As a nurse, you must have experienced difficult situations where you had to choose based on what you believe to be safe or unsafe and right or wrong. “Every day, nurses in all hospital departments face a variety of ethical issues, and they need to reconcile their values with their professional nursing obligation,” as per Marian Altman, RN, MS, CNS-BC, CCRN-K, clinical practice specialist with the American Association of Critical-Care Nurses (AACN). The decision you come up with will be based on ethical behavior. It is fundamental for all nurses to develop and implement ethical values in nursing practice.

Ethical dilemmas in nursing are situations where a nurse must choose between two competing values and expect consequences despite the outcome. The decision may conflict with the Nurses Code of Ethics or personal values. Nurses identify an ethical dilemma by considering how a situation makes them think and feel. Ethical dilemmas conflict between two correct courses of action with different principles or values. A dilemma is created when a situation involves doing something right and wrong simultaneously, with one action negatively impacting the other action. To develop a specific choice, the nurse should weigh the outcomes for both options after engaging in much thought and discussion. Nurses address these issues early before escalation. Nurses put in more time, effort, and energy to weigh ethical dilemmas and their impact for optimal results. A patient may be legally forbidden, but caregivers will acknowledge it if it has personal moral and ethical value to the patient and their family. Ethical dilemmas are present in various forms and for different reasons. They include; Patients refusing treatment, incompetent colleagues, patients or their loved ones making life or death decisions, shortage of staff, and nursing assignments contradicting cultural or religious beliefs. The American Nurses Association (ANA) established the Code of Ethics in the 1950s to set goals and values for nurses and guide them in their daily practice. The code is updated regularly and reflects the challenges nurses face in their daily tasks. It is used as a social contract between nurses and the public with values and commitments nurses should uphold as they identify the boundaries and responsibilities involving patient care.

Most Common Ethical Dilemmas in Nursing

Ethical principles and values in nursing are used as a guide in decision-making to ensure the patients get the best outcomes with respect for their rights, including; The right to respect, autonomy, justice, dignity, and equality. It is essential to involve patients in decision-making since all of these areas may be closely related.

Refusal of life-saving treatment

At times, patients will refuse to receive life-saving treatment or interventions that will prevent any danger to them. In this scenario, the caregiver may have a reason to intervene, but the patient disagrees with the course of action. It is fundamental for nurses to determine the reason for refusal, patient capacity – the ability to make decisions based on assessment, and the extent to which ethical care can be given. If the patient lacks decision-making abilities, the nurse uses the Mental Health Act 2007 approach to advocate for their treatment. If the patient is of sound mind and still refuses treatment, the nurse will explain the consequences and make sure others are not forcing them. The nurse seeks legal and professional advice at a point when the patient continues to deny life-saving treatment. A nurse can have personal views on what should be done; however, it can not be forced on the patient as it is unethical and will cause repercussions. Nurses should always engage patients in open discussions regarding treatment options and apply ethical principles and values to prevent risking their professional status.

Informed Consent

Informed consent is the most common ethical issue for nurses. If the patient or family members do not understand or have not been informed about a treatment regimen being used, concerns may be raised, which causes ethical dilemmas. At other times, patients become uncomfortable asking questions and giving their consent without fully realizing the result of their treatment. Patients cooperate with treatment plans when they feel involved and supported by caregivers, improving health outcomes. Nurses should explain all treatment plans and procedures to patients and make sure they understand to avoid ethical dilemmas. Educating patients on all the risks of a procedure, how it will take place, and the side effects of medications and treatments are essential to prepare them mentally. Therefore, nurses and other healthcare givers should take correct measures to ensure their patients are secure and obtain informed consent.

