Are you a nurse, or are you considering becoming a nurse, via accelerated nursing programs online? It’s a noble career to pursue, a highly-regarded profession and can be a stable, financially and emotionally rewarding career.
Nurses can fulfill various roles in various healthcare settings, from Emergency Room roles to general ward roles and even specialist nursing roles. There are even aged care and psychiatric nurses in different settings. In addition, you don’t always have to work in a hospital or aged care facility, with some nurses working in schools, community health centers, academia, and even in an outreach capacity or mobile capacity.
However, like most professions, moral dilemmas can arise when it comes to patient care. This can be difficult to manage as a nurse, as you’re bound by healthcare ethics broadly, as well as the codes of conduct and policies of the institution or organization you work for. Lucky for you, this helpful article will share how you can manage moral dilemmas in patient care as a nurse. Continue reading to learn more.
What Are Healthcare Morals and Ethics?
Ethics and morals refer to “right” or “wrong” conduct in a variety of settings. These are particularly important in a healthcare setting as nurses care for patients when they’re at their most vulnerable. You may provide care to people recovering from broken limbs, major invasive surgery, mental health crises, terminal illnesses and other diseases. It’s vital that patients feel supported, cared for and safe while providing nursing care.
There are four general principles of healthcare ethics that all nurses should follow:
- Beneficence: Seek the patient’s best interests and assess what counts as a treatment worth pursuing
- Autonomy: Determine the wishes and interests of the patient to protect their autonomy and right to self-determination
- Justice: Follow the appropriate due process to determine if there should be limits on healthcare and treat patients equally
- Non-maleficence: Avoid causing further harm at all costs
Examples of Moral Dilemmas in Healthcare
Now, let’s explore some common and not-so-common moral dilemmas in healthcare settings that nurses can come across.
Do Not Resuscitate Orders
A physician typically writes a Do-Not-Resuscitate (DNR) order, which instructs other healthcare providers, like nurses, not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops beating or they stop breathing. The DNR doesn’t have instructions for any other treatment and can only be permitted after a physician speaks with the patient.
A moral dilemma can arise when it’s not crystal clear if a patient was able or of sound mind to choose a DNR. In 2017, there was a case of a Florida man who was rushed to the hospital while unconscious and had a “do-not-resuscitate” tattoo inked across his chest.
After pondering the legitimacy of the tattoo as a DNR order and his critical existing medical conditions, the ICU unit staff decided to honor the message expressed in the tattoo despite the man’s inability to talk. They sought expert ethical advice on the case and according to this consultation, advised that “the law is sometimes not nimble enough to support patient-centred care”.
Nurses should consider that CPR can sometimes worsen pre-existing conditions. In such cases, questioning if the degree of pain that CPR would cause is worth the benefits of performing it can help nurses navigate severe situations that involve potential patient death.
Social Media Use
Nurses are people like everyone else, and social media is a widespread phenomenon in this current era of history. Social media can offer benefits to nurses, such as the ability to maintain connections with friends and family and with colleagues. It can strengthen professional relationships and offer valuable networking opportunities. However, nurses must maintain ethical and moral standards when using social media. Some examples of inappropriate use include adding patients as contacts on social media or contacting or following patients on social media. Another moral dilemma that can arise is potential harassment or stalking by either patients or other nurses. Most hospitals and healthcare organizations will have social media policies or guidelines that inform how staff can appropriately use social media.
Reporting Incompetent or Unethical Behaviour Displayed by Colleagues
Nurses must report any unethical or incompetent behaviour by their colleagues, including doctors. The AMA code governs this responsibility, but it can be a dilemma when nurses have relationships with their colleagues that they feel that reporting could jeopardize. However, it is the right thing to do – thinking back to the definition of morals and ethics. The code says that staff “should be able to report such conduct without fear or loss of favor”. If a patient is put at risk due to unethical or incompetent behaviour, nurses are required to report this behaviour to their superiors or the appropriate governing body.
Working with Students
Student placements or internships are an essential part of the training required for new nurses, doctors and other healthcare professionals. All of those working in a hospital will have undertaken a student placement throughout their studies. Students must have the opportunity to observe clinical practice and hone their skills in these settings. However, nurses are also obliged to seek patients’ best interests. If a patient doesn’t want a student to observe or be involved in their care, the nurse needs to respect their wishes. The dilemma here is balancing the need of the student to learn and further their education with the interests of the patient. The solution here is to respect the patient’s wishes, as chances are another patient will have no objection to a student’s observation, giving the student another chance to learn.
Accepting Gifts from Patients
Nurses will often be offered gifts from patients, either while they’re in the hospital or after they’ve been discharged. This can present a moral dilemma, especially if the gift is high-value, expensive or inappropriate. This is a tricky one. For instance, it’s widespread for patients or family members to drop in flowers, chocolates or baked goods at the nursing unit. These gifts are typically accepted and are appreciated. When it comes to expensive or inappropriate gifts, nurses may have to decline the gift politely. Most hospitals and healthcare organizations will have policies or guidelines about gift acceptance that nurses should follow.
Managing Conflicts of Interest
Sometimes, conflicts of interest arise for nurses working in healthcare settings. For instance, if the nurse has an existing relationship with a patient. This could be a family, intimate, professional, social or other relationship. In some cases, a nurse might have to decline to provide care to such a patient and instead rely on colleagues to provide the care. Another conflict of interest that can arise is financial, and the solution to this is that patient care and health should always come before a nurse’s financial interests.
Conclusion
This informative article has shared how nurses can manage moral dilemmas in patient care. We’ve shared six common and not-so-common moral dilemmas and how nurses can manage them. By now, you’re fully informed about these scenarios and what to do if you experience them.
