How to Handle Ethical Dilemmas in Nursing

Practical Strategies for Navigating Ethical Challenges in Nursing

When it comes to patient care, the decisions nurses must make are not always black and white. In fact, there are a number of hard choices and ethical dilemmas that many nurses face on a daily basis. It’s vital that nurses learn how to handle ethical dilemmas for their own safety as well as that of their patients. To ensure proper care and professional integrity, nurses should follow the Code of Ethics for Nurses from the American Nurses Association (ANA).

Not only does this code act as a guide, but it also provides concrete examples of how nurses should react to ethical dilemmas they may encounter. These issues can revolve around a lack of resources or time. In other cases, a nurse’s duty to care might clash with a patient’s values. If a nurse ignores these predicaments, they might suffer from burnout and even leave the nursing profession altogether. There is the potential for disciplinary charges or legal trouble as well. Above all else, we want to avoid comprised care.

In our latest article, we’re going to cover various types of ethical dilemmas and key strategies to combat them. If you’re inspired by the nursing profession, you might want to read how to become a Registered Nurse and kickstart your career. For those who are already in the field and want to advance, it could be beneficial to understand the highest paying nursing jobs and learn about more specialized roles in healthcare.

Common Ethical Dilemmas Nurses Face

Patient Autonomy vs. Medical Advice

There is an age-old conflict between respecting patient decisions and providing them with medical recommendations. An example of patient autonomy vs. medical advice would be a patient who refuses treatment. A nurse’s response to this dilemma requires a careful, balanced approach. Nurse.org uses the example of a patient with diabetes who refuses to take insulin. They outline the following steps that a nurse should take:

1. Respect the Patient’s Autonomy: Although you might disagree with their decisions, you must respect your patient’s right to make those decisions.
2. Offer Information: It’s crucial that you give your patient accurate, adequate, and comprehensive information about their treatment. This should include benefits and risks as well as potential alternatives.
3. Determine Comprehension: To assess their understanding of the situation, you should use a non-judgmental approach when it comes to communication. You want to ensure that they understand the consequences of refusing treatment.
4. Joint Decision-Making: Try to include the patient in your decision-making process. So, what does that mean? Incorporate them into discussions and identify alternatives that meet their values or preferences. This approach can help create trust and mutual respect.
5. Pursue Other Perspectives: Let’s say a patient’s decision still does not align with your judgment or poses a significant risk to their health. In that case, you should seek guidance from other medical professionals (i.e., your nurse manager, supervisor, etc.)
6. Document Everything: Remember to always document your discussions and assessments. Additionally, you must document your patient’s decisions. These records act as proof that you completed your ethical and professional responsibilities.

Confidentiality vs. Reporting Obligations

Another common dilemma is maintaining patient confidentiality while still reporting necessary information. Think of areas like domestic abuse, contagious diseases, etc. You must consider the potential harm to other people if critical information is not properly shared. Picture a situation where a nurse learns that a patient with a documented history of violence has confided in their desire to harm a former partner.

According to Nurse.org, this is how you could handle such a situation:

1. Gage the Seriousness of the Threat: Carefully determine the type of risk associated with this patient. For instance, is there a credible threat to the potential victim? Weigh factors like your patient’s history, mental state, and ability to carry out harm.
2. Create a Therapeutic Dynamic: Delve into the patient’s underlying issues and reasons for their violent intentions. Try to address any triggers that might add to their behavior or push them to seek other coping methods.
3. Consult with Supervisors: You must speak with your supervisor about the best course of action to guarantee the safety of the potential victim.
4. Adhere to Legal and Ethical Rules: Understand local laws and regulations when it comes to your duty to warn, protect, etc. Always adhere to these requirements.
5. Document, Document, Document: This probably goes without saying, but it documents every interaction and assessment. This will prove that you acted responsibly and ethically.

