An Analysis of Common Ethical Issues of Nurses
And Its Relation with Principles of Bioethics
Nurses are medical professionals who face various challenges in their daily duty. No matter where they practice and what kind of roles they have in their workplace, they are confronted with ethical dilemmas in their profession.
These problems can affect their performance at work. It can also affect their principles in life and their relationship with their patients. While some nurses are brave enough to stand on their feet and speak up, others just put a strong face and neglect everything.
Indeed, nurses witness the suffering of their patients while they try to help them relive their suffering and balance the complex interventions needed to restore their health. Every day, they ask themselves the questions: "What should be done?" and they deal with anxiety in battling personal principles over sworn duty.
Thus, in this paper, we will discuss what is an ethical dilemma and how does it affects the nurses. We will also relate two of the bioethical principles and ethical issues in nursing. Finally, we will identify ethical dilemmas and its relation to the morality of the society.
Understanding what is Ethical Dilemma
An ethical dilemma involves an intricate situation wherein a medical professional such as a nurse is torn between choosing the best action between two available options. The conflict involves compromising either professional or personal principle over one favorable decision. With this, there will be no perfect or right solution to the situation.
Ethical dilemmas can have various forms. One of their main challenges had to do with seeing their patients suffer which they find to be unnecessary. Some nursing interventions may increase the suffering of the patients without improving their outcome.
There also times when the family of the patients is not fully informed about the clinical prognosis and the treatment options involved. Even the voice of the patients is not represented. For example, advance directives are not followed because the relatives wanted other options.
Nurses are often bothered with concerns about pain, informed consent, and going beyond a common goal, but dilemmas in ethics are not only about end-of-life care. The distress starts when nurses feel that they know the correct thing to do but they cannot perform it because of the limitations in the organizational environment they are currently associated, according to Dr. Connie M. Ulrich of School of Nursing, University of Pennsylvania .
The American Nurses Association or ANA says that the work environment, genetics into practice, genomics, palliative care, and end-of-life issues are some of the major ethical concerns of the nurses.
Common Ethical Dilemmas of Nurses
Here are some of the common ethical dilemmas of the nurses today:
1. Patient Freedom over Nurse Control
There are patients who decide what they want about their treatment which is conflicting with the established medical practice as learned by the nurses.
For example, in dealing with women's health and reproduction, there are nurses who have strong views about a person's right to life, which makes the reproductive rights and women's health a major issue to discuss.
If a nurse believes in pro-choice in his personal life, they are faced with an issue on how to provide the right kind of care for a pregnant mother who decides to continue a pregnancy even if her situation is critical.
On the other hand, there are pregnant moms who request abortion who deserves high-quality care even if the nurse if pro-life.
Nowadays, around 200 million women become pregnant each year, every nurse will be faced with this dilemma in the hospital.
2. Religion and Personal Beliefs
Moreover, the religious and personal beliefs of patients may clash with the science-based empirical knowledge. Thus, nurses are faced with a decision to balance the patient's right to make their own choices versus the health care's responsibility to provide them with utmost care.
There are religious beliefs that strictly prohibits the use of specific branches of modern medicine. For example, there are religious followers who might report to an emergency room and they are in need of blood transfusion, but they deny such procedures because of their personal beliefs.
A nurse can negotiate and appeal to the patient or their relative regarding the logical side of blood transfusion, but oftentimes, religious practices win the argument.
In this case, nurses must learn how to respect the wishes of the patients while they provide as many information as possible.
3. Honesty and Selective Information
There are some patients who are emotionally fragile and have mental illnesses and they might have strong reactions when they learn about information on their medical conditions. In such cases, there are relatives of the patient who choose to withhold information about their medical condition to prevent distress on their part.
Now, the nurses are torn between what information he should relay to the patient while respecting the wishes of the family for the patient's emotional stability and mental health. Knowing what kind of information to share could cause a strong reaction to patients and this could be very difficult.
