Posted: September 11th, 2021

Nursing ethics issues

Nursing ethics issues.

Nursing is a highly regulated field. This regulation is essential to ensure the highest standards of patient care and professional conduct. Apart from the strict educational and training requirements, nurses are charged with observing nursing and healthcare ethical concepts in the delivery of patient care. These ethical concepts form the backbone of nursing practice, guiding nurses in their daily decision-making processes. These concepts obligate nurses to provide care that is quality, correct, and rational. The implementation of these concepts requires continuous education and reflection on ethical principles.

In a vacuum, doing right by the patient seems like a simple, straightforward aspect. However, real-world healthcare scenarios often present complex ethical dilemmas that challenge this simplicity. However, the decision-making process in nursing is not only about choosing what is right and what is wrong. It involves navigating a complex web of ethical considerations, professional obligations, and personal values. Like other professions, nurses are susceptible to different ethical issues and dilemmas on a daily basis. These ethical challenges can range from minor conflicts to major moral dilemmas that significantly impact patient care.

An ethical issue in nursing arises when a choice has to be made, yet the answers and options are contradictory. This contradiction often stems from competing ethical principles or conflicting obligations to different stakeholders. In such situations, the nurse may need to reconcile their personal values with the nursing obligation to make a sound decision. This reconciliation process can be emotionally taxing and requires a strong ethical framework and support system.

Some of the most common ethical issues that nurses face during practice include,
• Informed Consent. Under the ethical principle of autonomy, the patient has the right to make their own healthcare decisions. This principle is fundamental to patient-centered care but can be challenging to implement in certain situations. However, sometimes the nurse does not know how much they should disclose, especially in matters relating to end-of-life. The balance between providing complete information and avoiding unnecessary distress is a delicate one that nurses must navigate carefully.

• Emotional distress. Nurses often feel emotionally overwhelmed when they cannot do what they consider right because of the nature of their environment and the legal implications associated with the decision. This emotional burden, also known as moral distress, can have significant impacts on nurses’ well-being and job satisfaction.

• Pain management. Nurses are compassionate beings. This compassion is a core attribute of nursing but can sometimes lead to ethical dilemmas. When caring for patients with chronic pain, a nurse may get caught between administering higher doses of pain medications than recommended to relieve their patients from excruciating pain. This situation highlights the tension between beneficence (doing good) and non-maleficence (avoiding harm).

• Disclosing information. Nurses often face the ethical dilemma of telling a patient about their medical status or being deceptive. This dilemma touches on the principles of truthfulness and respect for patient autonomy. Sometimes families and custodians may request that the patient not be informed about their diagnosis, yet the nurse is obligated to tell them about their health condition. Navigating these conflicting requests requires careful communication and ethical reasoning.

• Patient’s privacy. Nurses have access to patient’s medical records and information and can release it ethically or unethically to the wrong people. The increasing digitization of healthcare records has made this issue even more pertinent in recent years. Nurses have the duty to preserve and protect the privacy of their patients. This duty extends beyond just safeguarding physical records to include digital privacy and confidentiality in all communications.

• Establishing boundaries. Nurses are constantly involved with their patients, ensuring that they provide the best care. This close involvement can sometimes blur the lines between professional and personal relationships. In the process, they can find it challenging to maintain a purely professional relationship. Maintaining appropriate boundaries is crucial for ethical practice and patient safety. Nurses are not allowed to develop any romantic relationship with their patients, and patients should rely on the nurses outside their professional capacity.

• Incompetence among peers occurs when a nurse is not equipped enough to approach and handle their duties effectively. This situation can pose significant risks to patient safety and quality of care. If a nurse happens to notice their peers’ lack of knowledge during practice, they might be faced with an ethical issue of whether or not to report the matter to the nurse manager. This dilemma touches on the principles of non-maleficence and professional responsibility.

Years of classroom training may equip nurses with the knowledge and skills to perform medical duties. However, theoretical knowledge alone is often insufficient to prepare nurses for the complex ethical realities of clinical practice. Still, nothing can adequately prepare them on how to deal with real ethical issues that arise during practice. Experiential learning and ongoing ethical education are crucial components of developing ethical competence. However, with proper training and years of interacting with patients can provide them with the experience needed to approach and deal with ethical issues as they arise. This experience, combined with a strong ethical framework and supportive work environment, can help nurses navigate the complex ethical landscape of modern healthcare.

References
Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses experiences of ethical dilemmas: a review. Nursing ethics, 27(1), 258-272.

Powell, S. B., Engelke, M. K., & Swanson, M. S. (2018). Moral distress among school nurses. The Journal of School Nursing, 34(5), 390-397.

Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), 3446-3461.

Khosravani, M., Abedi, H. A., Lak, S., Rafiei, H., & Rahimi Madiseh, M. (2024). Explaining ethical challenges and practical solutions from the perspective of nurse managers: A qualitative study. Journal of Family Medicine and Primary Care, 13(2), 520-526.

Dennis, V. (2022). The Challenges of Ethical Decision Making in Nursing. AORN Journal, 116(1), 7-9.

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Tags: Ethical Dilemmas, Nursing Ethics, patient autonomy, Professional Boundaries