Resource Allocation and Equity in Care

In the realm of healthcare, there are issues like limited resources and healthcare disparities. Some nurses face the impossible task of advocating for patients in situations where resources are very scarce. Imagine you’re a nurse during a terrible flu outbreak. The hospital is overwhelmed and only has so many beds, medications, and ventilators.

To fairly allocate resources, Nurse.org recommends that you follow these steps:

1. Prioritize Based on Need: Always follow protocol for triage and assist people based on the severity of their injury or condition. Decisions must depend on clinical needs and not personal biases.
2. Maintain Communication: Be open and transparent with patients as well as their families. Go over the challenges they face due to limited resources, criteria for resource allocation, etc.
3. Consult Other Healthcare Professionals: The goal is to collaborate with other medical professionals to provide the best care possible, such as doctors and hospital administrators. Doing so can help maintain fairness, accountability, and trust.
4. Use Ethical Decision-Making: Look to ethical frameworks like the Code of Ethics for Nurses to guide your actions.
5. Support Patients Through Advocacy: Always be an advocate for the health as well as the rights of your patients. Remember this when hard choices must be made.

End-of-Life Care and Patient Wishes

It can be very difficult to navigate decisions around life-sustaining treatments while respecting patient wishes and family dynamics. Some topics that may come to mind are palliative care choices or do-not-resuscitate (DNR) orders. To give you a better idea, Nurse.org presents a situation where you are caring for an elderly person who has a terminal illness. Although the patient would like to experience a peaceful death without interventions, their family wants to do everything possible to save their life.

As a nurse, this puts you in a complex situation. Here are some ways you could try and address the issue:

1. Communication Is Key: Speak with the patient and their family in a way that is informative yet empathetic. Discuss your patient’s prognosis and treatment options. Go over any potential benefits and disadvantages of continuing life-sustaining measures.
2. Advocate for Your Patient’s Autonomy: In the end, it is your patient’s right to decide how they wish to receive end-of-life care. Be their advocate in a respectful and compassionate manner.
3. Facilitate Open Dialogue: Act as a mediator between your patient and their family. You can also involve other members of the healthcare team, such as palliative care specialists and social workers.
4. Consult Ethical Decision-Making Guides: Follow the ethical principles found in the Code of Ethics for Nurses (i.e., beneficence, non-maleficence, autonomy, and justice). This will help you assess the situation and guide your actions.
5. Act as a Support System: No matter what decision is made, you should provide the patient and their family with holistic, supportive care. Try to always address physical, spiritual, and emotional needs.

The Importance of Ethical Decision-Making in Nursing

Ethical decision-making upholds the integrity of the nursing profession. It creates a much broader impact by fostering patient trust, refining the quality of care, and improving healthcare outcomes. As we previously stated, the American Nurses Association (ANA) has outlined a Code of Ethics for Nurses. In following this code, nurses can help establish a foundation based on ethics. Doing so will ensure that each nursing decision is the right step forward.

The ANA said it best:

“Trust in the nursing profession by individuals and society isn’t to be taken lightly. Increasing ethical awareness in nursing can help ensure that the nursing profession maintains that trust, supports nursing colleagues, and continues to develop the future of nursing.”

Strategies for Handling Ethical Dilemmas

1. Follow the ANA Code of Ethics

Since its development in the 1950s, the ANA Code of Ethics for Nurses has served as both a guide and a reference for Registered Nurses (RNs). Not only is the code a moral compass, but it helps promote high levels of care and acts as an ethical standard for aspiring nurses around the country. We would encourage medical students to familiarize themselves with this ethical framework so that they can apply it when faced with dilemmas.

The Code of Ethics for Nurses primarily consists of five categories: nonmaleficence, beneficence, autonomy, justice, and privacy/confidentiality. As technology advances and society changes, the Code of Ethics has been revised to reflect the current times. There are currently nine provisions in the Nursing Code of Ethics. To learn more about each prevision, visit this outline from Nurse.org. You can also look at a free copy of the Code of Ethics on the ANA website.

