Ethical issues arise when difficult decisions need to be made. In particular, nurses are likely to face various ethical issues and difficult situations in their daily work.
Here are examples of ethical dilemmas in nursing discussed by experts.
- A drug-addicted patient is admitted for extensive trauma, but the doctor fails to prescribe the proper pain medication.
- Inadequate staffing with too many patients per nurse to provide the care needed for each
- Limited health resources for many critically ill patients.
- Patients with a low level of literacy who do not know what documents they are signing in the hospital
- Patients with terminal illnesses expressed to end their life and want to suspend treatment but do not have Advance Directives
- Sense of duty and compassion versus hospital safety protocols
- Suspected abuse or maltreatment
- frequent questions
- What are the ethical dilemmas in nursing?
- How to address ethical dilemmas in nursing?
- Why is it important to address ethical dilemmas in nursing?
- What are the main ethical issues in nursing practice?
Laura Reyher, MSN, RN
nursing instructor,West Texas A&M University
A drug-addicted patient is admitted for extensive trauma, but the doctor fails to prescribe the proper pain medication.
Ethical dilemma:Should the nurse move up the chain of command to attend to the patient's needs and risk professional retaliation for insubordination, or ignore the situation because the patient is an addict?
What should the nurse do?ALWAYS advocate for the needs of the patient, especially if it costs an awkward conversation with a supervisor or administrator. They will always know where you are, championing the right of all patients to compassionate care.
Inadequate staffing with too many patients per nurse to provide the care needed for each
Ethical dilemma:Should nurses refuse to perform their duties, creating more staff shortages, or risk harming the patient through lack of care that could lead to lawsuits?
What should the nurse do?Be part of the solution instead of the problem. This is a system/administrative level issue, and patients come first.
As nurses, we must work together to bring this damaging issue to a mediation table to diplomatically develop solutions. If patients are disadvantaged by understaffing, judges and juries are much more likely to side with nurses acting in the best interest of their patients and doing what any reasonable nurse would do in a similar situation. .
Limited health resources for many critically ill patients.
Ethical dilemma:Which patients, in life-threatening situations, should receive higher levels of care that may increase their survival rates, and which patients should receive lower levels of care that may decrease their survival rates?
What should the nurse do?This is a triage challenge for nurses that requires expertise in critical thinking and clinical judgment.
Knowledge of the staff's experience, available support staff, and appropriate equipment, along with an understanding of the severity of the patient's condition and other comorbidities, will guide the nurse in analyzing which patients might have the best prospects. survival when receiving the highest level. of care.
Patients with a low level of literacy who do not know what documents they are signing in the hospital
Ethical dilemma:Should the nurse delay a busy surgical schedule to ask the surgeon to provide additional information for the patient, or should she go ahead and prepare the patient for surgery to keep the surgical team busy on schedule?
What should the nurse do?ALWAYS prefer vulnerable patients. Health care language is complicated, but every patient has the right to know what is going on.
The information must be given in such a way that the patient can understand, clarify doubts, allow or reject treatments, procedures, medications, surgeries or any other type of care. It can complicate a busy schedule, but they have a right to know.
Patients with terminal illnesses expressed to end their life and want to suspend treatment but do not have Advance Directives
Ethical dilemma:Should the nurse ignore the patient and listen to well-meaning family members pleading for all possible care, including chemotherapy, tube feeding, ventilator, and CPR (cardiopulmonary resuscitation)?
What should the nurse do?Nurses should encourage each patient to have an advance directive to inform the health care team of their wishes if their heart or lungs stop or an irreversible condition develops.
Families can be influenced by deep feelings, emotions, or other issues, but the wishes of the patient are paramount. If the patient is unable to speak for themselves and there is no advance directive, state law allows for a delimitation of authority for a patient to include a child's parent or guardian, spouse/adult children/siblings/other family members to make these important decisions.
If the patient has no family, the hospital ethics committee, which includes people from the community, can help reach a conclusion in the best interest of the patient.
