I 0899-5885/97 $0.oo + .20 Ethical Decision Making in the Critical Care Patient Experiences of a Nursing Ethics Forum Case Studies and Outcomes Dana Bjamason, RN, BS, CNA, Suzanne Prevost, RN , PhD, CCRN, CNAA Michele Carter, RN , PhD The National Need Unprecedented change, occurring at an ever- increasing pace, has left many health care pro- fessionals reeling as they try to make sense of a new and diverse system. Staff members are being asked to do more with less, cut costs, decrease length of stay, and supply us- age and diagnostic testing while maintaining or increasing quality. Legal and ethical issues are adding to the complexities of an already strained system, 6 underscoring the need to establish a sound, ethical knowledge base and use ethical principles to guide patient care and decision making. The rapidity with which decisions must be made often leaves opportunities for decision making that may not necessarily reflect the goals or values of the patient. To that end, hospitals and other institutions are implementing a variety of measures to educate nurses in ethical con- cepts, decision making, and pertinent legal standards and to provide a forum for the nurse to act as a patient advocate. 1 • 8 • 12 The Need in Our Hospital Unit The idea to create an ongoing nursing pro- gram to promote ethical reasoning and under- standing of the values associated with ethics arose after discussions between the unit's nurse manager and a clinical ethicist from the university's medical humanities program. The purposes of the program were to • Promote excellence in patient care through the exploration of ethical prin- ciples • Provide an opportunity for listening and critical thinking and heightening profes- sionalism • Foster healing, compassion, and em- pathy From the Department of Medical/Surgical Nursing (DB), and the Department of Outcomes Evaluation and Nurs- ing Education (SP), and the Institute for the Medical Humanities (MC), The University of Texas Medical The unit chosen as a forum for these discus- Branch at Galveston, Galveston, Texas sions admits patients with a primary diagnosis CRITICAL CARE NURSING CLINICS OF NORTH AMERICA I Volume 9 I Number 1 I March 1997 123