Healthcare professionals, including nurses, face ethical dilemmas fairly regularly. Most of the dilemmas are usually serious and very stressful because when faced with a dilemma, a nurse must make a decision, which is easier said than done.
As a nursing student, you might be assigned to write an essay where you identify, analyze, and resolve an ethical dilemma. We have noticed over the years that many students struggle with writing an ethical dilemma nursing essay. If that sounds like you, read this post that comprehensively explores ethical dilemmas in nursing, including their examples and solutions.
In most cases, essays about ethical dilemmas in nursing take the reflective essay approach, where you reflect on real, researched, or imagined clinical scenario or encounter. It could be during your placement, clinical rotations, or shadowing experiences. As you do so, you will borrow from various ethical theories and decision-making models.
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Let's get started with the basics to more advanced concepts.
An ethical dilemma is a scenario where it is not easy to decide one way or another. Nurses are faced with ethical dilemmas almost every day. They have to make serious and difficult decisions fairly regularly. The decisions can sometimes mean life or death. Therefore, as a student nurse, it is vital to learn about ethical dilemmas nurses face, how to identify them, and how to solve them correctly.
When facing an ethical dilemma, you should always follow the nursing code of ethics. This is because most dilemmas can be solved by following the nursing code of ethics. The nursing code of ethics is a bunch of rules nurses has to follow to provide quality, safe, and unquestionable care to those who need it.
While most dilemmas can be solved by following the code of ethics in nursing, some dilemmas cannot be solved in this manner. The reason is that the nursing code does not guide every ethical dilemma or situation.
If faced with a situation that makes it difficult for you to follow the nursing code of ethics, you should use your judgment to weigh the pros and cons of both decisions to make the right decision.
Examples of ethical dilemmas nurses face regularly include: how to deal with a non-compliant patient, how to deal with a patient that is refusing treatment, and whether to disclose confidential information to help a patient.
The terms ethical and moral are often used interchangeably in speech. However, the two terms do not always mean the same thing. For example, there is a slight difference between ethical and moral dilemmas.
An ethical dilemma involves two morally correct choices, but one is slightly more ethically problematic than the other. In contrast, a moral dilemma is a situation with two morally correct choices, but neither is preferable. For the moral dilemmas, the nurses know the right action yet might be limited to acting by forces outside their control.
As a nurse, you are more likely to face ethical dilemmas than moral dilemmas. Because ethical dilemmas are anticipated, a code of conduct has been created to help you always make the right decision.
There are many reasons why nurses face ethical dilemmas frequently when providing care to patients. The following are the eight main ones:
As evident in the section above, ethical dilemmas can arise virtually anywhere in the nursing world. It is up to you as a nurse to identify dilemmas when they arise and deal with them as expected by the ANA code of conduct. In this section, we are going to focus on how to identify ethical dilemmas in nursing.
Here are the main indicators of ethical dilemmas in nursing.
Principles of nursing ethics were formulated to help nurses consistently make the right decisions when faced with ethical situations. There are many principles of nursing ethics, but the main ones are non-maleficence, beneficence, autonomy, and justice. These are the ones that are always integrated into nursing training programs to help nurses make the right decisions whenever they are faced with difficult situations.
Nonmaleficence is probably the most well-known ethical principle in the healthcare world. It applies to nurses, doctors, and other medical professionals.
This principle teaches nurses that it is their responsibility to provide care, treatment options, and/or case management in a manner that does not harm the patient. When you internalize this principle as a nurse, you will always choose to provide care and treat patients safely.
Non-maleficence is an important part of providing patients with safe and quality care. Exercising this principle means doing everything possible as a nurse to provide care while ensuring the highest degree of patient safety.
An excellent example of non-maleficence in nursing practice is withholding the administration of a powerful medication until you get confirmation on whether a patient is allergic to it or not. Another example of maleficence in nursing practice is discontinuing medication when you notice signs of adverse reactions.