Protecting Patient Privacy and Confidentiality

Patient privacy and confidentiality dilemmas in nursing happen when nurses decide if it is appropriate to discuss a patient’s medical information with a parent, guardian, or caregiver. The Health Insurance Portability and Accountability Act (HIPA) is responsible for protecting medical information for patients. Therefore, there are guidelines and boundaries to protect their privacy. Nurses also need to protect patient rights and act towards achieving their best interests. Still, healthcare professionals should respect that patients have the right to make decisions regarding their care independently, based on their personal or cultural beliefs. Violating a patient’s privacy can lead to severe problems, including losing a professional license. It is always good to consult with supervisors if you are unsure of certain decisions. Patient rights may conflict with the personal views of healthcare professionals, but they still have to act according to ethical values. Patients may be aggressive or threaten others, and as a nurse, you should consider how serious it is and whether or not the patient intends to harm others directly. When the patients pose a threat to themselves or others, and when they refuse treatment exposing others to significant risk, confidentiality is broken. The nurse informs the patient of the implications and why confidentiality may be broken. If the risk is considered severe, patient consent is sought before breaking their confidentiality. Nurses should justify the reason for breaking confidentiality based on the risk to others and the patient’s rights.

Patient autonomy versus nursing expertise

Nurses are equipped with extensive knowledge and skills in managing various diseases. There is a big difference in how both the nurse and patient will view a clinical decision. Still, patients have the right to make their own decisions on the course of treatment. Challenging situations can be due to differences in the nurse’s suggestion on treatment and the patient’s opinion. A good example is when a patient wishes to be discharged early, but the healthcare staff does not see it as right. The patient has the right to choose, and their wishes are respected unless they are at risk. Nurses should record this in their notes and explanations to the patient before discharge. Denying the patient the wish to be discharged would violate their freedom and autonomy. In this scenario, the nurses’ role is to advocate for patient rights and provide the necessary information to guide their decisions.

Inadequate Resources to Provide Care

Lack of resources and inadequate staffing in healthcare settings strain the needs that patients require. They become at risk of not receiving the best care possible, and for this cause, the nurse is forced to make hard decisions. When there is a staff shortage, patients do not receive maximum attention, and most physical and emotional needs are not met. Optimum healthcare will be compromised as nurses will be under stress due to work overload. Ethical dilemmas come in when nurses are forced to determine priorities of how patients will receive treatment and care. In this case, triaging is necessary to prioritize them easily. The nurse should assess and determine if orders can be changed for any patient whose condition is improving.

How nurses deal with ethical dilemmas

Nurses should get insights from both parties involved to understand the uniqueness of a dilemma. First, they should know the dilemma; then, they can work to find common ground among the parties. This discussion and collaboration will result in a solution that will work well for both parties. The Code of Ethics established by The American Nurses Association has guides that nurses follow in making decisions on daily conflicts in the work environment. The code is updated regularly to align with the current healthcare structure. Nurses should look through it for supportive information when faced with ethical dilemmas. Nurses act as advocates for patients in the hospital. Some ethical dilemmas require the nurse to speak up, share their concerns with superiors and act as a voice for patients. This allows insights that can be used to come up with a better solution. After notifying superiors, nurses also need to follow up on the issue to get attention and be resolved it quickly. Nurses should seek input from family members as their perspectives could influence addressing the current ethical dilemma. Being calm and understanding to family members allows the nurse to understand the patient more and sort out the dilemma. The nurse then explains more details concerning the dilemma, offers insights, and listens to the family member’s opinion. Working in collaboration with family members makes it easier to explore potential solutions.

Final Thoughts

Avoiding ethical dilemmas in nursing practice can lead to stress and burnout, legal issues, and loss of jobs and licensure. The nurse needs to acknowledge the issues, address them sooner, and seek help in these situations. The most common ethical dilemmas encountered in nursing practice have been highlighted above, with quick tips for nurses on how to handle them. Decision-making is challenging, and that is why it is necessary to consult nurses’ guidelines and other healthcare professionals. A nurse should also prioritize the patient’s interest and be calm when approaching such situations. Nurses can also equip themselves with the skills and knowledge necessary to help them professionally solve ethical dilemmas while promoting effective, safe, and high-quality patient care. This reduces the risk of harming the patient and losing their license and helps preserve their rights.

References

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