ethical dilemma in nursing essay examples

Common Ethical Dilemmas in Nursing and their Solutions

Healthcare professionals, including nurses, face ethical dilemmas fairly regularly. Most of the dilemmas are usually serious and very stressful because when faced with a dilemma, a nurse must make a decision, which is easier said than done.

As a nursing student, you might be assigned to write an essay where you identify, analyze, and resolve an ethical dilemma. We have noticed over the years that many students struggle with writing an ethical dilemma nursing essay. If that sounds like you, read this post that comprehensively explores ethical dilemmas in nursing, including their examples and solutions.

In most cases, essays about ethical dilemmas in nursing take the reflective essay approach, where you reflect on real, researched, or imagined clinical scenario or encounter. It could be during your placement, clinical rotations, or shadowing experiences. As you do so, you will borrow from various ethical theories and decision-making models.

If you could use some help, our experienced online nursing essay writers can help you get a bespoke ethical dilemma essay at an affordable fee.

Let's get started with the basics to more advanced concepts.

What is an Ethical Dilemma in Nursing?

An ethical dilemma is a scenario where it is not easy to decide one way or another. Nurses are faced with ethical dilemmas almost every day. They have to make serious and difficult decisions fairly regularly. The decisions can sometimes mean life or death. Therefore, as a student nurse, it is vital to learn about ethical dilemmas nurses face, how to identify them, and how to solve them correctly.

When facing an ethical dilemma, you should always follow the nursing code of ethics . This is because most dilemmas can be solved by following the nursing code of ethics. The nursing code of ethics is a bunch of rules nurses has to follow to provide quality, safe, and unquestionable care to those who need it.

While most dilemmas can be solved by following the code of ethics in nursing, some dilemmas cannot be solved in this manner. The reason is that the nursing code does not guide every ethical dilemma or situation.

If faced with a situation that makes it difficult for you to follow the nursing code of ethics, you should use your judgment to weigh the pros and cons of both decisions to make the right decision.

Examples of ethical dilemmas nurses face regularly include: how to deal with a non-compliant patient, how to deal with a patient that is refusing treatment, and whether to disclose confidential information to help a patient.

Ethical Dilemma Versus Moral Dilemma

The terms ethical and moral are often used interchangeably in speech. However, the two terms do not always mean the same thing. For example, there is a slight difference between ethical and moral dilemmas.

An ethical dilemma involves two morally correct choices, but one is slightly more ethically problematic than the other. In contrast, a moral dilemma is a situation with two morally correct choices, but neither is preferable. For the moral dilemmas, the nurses know the right action yet might be limited to acting by forces outside their control.

As a nurse, you are more likely to face ethical dilemmas than moral dilemmas. Because ethical dilemmas are anticipated, a code of conduct has been created to help you always make the right decision.

Reasons Nurses Face Ethical Dilemmas in Healthcare

There are many reasons why nurses face ethical dilemmas frequently when providing care to patients. The following are the eight main ones:

• Inadequate staffing. When a healthcare facility has fewer staff than it needs to function optimally, nurses sometimes must make a tough decision. They have to decide whether to work longer to care for patients or to prioritize their mental and physical health and work only as much as possible.
• Incompetent peers. As a registered nurse, you will have a big dilemma if you notice a colleague showing incompetence. You will have to choose one of two options – to ignore your colleague's incompetence because they are a friend and they probably will not do it again, or report your colleague to a supervisor to ensure high standards are maintained. This is an ethical dilemma since the former is more ethically problematic than the latter.
• Religious/cultural beliefs. Your religious or cultural beliefs may present an ethical dilemma as a practicing nurse. For instance, you might be given a nursing assignment that contradicts your religious beliefs, e.g., you are asked to clean up the private parts of a male patient after a procedure as a Muslim female nurse (this is forbidden according to Islam). It is easy to see how this situation would present an ethical dilemma.
• Patient refusing treatment. There are occasionally situations when patients refuse treatment. As a nurse, you know what is best for the patient. However, you also know that they have the right to make their own decision. So when a patient refuses treatment, this will always present you with an ethical dilemma – do you insist and look for ways to ensure they get the treatment or grant them their wish?
• Artificial nutrition and hydration. Some patients and older adults do not want to be fed or hydrated using a tube. This presents a huge ethical dilemma for nurses. This is because nurses are trained to care for people who need it. Therefore, they feel bad about it when they see the need to provide artificial nutrition and hydration and get stopped because of a patient's wishes. They feel so bad because they know there is something they can do, yet they are asked not to do it.
• Providing futile care. Being asked by a patient's family to continue providing care despite a patient's continued decline is one of the biggest ethical dilemmas nurses face. This is especially true for critical care nurses. Being trained medical staff, they can see when it is not in a patient's best interest to continue receiving aggressive interventions. However, most of the time, patient families don't want to give up on their loved ones. Therefore, they insist that interventions continue presenting nurses with a big ethical dilemma.
• Opioid crisis. The opioid crisis across the United States presents nurses with several ethical dilemmas. For example, many nurses do not want to give patients opioid pain medications, especially when they believe they risk getting addicted. Now imagine knowing that a patient can benefit from a medication yet at the same time feeling like it could lead to them getting addicted to it
• Anti-vaccine stance. Nurses who do not mind vaccines face a dilemma whenever they interact with those against vaccines. This is because, on the one hand, they know they have to provide care to everyone without discrimination. Yet, on the other hand, they know that people against vaccines pose a serious public health hazard.

Identifying Ethical Dilemmas in Nursing

As evident in the section above, ethical dilemmas can arise virtually anywhere in the nursing world. It is up to you as a nurse to identify dilemmas when they arise and deal with them as expected by the ANA code of conduct. In this section, we are going to focus on how to identify ethical dilemmas in nursing.

Here are the main indicators of ethical dilemmas in nursing.

• Harm potential. When you face a healthcare situation that has the potential to impact a patient negatively, you are most likely facing an ethical dilemma. If it were so easy to spare the patient from the negative impact, the situation wouldn't be a dilemma because this is the option you would take.
• Conflict of interests. When you face a healthcare situation with a conflict of interests between you and the patient or you and the case management team, it is likely an ethical dilemma.
• Uncertainty. This is perhaps one of the biggest indicators of ethical dilemmas and dilemmas. When you face a healthcare situation in which you are unsure what to decide, you are most likely facing an ethical dilemma. Nurses are trained to judge situations and make decisions quickly. When you cannot do these things as a nurse, something is holding you back, and the situation is likely a dilemma.
• Cautiousness. When you face a healthcare situation in which you are cautious about the outcome of the options you can take, you are most likely facing an ethical dilemma. People are cautious when making ethical dilemma decisions because they do not want to see negative consequences (if any) caused by their decision(s).
• Delay. When you have a decision to make at work and keep delaying the decision-making, you are most likely facing an ethical dilemma. People delay making ethical dilemma decisions because they fear the consequences.

