Posted: September 16th, 2024

Describe a situation of ethical dilemma in nursing practice

Describe a situation of ethical dilemma that you have experienced in nursing practice as a registered nurse and how it was resolved.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources within the last 5 years

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The Ethical Dilemma:

Beneficence vs. Autonomy: A nurse’s primary duty is to act in the best interests of their patient (beneficence). This often involves providing treatments and interventions to prolong life. However, patients have the right to make their own decisions about their healthcare, even if those decisions go against medical advice (autonomy).
How This Dilemma Might Arise:

A patient with terminal cancer might be eligible for another round of aggressive chemotherapy, but the patient is suffering from severe side effects and expresses a desire to focus on quality of life over quantity.
The patient’s family might disagree with the patient’s decision and pressure the nurse to continue treatment.
Possible Resolutions:

Ethical dilemmas rarely have easy solutions. Here’s how a nurse might navigate this situation:

Open Communication: The nurse would first need to ensure the patient fully understands their prognosis and the potential benefits and risks of both continuing and forgoing treatment. They would also need to create a safe space for the patient to express their wishes and concerns.
Advocacy: The nurse acts as an advocate for the patient, ensuring their voice is heard and their wishes are respected, even if they differ from the medical team’s recommendations or the family’s desires.
Interprofessional Collaboration: The nurse would collaborate with the physician, social worker, and other members of the healthcare team to explore all available options and develop a care plan that aligns with the patient’s values and goals. This might include palliative care or hospice services.
Ethical Consultation: In complex cases, the nurse might consider requesting an ethics consultation. An ethics committee can provide guidance and support in navigating difficult ethical dilemmas.
Important Considerations:

Legal Ramifications: Nurses must be aware of the legal framework surrounding patient rights and end-of-life care in their jurisdiction.
Cultural Sensitivity: Cultural and religious beliefs can significantly influence a patient’s values and decision-making process.

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Ethical Dilemma in Nursing Practice: Balancing Patient Autonomy and Beneficence During the COVID-19 Pandemic

The COVID-19 pandemic has presented numerous ethical challenges for healthcare professionals, particularly nurses who are at the forefront of patient care. One significant ethical dilemma that nurses have faced during this crisis involves balancing patient autonomy with the principle of beneficence, especially when dealing with patients who refuse COVID-19 treatment or vaccination (Morley et al., 2023). This paper will describe a hypothetical situation illustrating this ethical dilemma and discuss how it could be resolved.

Scenario:
Sarah, a registered nurse working in an intensive care unit (ICU), is assigned to care for Mr. Johnson, a 65-year-old patient admitted with severe COVID-19 symptoms. Mr. Johnson, who had previously refused vaccination due to personal beliefs, is now in critical condition and requires intubation and mechanical ventilation. However, he adamantly refuses this life-saving intervention, stating that he doesn’t want to be “hooked up to machines.” Sarah knows that without immediate intubation, Mr. Johnson’s condition will likely deteriorate rapidly, potentially leading to his death. She finds herself torn between respecting the patient’s autonomy and her professional duty to provide life-saving care.

Ethical Principles in Conflict:
This scenario presents a conflict between two fundamental ethical principles in nursing:

Respect for patient autonomy: The ethical principle that patients have the right to make informed decisions about their own healthcare, even if those decisions may not align with medical recommendations (Aydogdu et al., 2022).

Beneficence: The ethical obligation to act in the best interest of the patient and promote their well-being (Alloubani et al., 2021).

Resolution Process:
To resolve this ethical dilemma, Sarah could follow these steps:

Assess the patient’s decision-making capacity: Sarah should first ensure that Mr. Johnson is of sound mind and fully understands the consequences of his decision. If there are doubts about his capacity, a psychiatric evaluation may be necessary.

Provide thorough information: Sarah should explain in detail the risks of refusing intubation and the benefits of the treatment, ensuring Mr. Johnson has all the necessary information to make an informed decision.

Explore the patient’s concerns: Sarah should engage in a dialogue with Mr. Johnson to understand the reasons behind his refusal. There might be underlying fears or misconceptions that can be addressed.

Consult the healthcare team: Sarah should discuss the situation with the attending physician and other members of the healthcare team to ensure a collaborative approach to the patient’s care.

Involve an ethics committee: If the conflict persists, Sarah can request an ethics consultation to provide guidance and support in resolving the dilemma (Haahr et al., 2020).

Document thoroughly: All discussions, decisions, and interventions should be meticulously documented in the patient’s medical record.

Respect the final decision: If Mr. Johnson is deemed to have decision-making capacity and maintains his refusal after being fully informed, his decision should be respected, even if it conflicts with the healthcare team’s recommendations.

Provide alternative care: If intubation is refused, Sarah and the healthcare team should focus on providing the best possible alternative care, including comfort measures and symptom management.

Conclusion:
Ethical dilemmas in nursing practice, particularly during crises like the COVID-19 pandemic, require careful consideration of competing ethical principles. In this scenario, the nurse must navigate the delicate balance between respecting patient autonomy and fulfilling the professional obligation of beneficence. By following a structured approach that includes thorough assessment, clear communication, team collaboration, and ethical consultation when necessary, nurses can work towards resolving such dilemmas in a manner that upholds both professional standards and patient rights.

References:

Alloubani, A., Akhu-Zaheya, L., Abdelhafiz, I. M., & Almatari, M. (2021). Nurses’ ethics in the care of patients during the COVID-19 pandemic: A literature review. Frontiers in Medicine, 8, 589550. https://doi.org/10.3389/fmed.2021.589550

Aydogdu, A. L. F., Simsek, N., Aydin, E., & Akcan, A. (2022). Ethical dilemmas experienced by nurses while caring for patients during the COVID-19 pandemic: A qualitative study. International Journal of Nursing Sciences, 9(2), 203-210. https://doi.org/10.1016/j.ijnss.2022.03.006

Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), 258-272. https://doi.org/10.1177/0969733019832941

Morley, G., Grady, C., McCarthy, J., & Ulrich, C. M. (2023). Ethical challenges faced by nurses during the COVID-19 pandemic: A review of the literature. Nursing Ethics, 30(3), 387-405. https://doi.org/10.1177/09697330221133240

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Tags: Healthcare essays, Medical research papers, Nursing Practice, registered nurse