Nurse Insights: What Are the Ethical Dilemmas Nurses Face?

Nursing is a profession that requires ethical decision-making on a daily basis. In this article, we will explore the major ethical dilemmas that nurses face, particularly when handling end-of-life decisions and maintaining patient confidentiality. We’ll discuss the ethical considerations, emotional impact, and guidelines for handling these challenging situations. Read on to learn how nurses navigate these complex ethical dilemmas to provide compassionate, patient-centered care.

Nurse Insights

What Are the Ethical Dilemmas Nurses Face?

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.

Handling End-of-Life Decisions

It is often a complex and emotionally challenging responsibility for nurses to be involved in making end-of-life decisions, such as deciding when to withdraw life support. These situations can give rise to ethical dilemmas and emotional turmoil.

Ethical Considerations

End-of-life decisions almost always involve complex moral dilemmas that can be difficult to navigate. While it’s widely accepted in the medical community that prolonging suffering is inhumane, the decision to withdraw life support isn’t straightforward. You might wrestle with questions like, “Is it right to end a life?” or “Is this what the patient would want?”

Practices and principles, such as obtaining informed consent from patients or their appointed guardian or health care proxy and honoring patients’ preferences, are ethical guidelines used in managing these decisions.

Emotional Impact

Handling the emotional side of end-of-life situations can put significant strain on you as a nurse. You might develop strong connections with patients and their families over time. Participating in discussions about discontinuing life support for a cherished patient can be heart-wrenching. On the one hand, you aim to alleviate the patient’s suffering; on the other hand, you want to preserve life as much as possible. You could feel a deep sense of loss and sadness with each life that ends.

To cope with this, open communication with fellow nurses, doctors, and support staff can be beneficial. Don’t hesitate to seek professional help if the emotional strain becomes too overwhelming.

Balancing Personal Feelings and Professional Boundaries

Keeping a balance between your personal feelings and professional responsibilities is yet another challenge. Displaying empathy is a crucial part of patient care, but you must also maintain a professional boundary. This balance prevents you from becoming too emotionally involved, leading to burnout.

Our profession’s code of ethics offers a strong foundation for decision-making in tough end-of-life scenarios. Continuing education on ethical decision-making processes will assist you in feeling more prepared for these situations.

Certainly, there’s no easy way to handle end-of-life decisions. But understanding the emotional and ethical undertones of these choices can better equip you to support your patients—and yourself—during this challenging phase of healthcare.

Maintaining Patient Confidentiality

As a nurse, you are ethically bound to respect patient confidentiality at all times. It is part of the professional nursing ethical guidelines to maintain the privacy of a patient, which includes their health status, personal life, and private information. The information you gather during the patient’s treatment is confidential and it’s vital it remains between you, the patient, and their chosen health providers. This implicit trust forms the basis of the nurse-patient relationship and promotes open communication.

Breach of Patient Confidentiality

There may be situations that complicate the practice of patient confidentiality. For example, when a patient’s health situation endangers others due to infectious diseases or cases of public health importance, it becomes tricky to handle such issues with the expected patient confidentiality. A situation like an abused child or an elderly person also presents a challenge as they may need further intervention or protection from appropriate authorities.

Ethical Guidelines for Challenging Situations

In these challenging cases, ethical guidelines recommend that you balance the duty to maintain confidentiality with the responsibility to protect public health or vulnerable individuals. In most cases, it is advisable to inform the patient about the need to share health information with the relevant authorities. You should also consult your nurse manager or legal department for the best course of action, following your institution’s policies.

Legal Implications

Breaking patient confidentiality may lead to legal consequences due to Health Insurance Portability and Accountability Act (HIPPA) violations, especially if privacy breaches lead to harm. You, as a nurse, could even lose your license or face financial sanctions for improper disclosure of a patient’s information.

Steps to follow when challenged with maintaining confidentiality.

In all cases, you should be mindful and prudent as you navigate these complex scenarios while maintaining the tenets of nursing practice, especially the duty to uphold patient confidentiality and privacy.

Navigating Cultural Differences

Nurses can often face ethical dilemmas when their personal beliefs or cultural norms conflict with those of their patients. It’s crucial in these situations to remember that everyone has the right to their beliefs and values. Even if they diverge from your own, they should be respected and understood as part of the individual’s identity and experience.

Recognize Your Biases

Be aware of your own biases and how they may affect your patient care. This might entail a deep self-reflection on your cultural norms and personal beliefs, and recognition of the possible prejudices or stereotypes you may harbor subconsciously. A recent study shows that self-awareness and emotional intelligence can enable healthcare professionals to provide more effective patient care.

Practice Cultural Sensitivity

Practicing cultural sensitivity is just as important in nursing as the medical training you receive. This involves being aware and respectful of cultural differences, understanding how a patient’s culture may affect their health beliefs and practices, and adjusting your nursing care to meet their specific cultural needs.

Seek Guidance

If you find yourself facing an ethical dilemma related to cultural differences, seek advice from a trusted colleague, a mentor, or your nursing ethics board. They can provide perspective and advice on how to approach the situation.

Implement Nursing Standards and Guidelines

Always remember to follow the certifications, professional guidelines, and nursing standards that promote non-discrimination, respect for individual dignity, and the provision of holistic care regardless of cultural differences in patients. They can provide guidance on how to handle such sensitive situations.