Principles of Nursing Ethics

Principles of nursing ethics were formulated to help nurses consistently make the right decisions when faced with ethical situations. There are many principles of nursing ethics, but the main ones are non-maleficence, beneficence, autonomy, and justice. These are the ones that are always integrated into nursing training programs to help nurses make the right decisions whenever they are faced with difficult situations.

1. Nonmaleficence

Nonmaleficence is probably the most well-known ethical principle in the healthcare world. It applies to nurses, doctors, and other medical professionals.

This principle teaches nurses that it is their responsibility to provide care, treatment options, and/or case management in a manner that does not harm the patient. When you internalize this principle as a nurse, you will always choose to provide care and treat patients safely.

Non-maleficence is an important part of providing patients with safe and quality care. Exercising this principle means doing everything possible as a nurse to provide care while ensuring the highest degree of patient safety.

An excellent example of non-maleficence in nursing practice is withholding the administration of a powerful medication until you get confirmation on whether a patient is allergic to it or not. Another example of maleficence in nursing practice is discontinuing medication when you notice signs of adverse reactions.

When a nurse lacks this principle, it can result in dire consequences for patients. More specifically, a lack of nonmaleficence can lead to reduced patient safety. And, of course, this can mean patient injury or even death. Patient injury or death resulting from lack of nonmaleficence can cause mental trauma, job loss, and even legal consequences.

Therefore, it is imperative to internalize and adhere to this nursing principle.

2. Beneficence

Beneficence is another important nursing principle. This principle is characterized by charity and kindness. It is basically all about ensuring your actions are guided by compassion and maximum consideration of the welfare of those you serve.

While some people choose to pursue nursing for the money or job security, most people in nursing are in it out of their love for serving others. Therefore, this beneficence principle is almost always naturally ingrained in the minds of most nurses.

The best way to apply this nursing ethical principle is to always act in the patient's best interest regardless of the circumstances. Practicing this principle regularly will ensure the patient is always cared for in the best way possible. You will also automatically improve positive patient outcomes.

An excellent example of beneficence in nursing practice is offering to sit with a patient to console them after giving them bad news about their situation. Another superb example of beneficence is drawing curtains to protect a patient's and his family's privacy when exchanging final goodbyes.

Lack of beneficence can result in poor nurse-patient relationships and reduced patient safety. When a patient realizes you are not kind or acting in their best interest, they will not be very interested in showing you kindness or respect. This can result in poor nurse-patient relationships and adverse patient outcomes.

As mentioned above, a lack of beneficence can also lead to reduced patient safety. When you don't act in the patient's best interest, it can lead to safety issues such as failure to record vital info, failure to use protective measures when providing care, and medication errors.

It is easy to see how following this principle can make it easier for nurses to provide quality care and make more ethical decisions.

3. Autonomy

Autonomy is a fundamental nursing ethical principle. It recognizes the right of the patient to make their own decisions. Nurses must never forget this right to avoid imposing their will or self-interest on the patient. 

Of course, there is a right way to recognize patients' independence and ability to make their own decisions. This right way involves offering the patient all the necessary information to make the best decisions. This information includes available treatment options and the pros and cons of each option.

Once a nurse has offered a patient all the correct information, they have to respect whatever decisions the patient makes, even if they disagree.

Autonomy is essential in nursing practice because it helps nurses adhere to the patient's wishes. It is also important because it passes responsibility for some major care decisions to the patient they will affect the most.

A good example of autonomy is when a nurse agrees to respect a patient's choice not to get treatment, even if they believe the treatment benefits the patient. Another excellent example of autonomy is a nurse respecting a patient's wish to be seen or attended to by a nurse of the same sex for religious reasons.

When a nurse doesn't practice this ethical principle, they can make decisions that make patients feel disrespected. They can also make decisions that can lead to a breakdown of the nurse-patient relationship. Thus, it is always essential to have this ethical principle in mind.

Justice is a fundamental ethical principle. It is all about nurses showing fairness in the way they provide care. Nurses must provide quality care to patients regardless of their appearance, age, financial history, religious preference, race, and gender.

Even when faced with a situation that involves healthcare for a convicted murderer or any other criminal, a nurse must still offer the best care they can provide.

This nursing ethical principle is crucial because it ensures fairness and equity in nursing. In other words, it provides patients care regardless of who they are. This usually has the effect of making patients feel valued. This, in turn, usually has the effect of enhancing patient outcomes.

A good example of justice in nursing practice is providing care to a known anti-vaccine campaigner when they get COVID or any other vaccine-preventable illness. This is justice and fairness because it allows the person to become well again without considering the negative influence of vaccine use.

A nurse lacking this ethical principle can act in ways that make a patient feel rejected, leading to adverse patient outcomes. It can also lead to unfair prioritization in care provision, resulting in dire consequences for the patient.

By following the nursing ethical principles discussed above and adhering to the ANA code of conduct, you can handle different ethical dilemmas correctly and without serious negative consequences.

Examples of Ethical Dilemmas in Healthcare

Understanding some ethical dilemma scenarios you can write an essay about as a nursing student is essential. Remember, there is never a right or wrong answer; in the same way, there is no small or big ethical issue. As long as it impacts healthcare, it falls within nursing practice or medical ethics.

The following are some of the most common ethical dilemmas in nursing.

1. Pro-choice versus pro-life.

The pro-choice versus pro-life dilemma is common in nursing. For example, when a patient wishes to have an abortion because they do not want a baby, yet a nurse is pro-life because of religious beliefs, it becomes a big dilemma.

SOLUTION : Respect the wishes of the patient.

2. Religious beliefs versus science.

This dilemma is common in nursing practice. For example, it can occur when a patient refuses a specific procedure or treatment because of religious beliefs, yet a nurse knows what science says is best in the situation.

SOLUTION : Respect patient autonomy and do as they wish.

3. Beneficence versus autonomy.

As a nurse, you must practice beneficence (kindness and charity). You are also required to respect the patient's autonomy. Now imagine you have been ordered to give a patient medication to ease pain and suffering, yet they insist on not taking it to stay awake and spend their last minutes with their loved ones. This presents a great beneficence vs. autonomy dilemma.

SOLUTION : Obey the patient's wishes as long as they are conscious and can make their own decisions

4. Anti-vaccine stance.

As a nurse, you must follow exactly what the guardian wants for a child unless it is required by law to do otherwise. Now imagine a situation where a parent refuses to let their child get vaccinated, yet you know at the back of your mind that vaccines benefit children. You know what you must do, yet a guardian insists you must not do it. This is a significant ethical dilemma.

SOLUTION : Obey the guardian's wishes for their child.

5. Withholding information versus being honest.

Nurses are ethically expected to be open and transparent with patients. However, there are cases when you may feel as a nurse that explaining the gravity of a situation to a patient will worsen their stress and anxiety. You may, therefore, think it is more appropriate to withhold some information from them. This presents a big dilemma.

SOLUTION: Always be honest, especially when the situation is complex. Patients deserve to know the truth.

