1. Rosario, Janet Del RN
  2. De'Bato, Erika BSN, RN

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Feelings about moral courage and palliative care

I appreciated the article emphasizing the quality of moral courage and the need for palliative care referrals ("Moral Courage: A Step Beyond Patient Advocacy," Transitions, June 2015).* Providing palliative care and alleviating suffering are both positive actions. Yet something about the article concerned me. On rereading it, I noted that the nurse "felt," "believed," and "connected" with patient MJ.


Now what could be missing? The author has skillfully drawn us in and, speaking for myself, elicited agreement. But, as I thought this over, I realized that his nurse apparently hadn't asked MJ what he wanted, although he wasn't described as confused. She did speak to the medical team about palliative care, but why not talk directly with MJ?


The implied acceptance of feelings and beliefs as inherently positive attributes worries me. Certainly they were in this situation. But consider alternative situations, such as a pro-life nurse dealing with a patient considering an abortion. If she "felt," "believed," and "connected" with the patient, would it be appropriate for her to urge the patient to consider a referral to a pregnancy support center? Some nurses might agree; others would say no.


Having worked in an ICU and seen many patients like MJ there, I'm grateful that palliative care is now an option. But I'd like to raise an alert about relying on feelings, beliefs, and connections as markers for moral courage.




Peekskill, N.Y.


Teamwork helps to prevent CAUTIs

I was very interested to read your article "Preventing Urinary Tract Infections with a Two-Person Catheter Insertion Procedure" (March 2015)* because this is how I inserted urinary catheters when I became a nurse 4 years ago.


Inserting urinary catheters can be challenging, especially with female patients, because everyone's anatomy is a little different. Sometimes having an extra set of eyes can be helpful; for example, to catch breaks in sterile technique.


Reducing healthcare-acquired infections is a goal of every hospital facility. At the hospital where I first worked, a urinary catheter buddy system was implemented to help reduce catheter-associated urinary tract infections (CAUTIs). With this system, two nurses assisted each other with the insertion of a urinary catheter. This technique gave me, then a graduate nurse, the confidence and experience I needed to properly insert urinary catheters.


Even though I no longer work at that hospital, I still use the buddy system every time I insert a urinary catheter. I'm so glad to know that other hospitals have implemented this system as well.




Spring, Tex.


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