When a nurse lacks this principle, it can result in dire consequences for patients. More specifically, a lack of nonmaleficence can lead to reduced patient safety. And, of course, this can mean patient injury or even death. Patient injury or death resulting from lack of nonmaleficence can cause mental trauma, job loss, and even legal consequences.
Therefore, it is imperative to internalize and adhere to this nursing principle.
Beneficence is another important nursing principle. This principle is characterized by charity and kindness. It is basically all about ensuring your actions are guided by compassion and maximum consideration of the welfare of those you serve.
While some people choose to pursue nursing for the money or job security, most people in nursing are in it out of their love for serving others. Therefore, this beneficence principle is almost always naturally ingrained in the minds of most nurses.
The best way to apply this nursing ethical principle is to always act in the patient's best interest regardless of the circumstances. Practicing this principle regularly will ensure the patient is always cared for in the best way possible. You will also automatically improve positive patient outcomes.
An excellent example of beneficence in nursing practice is offering to sit with a patient to console them after giving them bad news about their situation. Another superb example of beneficence is drawing curtains to protect a patient's and his family's privacy when exchanging final goodbyes.
Lack of beneficence can result in poor nurse-patient relationships and reduced patient safety. When a patient realizes you are not kind or acting in their best interest, they will not be very interested in showing you kindness or respect. This can result in poor nurse-patient relationships and adverse patient outcomes.
As mentioned above, a lack of beneficence can also lead to reduced patient safety. When you don't act in the patient's best interest, it can lead to safety issues such as failure to record vital info, failure to use protective measures when providing care, and medication errors.
It is easy to see how following this principle can make it easier for nurses to provide quality care and make more ethical decisions.
Autonomy is a fundamental nursing ethical principle. It recognizes the right of the patient to make their own decisions. Nurses must never forget this right to avoid imposing their will or self-interest on the patient.
Of course, there is a right way to recognize patients' independence and ability to make their own decisions. This right way involves offering the patient all the necessary information to make the best decisions. This information includes available treatment options and the pros and cons of each option.
Once a nurse has offered a patient all the correct information, they have to respect whatever decisions the patient makes, even if they disagree.
Autonomy is essential in nursing practice because it helps nurses adhere to the patient's wishes. It is also important because it passes responsibility for some major care decisions to the patient they will affect the most.
A good example of autonomy is when a nurse agrees to respect a patient's choice not to get treatment, even if they believe the treatment benefits the patient. Another excellent example of autonomy is a nurse respecting a patient's wish to be seen or attended to by a nurse of the same sex for religious reasons.
When a nurse doesn't practice this ethical principle, they can make decisions that make patients feel disrespected. They can also make decisions that can lead to a breakdown of the nurse-patient relationship. Thus, it is always essential to have this ethical principle in mind.
Justice is a fundamental ethical principle. It is all about nurses showing fairness in the way they provide care. Nurses must provide quality care to patients regardless of their appearance, age, financial history, religious preference, race, and gender.
Even when faced with a situation that involves healthcare for a convicted murderer or any other criminal, a nurse must still offer the best care they can provide.
This nursing ethical principle is crucial because it ensures fairness and equity in nursing. In other words, it provides patients care regardless of who they are. This usually has the effect of making patients feel valued. This, in turn, usually has the effect of enhancing patient outcomes.
A good example of justice in nursing practice is providing care to a known anti-vaccine campaigner when they get COVID or any other vaccine-preventable illness. This is justice and fairness because it allows the person to become well again without considering the negative influence of vaccine use.
A nurse lacking this ethical principle can act in ways that make a patient feel rejected, leading to adverse patient outcomes. It can also lead to unfair prioritization in care provision, resulting in dire consequences for the patient.
By following the nursing ethical principles discussed above and adhering to the ANA code of conduct, you can handle different ethical dilemmas correctly and without serious negative consequences.
Understanding some ethical dilemma scenarios you can write an essay about as a nursing student is essential. Remember, there is never a right or wrong answer; in the same way, there is no small or big ethical issue. As long as it impacts healthcare, it falls within nursing practice or medical ethics.