6. Limited resources versus healthcare needs.

Nurses occasionally face situations where their resources are not optimal for the people they serve. Remember the COVID-ventilator issue? Doctors and nurses had to decide whom to give ventilators initially at the start of the pandemic when there were not enough ventilators.

SOLUTION: When the resources are limited, choosing patients based on severity is recommended.

7. Questionable orders.

Doctors and other medical professionals are not perfect. They make mistakes from time to time. Therefore, you will have a big dilemma when a doctor prescribes treatment, and you feel it is not the best treatment in the back of your mind. Do you fulfill the doctor's order or intercede and question it?

SOLUTION: When you feel something wrong is about to happen, you should speak up to protect the patient's interest.

How to Address Ethical Dilemmas in Nursing

The best way to address ethical dilemmas is to internalize and follow the nursing ethical principles and the ANA code of conduct. However, not everyone constantly has the time and energy to review nursing ethical principles and the ANA code of conduct.

For this reason, we have shared the tips below to help you correctly address ethical dilemmas in nursing.

1. A Problem Shared Is a Problem Halved

When you feel uneasy about an ethical situation, you should share it with a trusted colleague or a supervisor. Communicating the problem with someone else invites a fresh perspective to the problem and increases the likelihood of arriving at a better decision.

2. Internalize Patient Autonomy

Remembering and recognizing patient autonomy or the right to make their own decisions is always important. It doesn't matter what you think is best for a patient – what they want is what you should do as long as it is legal and within your nursing responsibilities. Of course, you should present the patient with all the information they need to decide. So if you ever have to grapple with an ethical situation that makes you feel like ignoring patient autonomy, you shouldn't do it. You should choose the option that ensures patient autonomy.

3. Respect the Right to Privacy

Every patient has a right to privacy. This means you should treat their information as confidential and only to be shared with them or with persons they approve. It is not in your place to share patient information, especially when it is sensitive. You can only share info when given consent. Therefore, if you ever have a dilemma about sharing information, remember to respect the right to privacy and ask for consent to share info if you think it is necessary.

4. Transparency is Key

You should always be open and honest with patients. Doing this will help you to avoid many ethical situations. It will also make it easy for you to make ethical decisions. Therefore, whenever necessary, please share all the information you can share with patients to help them understand what is happening. Share with them the pros and cons of every treatment or management option. Let them be fully aware of the benefits and risks of everything.

5. Ask Yourself What Is in The Best Interest of the Patient

Whenever you need to make an ethical decision, in addition to all your other considerations, you should ask yourself what is in the patient's best interest. Asking yourself this question will help you act in a way that ensures the patient's best interests are taken into account. It will also force you to involve the patient in decision-making to know what they want or wish for. You can never go wrong by acting in a patient's best interest.

6. Stay Up-To-Date with Ethical Guidelines

Ethical guidelines change regularly. Therefore, to ensure you are always making the right ethical decisions, you should stay up to date with ethical guidelines (both professional guidelines and institution-specific guidelines). It is not always easy to do this, but you can subscribe to nursing blogs that discuss ethical guidelines. This will ensure you always have the latest information you need to make good ethical decisions. You can also stay up to date by enrolling in at least one online ethical nursing training program or course. This will help you to refresh your ethical principles knowledge and to be aware of the latest ethical issues in nursing.

7. Always Do Something as Soon as You Can

When faced with an ethical situation, never do anything and hope the situation will resolve itself. Always do something as soon as possible. This will ensure either the issue is solved or starts getting solved. When you ignore an ethical situation, it has the risk of snowballing and becoming a much bigger issue down the line. Therefore, please do something about an issue whenever you can do it quickly.

8. Negotiating Never Hurts Anybody

One of the best things you can do when facing a nursing ethical dilemma is to negotiate with the parties involved. When you do this respectfully and fairly, you can easily resolve most ethical situations. For example, if a patient refuses a specific treatment for religious reasons, you can convince them to accept it using various persuasion techniques. Of course, you should respect the patient's decision if they insist on a certain stance or position.

9. Talk to Somebody Higher Up

As a nurse, some ethical decisions are not yours; they are above your pay grade. In such a case, they should be referred to somebody higher up, e.g., the nurse manager or the nurse supervisor. Because the manager or supervisor is usually more experienced, they are often in a much better position to handle ethical decisions and teach you what to do when faced with the same situation again.

Consequences of Failing to Address Ethical Dilemmas in Nursing Properly

When you fail to address ethical dilemmas in nursing correctly, there are often negative consequences. The most common negative consequences nurses have to deal with include the following:

1. Loss of License

When you are faced with an ethical decision, you must make sure you act in the way expected of you according to the nursing code of conduct. Failure to act in the manner that is expected of you in the nursing code of conduct can lead to loss of licensure. This is especially true when your decision in an ethical situation is an egregious violation of the nursing code of conduct or the ethical principles of nursing. Therefore, when faced with an ethical decision, it is best to consider the options carefully and to act in the way that is expected of you.

2. Legal Issues

You could face legal issues when you fail to adequately address certain ethical dilemmas in nursing. As a nurse, you have specific responsibilities. You are also expected to adhere to the nursing code of conduct. If you fail to address ethical issues correctly, e.g., you leak confidential information about a celebrity patient for money to the public, you could face legal issues, including a lawsuit and/or criminal charges. Hence it is crucial to think long and hard about some ethical issues before deciding what to do.

3. Job Suspension or Termination

Most hospitals have a code of conduct that nurses and other healthcare professionals must sign when hired. They expect nurses to follow the code to the letter. Most hospitals also expect nurses to follow the ANA code of conduct and to always adhere to the ethical principles of nursing. So when faced with an ethical situation and failing to act correctly, you could end up before the ethics committee of your hospital, and they could recommend your suspension or the termination of your job contract.

4. Stress and Burnout

Ethical situations can cause a lot of stress and mental burnout. They can make it almost impossible for you to continue operating normally. When you ignore them or make the wrong decision, you can potentially make them worse. This can lead to even more stress and even physical burnout. Consequently, it is important to make the right decisions quickly when faced with ethical problems or issues.

5. Negative Patient Outcomes

The worse thing that could happen if you don't address ethical issues correctly is an adverse patient outcome, such as patient deterioration, patient injury, or death. It is always painful for nurses to realize or discover that their decisions caused an adverse patient outcome. It can lead to stress, loss of self-confidence, and so on. Of course, an adverse patient outcome can also lead to legal issues, job suspension, and job loss. So it is best to make the correct decision whenever faced with an ethical dilemma.

Takeaway about Ethical Dilemmas in Nursing Practice

Nursing training is all-rounded in anticipation of all the issues a trained nurse would experience in typical clinical settings. Learning about ethical dilemmas and how to solve them can be a stepping stone toward excellence as a nurse or medical/healthcare practitioner. You will be dealing with many ethical dilemmas in the workplace and an experience on how to solve them can always help you avert adverse situations.

