Ethical dilemma in nursing
An ethical dilemma is a condition which generally proposes a tough choice to be made between two sequences of activities, either of them involving contravening of a moral principle. The conflict is moral in nature involves the sacrifice of either the personal or professional terms in regards to favouring the activity. An ethical dilemma exists when under the following conditions:
- To decide which sequence of activity is best to offer
- Multiple sequences of action must be present in order to make a decision out of it
- Regardless of the decision taken that which activity must be preferred, the moral principle is conceded, because, anything as ‘perfect’ solution does not exist.
As the healthcare system now turns out to be more complex, nurses need to stick to stringent codes in addition to principles to offer maximum care. There are various governing mechanisms one of which is International Council of Nurses’ ICN Code of Ethics which states that nurses, in demand of carrying out their chief responsibilities like promoting health to patients, vindicating suffering and thwarting ill health, must also exhibit “ respect for human rights that are inclusive of cultural rights, the right to live and choose, to dignify and be treated with respect.” The code also asks that patients who are in the recruitment of having nursing care and their family members must be treated primarily by the nurses (Excite Education, 2019).
Moral distress is the term which is generally used to state an ethical dilemma. The term was given by Jameton and he defined it as ‘when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Moral distress occurs when one has to choose between the two similarly important situations. It was reported that when the moral stress gets disillusioned it generally produces a sense of angriness, guiltiness and hindrance and therefore causes psychological stress. To deal with the moral distress it is necessary to have experience in both, an ethical event as well as ‘psychological distress’ and then extracting the relationship between these two (Morley et al., 2017). Newly, it was cited that moral distress is caused due to six reasons and that if- they are uncertain towards moral issues; they feel distressful upon moral issues; that is neither high nor less but mild; they have a feeling of being in dilemma upon ethical issues; they have not been favoured in moral terms; the distress is associated with the situation requiring moral judgments (Campbell, Ulrich and Grady, 2016).
Vital values of elevating the sanity of life and alleviating illness are marked by associates of medical and nursing occupations. Code of secrecy, trustworthiness in addition to colleagueship are generally expected in these occupations. By tradition, nurses had followed up the orders given by doctors and their cognitive and knowledgeable skills were not treasured. Gradually now nurses do realise healing ability and patients on the other side now to require engrossment in care and treatment decisions. Changes have thus been observed in nurses and now they feel more accountable and contributing to the welfare for the patients in need. Therefore, ethical issues in nursing are considered as an emerging professional morality in which nurses feel subsidiary in a multi-disciplinary team or in a situation when they could have a connection with patients and their families (Wilson-Barnett, 1986). By the current developments in the field of nursing, it imitates improved knowledge to give care effectively, the needs of patients must be considered, and an effort must be implied to have a matching place to the doctors and not remain poor alternatives or simply ancillaries. Nurses must understand the potential strength that resides in them to take care of the patients and provide guidance and make the patient and his family members comfortable to deal with the problems. By this nature of duty, nurses do feel more responsible and authoritative by taking care of the patients. The work of nurses is not limited to follow up on the tasks which are prescribed by doctors but also, involves informing and evaluating the response of the patients to the treatments and report them to the physicians. No doubt that doctors are more knowledgeable in terms of taking medicinal care, but nurses play a nurturing role in providing comfort to the patients. The interpersonal relationships with the patients have been found to be principally healing in a number of ways. Being a friend, chaperon and lawyer are logically accepted as it is respected by the patient. Therefore, partnership instead of paternalism is to be encouraged by the doctors and the nurses in order of the welfare of the patients (Wilson-Barnett, 1986). Since ethical decision making always puts a person into the conflict, that which decisions should be made, that would serve as the best, with the minimal sacrifice. The problem in ethical decision making occurs as a four-component model, as stated by Rest in 1986, which originates due to environmental, social and cultural aspects. Inter-individual differences occur not only in how they are perceiving the ethical issues but also in how they respond to those ethical problems and this could depend upon the difference in their age, sex, race, or the duration of their practise. In addition to the intensity under which the nurses face ethical issues or problems, it directly influences the duration of their engagements in ethical behaviour. Thus, it is crucial that the intensity of the ethical problems faced by the nurses must be identified along with the production of stress level (Ulrich et al., 2010). The professional decisions made by the nurses based on the ethical terms, not only affects their problem cracking skills and their development on the professional terms but also the quality of patient care. It has been documented that recurrent implications were faced by the nurses in offering protection of rights to the patients, sovereignty, gaining informed consent, patterning of staff, planning in advance and decision making between others. Younger nurses having lesser experience were more likely to report a higher level of stress and face ethical dilemmas (Ulrich et al., 2010). It is important to have an education of ethics, but it would not be effective, until and unless students have virtuous ideals. Therefore, nurses and doctors, both should serve as being ideal in the eyes of their students. Through various studies, it has been found that nurses do not owe the expected level required to make a decision considering ethical terms. Students have frequently been observed in the ethical dilemmas like telling of truth to the unprepared patients and their family members, euthanasia, breaching of privacy, narrowing of treatment, restoring patient and his rights. In order to fill this loophole, ethics must be offered as a subject in their academics. Training must be carried out that should be based on improving skills upon thinking ethically and making decisions likewise. This would not only help them to take ethically based decisions during conflictual situations but also help them to develop solutions based on the ethical principles (Sari et al., 2018). According to the research carried out it was found that the primary reason for facing ethical issues was dependent upon understaffing. Due to lesser or uncooperative staff, it is problematic to preserve patient’s rights along with their family members and alleviating his sufferings in the course of maintaining their own integrity. For example, a nurse treating a patient having multiple needs obviously would need more attention, that would require much consumption of nurse’s time, restricting her to treat other patients. Therefore, the cooperativity of the staff is necessary to maintain the balance. With the lesser experience, moral apathy can take place in the treatment of the individuals and hence causes filtration in giving quality-of-care based on ethical dilemmas (Ulrich et al., 2010).
Future implications that are to be carried out on this:
There is a need to carry out more research that how staffing patterns could lead to a negative impact on the nurses which would then restrict the nurses to work efficiently. There is also a need to extract out significant components that would disturb nursing care, like a patient’s level of perspicacity and complexities while offering treatment to them (Ulrich et al., 2010).
Campbell, S., Ulrich, C. and Grady, C. (2016). A Broader Understanding of Moral Distress. The American Journal of Bioethics, 16(12), pp.2-9.
Excite Education. (2019). Major Ethical Dilemmas in Nursing. [online] Available at http://www.excite.com/education/blog/major-ethical-dilemmas-in-nursing [Accessed 18 Jul. 2019].
Morley, G., Ives, J., Bradbury-Jones, C. and Irvine, F. (2017). What is ‘moral distress’? A narrative synthesis of the literature. Nursing Ethics, [online] 26(3), pp.646-662. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506903/#bibr1-0969733017724354.
Sarı, D., Baysal, E., Celik, G. and Eşer, I. (2018). Ethical Decision-Making Levels of Nursing Students. Pakistan Journal of Medical Sciences, [online] 34(3), pp.724-729. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041523/pdf/PJMS-34-724.pdf.
Wilson-Barnett, J. (1986). Ethical dilemmas in nursing. Journal of Medical Ethics, [online] 12(3), pp.123-135. Available at: https://jme.bmj.com/content/medethics/12/3/123.full.pdf.
Ulrich, C., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M. and Grady, C. (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal of Advanced Nursing, [online] 66(11), pp.2510-2519. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865804/.
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