Ethical Dilemmas in Nursing
The nursing profession involves caring for individuals and families. The practice is guided by ethical principles, values, and morals. These principles serve to create an enabling environment for healthcare professionals, patients, and family members to relate well and apply desired measures to achieve the best outcomes (Ilkafah et al., 2021). However, ethical dilemmas arise from the healthcare environment and occur when two or more ethical principles conflict or counteract one another. Therefore, nurses must be skilled and apply practical interpersonal relationship skills to achieve the best outcomes.
Ethical dilemmas can arise when a patient refuses to take medication. The dilemma arises because, on one side, ethical principles in nursing demand that nurses allow patients to take active roles in the care team and assist patients in making effective decisions concerning their care (Munkeby et al., 2021). This principle is known as autonomy, and it gives patients more weight in making decisions concerning their care. Therefore, ethically practicing nurses must adhere to autonomy and allow patients to make effective decisions concerning their care. On the other hand, beneficence and non-maleficence require nurses to do or cause no harm and provide high-quality services. However, in some cases, a patient’s ability to make effective decisions may be compromised by one or more reasons. An ethical dilemma may occur when a patient refuses to take medication or undergo a particular therapeutic procedure.
Reflecting on my experience, I once experienced a situation where an elderly woman under my care, was critically ill and presented with severe anemia. A blood transfusion was suggested but she and her whole family were Jehovah Witnesses , religion that is totally opposed to getting blood or any of its components. The patient was in PACU and under the effects of anesthesia, so we talked to her son, who was the person legally designated to make decision for her under those circumstances, and he aggressively reject the order of transfusion.What to do then? We continued with intensive administration of IV fluids until the patient was completely recovered from sedation and alert enough to explain her in details her current situation and our considerations about the treatment, including a blood transfusion. It was a releaving surprise for us, in a moment we were facing a serious dilemma, when she sitted up in her bed and said that she had beautiful grandkids that she wanted to see growing and running all around, and even when she was aware and had faith in her religion, those kids were above it. She was the one who informed her son, who got absolutely upset, but still the patient’s will prevailed and she got the blood. Although the patient has a right to choose which therapy they should use, or the designated person to do it when they are not in mentally conditions to do it, adhering to this could compromise their outcomes and indicate poor service quality, or at least we get that feeling of impotence for not to be able to do something for the patient that would be determinat for their outcomes. (Pietrzykowski & Smilowska, 2021). In addition, the situation could lead me to ethical problems for failing to provide the required standard of care, but in this case we did the right thing, and even if her son decided to present a formal claim, the patient’s consent, as a right of total autonomy will always makeus a winner in any legal battle.
The Ethical Principle
The ethical principle in this situation is autonomy. Autonomy requires the nurse to offer the patient an opportunity to make independent and informed decisions concerning their care. However, a conflict may arise when the patient decides to adhere to a problem that results in negative outcomes such as preventable complications, injuries, or death. Therefore, the best solution to solving problems and ethical dilemmas revolves around autonomy in administering informed consent (Pietrzykowski & Smilowska, 2021). Informed consent allows the patient to make independent choices concerning care.
Facilitating informed decision-making is an essential component of providing quality services and solving ethical dilemmas that occur in the nursing practice. There are several elements that nurses and other healthcare professionals must consider and implement to ensure informed decision-making. For instance, the patient must be adequately educated or informed concerning their condition, available options, and the outcomes of each alternative. When discussion available alternatives for managing the patient’s conditions, the nurse must ensure that the patient understands the consequences of choosing each alternative over the other (Pietrzykowski & Smilowska, 2021). The benefits and the negative outcomes must be adequately communicated without biasness to ensure that the patient makes decisions they adequately understand.
References
Ilkafah, I., Mei Tyas, A. P., & Haryanto, J. (2021). Factors related to the implementation of nursing care ethical principles in Indonesia. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2211
Munkeby, H., Moe, A., Bratberg, G., & Devik, S. A. (2021). “Ethics between the lines”: Nurses’ experiences of ethical challenges in long-term care. Global Qualitative Nursing Research, 8, 233339362110600. https://doi.org/10.1177/23333936211060036
Pietrzykowski, T., & Smilowska, K. (2021). The reality of informed consent: Empirical studies on patient comprehension: A systematic review. Trials, 22(1). https://doi.org/10.1186/s13063-020-04969-w
