Ethics in Everyday Practice: Pick Up Your Stethoscope

摘要

Have you ever noticed how many critical care clinicians have a stethoscope draped around their necks or tucked into a lab coat pocket? The stethoscope is regarded as a badge of honor and as a symbol of caring and healing. It is a sentinel moment when a nurse in training uses it for the first time— simultaneous wonder about the intricate workings of the human body and trepidation in detecting subtle changes that may signal decompensation. With experience, it becomes a symbol of competence and identity, a trusted tool used to prevent harm and promote safe patient care. The symbolism of the stethoscope can be traced to the evolution of technical proficiency within nursing and the attendant competencies associated with its use. For decades, critical care nurses have honed their skills in the auscultation of heart sounds, detecting irregularities and arrhythmias, and identifying deviations in breath sounds as a means for preventing or treating underlying disease. This artful listening is increasingly replaced by devices aimed at reducing variability and increasing efficiency. Cardiac monitors stream heart rate, rhythm, and blood pressure; Doppler imaging projects venous and arterial flow; findings autopopu-late the electronic medical record. Such monitoring becomes a rote activity aimed at gleaning the data required by protocols, regulators, or insurers. Concurrently,