2. Utilize Ethical Decision-Making Models

There are several models you can consider for ethical decision-making. Two of the most common models are the Four Quadrant Approach and the Nursing Process. We touched on the Four Quadrant Approach, which falls under the ANA Code of Ethics for Nurses. It helps guide nurses through four major ethical nursing principles:

1. Autonomy: Simply, this means a patient has the right to make their own decisions. As a nurse, you must provide your patients with adequate information to make informed choices, even if they conflict with your values.
2. Beneficence: This category literally means “the promotion of good.” You always want to ensure that your patient’s best interest is given the utmost consideration. This could translate to you comforting a dying patient or helping a patient perform tasks.
3. Justice: You must be fair and ensure there is equality when it comes to distributing benefits. This means that you remain impartial about a patient’s age, religion, ethnicity, etc.
4. Nonmaleficence: In this category, nurses avoid causing harm as much as possible. The ultimate goal in nursing is to provide safe and effective care to each patient.

Regarding the Nursing Process, the American Psychiatric Nurses Association (APNA) identifies the following steps for ethical decision-making:

1. Identify the problem.
2. Apply the code of ethics.
3. Determine the nature and dimensions of the dilemma.
4. Generate potential courses of action.
5. Consider the potential consequences of all options.
6. Evaluate the selected course of action.
7. Implement the course of action.

3. Seek Guidance from Supervisors or Ethics Committees

Nurses are encouraged to consult supervisors, ethics committees, or interdisciplinary teams when faced with challenging ethical decisions. These resources can help nurses gain perspective and make more informed decisions. The Journal of Nursing Reports in Clinical Practice stated the following:

“By upholding ethical standards and principles, nurses can provide safe, compassionate, and respectful patient care while promoting trust and confidence in the healthcare system.”

4. Maintain Open Communication with Patients and Families

We cannot overstate the importance of clear, compassionate communication with patients and their families. Keep in mind that there is both verbal and non-verbal communication, such as active listening and body language. In addition, nurses must be able to convey complex information to patients and families. They must also focus on clarity and demonstrate empathy while accurately documenting the patient’s treatment.

Below are some practical tips to enhance team dynamics and patient outcomes:

• Practice active listening by summarizing what patients say and asking clarifying questions.
• Use plain language when explaining medical terms to patients.
• Engage in role-playing exercises with colleagues to improve communication skills in various scenarios (this should also help you focus on conflict resolution).
• Consider taking a course in medical communication or attending workshops on patient interaction.

5. Document Decisions and Actions

All medical professionals should become masterful at thorough documentation. When it comes to ethical dilemmas, documentation can help protect the nurse as well as the patient. You should always follow legal and professional regulations to ensure compliance with documentation, records, etc.

Your documents should be clear, accurate, and accessible. The ANA has Principles for Nursing Documentation that identifies six guidelines for nurses to follow.

1. Documentation Characteristics. According to the ANA, quality documentation is:

• Accessible
• Accurate, relevant, and consistent
• Auditable
• Clear, concise, and complete
• Legible/readable
• Thoughtful
• Timely, contemporaneous, and sequential
• Reflective of the nursing process
• Retrievable on a permanent basis in a nursing-specific manner

2. Education and Training. All nurses should be provided with education and training that covers the technical components of documentation.

3. Policies and Procedures. As a nurse, you must familiarize yourself with the organizational policies and procedures around documentation.

4. Protection Systems. Protection systems must be incorporated into documentation systems. This helps protect data security, confidentiality, and more.

5. Documentation Entries. This guideline emphasizes, among other things, that documentation must be accurate, valid, complete, authenticated, dated, and legible.

6. Standardized Terminologies. As stated by the ANA, “These terminologies should include the terms that are used to describe the planning, delivery, and evaluation of the nursing care of the patient in diverse settings.”

