurses interested in ethics can access the ICNE web-site to share resources and discuss ethical issues (www.nursing-ethics.org).
Conclusion
Overall, the ICN Congress provided many opportunities to discuss and reflect on the meaning and role of nursing ethics in contemporary and global healthcare contexts. Despite the many challenges discussed there was also a strong commitment to the development of nurse professionalism and a determination to work together to respond creatively and ethically.
Ann Gallagher
7th July 2009
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