Practice Tip of the Week: Crisis Standards of Care
Tuesday, March 31, 2020
Posted by: Laura Lang
By Catherine Robichaux PhD, RN, Alumna CCRN
As the ever-changing healthcare environment created by the COVID-19 pandemic unfolds, hospitals, taskforces and government officials are discussing implementing crisis standards of care (CSC).
A CSC declaration is a recognition that resources are limited and that normal standards of care are not possible under the circumstances. They were developed in response to events that can have an extended impact which potentially overwhelms the health care system.
When a CSC is initiated, the focus of care shifts from the primary obligation to meet the needs of individual patients, to the allocation of limited resources to achieve the best health outcome for the population as a whole. As with other CSCs, The North Texas Mass Critical Care Guidelines provide a framework that can be used by providers, hospitals and other clinical settings to create decision-making tools during a mass disaster.
Ethical Decision Making
Using a triage model based on ethical principles including respect for persons and fairness, the purpose of the guidelines is to save as many lives as possible while seeking consistency and transparency in decision-making across health care systems.
This shift in the conceptualization of the “duty to care” ethical mandate from patient-centered to public-centered can be a source of significant moral distress for nurses and all health care providers. Moral distress happens when an individual experiences conflict between what they feel is ethically appropriate and what they are being requested or required to do. Limiting or withdrawing interventions to conserve or allocate to “those who would most benefit medically” (North Texas Mass Critical Care Task Force, 2014 pp.1) is especially problematic.
Safety and Support
While nurses remain obligated to provide care during the COVID-19 pandemic, healthcare institutions and other employers have a corresponding obligation to reduce safety risks and address moral distress. To preserve personal and professional integrity, nurses must have access to ethics resources and other support services including spiritual care/chaplaincy and palliative care. Practicing self-care and encouraging others to do the same will sustain the ability to care for those in need.
Altruism and courage are well-known nursing virtues that we are witnessing daily in the actions of our peers across the globe. Balancing responsibility with risk, however, means that situations and circumstances — such as a lack of necessary protective equipment — are assessed for potential harm to patients and colleagues. “Accepting personal risk exceeding the limits of duty is not morally obligatory; it is a moral option” (ANA, 2015, pp.3).
Free Webinar: Crisis Standards of Care | Apr. 2, 6PM CT: Join ethics experts and TNA's CEO to learn more about how standards of care may change during a crisis. Participants will look at ethical issues involved during crises and will have the chance to ask questions.