The following are some of the most common ethical dilemmas in nursing.
The pro-choice versus pro-life dilemma is common in nursing. For example, when a patient wishes to have an abortion because they do not want a baby, yet a nurse is pro-life because of religious beliefs, it becomes a big dilemma.
SOLUTION: Respect the wishes of the patient.
This dilemma is common in nursing practice. For example, it can occur when a patient refuses a specific procedure or treatment because of religious beliefs, yet a nurse knows what science says is best in the situation.
SOLUTION: Respect patient autonomy and do as they wish.
As a nurse, you must practice beneficence (kindness and charity). You are also required to respect the patient's autonomy. Now imagine you have been ordered to give a patient medication to ease pain and suffering, yet they insist on not taking it to stay awake and spend their last minutes with their loved ones. This presents a great beneficence vs. autonomy dilemma.
SOLUTION: Obey the patient's wishes as long as they are conscious and can make their own decisions
As a nurse, you must follow exactly what the guardian wants for a child unless it is required by law to do otherwise. Now imagine a situation where a parent refuses to let their child get vaccinated, yet you know at the back of your mind that vaccines benefit children. You know what you must do, yet a guardian insists you must not do it. This is a significant ethical dilemma.
SOLUTION: Obey the guardian's wishes for their child.
Nurses are ethically expected to be open and transparent with patients. However, there are cases when you may feel as a nurse that explaining the gravity of a situation to a patient will worsen their stress and anxiety. You may, therefore, think it is more appropriate to withhold some information from them. This presents a big dilemma.
SOLUTION: Always be honest, especially when the situation is complex. Patients deserve to know the truth.
Nurses occasionally face situations where their resources are not optimal for the people they serve. Remember the COVID-ventilator issue? Doctors and nurses had to decide whom to give ventilators initially at the start of the pandemic when there were not enough ventilators.
SOLUTION: When the resources are limited, choosing patients based on severity is recommended.
Doctors and other medical professionals are not perfect. They make mistakes from time to time. Therefore, you will have a big dilemma when a doctor prescribes treatment, and you feel it is not the best treatment in the back of your mind. Do you fulfill the doctor's order or intercede and question it?
SOLUTION: When you feel something wrong is about to happen, you should speak up to protect the patient's interest.
The best way to address ethical dilemmas is to internalize and follow the nursing ethical principles and the ANA code of conduct. However, not everyone constantly has the time and energy to review nursing ethical principles and the ANA code of conduct.
For this reason, we have shared the tips below to help you correctly address ethical dilemmas in nursing.
When you feel uneasy about an ethical situation, you should share it with a trusted colleague or a supervisor. Communicating the problem with someone else invites a fresh perspective to the problem and increases the likelihood of arriving at a better decision.
Remembering and recognizing patient autonomy or the right to make their own decisions is always important. It doesn't matter what you think is best for a patient – what they want is what you should do as long as it is legal and within your nursing responsibilities. Of course, you should present the patient with all the information they need to decide. So if you ever have to grapple with an ethical situation that makes you feel like ignoring patient autonomy, you shouldn't do it. You should choose the option that ensures patient autonomy.
Every patient has a right to privacy. This means you should treat their information as confidential and only to be shared with them or with persons they approve. It is not in your place to share patient information, especially when it is sensitive. You can only share info when given consent. Therefore, if you ever have a dilemma about sharing information, remember to respect the right to privacy and ask for consent to share info if you think it is necessary.
You should always be open and honest with patients. Doing this will help you to avoid many ethical situations. It will also make it easy for you to make ethical decisions. Therefore, whenever necessary, please share all the information you can share with patients to help them understand what is happening. Share with them the pros and cons of every treatment or management option. Let them be fully aware of the benefits and risks of everything.
