Ethical Dilemmas among Nurses

Ethical Dilemmas among Nurses

Clinical ethics refers to an area that provides a structured approach used to identify, analyze and resolve ethical concerns in clinical medicine. Clinical medicine, either from the scientific or technical perspective, involves an encounter between the physician and human beings. The nurse's work is to diagnose the disease, offer advice, and provide treatment based on the moral context (Aroskar, 1993). A healthy ethical relationship can be attained through the nurse and patient's willingness to embrace moral values. The most common moral values in nursing practice include mutual respect, trustworthiness, honesty, commitment, and compassion. On some occasions, the physician and the patient may disagree based on values or may be faced with choices that are challenging to their values. The events begin with ethical problems that can escalate if not adequately solved. In this study, the ethical issues surrounding the professional obligations of nurses are discussed. The study also extends into how the nurses' professional obligations are shaped by the two principles of ethics, beneficence, and nonmaleficence.

Each nurse should take responsibility for their professional practice and the nursing team's responsibility. Nurses owe the same duty to themselves as they do to others, including promoting health and safety, preserving the wholeness of integrity and character, maintaining confidence, and continuing professional and personal growth. Very few nurses perform their duties independently, as a vast majority are employed by agencies such as hospitals, community health departments, schools, physicians, and industries, among others. The contract signed between the nurse and the agency is meant to enable them to conduct their primary obligation to the patients or clients. The primary obligations include preventing illnesses, promoting health, providing supportive care, alleviating suffering, and restoring health (Aroskar, 1993). The responsibilities of the nurses are specified within the contract either through oral or written forms and are also provided under the ANA code of conduct for nurses.

At times, since nurses fall under the compassion trap, they are obligated to do more than specified in the contract. As a result, they end up accepting patients' expectations and employing agencies and healthcare workers. In other words, nursing is a helping profession and, therefore, can subordinate their desires and needs to those of others. Engaging in ethical analysis assists nurses in thinking critically about difficult situations. The ethical analysis permits an individual to examine all aspects of the situation and past personal feelings. Beyond feelings and personalities, nurses formulate a more objective and critical perspective. The idea is often present whenever an individual is faced with an ethical dilemma. For instance, when a nurse spots a situation where the patient is not given the kind of care they deserve, they will have to decide whether to report the situation to the supervisor or not. Two scenarios are bound to occur. Either they will report the situation and uphold the integrity of the facility or keep silent and risk the patient's life.

Nurses must adhere to various ethical principles to function entirely with integrity. The principles include autonomy, justice, beneficence, and nonmaleficence. Ethical values refer to the universal codes of conduct that form the practical basis for identifying the types of actions, motives, and intentions that are valued (Haddad & Geiger, 2018). In line with professional obligations, ethics refer to the moral principles governing how nurses or a group of nurses conduct or behave themselves when discharging their duties. Therefore, the main focus of the concept is based on the right and wrong of the actions and includes the decision-making process in determining the ultimate consequences of such actions. Each individual is endowed with their own set of morals or ethical values. Therefore, ethics in healthcare is crucial since nurses must recognize the dilemmas and make sound judgments based on the values while also observing the law.

The process of responding to medical indication daily by nurses who care for patients include diagnosis of their condition and the provision of helpful treatment. The principles of beneficence and nonmaleficence govern the activities surrounding such undertakings. The principles pertain to the process of acting to provide benefits to the patients as opposed to hurting them. One of the ancient Hippocratic oaths in medicine states, "I will use treatment to benefit the sick according to my ability and judgment but never with a view to injury and wrongdoing." (Jonsen et al., 1982). The oath portrays the commitment of nurses to ensure that patients are well taken care of in the treatment process to ensure the successful restoration of their health. Another Hippocratic that is vital for clinicians states that people should always aspire to create benefits for others and not harm them.

The principle of nonmaleficence reminds nurses that the most important concern of their practice is to cause no harm to the patients. Beneficence, on the other hand, is concerned with the promotion of actions that provide support to others. When considered together, the two concepts suggest that nurses ought to act in a manner that creates benefits for patients and at the same time protects them from any harm. Unfortunately, many ways exist for a nurse to harm a patient, including negligence, assault, and medical malpractice. On the contrary, there are also many ways in which nurses can benefit the patient, such as providing evidence-based care and ensuring prompt follow-up after therapy. Therefore, in medicine, the concepts of harm and benefits have specific meanings that are different from other uses.

The principles of beneficence and nonmaleficence in nursing practice generally refer to assisting the patient by attempting to relieve, with safety in mind, the patient the condition and the pain, distress, and loss of function associated with the condition. Beneficence generally refers to the efforts to try and bring improvements in the psychological and physical health that can be achieved. The diagnostic and therapeutic actions under the principle of beneficence include diagnosis and cure of infections, treating cancer whose ultimate result is remission, palliating pain, and facilitating the healing of a fracture. Therefore, when such practices are fused with the principle of nonmaleficence, it will mean performing such activities that lead to a greater good without causing further complications. In other words, nonmaleficence teaches nurses to perform their duties to the best to reduce risks (Jonsen et al., 1982). Medical benefits are treated under these two principles as nurses' objective contribution to patients' health.

The principles of beneficence and nonmaleficence are assessed in medicine using the benefit-risk ratio reasoning. This would be wrong if a nurse sets out to harm a patient. Nonetheless, it is also inevitable that whenever e nurse attends to the patient's needs, for instance, by surgery or medication, some harm may ensue or occur. Most prescribed drugs are associated with risks or side effects, while surgical procedures may create wounds. Therefore, the two principles do not merely instruct nurses to assist patients and cause no harm but rather act as guidance to the nurses to assess the amount of risk justifiable through the intended benefits. The nurse will have to determine the ratio and include it in the recommendations to the patients, who then evaluate them in their values. For instance, a nurse will have to decide whether to offer steroids to a patient with diabetes and asthma to quell the worsening pain. The nurse knows clearly that steroids are not suitable for treating diabetes.

In conclusion, the study aimed to examine the concept of the professional obligation of nurses and how the two principles of ethics, beneficence, and nonmaleficence. Nurses are expected to take responsibility for their actions and those of others in the same team. The primary obligations of nurses when they enter into a contract with their respective agencies include health restoration, reducing suffering, and offering supportive care for the dying. Ethical considerations provide nurses with structured means of identifying challenges, analyzing, and resolving clinical problems. Two ethical principles are crucial in efforts by nurses to discharge their professional obligations, beneficence, and nonmaleficence. Whereas beneficence reiterates the need to provide benefits to others and improve their welfare, nonmaleficence pertains to the obligation of the nurse not to intentionally cause harm to the patient. Therefore, the two are crucial in shaping the professional obligation of nurses and the nursing profession.

References

Aroskar, M. A. (1993). ETHICS in NURSING by Martin Benjamin and Joy Curtis. JOURNAL OF CLINICAL ETHICS, 4(4), 368-369.

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. National Library of Medicine.

Jonsen, A. R., Siegler, M., & Winslade, W. J. (1982). Clinical ethics a practical approach to ethical decisions in clinical medicine.