Open Communication

Finally, maintaining open communication with your patients is essential. Let your patients express their cultural practices or beliefs that might be pertinent to the care they need. Collaborating with them to find a balance between their cultural practices and necessary medical treatments strengthens trust and respect between you and your patients. Providing culturally competent care also results in improved patient satisfaction, adherence to treatments, and better health outcomes.

Improper Practices and Whistleblowing

In your nursing career, you may encounter instances where you witness colleagues engage in improper practices. These situations can lead to ethical dilemmas and challenging decisions about voicing concerns or whistleblowing.

Reporting Abusive Behavior

Abusive behavior, such as harassment or intimidation against colleagues or patients, is an example of improper practices that you may observe. The distress caused by these actions can negatively affect patient care and the work environment. You may feel conflicted regarding whether to report such behavior due to concerns about retaliation. However, patient safety and the well-being of colleagues should take precedence.

Unethical Healthcare Decisions

Another potential situation involves the observation of unethical healthcare decisions. This may include the inappropriate administration of treatments or refusal to provide necessary care. The professional duty of a nurse is to advocate for patient’s rights, making it an ethical dilemma whether to report or overlook these actions.

Breaching Confidentiality

Confidentiality breaches are another improper practice you may encounter. Privacy is every patient’s right, and any unauthorized disclosure of their health information constitutes an ethical violation. It’s your duty as a nurse to uphold these standards, so witnessing such behaviors can place you in a predicament on whether to report or stay silent.

Remember, as a nurse, you have obligations to your patients, profession, and yourself. It’s essential to uphold ethical principles and take appropriate actions in case of improper practices. If unsure of what to do in a situation, it may be helpful to seek advice from trusted colleagues, superiors, or a nursing union representative.

Whistleblowing in healthcare is a sensitive issue with potential consequences, but it is also a vital aspect of maintaining the integrity of the nursing profession.

Balancing Patient Autonomy and Nurse Duty

Patient autonomy, the idea that patients have the right to make informed decisions about their own health care, is a cornerstone of ethical nursing practice. However, situations often arise where a patient’s autonomous decisions may conflict with what you, as a nurse, perceive to be in their best healthcare interest. In these situations, you’re faced with an ethical dilemma.

Understanding Patient Autonomy

To comprehend the depth of the ethical conflicts that may arise, you must first understand the concept of patient autonomy. In essence, it’s a patient’s right to self-determination, which includes the right to refuse treatment or interventions. However, this right is not an absolute one, and it must be balanced against other important considerations such as benefit, harm, and duty of care.

The dilemma arises when a patient’s decisions about their own care don’t align with effective healthcare. For example, a patient may refuse to take prescribed medication, choose to leave the hospital against medical advice, or refuse important diagnostic tests.

Ethical Dilemmas

In these situations, you’re ethically obliged to respect the patient’s autonomy, but simultaneously, you have a professional obligation to provide competent care, aiming for the best possible health outcomes given the circumstances. The ethical dilemma lies in reconciling these two conflicting obligations.

Three main dilemmas often encountered include:

1. Informed Refusals: When patients refuse treatment that you consider beneficial or necessary.
2. Risky Choices: When patients opt for a more hazardous care plan.
3. Avoidance of Required Care: When patients ignore or avoid necessary healthcare interventions.

Addressing Ethical Dilemmas

When confronting these dilemmas, remember to promote a respectful and truthful conversation with the patient. It’s essential that you clarify and understand the patient’s perspective – their fears, beliefs, or misunderstandings that influence their decision-making. It’s your role to provide accurate, comprehensive information in plain language, helping the patient make an informed choice.

If a resolution cannot be reached, further discussion with a multidisciplinary team may be necessary, or in extreme cases, the intervention of an ethics committee.

These dilemmas require careful navigation to balance the patient’s right to autonomy and your responsibility as a nurse to provide appropriate care.

Managing Resource Limitations

Sometimes, nurses face ethical dilemmas owing to limited resources in healthcare environments such as hospitals and clinics. These constraints often include staffing shortages, lack of equipment, or insufficient diagnostic tools and require careful management to ensure patients receive the best possible care.

Prioritizing Patient Needs

One of the primary ways you can tackle resource limitations is to prioritize patient needs. Develop criteria to assess and triage patients based on the severity of their conditions and their immediate needs. Use these to allocate available resources fairly and efficiently. For example, a patient with a life-threatening condition must receive immediate attention over a patient with a minor ailment.

Effective Communication

When resources are limited, it’s vital to communicate honestly and reliably with patients, their families, and the healthcare team. Share information on available resources and any changes in them to set expectations and plan cooperatively. Transparency helps everyone involved make informed decisions and minimizes frustration or conflict.

Advocacy and Networking

As a nurse, you’re the patients’ advocate. If resources are scarce, collaborate with management and peers to find solutions. For example, if there’s a staffing shortage, you can suggest utilizing volunteers, if appropriate, or adjusting work schedules.

Continuing Education and Training

Keeping yourself updated with the latest nursing practices can help you provide quality care despite resource constraints. Use evidence-based practices, research trends, and technological advances to optimize patient care. Continuous training ensures you stay efficient while making the most of what’s available.

Remember, resource limitations can challenge your nursing skills, but they also present opportunities to innovate and evolve. Grappling with these ethical dilemmas can lead to growth and resilience in your nursing career. By incorporating these strategies, you can ensure the highest care possible when faced with ethical dilemmas.