Finding the balance between autonomy, justice, beneficence and non-maleficence is the most challenging part of being a medical practitioner in the face of conflict. While we entrust nurses with caregiving, protection and decision-making, patients still have a say in their health based on external beliefs, narratives or values, depending on what informs their opinions.
Ethical issues arise when there needs to be more clarity on the ideality of the choices, yet the only option is to choose one direction. The results are ethical implications, typically leading to more unanswered questions than answers. In the middle of the turmoil are professionals who know the right thing to do but are not allowed to do it or are unsure of their actions, thus causing moral distress, problematic medical relationships and generally doubtful patient care.
What are the top ethical issues in nursing?
The formal code of ethics was implemented in the 1950s by the American Nurses Association to guide nurses in their daily practice. “The Code” – as healthcare professionals often refer to it – has seen several reviews and amendments over the years to accommodate the consistent changes in the field and provide further guidance based on arising ethical issues.
With these changes, pursuing a nursing education at a progressive institution such as Cleveland State University is vital. The university offers comprehensive and flexible programs, including the opportunity to acquire a master’s in nursing education online. The program aims to help nurses grow their careers beyond the hospital. Through the comprehensive curriculum, you will learn best practices to improve patient outcomes and establish a robust and productive career as a nursing educator. In addition, you will gain a better understanding of ethics in the workplace to help you navigate the challenges that come with the nursing profession.
The most prevalent ethical issues facing both experienced and inexperienced nurses include the following:
Patient privacy and confidentiality
The Health Insurance Portability and Accountability Act (HIPAA) defines the boundaries for protecting a patient’s medical information. The law stipulates the legally enforceable right of the patient to see and obtain copies of their medical information from healthcare providers, and anything to the contrary can lead to legal ramifications.
Although nurses are responsible for acting in their patient’s best interest, they must tread carefully and not disregard the patient’s right to autonomy. For example, a patient may withhold information meant to help in their assessment and treatment when the patient feels they cannot trust the nurse with this information.
Pro-life vs. pro-choice
Nurses will find themselves in medical situations where politics and the field of healthcare collide. The conflict between the patient’s wants and the law can be formidable, especially when it comes to terminating a pregnancy. A perfect example is a pregnant patient with a history of lupus who decides to keep the pregnancy despite the risks. The nurse must do what is best for the patient, but they cannot oversee the patient’s autonomy.
Autonomy vs. beneficence
Another case of a patient’s decision vs. a nurse’s responsibility is when a patient, for some reason or other, opposes or refuses treatment. Think of a situation where a patient is critically ill, but the side effects of the medication make them feel worse than better, so they prefer to avoid the treatment. However, the patient’s family depends on the nurse to find alternative medication delivery methods. The code instructs medical professionals to obey the patient’s wishes, yet a family does not want to give up and eventually lose their kin. Regardless, the law instructs medical professionals to follow the patient’s wishes.
Equity vs. availability of resources
Supply does not always meet the demand, even in a hospital setting. Imagine the scenario of a nurse stationed in a remote area, and there is a cholera outbreak. All patients come in critically ill and require emergency services. However, the hospital is also short-staffed, and all these patients are relying on the nurse for emotional and physical support.
While the primary ethical obligation of the nurse is to ensure everyone gets the best care possible, how do they decide who deserves or needs care at a specific time? The nurse may bear the load of prioritizing care.
Ethical implications arising from ethical issues
Ethical implications in this context refer to the consequences of an ethical dilemma. The lack of consensus during the decision-making process often leads to the following issues:
Legal ramification
A patient or their family pays to sue a hospital or staff if they feel they were not given adequate or quality care. It is worth noting that legal issues are often set and are punishable by law. On the other hand, ethical standards are only sometimes formed legally. Regardless, the code of ethics is detrimental in determining the penalties for violations.
Emotional distress
In the face of conflict, both parties – the patient and the nurse – face emotional distress. Ethical issues significantly hinder their performance primarily because the nurse tries to find better or alternative solutions to administer the best care without violating the patient’s rights. In contrast, the patient seeks relief and sometimes disregards medical advice to adhere to their beliefs. The emotional distress may further compromise the patient’s physical health and affect the nurse’s ability to perform their duties.
Compromised patient care
Any doubt by the patient in their nurse’s ability to give proper care may trigger a question of the integrity of the practitioner and the healthcare facility. While the patient can limit the level of care they receive, they can also tarnish the system’s reputation, affecting the decisions of other patients. Such cases have led to constant code review to create more clarity and avoid such scenarios.
How can nurses best handle ethical issues?
Despite the numerous years of education and training, many methods exist to help nurses deal with ethical issues. Nevertheless, nurses must adhere to the ANA Code of Ethics to back their practice. It provides clear guidelines and acts as the social contract between the nurse and society.
It would also benefit nurses to establish personal boundaries and consult their peers and superiors in decision-making. Ultimately, a nurse’s decisions should always be well-informed according to the code and their own academic knowledge. They can also learn from the mistakes of others and remain conscious of how they approach general challenges.