The Ethical Tightrope: Navigating Complex Ethical Dilemmas in Nursing

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The Ethical Tightrope: Nurses often encounter situations with complex ethical dilemmas. Discuss a specific ethical challenge nurses face and analyze the framework used to navigate it. How can strong ethical decision-making impact patient care and professional integrity?

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Introduction

The introduction provides an overview of the text. The text argues and describes how nurses must navigate a dense web of ethical problems in their professional field. It explains that research into nursing ethics is usually conducted under one of three examinations of the ethical: normative ethics (emphasizing moral theory and what moral principles should be followed), descriptive ethics (an examination of what and how people understand and act towards morality) and meta-ethics (examination of the language, concepts and methods of reasoning in ethics). Moreover, it explains that the framework for ethical decision-making that is the focus of the book is to be explored and applied in the resolution of ethical questions. This, the text suggests, presupposes a great deal of discussion and dialogue between nurse and patient and between nurse and other healthcare providers; saying that it is about responding to the social framework that forms the conditions within which nurses carry out their work. In this light, the book begins to elaborate the nature of the ethical dilemmas which are peculiar to nursing practice and it also sets out both the nature of authority in the nurse-patient relationship and the importance of the ethical dimension of that relationship. The text indicates that the book is primarily concerned with the question of what nurses should do in a situation where there is a perceived conflict of interest between the nurse and patient. The text explains that having developed a clear thesis which the text will go on to work with, the author must now set out a structured map in terms of explaining where the argument will go and why. The reader is given a clear signpost at every stage of the analysis and is unlikely to be misled and it gives a good idea of the outline of the project in terms of the different areas that will be covered.

1.1. Definition of Ethical Dilemmas

Ethical dilemmas or moral dilemmas are situations in which a choice must be made in light of a moral principle or set of moral principles. These situations can arise in any area of the medical field, and the field of nursing is no exception. Traditionally, the term “ethics” is defined as a “branch of philosophy that addresses questions about morality—that is, concepts such as good and evil, right and wrong, justice, and virtue.” However, in the context of health care, what we typically refer to are the practical application or approach to what would be considered a reasonable decision in a given situation. Unfortunately, ethical dilemmas can occur, and are, in and of themselves, a kind of good and warranted reasoning in which the best course of action is a matter of some real ethical problems and the best solution is not always clear. This definition of ethical dilemmas in terms of accepted norms of reasoning in which a conclusion is based on good and warranted reasoning is a useful working definition, and is what not only the practice of nursing ethics but also many nursing and medical researchers and scholars are trying to achieve. Ethical dilemmas are particularly prevalent in the acute care setting for a variety of reasons. Many times, patients are too sick to participate in decision making and there is an increased need for interventions with patients, which can sometimes lead to more opportunities for ethical distress. Also, as in many areas of healthcare, technological advancements continue to outpace our ability to understand the best and most appropriate uses of these technologies in the care of the sick and the dying.

1.2. Importance of Addressing Ethical Challenges in Nursing

Addressing ethical challenges is a critical component of the nursing profession, as has been noted during the past decade. Rainer (2000) states that “ethics, and the way professionals approach ethics, will shape our future, and the future of the patients that we care for.” The literature is replete with evidence supporting the notion that nurses must be more attentive to the ethical challenges that they face in their work environment. As recently as 2014, Borhani and colleagues have emphasized the importance of recognizing these challenges. In align with this imperative, “The Code” has been published and many organizations, including hospitals and clinics, are instituting the document as a means to guide ethical decision-making for nurses across various specialties. This publication signed by members of the American Nursing Association is more popularly known as the Code of Ethics for Nurses with Interpretive Statements. The Code is intended to provide guidance to nurses so that they might be better equipped to recognize and understand the ethical decisions that they will undoubtedly face. The authors of The Code note that while adherence to the code is strictly voluntary, the nurses who adopt the code subscribe to its most fundamental values and obligations. It is argued that ethical challenges, if left unaddressed, provide a difficult environment for nurses at all career stages. For example, an ethical climate which supports health care and the nursing profession promotes mutual respectful dialogue and at times can lead to a higher quality of patient care. However, when it is absent, ethical challenges can lead to a hostile, volatile, uncertain and unsatisfying work place. Additionally, ethical dilemmas are emotionally draining and nurses who confront them are likely to experience moral distress, which may in turn result in psychological and emotional discomfort. This refers to the negative feelings that arise when someone knows the right course of action but because of a variety of constraining factors, such as lack of time, morale, or fear of disciplinary action, acts in a different manner. Moral distress has been identified as a contributing factor to nurse turnover and may ultimately pose a risk to patient safety. Given the potential for this “perfect storm” of negative nurse prevalence and ethical challenges to result, it is of utmost importance that nurses familiarize themselves with The Code and also understand the prevailing literature on this issue. By doing so, it is believed that nurses’ professional growth, moral practice, and patient care can be fostered. This is especially important as nursing frameworks are updated frequently to things like healthcare reform efforts, technology expansion and access to or manipulation of patient data.

1.3. Overview of the Framework for Ethical Decision-Making

The framework for ethical decision-making is introduced here, and it notes that such a framework can help to clarify the nature of an ethical dilemma. This, in turn, will make the process for resolving the ethical issue more clear and effective. There are five steps in the framework. First, the nurse must identify if the issue is an ethical dilemma. This may seem unnecessary, but it is crucial for identifying a course of action in the second step, which is gathering relevant information. At this step, the nurse will also need to examine and determine the nature and type of the ethical dilemma. The third step involves exploring and discussing the ethical dilemmas with other members of the healthcare team. This step involves not simply stating the conclusion to the dilemma that seems to be evident. Rather it leads to a careful, thorough and critically open investigation of the problem. The nurse will engage in the process of evaluating ethical principles within the context of the problem, which is the fourth step of the framework. To evaluate the problem, the nurse will need to be involved in the process of active reasoning by considering the aspects of the problem as described in the previous steps. Finally, having completed the previous steps conscientiously, the fifth step is to make a decision. However, one must be prepared to falsify one’s moral judgement if they are mistaken on any argument of the evaluation of the problem. No matter how effortless the reasoning might progress, achieving this criterion is no picnic because it takes great effort to perceive and explain a problem as thoroughly and fairly as possible. To sum up, working through the framework provides a method of inquiry and a systematic approach for the nurse, allowing for possible action. By carefully analyzing and considering the nature of the dilemma and utilizing this step-by-step guideline, nurses can make logical and effective decisions in a methodical way. The text in this article is licensed under the Creative Commons-License Attribution 4.0 International (CC BY 4.0).

Specific Ethical Challenge: Patient Confidentiality

2.1. Understanding the Importance of Patient Confidentiality

2.2. Balancing Patient Confidentiality with the Need for Information Sharing

2.3. Legal and Ethical Considerations in Maintaining Patient Confidentiality

Framework for Navigating Ethical Challenges

3.1. Identify the Ethical Dilemma

3.2. Gather Relevant Information and Identify Stakeholders

3.3. Evaluate the Ethical Principles at Stake

3.4. Explore Alternative Courses of Action

3.5. Make a Decision and Implement the Chosen Course of Action

Impact of Strong Ethical Decision-Making on Patient Care

4.1. Enhanced Trust and Communication with Patients

4.2. Improved Patient Outcomes and Satisfaction

4.3. Upholding Professionalism and Integrity in Nursing Practice

Conclusion

5.1. Recap of the Importance of Ethical Decision-Making in Nursing

5.2. Call to Action for Nurses to Prioritize Ethical Considerations