Ethical dilemmas are prominent in the nursing field. Nurses are exposed to situations that require ongoing critical thinking and may result in moral distress. We are expected to act with morals and ethics for the benefit of the patient. With advances today in technology and new health care treatments rising, dilemmas come into effect and the issues nurses face are increasing. It is expected to respond to ethical situations safely, while also advocating for patients. In this essay, I will elaborate on how nurses can deal with ethical dilemmas by encouraging the idea of creating leadership in the industry, analyzing and reflecting our own moral reasoning, and consulting ethical frameworks.
As nurses, there is a role to play in providing care that is parallel to ethical leadership. Nurses need to be able to express their feelings after long shifts. Makaroff, Storch, Pauly, and Newton (2014) performed a study based on ethical leadership in nursing. Their goal was to seek out how nurses and nurse educators see ethical nursing leadership in the industry. The studies were conducted in an eight-year span with 600 participants. Their guiding research question was, “How do frontline nurses and FNL’s (formal nurse leaders) envision ethical nursing leadership?”.
Through their findings, they found that nurses sought out to have supportive, visible, and responsive educators. Nurses faced obstacles, such as the following: some nurses explained that their leaders were not visible and supportive to staff. It was also elaborated that after a long shift, they left work and were unable to speak to anyone about their work-related issues, resulting in bottled-up feelings and stress. Some nurses even stated, “they could not debrief these ethically challenging situations with their nurse leader” (p.647). These obstacles created a dialogue whereby nurses who were able to share stories about ethical difficulties, felt more connected and valued. Unfortunately, educators prioritize the needs of their organizations over the ethical needs of their staff and their profession (p.656).
The study found that creating great leaders required educators to have an open-door policy for their nursing staff. This also included the use of forums. Nurses would be able to show educators what they needed to do to strengthen their staff’s leadership roles. The need for ethical leadership is important as it creates an ethical climate for nurses and their patients (p.655). Nurses and their educators should come together to articulate the needs of the organization so that ethical resources are provided.
Moral reasoning is used for decision-making when a nurse is faced with an ethical dilemma. It is developed primarily over time and improves moral judgment in practice (McLeod-Sordjan, 2014, p. 478). McLeod-Soudjan (2014) researched ways in which nurses use moral reasoning to solve ethical dilemmas. Data was obtained that measures care-based and justice-based moral reasoning during patient ethical issues. Two different frameworks were discussed which provided the theory and conceptual idea of ethical knowledge. Theoretically, moral dilemmas could be addressed through values and exploring alternatives to the idea. Conceptually, Kohlberg and Gilligan discussed moral reasoning was achieved by the ability to analyze conflicts and making rational justification of their choices.
Physical maturity and moral maturity were also grounded in the achievement of solving an ethical problem. To elaborate, it is believed that lower stages of moral development could not hold principles of justice (McLeod-Sordjan, 2014, p. 474). Alternatively, solving ethical problems show opportunities for moral development. This, in turn, increases the ability to think when moral reasoning is needed (p.476). Kohlberg’s and Gilligan’s moral reasoning theories are designed to produce outcomes such as autonomy, justice, and caring. As such, moral reasoning relies on the formation of these principles for decision-making when faced with ethical dilemmas (p.477).
Moreover, Haddad and Geiger (2019) provided insight into ways nurses can reflect on their own experiences in the health care industry. Different ways were introduced to assist nurses to demonstrate leadership qualities for their patients and the interprofessional team. It was found that when ethical situations were brought up in conversation at work, nurses were able to reflect on what happened and what could have gone better. It was also established that nurses are encouraged to gather for groups where ideas are shared. This helps strengthen voices for justice and solving ethical dilemmas, and it also allows nurses to see how others have solved similar problems (Haddad and Geiger, 2019). This includes but is not limited to collaborating with the team to help give the best care for the patient and understanding professional boundaries and knowing that every patient is to have autonomy and respect for their choices. When nurses can discuss the ethical problem they are having, they can take steps to address the dilemma and allow for positive outcomes (Canadian Nursing Association, 2017, p. 4). In retrospect, nurses have their rights as well but experience obstacles. Healthcare workers have a right to refrain from maltreatment, minimize harm, and promote good towards patients (Haddad and Gieger, 2019). It may be difficult to recognize that nurses deserve as much respect as they give to their patients. It is important to reflect and reach out to others when in doubt of ourselves and our own moral reasoning.
Furthermore, Keatings and Adams (2020) also assist with guiding ethical decision-making for nurses. Ethical frameworks and ethics committees are discussed in great depth that assists with reflection and support from the workplace when an ethical dilemma is brought to light. Ethical frameworks provide theories to facilitate discussions about challenging issues. Ethics committees offer help for nurses in difficult times to help weigh pros and cons in situations and are there for a high degree of support for the patient and the health care team.
The College of Nurses of Ontario (2019) offers Practice Standards for RPNs and RNs to follow and assist in their own nursing practice. This practice standard provides an ethical framework that assists nurses in the prevention of conflicts and assisting to work through conflicts if they occur. It highlights ethical values which include the patient, the patient’s choice, confidentiality, respect for human life, maintaining commitments, and truthfulness. It also features many ethical scenarios with resolutions regarding the ethical values listed above.
The Canadian Nurses Association (2017) introduces the Code of Ethics. Ethical models can help start discussions within the interprofessional team and create a moral space for everyone (p.28). It also assists nurses by presenting seven values for nurses to adhere to and help them in making ethical decisions for their patients. This includes providing safe, compassionate care, promoting health and well-being, promoting and respecting informed decision-making, honoring dignity, maintaining confidentiality, promoting justice, and being accountable (CNA, 2017, p. 3). The nursing practice involves ethical and legal aspects, where this code can support nurses in advocating for themselves and the policy.
Applying the Code of Ethics can assist nurses when obstacles arise. Whenever unsafe or unethical care is observed, a nurse should take quick steps to intervene. This includes speaking up to management about medication errors, questioning unclear orders, intervening in unsafe restraint practices, and reporting to the College of Nurses of Ontario (CNA, 2017, p.34). The most common form of ethical dilemmas can be when it conflicts with the nurse’s own conscience and beliefs. Blood transfusions, abortions, and medical assistance in dying are often common dilemmas nurses face. When such dilemmas arise, nurses can vocalize their concerns and arrangements can be made to transition the nursing care to another health care provider. Nurses have the right to follow their conscience and it is recognized as a conscientious objection (p. 35).
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