Related Readings:

• List of hot controversial topics for nursing issue papers

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20 Common Examples of Ethical Dilemmas in Nursing + How to Deal With Them

If you are a nurse, chances are you have faced situations where you had to make decisions based on your belief of whether something is right or wrong, safe or unsafe. This type of decision is based upon a system of ethical behavior. It is essential that all nurses develop and implement ethical values into nursing practice. If this sounds familiar, you may be asking, "What are the common examples of ethical dilemmas in nursing?" There are many things that could be considered an ethical dilemma in nursing, and it is important for nurses to know how to address them when they occur. In this article, I will share the 20 most common examples of ethical dilemmas in nursing and offer some insight into handling them.

What Is An Ethical Dilemma In Nursing?

5 main reasons why nurses face with ethical dilemmas in nursing.

1. Patients or their loved ones must make life or death decisions 2. The patient refuses treatment 3. Nursing assignments may contradict cultural or religious beliefs 4. Nursing peers demonstrate incompetence 5. Inadequate staffing

How To Identify Ethical Dilemmas In Nursing?

What are the common examples of ethical dilemmas in nursing, example #1: pro-life vs. pro-choice, ethical dilemma:, how to deal with this ethical dilemma:, example #2: protecting the adolescent’s right to privacy, example #3: empirical knowledge vs. religious beliefs, example #4: parent refuses to vaccinate child, example #5: personal and professional boundaries related to social media, example #6: nurse is instructed to have patient with low literacy level to sign consent for treatment, example #7: end-of-life decision-making, example #8: inadequate resources to provide care, example #9: former patients - to date or not to date, example #10: informed consent, example #11: inadequate staffing, example #12: spirituality vs. science, example #13: patient addicted to prescription pain medication, example #14: duty and compassion do not align with facility safety protocols, example #15: patient does not have an advanced directive, example #16: incompetence among nursing peers, example #17: disclosing the seriousness of medical conditions, example #18: questioning physician orders, example #19: asked to work in a department without training, example #20: beneficence vs. autonomy, 4 consequences of avoiding ethical dilemmas in nursing, 1. nurses can quickly experience burnout., 2. avoiding ethical dilemmas in nursing can lead to legal issues., 3. nurses who avoid ethical dilemmas could lose their jobs., 4. loss of licensure:, my final thoughts.

10 Examples of Ethical Dilemmas in Nursing

When caring for human lives, the decisions you have to make as a nurse are anything but black and white. In addition to taking vital signs and doing dressing changes, there are a realm of tough choices and ethical dilemmas that nurses have to face every day.

Picture this: a nurse finds himself torn between respecting a patient's right to refuse treatment and their deteriorating health. Moral puzzles like these leave even the most experienced nurses scratching their heads and feeling caught between a rock and a hard place. However, understanding how to handle ethical dilemmas isn't just a theoretical exercise. It's a crucial skill that nurses need to have in their toolkits. 

The nursing code of ethics acts as a guide for nurses to help in these decisions, but it can be helpful to see actual examples of ethical dilemmas in nursing and what a nurse should do with each of them. That’s exactly what this article is about. 

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10 common ethical dilemmas in nursing .

While there are many different situations in which a nurse may find themselves dealing with an ethical dilemma, here are 10 common ethical dilemmas in nursing to consider and how a nurse might deal with them:

1. Patient Autonomy vs. Beneficence

Balancing a patient's right to make decisions about their own care with the nurse's duty to promote their overall well-being.

Let's say a patient diagnosed with diabetes refuses to take insulin, despite it being essential for controlling their blood sugar levels and preventing serious complications. 

In dealing with this situation, a nurse should follow the nursing code of ethics and take the following steps:

Respect Autonomy: Respect the patient's right to make decisions about their own care, even if they disagree with those decisions. 

Provide Information: Ensure the patient has accurate and comprehensive information about the treatment, including its benefits, risks, and alternatives. This allows the patient to make an informed decision.

Assess Understanding: Engage the patient in open and non-judgmental communication to assess their understanding of the treatment and the potential consequences of refusing it. 

Collaborative Decision-Making: Engage the patient in collaborative decision-making. Involve them in discussions and explore alternatives that align with their values and preferences. This approach fosters a sense of working together and mutual respect.

Seek Additional Perspectives: If the patient's decision still conflicts with the nurse's professional judgment and poses a significant risk to the patient's health, the nurse should seek guidance from the healthcare team and the nurse manager or supervisor they report to.

Document the Process: Throughout the decision-making process, carefully document all discussions, assessments, and the patient's decisions. This documentation serves as evidence that the nurse has fulfilled their ethical and professional responsibilities.

>> Related: What is Autonomy in Nursing?

2. Confidentiality vs. Duty to Warn 

Struggling with maintaining patient confidentiality while also considering the potential harm to others if vital information is not shared.

Imagine a scenario where a nurse working in a mental health facility becomes aware that a patient with a history of violent behavior has confided in the nurse about their plan to cause harm to their former partner. 

The nurse finds themselves in a challenging ethical dilemma: on one hand, they have a duty to maintain the confidentiality of the patient's personal information, and on the other hand, they have an obligation to protect other people from harm.

To deal with this situation, the nurse should take the following steps:

Evaluate the Severity of the Threat: Carefully assess the level of risk involved in the patient's intentions. Is there an immediate and credible threat to the safety of the potential victim? Consider factors such as the patient's history, current mental state, and access to means for carrying out the harm.

Engage in a Therapeutic Relationship: Explore the underlying issues and reasons behind the patient's harmful intentions. Attempt to address any underlying issues or triggers that may contribute to their behavior and encourage them to seek alternative ways to cope.

Seek Supervision and Consultation: It’s important for the nurse to consult with their supervisor or team members about the appropriate course of action to ensure the safety of the potential victim.

Follow Legal and Ethical Guidelines: Be aware of local laws and regulations regarding the duty to warn or protect. If there is a legal obligation to disclose information in order to prevent harm, the nurse should adhere to those requirements while minimizing the breach of confidentiality to the extent possible.

Document the Process: Document all steps taken, including the patient's disclosure, assessments, consultations, and decisions made. This documentation serves as evidence that the nurse acted ethically, responsibly, and in line with professional standards.

3. End-of-Life Care

Managing the ethical complexities around decisions about withdrawing or withholding life-sustaining treatment, considering the patient's wishes, quality of life, and family dynamics.

For example, consider the situation where a nurse is caring for an elderly patient with a terminal illness. The patient expresses the desire to die a peaceful death without aggressive interventions. However, the patient’s family opposes this and wants “everything medically possible” to be done to save the patient’s life. 

The nurse finds themselves in a complex ethical dilemma, torn between honoring the patient's wishes and respecting the concerns of the family.

Here’s how the nurse might address this situation:

Communication and Education: Engage in open and compassionate communication with both the patient and the family about the patient's medical condition. Discuss the patient’s prognosis, available treatment options, and the potential benefits and downsides of continuing or discontinuing life-sustaining measures. 

