There is a good chance that, as a nurse, you have had to make decisions based on your perceptions of whether something is right or wrong, safe or unsafe. This type of judgment is based on an ethical code of conduct. All nurses must establish and incorporate ethical values into their nursing profession.
If this seems familiar, you may wonder, “What are some typical ethical dilemmas in nursing?” Numerous situations in nursing could be called ethical dilemmas, and nurses need to know how to handle them when they arise. This article discusses the most prevalent ethical dilemmas in nursing and provides advice on how to handle them.
What Is An Ethical Dilemma In Nursing?
A nursing ethical dilemma is a circumstance in which a nurse must choose between opposing ideals with the knowledge that their decision will have implications. Ethical dilemmas may contradict nurses’ values or the Nurses’ Code of Ethics.
5 Main Reasons Why Nurses Face Ethical Dilemma in Nursing
When caring for patients, nurses frequently face ethical dilemmas. There are a variety of forms and causes of medical-ethical dilemma cases. The following are the five most common causes of ethical dilemmas for nurses.
- Patients or their loved ones must make decisions concerning life and death.
- The patient resists care.
- Nursing assignments may conflict with cultural or religious values.
- Nursing colleagues exhibit incompetence
- Inadequate staffing
How to Identify Ethical Dilemmas in Nursing?
Occasionally, nurses of all specialties face ethical challenges. Consider how a scene makes you feel to better express and recognize an ethical challenge in nursing. Ethical dilemmas involve a disagreement between two correct but distinct principles or values-based courses of action. This is the source of the dilemma: a circumstance in which doing something good and incorrect at the same time has a negative effect on the other activity.
What are the common ethical dilemma examples for nursing students?
Here are common ethical dilemma examples in nursing and tips on dealing with each one.
Example #1: Pro-Life vs. Pro-Choice
Scenario:
Samantha, a college student 28 years old, is eighteen weeks pregnant. Her history of cardiovascular illness has deteriorated as a result of her pregnancy. Samantha’s physician is concerned that if she continues her pregnancy, her heart condition may deteriorate, leading to a life-threatening emergency. He has suggested that the pregnancy be terminated within the following two weeks.
Samantha expresses reluctance, explaining that she was raised to think abortion is terrible and that God will cure her, despite the fact that she does not currently attend church. She desires to know what the nurse would do if placed in her situation. Jennifer, the nurse, opposes abortion under all circumstances.
Ethical Dilemma:
Patients frequently seek advice from nurses regarding their health, wellness, and treatment decisions. In certain situations, such as the one given here, the medical necessity of a therapy or intervention conflicts with a patient’s moral and religious convictions.
It is not uncommon for patients to desire someone to advise them on the best course of action. In such cases, an ethical dilemma may arise in nursing, particularly if the nurse holds ideas that differ from those of the patient or physician.
How to Deal with this Ethical Dilemma:
According to the American Nurses Association Position Statement on Reproductive Health, “healthcare clients have the right to privacy and the ability to make decisions regarding their health care based on complete information and without coercion.” Additionally, nurses can decline participation in a case for ethical reasons. However, if a client’s life is in danger, nurses are required to ensure the client’s safety and prevent desertion.
Although Nurse Jennifer is opposed to abortion, she should refrain from expressing her thoughts or opinions to the patient. Instead, the nurse should encourage the patient to seek counsel from her partner (if applicable), family, spiritual advisor, or anyone else she thinks she can confide in. Before the two-week deadline, the nurse should schedule a follow-up appointment with the doctor to review choices and decisions.
Example #2: Protecting the Adolescent’s Right to Privacy
Scenario:
Michael, age 16, has been diagnosed with a sexually transmitted infection (STI). However, Michael’s mother is in the reception area and wants to know what the doctor says. Michael told the doctor and nurse that he did not want anyone, especially his mother, to know about the STI.
Ethical Dilemma:
When nurses decide if it is proper to communicate a patient’s medical information with a parent or guardian, this may be one of the most common ethical dilemmas in nursing. Parents and guardians had access to the medical records of patients under the age of eighteen for many years.
Currently, every state has legislation permitting children to consent to care under specific circumstances without parental awareness, consent, or access to their medical records.
How to Deal with this Ethical Dilemma:
When an adolescent is old enough to agree to healthcare in most states, information regarding that care is usually deemed confidential. Severe repercussions can result from violating a patient’s confidentiality, including losing a job or a license.
Therefore, nurses must be familiar with their state’s regulations and work closely within those rules and with supervisors to conform to their organization’s policies. If uncertain, you should always defer to your facility’s policies or seek a supervisor’s intervention or direction.
Example #3: Empirical Knowledge vs. Religious Beliefs
Scenario:
Mr. Elliott is a fifty-eight-year-old male who arrived at the emergency room after a car accident. He has multiple wounds, and it has been established that he is bleeding internally. The emergency physician has requested a consultation with surgeons.
Mr. Elliott consents to surgery if necessary. However, he refuses to consent to a blood transfusion even if it might save his life. Mr. Elliott refuses a blood transfusion because he is a Jehovah’s Witness, and receiving blood would violate his religious convictions.
