You walk into a patient’s room and observe that the patient’s condition is deteriorating significantly – the family is begging you to save the patient’s life, but the chart says, “Do Not Resuscitate (DNR).” What should you do? Sometimes, the right decisions are not the easiest ones, and nurses face these types of ethical dilemma in nursing that are part of their daily practice.
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What is an Ethical dilemma in nursing?
Nursing is not just about monitoring vital signs or administering medications, but it is also about making tough ethical decisions every day. An ethical dilemma in nursing occurs when nurses face two or more conflicting options, none of which feels completely right or completely wrong. Some of the ethical dilemmas that nurses might face in their careers are as follows:
- End-of-life decisions.
- Family wishes vs Do Not Resuscitate (DNR)
- Cultural and religious conflicts
- Telling the truth or protecting the patient’s trust
- Allocation of limited sources
Examples of ethical dilemmas in nursing
Nursing is not just about providing care to the patients, but sometimes they also have to make tough decisions. Nurses face ethical dilemmas in their careers all the time. Here are some most common ethical dilemmas that nurses face in healthcare.
End-of-life decision:
Nurses see that the patient’s condition is deteriorating, and the chart clearly says, “Do not resuscitate (DNR).” This means that the patient doesn’t want any aggressive intervention, but the family wants the nurses to do everything to save their loved one. What should nurses do in this situation? The nurse is facing an ethical dilemma as she has to make a tough decision. In this situation, nurses must follow the legal and ethical rules of the hospital and respect the patient’s documented wishes, which can be really tough and emotionally challenging.
Patient’s autonomy vs medical advice
Patients have the right to say no to the treatments even if it is good for them. The nurse’s duty is to respect the patient’s choice.
Example: For example, if a diabetic patient refuses to take insulin. Nurses know that not taking insulin can cause serious problems, but they still have to respect patients’ decisions. The best thing a nurse can do is talk to the patient and explain the risks. If the patient still refuses it, nurses have to clearly document the refusal. This is another common ethical dilemma that nurses face in healthcare.
Confidentiality vs privacy
One of the biggest responsibilities of nurses is to protect patients’ information under HIPAA, but sometimes protecting patients’ information can put someone else at risk. Here, nurses face an ethical dilemma where they have to choose between protecting patients’ information and keeping others safe.
Example: For example, if a patient is diagnosed with TB (tuberculosis) and is living with multiple roommates. He refuses to tell his roommates because of the fear of being evicted. Here is an example of an ethical dilemma that a nurse is facing. Legally, she cannot tell the roommates about the patient’s condition because she has to protect the patient’s information. But ethically, she is worried about the health and safety of others, as she knows that it can be risky for roommates. The nurse’s duty is to educate the patient and notify the provider, so the public health department can take legal reporting steps to save others.
Inadequate staffing and patient safety
To provide high-quality care to the patients, the nurse-to-patient ratio must be right. But sometimes there is a possibility that nurses have to take care of more patients at one time, which can be overwhelming. If the nurses are taking care of a large number of patients, then this increases their workload and can create burnout, which might result in medical errors.
Example of dilemma: A nurse is assigned twice the number of patients during the night shift, which can result in medical errors. Ethically, she should advocate for patient safety, but she also fears that speaking up can be risky in some work areas. In this situation, she should do the following:
- Speak to the charge nurse or supervisor.
- Document everything in real-time so everything is accurate and nothing is missing.
- Talk to the hospital safety team if the situation continues.
Cultural and religious beliefs vs medical treatments
Another dilemma nurses face is when there is a conflict between cultural and religious beliefs vs medical treatments.
For example: Nurse notice that the life-saving medication that is prescribed to their Muslim patient has gelatin in it, which is derived from pork. It is the nurse’s responsibility to inform the patient and the provider about the medication. If the patient refuses to take the medication due to religious beliefs, then the nurse should respect the patient’s decision. What should the nurse do during this situation?
- Respect patient beliefs and document the refusal.
- She should look for other halal alternatives.
- Consult the physician to adjust the prescription.
How can nurses resolve ethical dilemmas?
Nursing is not just about administering medications and providing care for the patients, but it is also about making tough decisions where the right choice isn’t always clear. This is called an ethical dilemma in nursing, where you don’t know which decision is right to make. Here are some ways nurses can navigate ethical dilemmas in nursing:
Follow the American Nurses Association (ANA) code of ethics, which will guide you in making these tough decisions.
Use ethical decision-making models when facing a dilemma, which include the following:
- Identify the dilemma.
- Gather the facts and information.
- Consider the best possible actions you can take.
- Evaluate the outcomes.
- Make and justify the decision.
Seek help and support: You don’t have to handle tough situations alone. You can always ask for help and guidance from the hospital’s ethics committee, supervisors, or managers.
Clear communication: Always communicate clearly and document everything. Clear communication prevents misunderstandings and shows professionalism.
Stay educated or up to date: Ethical challenges keep changing, and therefore, it is important to stay up to date by reading new cases and discussing real-world situations. This will help you prepare and handle nursing dilemmas confidently.
Conclusion
Ethical Dilemma in Nursing are part of nursing, which are challenging, and to navigate these challenges, nurses require a strong understanding of the ANA code of ethics, ethical decision-making models, etc. Nursing is not just about administering medications but also making tough decisions, which can sometimes be emotionally distressing. Some of the common examples of ethical dilemmas in nursing include patients’ autonomy, end-of-life decisions, religious beliefs vs medical treatments, etc. Nurses should develop skills to handle ethical dilemmas with confidence. Still thinking about how to make more money with travel nursing?
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