Respect for Autonomy: Advocate for the patient's right to self-determination and respect their wishes regarding end-of-life care.

Collaboration and Mediation: Facilitate a respectful and open dialogue, promoting a collaborative decision-making process. The nurse can involve the healthcare team, including palliative care specialists and social workers, to provide support, guidance, and mediation to resolve this situation.

Consider Ethical Decision-Making Frameworks: The nurse should use ethical principles in the nursing code of ethics, such as beneficence, non-maleficence, autonomy, and justice, to analyze the situation and guide their actions. By considering the patient's values, goals, and potential impact on their quality of life, the nurse can advocate for the most ethically appropriate course of action.

Supportive Care: Regardless of the final decision made, the nurse should provide holistic and supportive care to the patient and their family. This includes addressing physical, emotional, and spiritual needs, ensuring optimal comfort, and facilitating open communication to foster a sense of trust and understanding.

4. Resource Allocation

Facing the difficult task of distributing limited resources fairly and ethically among patients, especially during times of scarcity or emergencies.

Consider this scenario: During a severe flu outbreak, a nurse working in a hospital emergency department faces the ethical dilemma of resource allocation. The hospital is overwhelmed with patients and the available resources, such as beds, ventilators, and medications are limited. The nurse must make decisions about which patients receive the resources, balancing the needs of the patients in their care while also considering the needs of other patients in the hospital.

The nurse should manage this situation with fairness and transparency, using the following steps:

Prioritization and Triage: Follow established guidelines and protocols for triaging patients based on the severity of their condition and their likelihood of benefiting from the available resources. This ensures that decisions are made based on clinical needs rather than personal biases.

Open Communication: Maintain open and transparent communication with patients and their families. Explain the challenges faced due to limited resources and the criteria being used for resource allocation. This promotes understanding and trust, even in difficult circumstances.

Collaboration and Consultation: Work collaboratively with the healthcare team, including physicians and hospital administrators, to make informed decisions about resource allocation. Seeking input from multiple perspectives helps ensure fairness and accountability.

Consider Ethical Decision-Making Frameworks: Use the ethical principles of fairness and justice in the nursing code of ethics to guide the nurse’s actions. By considering factors like the potential benefits, risks, and overall impact on patients and the community, the nurse can strive to allocate resources in an equitable and ethical manner.

Advocacy and Support: Advocate for the well-being and rights of their patients, even when difficult decisions must be made. 

5. Informed Consent

Ensuring patients have a clear understanding of the risks, benefits, and alternatives of proposed treatments or procedures before they provide consent.

Here’s an example of how this ethical dilemma could occur: A nurse assists a physician who is rushing to obtain informed consent for a surgical procedure, despite the patient's pain and anxiety. However, the nurse quickly recognizes the patient's limited understanding of the procedure’s implications, raising ethical dilemmas regarding informed consent.

To handle this situation, the nurse should follow these steps:

Ensure Adequate Information: Intervene respectfully but assertively and ask the physician to slow down and provide the patient with complete information about the procedure, risks, benefits, potential outcomes, and available alternatives. 

Clarify Patient Understanding: Speak with the patient and assess their understanding of the information provided. Encourage the patient to ask questions and address any concerns they may have. 

Advocate for Time and Support: If the patient appears overwhelmed or is struggling to comprehend the information, the nurse should advocate for additional time or resources, such as involving a family member or providing educational materials or an interpreter (if appropriate) to support the patient in making an informed decision. 

Document the Process: Document the steps taken to address the concerns related to informed consent. Be sure to include any discussions, explanations provided, patients' questions, and their ultimate decision. Accurate documentation demonstrates the nurse's commitment to upholding ethical standards and professional accountability.

6. Cultural and Religious Beliefs

Navigating conflicts between a patient's cultural or religious values and the standard practices or protocols of healthcare.

In a multicultural society, nurses often encounter ethical dilemmas when a patient's cultural or religious beliefs clash with the standard practices or protocols of healthcare. An example is when a nurse is caring for a patient from a cultural background who strongly believes in traditional healing methods and is hesitant to accept Western medicine.

In this situation, the nurse should have a culturally sensitive discussion with the patient and demonstrate respect for diversity. Here are the steps the nurse should take:

Culturally Competent Assessment: Conduct a culturally competent assessment to understand the patient's cultural and religious beliefs, values, and preferences regarding healthcare. This requires active listening, open-mindedness, and avoiding assumptions or stereotypes.

Establish Trust and Rapport: Build a trusting relationship with the patient by acknowledging and respecting their cultural and religious beliefs. This can be achieved through effective communication, empathy, and demonstrating cultural humility.

Collaborative Decision-Making: Engage the patient and their family in collaborative decision-making regarding their healthcare. Respectfully discuss the patient's beliefs and preferences, and explore opportunities to integrate traditional healing practices with evidence-based Western medicine. 

Consultation and Education: If there are concerns about the patient's well-being or the appropriateness of certain traditional healing methods, the nurse should seek guidance from a cultural consultant, interpreter, or healthcare team. 

Advocacy and Liaison: Serve as an advocate for the patient, ensuring their cultural and religious rights are respected within the healthcare system. This may involve facilitating communication between the patient and healthcare providers, ensuring the provision of culturally competent care, and addressing any cultural or religious barriers that may arise.

7. Impaired Colleague

Grappling with the ethical responsibility of reporting concerns about a colleague's impairment due to substance abuse or mental health issues.

This situation might occur when a nurse becomes aware that a nursing colleague is impaired while on duty. The impaired nurse exhibits erratic behavior and smells strongly of alcohol. The nurse who witnesses this behavior finds themselves in a challenging ethical dilemma, torn between their duty to ensure patient safety and their loyalty to their colleague.

Nevertheless, the nurse needs to prioritize patient safety and act professionally by following these steps:

Immediate Concern for Patient Safety: The nurse's primary responsibility is to ensure the safety and well-being of patients. If they observe signs of impairment in their colleague that could compromise patient safety, they should take immediate action.

Reporting: The nurse should report their observations and concerns to the appropriate authority within the healthcare facility, such as the nurse manager or supervisor. This report should be made objectively without personal judgments or assumptions and with a focus on patient safety.

Confidentiality and Professionalism: Maintain confidentiality throughout the reporting process, being mindful not to disclose personal details of the impaired colleague unless necessary for the investigation.

Collaboration and Support: Collaborate with the healthcare team and support the impaired colleague's well-being by encouraging them to seek appropriate help and support, such as employee assistance programs or counseling services. 

Ethical Obligation: Nurses have an ethical obligation to protect the welfare of patients and maintain the standards of the nursing profession. This includes recognizing and addressing impairment issues among colleagues to ensure safe and quality care.

8. Professional Boundaries

Striking a balance between providing compassionate care and maintaining appropriate professional boundaries, particularly when it comes to personal relationships with patients.

In this example, let’s look at a scenario where a nurse develops a close friendship with a patient and begins sharing too many personal details about their own life unrelated to the patient’s healthcare needs.

