Nurse Insights: How Do Nurses Approach Ethical Decision-Making?
Ethical decision-making is a crucial aspect of nursing practice. Nurses must navigate complex situations that require balancing the well-being of their patients with their own values and beliefs. In this article, we will explore how nurses approach ethical decision-making, including the guidelines provided by the Code of Ethics for Nurses and the application of the four main ethical principles in daily nursing practice.
Nurse Insights
How Do Nurses Approach Ethical Decision-Making?
In our Nurse Insights series, experienced nurses offer an insider’s perspective on the nursing profession by addressing common questions, challenges, and triumphs of their careers.
Understanding the Code of Ethics for Nurses
The American Nurses Association (ANA) developed the Code of Ethics for Nurses to provide a standardized set of guidelines for ethical behavior in nursing practice. This Code of Ethics consists of nine provisions and outlines the values, duties, and responsibilities that are inherent to the nursing profession.
Provision 1: Respect for All Individuals
The Code states that you should respect the inherent dignity, worth, and unique attributes of every person, regardless of their health status, race, age, or any other factors. This provision reminds you that every patient deserves respect and good care.
Provision 2: Commitment to the Patient
This provision emphasizes nurses’ primary commitment to the patient, whether it be an individual, family, group, community, or population. It reinforces the importance of loyalty and advocating for the patient’s well-being and safety.
Provision 3: Advocate for and Protect the Rights of the Patient
This provision underscores the importance of advocating for the rights, health, and safety of the patient. You’re expected to safeguard the patient’s privacy and keep them informed about their health situation.
Provision 4: Responsibility and Accountability
This provision highlights your responsibility for individual nursing practice and the requirement to maintain competence. It’s your duty to continually enhance your professional knowledge and skills for the best patient outcomes.
Provision 5: Duty to Provide Optimal Levels of Health Care
As a nurse, you should promote, advocate for, and protect the health, safety, and rights of the patient. This provision includes a mandate for maintaining personal health to ensure the ability to provide optimal care.
Provision 6: Improves Ethical Environment
The Code states that you should establish, maintain, and improve the ethical environment of the work setting to provide safe, quality healthcare.
Provision 7: Advance the Nursing Profession
Provision 7 dictates that you shall advance the nursing profession through research and scholarly inquiry, professional standards development, and the initiation of both nursing and health policy.
Provision 8: Collaboration With Other Health Professionals
You shall collaborate with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
Provision 9: Maintain the Integrity of the Profession
Through professional organizations, the nursing profession must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
Following the Code of Ethics in nursing will guide you in making sound decisions in difficult situations. It is an important reference point when dealing with ethical issues, patient rights, and advocacy.
By adhering to these principles, you uphold the integrity of the nursing profession, set an example for other health professionals, and, more importantly, provide the best care for your patients.
Application of Ethical Principles in Nursing Practice
Nurses apply the four ethical principles of autonomy, beneficence, nonmaleficence, and justice in their daily work by respecting patient autonomy, prioritizing patient well-being, avoiding harm, and promoting fairness and equality.
Autonomy
As a nurse, you respect autonomy when you acknowledge that your patients can make their own decisions. It involves understanding and supporting a patient’s decision-making capabilities, meaning you honor their choices even when you might not agree with them. In daily practice, respecting autonomy can mean providing essential information so patients can make informed decisions, seeking their consent before treatments, advocating for patient privacy, and upholding confidentiality.
Beneficence
The principle of beneficence compels you to actively contribute to your patient’s well-being. Practically, beneficence could mean providing effective pain management, ensuring a high standard of personal care, promoting preventive health measures, assisting in rehabilitation, or providing emotional support. The exact application of beneficence often depends on the specific needs of the individual patient.
Nonmaleficence
Nonmaleficence means “doing no harm,” and it is a fundamental principle in nursing. Practically applied, it means you must ensure the care and treatments provided do not knowingly cause harm or pain to your patients. It may involve managing potential side effects, mistakes, or adverse events, and balancing benefits and risks in care decisions.
Justice
As a nurse, you apply the principle of justice by treating each patient equally and without bias. This involves ensuring equitable distribution of nursing care and resources, upholding patients’ rights, advocating for your patient’s access to healthcare, and delivering care without discrimination.
The Role of Moral Courage in Nursing Ethics
As a nurse, you will frequently encounter situations where you need to demonstrate moral courage. This is the ability to stand up for what you know is right, even in challenging situations or when faced with adversity. By showing moral courage, you can make sound ethical decisions that respect the dignity, rights, and values of your patients.
Being Courageous in Difficult Situations
Moral courage can involve actions such as advocating for a patient who can’t voice their own needs, refusing to participate in practices that compromise patient care, or speaking up when you observe unethical behavior. This could mean confronting a colleague who isn’t respecting the privacy of a patient, or standing up to a system or protocol that you believe is not in the patient’s best interest. The purpose of moral courage is to safeguard the health and well-being of patients, even when it’s difficult or uncomfortable to do so.
Moral Courage and Ethical Decision-Making
Moral courage directly influences your ethical decision-making processes in nursing. With moral courage, you stand by your professional and personal values, allowing you to navigate complex ethical dilemmas. These dilemmas often have no clear right or wrong answers. For instance, when allocating limited resources, you might need to decide between two equally needy patients. By relying on moral courage, you can make a decision that best upholds the principles of nursing ethics, such as autonomy, beneficence, justice, and non-maleficence.