6. Develop Cultural Competence

If you understand and respect cultural differences, you can better navigate ethical challenges related to care preferences, communication styles, and family dynamics. Think about it like this: Ethical practice is the foundation of trust between nurse leaders, patients, and team members. It ensures that care is delivered in a responsible and respectful manner, upholding the dignity and rights of each patient.

Key components focus on confidentiality, integrity, and professional boundaries. Nurses should promote cultural competence by understanding patients’ cultural backgrounds and advocating for equitable care. Here are just a few tips for you:

• Familiarize yourself with the ethical guidelines provided by your professional association, such as the Code of Ethics for Nurses.
• Reflect on ethical dilemmas you encounter in your work and seek advice from colleagues when needed.
• Participate in ethics training or workshops to strengthen your understanding of ethical issues in occupational therapy.
• Always put the well-being and rights of your patients first, ensuring that your actions align with ethical standards.

Importance of Self-Care and Emotional Resilience in Facing Ethical Dilemmas

This might sound obvious, but dealing with ethical dilemmas can be emotionally taxing for nurses. It’s vital that you build emotional resilience, such as seeking support from colleagues, practicing mindfulness, and maintaining a healthy work-life balance.

Here are some self-care tips to help you get started:

Self-Care Techniques

• Engage in mindfulness practices, such as meditation or deep breathing exercises, to stay grounded and reduce stress.
• Seek professional therapy or counseling to process traumatic experiences and develop coping strategies.
• Incorporate relaxation techniques like progressive muscle relaxation or yoga to ease physical and mental tension.
• Unplug from social media, which can lead to a loss of sleep or motivation.

Adequate Rest

• Quality sleep is vital for physical recovery, cognitive function, and emotional resilience.
• Establish a regular sleep schedule, even on days off.
• Create a relaxing bedtime routine to remind your body that it’s time to wind down.
• Minimize exposure to screens and bright lights before bed to enhance melatonin production.

Balanced Diet Tips and Meal Planning

• Prioritize nutrient-dense foods, such as lean proteins, whole grains, fruits, and vegetables, to fuel your body.
• Stay hydrated by drinking plenty of water throughout the day.
• Plan and prepare meals in advance to ensure you have access to healthy options, even during busy shifts.
• Consider small, frequent meals or healthy snacks to maintain steady energy levels during long hours.

Communication

• Share your feelings by talking about your stresses with a mental health professional, friend, or family member. Speaking out reduces tension and shows strength, not weakness.
• Listening to a friend encourages them to open up and share. This mutual support helps both of you tackle challenges together and feel less alone.
• Reach out to those who usually support you. They may need support, too. Ask how they’re doing and listen carefully—it’s important to care for those who support you.
• Instead of texting, call someone to talk about how you’re really feeling. A brief phone call can offer a sense of connection and help you process your day.
• Learn to say “no” when necessary to avoid overcommitting and added stress. Setting boundaries helps you manage your time and reduces guilt.

Advance Your Career at Unitek College

In this article, we explored the importance of ethical decision-making in nursing. We also covered various strategies you can use to handle ethical dilemmas. From following the Code of Ethics for Nurses to embracing self-care, there are a number of tactics you can use to be the best nurse possible. Although ethical dilemmas are common in nursing, you don’t have to make these decisions alone—remember to follow ethical frameworks, consult your supervisors, and seek support from colleagues. By actively employing these strategies, you can ensure that you remain adaptable, compassionate, and effective in your role, no matter the challenges you face.

If you’re looking to start or advance your career as a nurse, consider the nursing programs at Unitek College. Start by exploring the Bachelor of Science in Nursing (BSN) program with Unitek. These programs are designed to provide students with the comprehensive education and hands-on training needed to develop essential nursing skills. With experienced instructors, various facilities, and a supportive learning environment, Unitek College is committed to helping you succeed in this fulfilling and dynamic field.