When the nurse realizes what’s happening, they need to prioritize maintaining professional boundaries and act in the best interest of the patient by following these steps:

Recognize the Boundary Issue: Use personal reflection to recognize when professional boundaries are being crossed or compromised. Acknowledging this ethical dilemma is the first step toward resolving it.

Reflect on the Nurse-Patient Relationship: The nurse should remind themselves of their professional role, the duty of care, and the need to maintain objectivity and professional distance.

Reestablish Boundaries: Take appropriate actions to reestablish and reinforce professional boundaries with the patient. This may involve redirecting conversations back to the patient's healthcare needs, avoiding personal disclosures, and focusing on the patient's well-being.

Seek Guidance and Supervision: If the situation becomes challenging to resolve alone, the nurse should seek help from a supervisor, nurse manager, or experienced nursing team member. Consulting with experienced professionals can provide valuable insights and support in addressing this ethical dilemma.

Continuous Professional Development: Engage in ongoing professional development and education regarding nursing ethics and setting professional boundaries. Staying current on ethical guidelines and participating in discussions and training on maintaining professional boundaries can help prevent future boundary issues with patients.

9. Whistleblowing

Facing the ethical dilemma of reporting concerns about wrongdoing or unethical practices within the healthcare system, despite potential professional and personal repercussions.

An example of whistleblowing would be when a nurse becomes aware that a colleague is stealing controlled substances from the medication supply. The nurse decides to report this to their supervisor because it compromises patient safety and violates professional and legal standards. However, the nurse is worried about their colleague being disciplined and possibly losing their license.

Here are the steps the nurse should follow:

Gather Evidence: Collect factual evidence such as documentation discrepancies in medication records, witnessing the colleague's actions, or capturing any other supporting documentation. 

Consult with Colleagues: Seek advice from trusted colleagues, supervisors, or mentors within the healthcare organization. Discuss the situation and determine the best course of action. It’s important to maintain confidentiality during these discussions to protect both the patient and the nurse making the report.

Follow the Proper Chain of Command: Follow the established reporting channels within their healthcare organization. This typically involves reporting concerns to a supervisor, nurse manager, or a designated ethics or compliance hotline. Ensure that the report is made in writing and contains all relevant details and evidence.

Protection and Confidentiality: Be familiar with the whistleblower protection policies and laws in their jurisdiction. The nurse should ensure that their report is treated confidentially and that appropriate steps are taken to protect them from retaliation.

Documentation: Keep a detailed record of all actions taken, including the date and time of the incident, any conversations or consultations, and copies of the report submitted. This documentation helps demonstrate the nurse's commitment to reporting and acting in accordance with professional and ethical standards.

10. Ethical Use of Technology

Considering the ethical implications of using technology in healthcare, such as maintaining patient privacy and security, avoiding biases in algorithms, and ensuring equitable access to care.

An example of this ethical dilemma could occur when a nurse becomes concerned about potential biases in an algorithm and decides to report this to her supervisor. She recognizes that an algorithm where she works may disproportionately allocate resources based on patient factors such as age, race, and gender, resulting in inequitable access to care.

The nurse should advocate for equitable care by taking these steps:

Investigate and Evaluate: Become familiar with the AI algorithm being used and investigate its development process. Assess whether the algorithm has been validated and tested for biases and fairness. 

Raise Concerns: If the nurse identifies biases or inequities in the algorithm, they should communicate their concerns to the appropriate individuals, such as nurse leaders, healthcare administrators, or the technology implementation team. 

Collaborate for Improvement: Engage in collaborative discussions with the healthcare team, including the nursing supervisor, IT specialists, and data scientists. Work with the team to develop strategies to eliminate biases and ensure equitable use of the technology for all patients.

Promote Patient Advocacy: Advocate for the rights and well-being of the patients who may be affected by the technology. This involves ensuring informed consent and transparency regarding the use of AI algorithms. Patients should have the opportunity to understand and discuss the potential biases and their impact on their care.

Continuous Evaluation: Advocate for ongoing evaluation and monitoring of all AI technology being used in patient care to identify and resolve biases or unintended consequences. 

Ethical dilemmas are common in nursing and can be difficult to deal with. But you don’t have to make the decisions about these issues alone. Seek out the support and input of your nursing colleagues, supervisor, or nurse manager. By doing so, you will feel more comfortable and confident about how to handle the ethical dilemma you find yourself in.

*This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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Ethical Dilemma in Nursing

Definition of ethical nursing practice, the basis or framework for definition, the difference between legal and ethical nursing practice.

An Ethical Nursing Practice is a decision-making challenge between two potential normative choices, neither of which is undoubtedly desirable to a nurse. Typically, nurses encounter the problem in almost every aspect of their personal, social, and professional life. Consequently, due to their complexity, it is rather difficult for most people to find the right solution to the challenge (Sari et al, 2018). Thus, the paper aims at exploring the meaning, framework, as well as solution to a dilemma in the field of nursing.

The above framework of the Ethical Nursing Practice is based on the power to follow and to uphold moral values, ethical standards, and policies. At all costs, a person or an expert facing the issue must accurately scan the environment and only choose the right option out of the alternatives (Sari et al, 2018). As a result of the above framework, the nurses must work to operate within the prescribed definition.

Ethical standards are based on the profession’s principles, values, and poli.

De Vries, K., & Plaskota, M. (2017). Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer . Palliative &Supportive Care , 15 (2), 148-157. Web.

Sari, D., Baysal, E., Celik, G. G., & Eser, I. (2018). Ethimcal decision making levels of nursing students. Pakistan Journal of Medical Sciences , 34 (3), 724-729. Web.

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Ethical Issues in Nursing: Explanations & Solutions

June 5, 2020

View all blog posts under Articles | View all blog posts under Master of Science in Nursing

Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it. Nurse managers, in particular, are susceptible to ethical issues in nursing and moral distress because of their leadership and mentoring roles. Nurses and other medical staff look to nurse managers for appropriate and ethical decisions.

Before stepping into a role as a nurse manager, registered nurses (RNs) should understand the role ethical decision-making plays in the day-to-day work. Through Duquesne University’s Master of Science in Nursing program, students explore the foundations of ethical management and leadership from professors with real-world experience. The coursework not only covers the fundamentals of ethical nursing but delves deep into controversial case studies, giving students the chance to examine alternative viewpoints and develop reasoning skills.

For nurse managers, ethical decision-making stems from the American Nurses Association Code of Ethics, which was developed as a guideline for nursing responsibilities “in a manner consistent with quality in nursing care and the ethical obligations of the profession.” Nurse managers help solve ethical issues in nursing through using their leadership qualities to implement the Code of Ethics in their daily lives.

Nurses’ Code of Ethics

ANA adopted its first Code of Ethics in 1950. Since then, it has undergone several revisions to offset advances and changes in research, technology, law and overall challenges in nursing. The guidelines are divided into nine provisions that cover topics that include human dignity, confidentiality, moral virtue and healthcare as a right. ANA said that each of the provisions covers topics important to the challenges of nursing in the 21st century.