4. Stressful Work Environment
Sometimes, nurses are having difficulties in their work such as issues of violence and bullying which poses serious work environmental ethical concerns.
There are issues of hierarchical and work structure that do not encourage conversations among staff. Questions remained unanswered and dialogues are awkward.
Also, staffing issues and patient safety falls in the work environment category. There are nurses who report that they do not have time to do what they wish to do for their patients, such as helping them recover or addressing their emotional needs. They feel like they are compromised since their moral obligations are not recognized by the institution they work.
As such, nurses often feel like they did not do any good to their patients and they did not receive optimal care.
The resources a nurse have in the hospital are typically limited. Nurses run between each room just to provide quality care to their patients. Oftentimes, they have more patients than what they can handle. In this case, a nurse must proportionately distribute the resources, but this is not an easy task. How can a nurse decide who's more important among his patients?
5. Application of Genomics and Genetics Studies
The technology on Genetic Testing must be available to all and not only to some. However, the workforce is not up to speed on such topic. Some nurses and doctors have already graduated on their schooling long before genetic testing is popular. Yet, there are patients who have learned about genetic profiling through an online service, which puts the nurses in an awkward position.
Relating Principles of Bioethics with Ethical Dilemmas
The healthcare available to the patients today is complex. There are various regulatory mechanisms that are specially designed to ensure that the highest standards of ethics are met in the healthcare scenarios. Nurses, while performing their jobs, must follow the strict codes and ethical principles to provide the highest quality of care that each patient deserve to have.
According to one of the principles of bioethics which is beneficence, nurses must provide procedures with the intent to do good for the patient under any circumstances. It requires nurses to continually update themselves through education and training in order to provide quality health care.
On the other hand, the patient's autonomy is another principle of bioethics. On this aspect, patients have autonomy of thought, actions, and intention when they make a decision regarding their health care procedures. Thus, the decision-making procedure must be free of coercion and he must understand all the risk involved in the likelihood of success.
The Code of Ethics of the International Council of Nurses also states that nurses, in addition to carrying out their duties to promote quality health care, must mitigate the suffering of their patients. They must also respect human rights, cultural rights, and the patients' right to life and choice.
Also, while nurses are responsible for the individual health care, they must also give services and share appropriate information to patient's family members and even the community.
In a nutshell, nurses have multiple responsibilities to individual patients. Ethical dilemmas usually crop up in their work. However, what must nurses do is to balance their personal principles, patient's demands, and code of conduct as required in their job. They must continually educate themselves on the guidelines and seek help from team lead or hospital authorities if needed.
Communication is key to helping nurses work through these issues. In fact, having conversations with the healthcare team and holding family conferences can help ease the ethical conflict.
The Challenges of Ethical Dilemmas
In a nutshell, all of the facts discussed still leads to the question, "How should a nurse act and what kind of medical professional they should strive to be?" We simply cannot rely on theories to help nurses deal with the pressing demands of everyday ethical issues. Nor we can rely on the biological dispositions to lead to the best ethical judgments.
The best thing to do is to confront the integrity of our honed intuitions, character, sense of justice, and honesty. We also need to work in action to see how such traits are exhibited in our workplace.
The points discussed above do just that. This is how we solve ethical dilemmas in our work and with our patients. Usually, the moral evaluation in our communities focus on the broader issues. Thus, it is best to consider our best judgment, bioethical knowledge, and moral health in discussing about nursing ethical dilemmas.
References:
1. American Nurse Today: Official Journal of American Nurses Association. Genetics in the Clinical Setting: What Nurses Need to Know to Provide the Best Patient Care. (n.d.). Retrieved from https://www.americannursetoday.com/genetics-clinical-setting/
2. Bratianu, P. Nursing Ethics: Ethical Dilemmas Faced By Nurses Everyday (n.d.). Retrieved from https://www.nursingexplorer.com/blog/nursing-ethics-ethical-dilemmas-faced-by-nurses-everyday-47
3. Gore, J. (March 2015). Ethical Issues. American Journal of Nursing.
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