“I believe in turning angst into action. I embrace the power and promise of everyday clinical ethics -that ethics unfolds in the space between every clinician and patient.”
Dr. Meyer is a clinical psychologist at Boston Children’s Hospital, nurse, and bioethicist. She is faculty at the Center for Bioethics and Associate Professor of Psychology at Harvard Medical School. She is a founding member of the International PERCS Collaborative (Program to Enhance Relational and Communication Skills) that has partners in Italy, Australia, Germany, and Argentina. Dr. Meyer is a thought leader and publishes widely on a range of timely professional issues such as pediatric critical care, clinicians’ emotional engagement and moral distress, virtues and interprofessional teamwork, simulation-based education, and the ethics of everyday clinical encounters. Dr. Meyer will present the Closing “Being Present not Perfect.”
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Q:
The theme of this year’s National Nursing Ethics Conference is “Ethical Reflection: Finding Our Way Forward.” In what way does this theme resonate with you?
During this time of the pandemic, I have found myself naturally reflecting more on my personal and professional life. Through the many losses and challenges, I have become keenly aware that each day and each life is precious. I ask myself, “What is the good and right thing to do? What is my purpose?” The ethics lens helps me to take the perspective of others and to see how my life and contributions might make a difference. Ongoing ethical reflection is a welcome companion as we all try to figure it out.
– Elaine C. Meyer
Q:
The pandemic has highlighted an array of challenges we face, including work environments, systemic racism, and disparities in health care. As a leader in your field, what are some recommendations for recognizing what feels broken while making space for healing, in order to look forward?
There can feel like so many things are broken in healthcare, and it can be overwhelming to know where to start. My recommendation to create a healing space would be not to worry alone or to try to tackle problems alone. Remember that we are in a community and efforts to nurture and build community are valued. Invest your energies in healthcare settings and with people who are open-minded and forward-thinking in making good faith efforts to address the root causes of disparity and disenfranchisement. To create healing spaces, we need to listen and learn from everyone, especially those who have borne the greatest burden and suffering. Rather than prioritizing efficiencies, our healthcare institutions must shift to emphasizing relationships and moral spaces. Upholding the dignity and humanity of all people in our daily interactions, however small, can help to heal the world. Seeking ideas and solutions from all quarters will advance social justice and healing in the form of accountable, equitable organizations and communities. To create healing, remember to stand in solidarity with those who deserve better.
– Elaine C. Meyer
Q:
A lot of your work is focused on healthcare communication. What are the gaps and how have those gaps been magnified given the current ethical landscape?
Much of my work has focused on helping interprofessional clinicians to feel more capable and confident when establishing relationships with patients and their families and when holding challenging healthcare conversations. In some settings, we have delegated the difficult conversations to certain members of the team—the social worker, the psychologist, or the chaplain. That may seem like a solution, but what happens at 3 am or during the middle of a pandemic? Helping all clinicians to master a basic level of communicative and relational skill and competence has been a passion of mine. I have championed the “emotional standard of care” in our healthcare delivery, and its importance has been highlighted given the mental health crises, professional moral distress, and ethical challenges that have burgeoned during the pandemic. Skill and confidence with communication skills benefit the patients and families in myriad ways and can foster a deep sense of satisfaction and pride in clinicians. All of us need to have a certain level of skill in these areas, to be generalists in these areas if you will while being specialists in our designated areas of practice.
– Elaine C. Meyer
Q:
What are the principal ethical considerations for nursing emerging from this pandemic?
As we emerge from this pandemic, we do not want to lose momentum for change. Respect for persons and the pursuit of social justice is the principle ethical considerations. Our patients and their families need and deserve access to quality healthcare. We need to press forward to address the revelations of just how deep the disparities and obstacles to access to healthcare truly are in our country. Similarly, we cannot forget the sacrifices and super-human expectations of nurses and other healthcare professionals who labored through the pandemic and delivered us to the other side. Nurses need and deserve proper recognition, respect, and compensation within healthy organizational healthcare systems that put people first. We need a massive reordering of our priorities that assures nurses have confidence and pride in the nursing profession and that young people will want to become nurses in the future. Importing nurses from low-resource countries that siphon talent from their homelands is a short-sighted answer that undermines global well-being and social justice. The pandemic has fostered a deeper appreciation for the contributions of nurses who form the backbone of the healthcare enterprise, and we need grassroots energy, principled leadership, and the political will to emerge from the pandemic and stabilize the profession of nursing. Virtue ethics has a meaningful role to play in re-establishing our nursing professional aspirations, authority, and expertise to flourish with compassion, integrity, and trustworthiness and assures that nursing has a seat at the table in reimagining healthcare.
– Elaine C. Meyer
Q:
What are some highlights of your nursing career that you are most proud of?
I am proud of my early efforts to bring forth the perspectives and priorities of parents who had lost children in the pediatric intensive care unit so that their input could influence the care we provide, our healthcare policies, and our educational efforts. I asked the parents important questions, “What was most helpful? What was least helpful? What advice would you offer for clinicians? What advice would you have for other families who might find themselves in a similar situation?” To advance these lessons, I loved teaching simulation-enhanced communication and relational workshops with patients, parents, and family members side-by-side as co-faculty. Highlights have been when I advocated for what I thought was right, on behalf of patients and families, even when it was not popular. For years I worked to save a children’s healing garden, for example, that was slated for destruction—a magical garden that offered solace and respite and a place for play and imagination. I walked with many families in that garden during their times of greatest need, and that was a true highlight. I came to understand the garden as an irreplaceable healing and spiritual resource with its majestic dawn redwood tree. Nature gives freely of her gifts and never forsakes us. Even though the garden was cut down, engaging fully in the struggle and having the clearness of conscience that comes with having tried my best sustains me.
– Elaine C. Meyer
Q:
Is there anything else you’d like to share?
My Quaker faith has provided a solid foundation for me throughout my career. I believe in turning angst into action. I embrace the power and promise of everyday clinical ethics—that ethics unfolds in the space between every clinician and patient. And that all of us engaged in the healthcare enterprise need to be ethicists. The Wizard of OZ metaphor has scaffolded my practice over the years. To bring the most to our relationships in healthcare, we need to combine ingredients of courage, brains, and heart. It is a lifelong journey to cultivate our ethical awareness and capacity. We can ask ourselves, “What have I learned today? Have I made any meaningful difference? What have I taught today?”