Moral courage also prevents you from remaining silent or ignoring ethical issues. It pushes you to engage in dialogue, ask hard questions, and explore possible solutions to ethical problems. By doing this, you help create a culture of ethical excellence and patient-centered care in your workplace.
Remember, exercising moral courage can be tough and might lead to stress or emotional fatigue. Therefore, it’s essential to have strategies in place to maintain your resilience and emotional well-being, such as regular debriefs, time for self-reflection, and strong support networks.
Steps in the Ethical Decision-Making Process
Making ethical decisions is an essential part of our lives. However, it can often be challenging to make the right decision. To make an ethical decision, one must follow a set of steps that involve identifying the ethical issue, considering possible actions, evaluating those options, and making a decision. These steps can help ensure that the decision made is fair, just, and aligns with ethical principles.
Step 1: Identify the Ethical Issue
Identifying the ethical issue at hand is the first and most crucial step in the ethical decision-making process. It’s important to take the time to discern whether the situation at hand is indeed an ethical dilemma, or if it is an issue that should be dealt with through a different set of procedures.
Step 2: Gather Information
Once you’ve identified the issue as an ethical one, you should then gather all relevant information. This could include any facts about the situation, the individuals involved, your institutional guidelines, and any legal or professional standards that could apply.
Step 3: Evaluate the Options
A part of ethical decision-making is considering all possible actions in response to the issue. You can evaluate each of these potential actions based on outcomes, potential benefits and harms, legal implications, and alignment with ethical and professional standards.
Step 4: Make a Decision
After carefully considering all the facts and potential actions, it’s time to make a decision. As a nurse, you are guided by the nursing code of ethics and your professional judgment to ensure that your decision best reflects the care and welfare of your patients and aligns with your responsibilities as a nurse.
Step 5: Implement the Decision
Your decision should be implemented in a timely and appropriate manner. You should also communicate your decision to the relevant parties involved, ensuring they understand why this decision was made, and what the next steps will be.
Step 6: Evaluate the Outcome and Reflect
Finally, it’s important to assess the results of your decision. Reflect on whether the outcome was as anticipated and if it adequately resolved the ethical dilemma. This reflective practice will help you learn from the situation and improve your ethical decision-making in the future.
Challenges With Ethical Decision-Making in Nursing
Nursing often involves ethical dilemmas where you will have to make decisions that are in the best interest of your patients. This requires careful thought and consideration of all the relevant ethical principles. One of the main challenges you might face pertains to conflicting ethical principles. For example, you may have to respect a patient’s autonomy, but you must also ensure their well-being.
Balancing Ethical Principles
You might have to choose between patient autonomy and nonmaleficence, which means not causing harm. For example, if a patient doesn’t want a blood transfusion due to personal beliefs, but you know that not getting a transfusion would put their health at risk, this might create an ethical dilemma. A possible solution would be clear and respectful communication to understand your patient’s perspective better, and educating them on the benefits and risks of their decision.
Uncertainty
At times, you may face situations where the best course of action is unclear, such as in end-of-life care or informed consent in diminished capacity cases. At such times, it’s important that you consult with colleagues, professional guidelines, or an ethics committee to gain further insight and clarify doubts.
Cultural Differences
Cultural variations can present significant challenges as well. For example, you may encounter practices and beliefs in certain cultures that are contrary to the conventional healthcare system. It’s crucial that you respect cultural diversity while maintaining a commitment to provide evidence-based care.
Institutional Policies
Your organization’s policies or practices might sometimes not align with your ethical beliefs. If such conflicts arise, engaging in open, respectful dialogue with management or seeking advice from an ethics committee can be helpful.
One of the key strategies to overcome these ethical decision-making challenges is enhancing your ethical competence through continuous education and training, and engaging in reflective practice.
Importance of Continuous Education in Nursing Ethics
The dynamic nature of the healthcare field brings new medical advancements and alterations in policies. Therefore, as a nursing professional, maintaining your learning curve is of great importance. Staying abreast of the latest practices and guidelines is essential in understanding the current best practices in patient care and nursing ethics.
Current Best Practices
Staying updated about the latest best practices in nursing ethics enhances your ability to make sound decisions when ethical dilemmas arise. New or revised guidelines may present innovative approaches to addressing common ethical issues, like patient confidentiality or end-of-life decisions. These insights equip you with the necessary skill set to approach ethical scenarios appropriately, ensuring the utmost respect for a patient’s dignity, autonomy, and well-being.
Interpretation and Application of Ethical Guidelines
Keeping up with new ethical guidelines isn’t sufficient. You must also understand how to interpret and apply these guidelines in real-world scenarios. Continuous learning helps ensure that you can effectively translate theoretical ethical principles into practical action, leading to better patient outcomes and fewer ethical violations.
Fostering a Culture of Ethical Practice
You can serve as role models for nursing students, fellow nurses, and other professionals through your commitment to continuous education and adherence to ethical guidelines. Instilling a culture that promotes ethical practice within your healthcare environment only helps strengthen professional relationships, increasing team harmony and patient satisfaction.