Whenever you need to make an ethical decision, in addition to all your other considerations, you should ask yourself what is in the patient's best interest. Asking yourself this question will help you act in a way that ensures the patient's best interests are taken into account. It will also force you to involve the patient in decision-making to know what they want or wish for. You can never go wrong by acting in a patient's best interest.
Ethical guidelines change regularly. Therefore, to ensure you are always making the right ethical decisions, you should stay up to date with ethical guidelines (both professional guidelines and institution-specific guidelines). It is not always easy to do this, but you can subscribe to nursing blogs that discuss ethical guidelines. This will ensure you always have the latest information you need to make good ethical decisions. You can also stay up to date by enrolling in at least one online ethical nursing training program or course. This will help you to refresh your ethical principles knowledge and to be aware of the latest ethical issues in nursing.
When faced with an ethical situation, never do anything and hope the situation will resolve itself. Always do something as soon as possible. This will ensure either the issue is solved or starts getting solved. When you ignore an ethical situation, it has the risk of snowballing and becoming a much bigger issue down the line. Therefore, please do something about an issue whenever you can do it quickly.
One of the best things you can do when facing a nursing ethical dilemma is to negotiate with the parties involved. When you do this respectfully and fairly, you can easily resolve most ethical situations. For example, if a patient refuses a specific treatment for religious reasons, you can convince them to accept it using various persuasion techniques. Of course, you should respect the patient's decision if they insist on a certain stance or position.
As a nurse, some ethical decisions are not yours; they are above your pay grade. In such a case, they should be referred to somebody higher up, e.g., the nurse manager or the nurse supervisor. Because the manager or supervisor is usually more experienced, they are often in a much better position to handle ethical decisions and teach you what to do when faced with the same situation again.
When you fail to address ethical dilemmas in nursing correctly, there are often negative consequences. The most common negative consequences nurses have to deal with include the following:
When you are faced with an ethical decision, you must make sure you act in the way expected of you according to the nursing code of conduct. Failure to act in the manner that is expected of you in the nursing code of conduct can lead to loss of licensure. This is especially true when your decision in an ethical situation is an egregious violation of the nursing code of conduct or the ethical principles of nursing. Therefore, when faced with an ethical decision, it is best to consider the options carefully and to act in the way that is expected of you.
You could face legal issues when you fail to adequately address certain ethical dilemmas in nursing. As a nurse, you have specific responsibilities. You are also expected to adhere to the nursing code of conduct. If you fail to address ethical issues correctly, e.g., you leak confidential information about a celebrity patient for money to the public, you could face legal issues, including a lawsuit and/or criminal charges. Hence it is crucial to think long and hard about some ethical issues before deciding what to do.
Most hospitals have a code of conduct that nurses and other healthcare professionals must sign when hired. They expect nurses to follow the code to the letter. Most hospitals also expect nurses to follow the ANA code of conduct and to always adhere to the ethical principles of nursing. So when faced with an ethical situation and failing to act correctly, you could end up before the ethics committee of your hospital, and they could recommend your suspension or the termination of your job contract.
Ethical situations can cause a lot of stress and mental burnout. They can make it almost impossible for you to continue operating normally. When you ignore them or make the wrong decision, you can potentially make them worse. This can lead to even more stress and even physical burnout. Consequently, it is important to make the right decisions quickly when faced with ethical problems or issues.
The worse thing that could happen if you don't address ethical issues correctly is an adverse patient outcome, such as patient deterioration, patient injury, or death. It is always painful for nurses to realize or discover that their decisions caused an adverse patient outcome. It can lead to stress, loss of self-confidence, and so on. Of course, an adverse patient outcome can also lead to legal issues, job suspension, and job loss. So it is best to make the correct decision whenever faced with an ethical dilemma.
Nursing training is all-rounded in anticipation of all the issues a trained nurse would experience in typical clinical settings. Learning about ethical dilemmas and how to solve them can be a stepping stone toward excellence as a nurse or medical/healthcare practitioner. You will be dealing with many ethical dilemmas in the workplace and an experience on how to solve them can always help you avert adverse situations.
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