Teaching Future Nurses to Lead With Moral Courage and Compassion

A new AACN teaching tool draws upon the lessons and genuine person-centered care shown in the early 1980s by the nurses and other clinicians of the country's first AIDS ward.

The nurses who took extraordinary action to care for patients in the country's first AIDS ward in the early 1980s have inspired a new teaching resource that motivates future nurses to follow in their risk-taking, problem-solving, and patient-advocating footsteps.

The Trailblazing Innovation Faculty Tool Kit centers on themes highlighted in the documentary 5B, which features first-person accounts from nurses and other professionals who, without existing protocols, cared for patients most other clinicians were afraid of treating and forged a new, person-centered approach to patient care in Ward 5B at San Francisco General Hospital.

It was commissioned by the American Association of Colleges of Nursing (AACN), in collaboration with Johnson & Johnson Services, Inc.

The tool kit, developed by a team of experts led by Edilma Yearwood, PhD, PMHCNS-BC, FAAN, chair of the Department of Professional Nursing Practice at the Georgetown University School of Nursing & Health Studies, centers on 17 core themes central to nursing practice, including allyship, compassionate care, moral courage, respect, trauma-informed care, and wellness.

HealthLeaders spoke with Yearwood about the new tool kit and the documentary's influence over it.

This transcript has been edited for clarity and brevity.

HealthLeaders: How and why did the concept of the tool kit originate and how was it tied in with the 5B documentary?

Edilma Yearwood: Some schools of nursing showed it to some of their students … and the feedback was overwhelmingly positive. Johnson & Johnson thought that because of the feedback from the faculty and the students, this might be a good opportunity to use the documentary to develop some skills and tools for nursing schools to use to assist students in a variety of different ways. AACN formed an advisory group to work on the toolkit, and we worked on it for about a year.

HL: How innovative is something like this for nursing schools? Aren't they teaching person-centered care already?

Yearwood: A lot of what we have taught in nursing is patient-centered care. And if you look at the difference in how they describe "patient" versus "person," person-centered care is much more holistic, and includes other elements. Now, I'm an old nurse, so when I heard patient-centered, I would think about that individual patient in front of me. But person-centered care really asks you to see that person in front of you, in the context of home, community, their illness, all of that.

HL: What are some of the points that make this tool kit unique and valuable?

Yearwood: For me, as somebody on this committee, it was helpful for us to work together to identify some of the themes that we saw in the documentary and walk people through what those themes meant and mean, and how we can translate that in our work with our students.

If you're going to be innovative, and if you're going to be a leader in driving care, you have to understand what leadership is. You have to understand that sometimes you have to have moral courage to make a decision that you're going to drive. So, the different pieces that we came up with that we identified as what we call themes include things like allyship—how do we look at the environment, the clinical environment, and who are the allies to help move the needs of the patient forward? It's not the individual nurse by himself or herself; it's about who are those other folks who we need to bring along with us to make the plan work for this particular patient and/or their family.

Sometimes, you have to take a stand if you feel strongly that Plan A is a good way to go, and everybody else on the team might say, "Well, we only can afford Plan B." If you think Plan A is going to be the best path forward, how do you step up and have moral agency and moral courage to execute, given your conviction? How do you deliver compassionate care? Within all the frames of what we're doing, you've got to keep the person at the center and understand that you have to listen to them and be compassionate about what they're telling you they need.

HL: What is it about the documentary that made it figure so prominently in this tool kit?

Yearwood: We all looked at the documentary multiple times and what we each did, independently and then collectively, is we identified snippets from the documentary that held a particular message. And we made a list of those snippets. So those pieces are tools that the educator can use to explore a concept in their teaching of students. They're like sparks to having a conversation and having an opportunity to do a deeper dive on some of these concepts.

HL: What snippet from the documentary particularly resonated with you?

Yearwood:  One of the nurses had a needle stick and she became HIV positive. That was one that particularly touched me because in talking with students, that piece is important—your vulnerability in the healthcare environment where there are things going on that we know very little about. COVID is a great example.

When COVID first came out as a prominent issue in our lives in 2020, we were unclear about transmission. We were unclear about how long this was going to go on. And we were unclear about the risk for the staff. And in the documentary, this nurse was vulnerable because she contracted HIV as part of her work, but it didn't deter her from her work. She clearly was still passionate about her work with this vulnerable group of individuals who were sick and dying.

It was a lesson for me that I can talk with students about how sometimes we don't know how things are transmitted, and sometimes we become more at-risk or vulnerable. Does that mean that we avoid the bigger picture, which is the need to deliver compassionate care and moral agency about doing the right thing? That, for me, was memorable.

HL: How effective are the tool kit's lessons in courage, ingenuity, and compassion in encouraging new nurses to stick with the profession?

Yearwood: I'm a psych nurse and one of the things I talked to my students all the time about is the importance of self-care and paying attention to your own well-being. When you get to the point where you're feeling like you're getting depleted, double down on self-care, but it's also okay to make a change.

There are so many facets of nursing that one can go into that one does not need to get to the point where they're totally burned out from being in an acute, high-risk kind of environment. Sometimes, it's okay to take a pause … and at another point in your life, you might want to return to that early passion, but you can be as effective by moving on and doing something different.

HL: The National Academy of Medicine's The Future of Nursing 2020-2030 report put health equity as a nursing priority over the next decade. How does this tool kit address that?

Yearwood: I wrote the [tool kit] piece on health equity and this is a central place nursing has to feel comfortable with and incorporate, and for us to have better health outcomes for all, we have to understand that we also are responsible for the equity and the treatment access issues that all patients have. So, it's a very central theme in not only the documentary, but also in the tool kit that we developed.

We talk with students in the tool kit about not limiting their perspective on what the term "helps" means or looks like, that in order to forge health equity for all we have to really understand the person's lived experience and determinants of health factors that impact them and their illness and/or their road to well-being.

Once we know what those factors are that might be contributing to an illness, we have to address all of those factors as much as we can.

HL: What is the overarching idea that student nurses can take from the tool kit?

Yearwood: That there are ways to understand and to grow within the profession and to be their best self as a compassionate clinician. They can use some of the things found in the tool kit to move forward as a moral agent, and I think even new nurses can be moral agents.

They don't have to stay silent; they can take risks, and they can lead when they know that what they're trying to do is the right thing to do. They don't have to just follow; they can actually lead when they are looking after the best interest of the consumer or the person.