Ethical Dilemma:
Maintaining objectivity when dealing with patients, particularly in life-threatening situations, can be challenging. A nursing ethical dilemma might arise when a patient’s desires conflict with what may be medically essential to improve health or prolong life.
How to Deal with this Ethical Dilemma:
If a patient is conscious, focused, and aware of the repercussions of accepting or refusing medical care or treatment, he may refuse it. Although it is natural for nurses to want to advocate life-saving interventions, they must distinguish between presenting correct information and imposing their thoughts or beliefs.
The nurse should document any education provided, the patient’s response, and the rationale for his refusal of treatment. If the client or his family later believes that treatment should have been provided, proper documentation will shield the nurse and healthcare facility from legal liability.
Example #4: Parent Refuses to Vaccinate Child
Scenario:
Mr. Black is the father and only guardian of twins who are five years old and about to enter kindergarten. Mr. Black never vaccinated his children and claims that forcing him to do so violates his and his children’s rights.
Ethical Dilemma:
The healthcare industry promotes vaccination against preventable diseases to safeguard population and community health. Nurses may feel torn between being aggressive about vaccinations and respecting the patient’s or guardian’s right to refuse treatment.
How to Deal with this Ethical Dilemma:
Generally, vaccination laws are based on CDC recommendations. Each state needs a current immunization record for elementary, secondary, and postsecondary school students and daycares. While some states permit vaccine exemptions under specific conditions, it is not the nurse’s responsibility to enforce vaccination.
Instead, it is the nurse’s responsibility to provide adequate information for the parent to make an informed decision about the safety and potential hazards of the vaccine. If a parent declines to vaccinate their child, the nurse should have the parent sign a declination form and document any vaccination education delivered.
Example #5: Personal and Professional Boundaries Related to Social Media
Scenario:
Nurse Madison enjoys her work in a busy pediatric unit. Recently, the mother of one of Nurse Madison’s patients sent her a friend request on social media and wrote a question on her public page concerning a patient in the room adjacent to her son’s. The message said, “Hey Maddie! How is Gavin doing? We have not seen him since Austin’s discharge.”
Ethical Dilemma:
Our world is filled with accessible technologies. When done correctly, there is nothing wrong with using technology such as social media platforms. Nurses must recognize the boundary between personal and professional ties or acquaintances and avoid blurring or crossing that boundary.
How to Deal with this Ethical Dilemma:
All nurses are responsible for safeguarding patient privacy and confidentiality. This obligation continues after a patient is dismissed from care. In this situation, Nurse Madison should NOT accept the friend request from the mother of her former patient.
If Nurse Madison and the mother build a friendship that extends beyond the care of the mother’s son and a social media link is established, Nurse Madison must be responsible for anything placed on her public wall or shared with anyone. Additionally, she must be proactive by removing any correspondence from public view and informing her friend that she must always protect patient confidentiality.
Example #6: Nurse Is Instructed to Have Patient with Low Literacy Level to Sign Consent for Treatment
Scenario:
The attending physician instructs Nurse Gloria to have Mr. Isaacs sign a consent form before a colonoscopy. As Nurse Gloria reviews the paperwork with the patient, she observes that he appears confused and unsure where or how to sign.
Ethical Dilemma:
Typically, nurses collect signatures on consent papers, particularly for operations such as those mentioned in this case. When faced with a situation such as this, the nurse is uncertain whether the patient understands what he is being told or can read. The decision of whether to delay a busy schedule to have the doctor return and speak with the patient or to explain to the best of her ability and obtain the patient’s signature may appear challenging.
How to Deal with this Ethical Dilemma:
Most patients find the terminology used in healthcare and on healthcare documents confusing. It might be especially difficult for people with low literacy levels. Nonetheless, all patients have the right to be informed of and comprehend their treatment options and processes before receiving care. Always err on the side of a patient’s sensitivity.
The nurse should present patient-comprehensible information, allowing him to ask questions and have the option to consent to treatment. If the patient does not comprehend what the nurse is saying, the nurse should notify the doctor and request that he describes the process, including expected outcomes and any dangers.
Example #7: End-of-Life Decision-Making
Scenario:
Mrs. Douglas has metastatic lung cancer. Her doctor has suggested therapy choices that could extend her life by six to twelve months. To the dismay of her family, Mrs. Douglas has opted for merely palliative measures. Mrs. Douglas has executed a DNR as part of her Advance Directive (Do Not Resuscitate).
Ethical Dilemma:
End-of-life care decisions are among the several ethical challenges in nursing. It is easy for nurses to become overwhelmed when attempting to comfort family members while also respecting patient desires.
How to Deal with this Ethical Dilemma:
Nurses provide patients and their loved ones with crucial help during end-of-life transitions. If Mrs. Douglas clearly understands her prognosis with and without treatment and is of sound mind, she has the right to decide whether or not she wants therapy.