“The code is particularly useful in today’s healthcare environment because it reiterates the fundamental values and commitments of the nurse, identifies the boundaries of duty and loyalty and describes the duties of the nurse that extend beyond individual patient encounters,” ANA said in a statement.

Daily, nurse managers face a barrage of decisions and must maintain ethical fortitude to ensure the health, safety and well-being of their patients and staff. They actively work toward resolving ethical issues in nursing that they find in their workplace.

Examples of Ethical Dilemmas in Nursing

The ANA Code of Ethics provides a standard by which nurse managers can assess ethical issues in nursing. However, the way it addresses ethical dilemmas can vary in different situations. One ethical dilemma that can occur in healthcare facilities is when nurses themselves are not properly equipped to complete their duties. Nurses who notice their coworker’s lack of knowledge face an ethical dilemma of whether they should bring the issue to their nurse manager. To help curb this ethical dilemma, nurse managers can work hard to educate their nurses regarding the Code of Ethics as well as educate them regarding the Code of Ethics for their specific medical facility. Nurse managers can also provide regular trainings for their nurses regarding recurring issues.

One example of a common ethical dilemma nurses deal with is establishing boundaries with patients. Nurses and nurse managers devote their careers to helping patients receive the care they need, so it can often be difficult to establish professional boundaries. Patients should not rely on nurses beyond their professional capacity and should not develop romantic relationships with them or offer them gifts. Nurse managers can intervene in situations where ethical and professional boundaries are crossed by either patients or nurses.

Another ethical issue in nursing pertains to patient privacy. Nurses and nurse managers have access to a patient’s records and medical history and cannot ethically or legally release that information to anyone besides the patient. Nurses should have the best interest of patients in mind, understanding that they need to protect their privacy and medical data.

Common Ethical Situations for Nurse Managers and Nursing Ethics Examples

Even though nursing is a fast-paced job with new challenges daily, many nurse managers report facing similar ethical dilemmas. A recent study found that the most frequently occurring and stressful ethical situations are protecting patients’ rights, staffing, advanced care planning and decision-making. Exacerbating the problem is the large number of inexperienced nurses entering the field, many who have never faced ethical issues in nursing. Such challenges make experienced nurse managers all the more critical to daily healthcare needs nationwide.

The following are some other examples of common ethical situations that nurse managers face:

• Honesty vs. withholding information. Family members may want to withhold medical information from sick patients to protect their emotions. However, patients have the right to know about their medical conditions. Deciding how to share this information, especially if it goes against the family’s beliefs, can be a touchy situation. ANA advocates for truth telling, or veracity, as a key factor in nurse-patient relationships.
• Science vs. spirituality. Healthcare, which is science-based and results driven, can impede religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering and to allow patients to concentrate on self-care. For patients or their families with strong religious or spiritual convictions, the focus may be on adhering to a strict set of guidelines. The ANA Code of Ethics states that nurses should respect the “unique differences of the patient,” including “lifestyle, value system, and religious beliefs.” However, respect for the belief “does not imply that the nurse condones those beliefs or practices on a personal level.”
• Healthcare needs vs. resource allocation. The rising cost of healthcare is increasingly putting nurse managers at odds with budgeting constraints and patient needs. A large number of medical facilities have scarce resources, which puts patients at risk for not getting the care they need. These resources range from medical equipment to healthcare staff. Research suggests that nurse leaders must include staff in the budgeting process so that they can better understand the needs and demands.
• Autonomy vs. beneficence. Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care. ANA highlights that it is important for nurses and nurse managers to understand patient backgrounds and individual circumstances to inform the patient of the medical necessity. ANA explains: “Using ethical principles to arrive at a solution should be done in an atmosphere of caring, respect, openness, and honesty. This process should be based on a sound ethical, decision-making model, using the best evidence-based-practice guidelines available.”

How to Deal With Ethical Dilemmas in Nursing

Nurses undergo many years of education and clinical training before they can become certified nurses, and yet, dealing with real ethical issues in nursing can be far more complex than solving hypothetical issues in textbooks. Nurses can learn how to deal with ethical dilemmas in the workplace through gaining experience and interacting with patients over time. Although nurses have great levels of empathy, it can benefit them to establish professional boundaries with each of their patients at the outset of their careers. Whenever nurses struggle to identify whether something is ethical, they can review the ANA Code of Ethics.

Nurses can also benefit by surrounding themselves with well-seasoned nurses as well as experienced nurse managers. They can rely on the guidance of nurse managers when it comes to situations they may not know how to address. Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges.

Help Avoid Ethical Dilemmas in Nursing

The Duquesne University School of Nursing’s MSN program integrates ethical problem-solving and decision-making to help MSN graduates explore and address ethical issues. Students in each of Duquesne University’s MSN tracks — Adult-Gerontology Acute Care Nurse Practitioner, Family (Individual Across the Lifespan) Nurse Practitioner, Psychiatric-Mental Health Nurse Practitioner, Executive Nurse Leadership and Health Care Management, Forensic Nursing and Nursing Education and Faculty Role — learn how ethics and problem-solving play distinct roles in nursing.

U.S. News & World Report ranked Duquesne University’s online MSN program among the Best Online Graduate Nursing Programs in 2017. If you are interested in advancing your career as a nurse manager, explore how Duquesne University’s Master of Science in Nursing program can help you pursue your professional goals and help you avoid ethical issues in nursing.

Recommended Readings

Family Nurse Practitioners and Professional Liability Insurance

Importance of Nurse Manager Resilience

Using Escape Rooms for Nurse Education

American Nurses Association, View the Code of Ethics for Nurses 

Houston Chronicle , “Legal & Ethical Issues That Health Care Professionals Face” 

Lippincott Solutions, Best Practices for Ethical Nursing Leadership 

Medical Records Info, Top 10 Most Prevalent Ethical Issues in Nursing 

National Center for Biotechnology Information, “Ethical Problems in Nursing Management —A Cross-Sectional Survey About Solving Problems” 

NurseChoice, “4 Common Nursing Ethics Dilemmas” 

Ethical Dilemmas in the Nursing Field Essay

Introduction, personal experience, lessons from this course, guiding staff in a similar situation.

Nurses encounter a myriad of ethical dilemmas because of the nature of their work. They are engaged in all stages of healthcare system, helping in policy formulation and making critical decisions. As per Cope, Jones, and Hendricks (2016), nurses have an obligation to ensure that patients get quality health services. In the process, they have to attain balance between maleficence and non-maleficence. In my nursing career, I have encountered many impasses, but one that has remained in my mind involved dealing with an elderly patient. I was taking care of an elderly woman who suffered from occasional convulsions, thus she required a lot of attention. In spite of her living in a storey building, she always liked walking down stairs and taking a stroll in the neighborhood. At times, she would complain that I was infringing on her privacy, as I insisted on being there whenever she wanted to go out.