Related:More than 25 examples, questions and scenarios of moral dilemmas
Organizational Psychologist | Registered Nurse | Founder, Network Nurse2Nurse
Sense of duty and compassion versus hospital safety protocols
A nurse mentor from the Nurse2Nurse Network told me about a nurse working on a COVID unit who has lingering feelings of guilt and doubt about a decision she was forced to make between her sense of duty and compassion for a dying patient and the demands of hospital protocols. security.
I was at the bedside of a patient whose death was imminent but taking longer than expected. The nurse had promised the patient and his family that the patient would not be alone at the time of his death.
However, due to the protracted nature of this death, he was at her bedside for much longer than allowed by the guidelines the hospital had put in place to protect nurses from prolonged exposure to the virus.
His coworkers, then his supervisor, would shrilly gesture for him to leave the room. The nurse tried to ignore them at first, but the supervisor's gestures clearly became an order.
Finally, the nurse left the room before the patient died. She feels that she has betrayed the patient's trust in her at the patient's most vulnerable moment. It's been hard to let go of the guilt and regret, even though she knows she was in an impossible situation.
Related:16 real examples of ethical dilemmas
Dr. Peter Cook
Clinical Ethical | philosophy teacher,villanova university
As a clinical ethicist, I have found that nurses often face unique ethical dilemmas due to their role as primary caregivers and patient advocates.
This role is unique because nurses experience daily patient care and often get to know their patients and families in ways that doctors and specialists cannot.
Suspected abuse or maltreatment
Of the many types of dilemmas that nurses can face, one that is particularly daunting and problematic arises in pediatric nursing. Unfortunately, it is common to care for a child who a nurse suspects is being abused or maltreated, perhaps as evidenced by the reasons the child was admitted in the first place.
Although various state legal frameworks exist, these situations still pose a number of ethical dilemmas for nurses, especially since there is often some degree of uncertainty about the occurrence of the abuse.
Such situations require nurses to engage professionally with the child's parents, who make decisions on the child's behalf while balancing increased concern for the child's well-being.
All of that, in turn, must be balanced against uncertainty and the risk of making mistakes if the nurse decides to report the suspicion. Such situations are sources of great moral suffering for nurses, which is understandable.
What are the ethical dilemmas in nursing?
Ethical dilemmas in nursing are situations involving conflicting values, principles, or interests that make it difficult to determine the correct course of action. They may arise in the care of patients or in relationships with colleagues, employers or in the community.
Ethical dilemmas can arise from a variety of situations, including confidentiality, end-of-life care, patient autonomy, equity, and resource allocation.
How to address ethical dilemmas in nursing?
Ethical dilemmas in nursing can be addressed by:
• Consult with colleagues, supervisors, or ethics committees to discuss the situation and identify possible solutions.
• Examine the situation from different perspectives, including that of the patient, the family, and the health professional.
• Apply ethical principles and values, such as autonomy, beneficence, non-maleficence and justice, to guide decision-making.
• Communicate effectively with the patient and family to ensure that they are informed and involved in the decision-making process.
• Maintain a respectful and nonjudgmental attitude toward patients, colleagues, and the community.
Why is it important to address ethical dilemmas in nursing?
It is important to address ethical dilemmas in nursing because they can affect the quality of patient care, patient outcomes, and trust between health professionals and patients. Failure to address ethical dilemmas can also have legal and professional consequences for healthcare professionals.
By addressing ethical dilemmas in a timely and appropriate manner, healthcare professionals can ensure that patients receive the best possible care and that ethical principles and values are upheld.
What are the main ethical issues in nursing practice?
•patient autonomy: Nurses must respect the right of patients to make decisions about their own health care, even if they disagree with those decisions.
•confidentiality: Nurses must protect patient information and share it only with those who need to know.
•charity: Nurses should strive to do good and promote the well-being of their patients.
•no maleficence: Nurses should avoid causing harm to their patients.
•Justice: Nurses must treat all patients fairly, regardless of their background or circumstances.
•veracity: Nurses must be honest with their patients, even if it is difficult.
•loyalty: Nurses must be loyal to their patients and maintain professional boundaries.
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