Despite the difficulty of the circumstance, the nurse’s primary duty is to her patient. Nurses must advocate for patients’ autonomy and rights. Because the patient prepared an Advance Directive in this circumstance, it may be easier to carry out her desires.
Example #8: Inadequate Resources to Provide Care
Scenario:
Nurse Judy is the agency’s wound care nurse. She visited the office to pick up additional wound care materials for her weekend appointments. However, the charge nurse informed her that the shipment of wound care materials had not arrived. As a result, there are insufficient supplies for the visits scheduled by Nurse Judy.
Ethical Dilemma:
In some instances, nurses may be required to assess which patient requires supplies or care the most. Although this is not an ideal circumstance, it occurs more frequently than most people would want to admit.
How to Deal with this Ethical Dilemma:
The nurse must utilize her triage skills to decide which patients could have their instructions revised or amended safely. The nurse should review nursing records and obtain a report from the last person to see the patients she is scheduled to care for over the weekend.
If a patient’s wound is healing or improving, she should notify the nurse supervisor, primary care provider, or on-call physician to evaluate if instructions can be modified. The nurse may now have sufficient supplies to care for patients requiring wound care services until further supplies arrive.
Example #9: Former Patients – To Date or Not to Date?
Scenario:
Wesley is a patient at the outpatient clinic where Sabrina works as a nurse. After over a year as a patient at the clinic, Wesley told Sabrina he finds her very attractive and invited her out to dinner.
Ethical Dilemma:
Patients entrust their most sensitive information to nurses. While this trust is beneficial and places nurses in a unique position to assist patients, an ethical issue might arise if the nurse fails to maintain professional connections.
How to Deal with this Ethical Dilemma:
Professional limits protect nurses and patients. Before things get out of hand, nurses must notice warning indicators that could lead to boundary violations. Avoid making or receiving personal after-hours calls to or from a patient, giving or getting presents, flirting, maintaining secrets, or becoming unduly involved in a patient’s business or personal matters.
Example #10: Informed Consent
Scenario:
Mr. Thomas has a history of diabetes and peripheral hypertension and is 68 years old. Due to vascular alterations and excessive blood sugar, Mr. Thomas’ right heel developed ulcers. The wounds have been unsuccessfully treated, and Mr. Thomas’ doctor recommends amputation as the next step.
Mr. Thomas agrees with the physician; however, his wife disagrees. Mrs. Thomas expresses concern to the nurse that her husband is being duped into having his foot amputated since the physician is exhausted from treating the wounds.
Ethical Dilemma:
The concept of informed consent is a frequent ethical challenge in nursing. Informed consent to treatment is when a patient or their authorized representative authorizes healthcare providers to give treatments or execute operations. To obtain informed consent, healthcare providers must inform patients about the potential risks and benefits of proposed therapies and any available alternatives.
How to Deal with this Ethical Dilemma:
When anxious or stressed, it is normal for patients or their loved ones to confide in nurses or ask questions before speaking with physicians. In this scenario, Mrs. Thomas appears more at ease conversing with the nurse. The nurse must attempt to comprehend Mrs. Thomas’ concerns and provide comfort.
In addition, the nurse must inform the charge nurse and physician of Mrs. Thomas’s comments and concerns. While Mr. Thomas is ultimately responsible for his treatment decision, his spouse’s worries should not be disregarded.
4 Consequences of Avoiding Ethical Dilemmas in Nursing
There are ethical dilemmas for nurses in every specialty and type of nursing facility. Nurses must recognize when an ethical problem arises in nursing and learn how to reconcile their ideas and values with the dilemmas.
Avoiding ethical issues, such as the instances of ethical dilemma questions presented in this article, might have detrimental repercussions. The implications of failing to address ethical dilemmas in nursing include the following.
1. Nurses can quickly experience burnout.
Ethical dilemmas are quite stressful. Nurses must recognize and treat these issues immediately when confronted with them. Failure to do so can result in increased stress, leading to burnout among nurses.
2. Avoiding ethical dilemmas in nursing can lead to legal issues.
Some ethical dilemmas can have grave legal consequences. It is never wise to disregard an ethical dilemma. The issue should be addressed with the appropriate party, including supervisors, and handled properly to avoid legal concerns.
3. Nurses who avoid ethical dilemmas could lose their jobs.
Failure to confront an ethical challenge in nursing could result in a reprimand from management or loss of employment, depending on the circumstances.
4. Loss of licensure:
Certain ethical dilemmas in nursing must be avoided at all costs. When this occurs, the nurse’s license to practice could be revoked. As a general guideline, addressing issues and seeking help from superiors is always advisable before your job or license is at risk.
Final Thoughts
Any nurse who has worked in the field for sufficient time will eventually face ethical dilemmas. You may have encountered ethical issues or asked, “What are some typical ethical dilemmas in nursing?” The ethical dilemma scenarios for students presented in this article represent the types of circumstances that nurses experience.
Although it is impossible to avoid all ethical dilemmas, nurses can provide the knowledge necessary to handle and overcome problems professionally while promoting high-quality, safe, and effective patient care.
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