I had challenges deciding on whether to let her walk alone. The ethical principle of autonomy requires nurses to respect the freedom of their patients (Vosner, Zeleznik, Kokol, Vosner, & Zavrsnik, 2016). They should allow them to make independent decisions. In as much as I wished to respect the lady’s confidentiality and freedom, I did not want to risk her injuring herself in the event that she got seizures in my absence. As a human, I felt that the safety of the lady took precedence; hence I could not allow her to walk alone. It was difficult to convince her that she would be danger in case she opted to go out without alerting me. I had to always accompany her to a public park where she liked to visit. Nonetheless, she made sure that I was aware of her disapproval of my presence. Eventually, we had to compromise on some issues to avoid the likelihood of protracted differences. The lady allowed me to accompany her to the park, but I had to respect her independence by sitting on distant bench.

The study of nursing ethics has been of significant value to me as it has enabled me to view many things from a different perspective. In the past, I had difficulties striking a balance guaranteeing the safety of patients and respecting their privacy. However, after this course, I have realized that the wellbeing of a patient is paramount and should take precedence. If torn between the principles of autonomy and maleficence, I would opt for the latter. At times, nurses are forced to subject patients to pain as a way to save life (Preshaw, Brazil, McLaughlin, & Frolic, 2015). Even though the principle of non-maleficence demands that nurses do not injure patients, at times it is necessary to take such measures for their wellbeing.

As a nurse leader, I would encourage my staff to always put the safety of their patients first. Faced with a case like mine, I would advise them to sit down with the patient and explain to him/her the risks that she might subject herself to by going out alone. I would also suggest that they try to resolve the issue by agreeing on arrangements that would not expose a patient to danger.

The nursing career is awash with ethical dilemmas that nurses have to navigate to provide quality healthcare. The principle of autonomy demand medical professionals to respect the freedom of their patients. Nonetheless, it is imperative to ensure that one does not engage in risky activities. Faced with a dilemma that pits a patient’s security against their independence, a nurse should choose the former.

Cope, V. C., Jones, B., & Hendricks, J. (2016). Residential aged care nurses: Portraits of resilience. Contemporary Nurse, 52 (6), 736-752.

Preshaw, D. H. L., Brazil, K., McLaughlin, D., & Frolic, A. (2015). Ethical issues experienced by healthcare workers in nursing homes: Literature review. Nursing Ethics, 23 (5), 490-506.

Vosner, H. B., Zeleznik, D., Kokol, P., Vosner, J., & Zavrsnik, J. (2016). Trends in nursing ethics research: Mapping the literature production. Nursing Ethics, 24 (8), 892-907.

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Ethical Dilemma in Nursing Case Study

This essay about ethical challenges in nursing focuses on a hypothetical case involving an elderly woman named Jane, who prefers palliative care over aggressive treatment for her terminal cancer, contrary to her family’s wishes for continued medical intervention. The narrative explores the role of nurses in balancing patient autonomy with the desires of the patient’s family, highlighting the complexities of ethical decision-making in healthcare settings. Nurses often act as mediators in these situations, advocating for the patient’s wishes while also addressing the family’s concerns through effective communication and ethical deliberation. The essay underscores the importance of respecting patient rights and maintaining compassionate, patient-centered care amidst emotionally charged family dynamics. This discussion serves to illuminate the broader implications for nursing ethics and the essential ongoing dialogue within the profession about handling such conflicts.

How it works

In the heart of every hospital, ethical questions weave through the corridors just as surely as the doctors and nurses who rush from room to room. One such question sits heavily on the shoulders of those in the nursing profession: How do they balance patient autonomy with family desires, especially in end-of-life care scenarios? To explore this, we look into a hypothetical yet all too common situation faced by those in the medical field.

Imagine a scenario involving an elderly woman, let’s call her Jane, who is battling terminal cancer.

Jane has clearly expressed her wish to forego aggressive treatments that would only prolong her suffering. Instead, she chooses palliative care, hoping to spend her remaining days in peace and dignity at home surrounded by loved ones. However, Jane’s family, grappling with impending grief, insists on pursuing every possible medical intervention, driven by a mix of hope, denial, and perhaps guilt.

This dichotomy presents a profound ethical challenge for the nurses involved. On one hand, there’s the ethical duty to honor the patient’s wishes, an aspect central to the nursing code which respects patient autonomy. On the other, there is a pressing need to empathize with Jane’s family, who are not ready to let go and might view the cessation of aggressive treatment as akin to giving up.

Nurses find themselves navigating these treacherous waters, often serving as mediators between what the patient wants and what her family thinks is best. The situation calls for nurses to use their professional judgment and interpersonal skills to handle the delicate balance of providing care that respects Jane’s wishes while compassionately communicating the realities and limitations of medical treatment to her family.

Such situations are fertile ground for ethical deliberation, often involving discussions with ethics committees, multiple team meetings, and sometimes legal advice. These processes are integral to ensuring that decisions are made in the best interests of the patient while considering the emotional and ethical standpoint of the family.

The case of Jane highlights the indispensable role of nurses as advocates for their patients’ wishes. It also underscores the importance of having clear and open communication channels within families and between families and medical professionals. These discussions are never easy, but they are necessary to navigate the complex interplay between medical possibilities, ethical responsibilities, and human emotions.

In conclusion, understanding and managing ethical dilemmas like this one is crucial for maintaining the integrity of the nursing profession and ensuring patient care remains compassionate and patient-centered. Each case, while unique, adds to the broader understanding and ongoing conversation about the best practices in nursing ethics, particularly in how to handle conflicts between patient rights and family wishes effectively.

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Ethical Dilemmas in Nursing (Essay Sample)

Table of Contents

Instructions:

Write a paper of 750-1,000 words in which you describe your professional moral compass. As you write your paper, include the following:

• What personal, cultural, and spiritual values contribute to your worldview and philosophy of nursing?
• How do these values shape or influence your nursing practice?
• Define values, morals, and ethics in the context of your obligation to nursing practice. Explain how your personal values, philosophy, and worldview may conflict with your obligation to practice, creating an ethical dilemma.
• Reflect and share your own personal thoughts regarding the morals and ethical dilemmas you may face in the health care field.
• How do your personal views affect your behavior and your decision making?

Do not be concerned with the use of ethical terminology for this paper.

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Introduction

Dilemmas, as far as they go, exist in virtually every type of profession. All fields of work come about with some form of exceptionalities which comprehensively eliminate the aspect of a perfect profession. To a greater extent, ethical dilemmas complement each profession. On an outer look, nursing is perceived as one of the most fulfilling professions around the globe. Challenges in any profession are inevitable. Nursing from an inner look is faced with challenges and most profoundly the ethical dilemmas on a daily basis. Ethics in any profession are a set of regulations or principles through which decisions based on ethics are made. The major purpose of these mechanisms is the fostering of ethics of very high standards. The core business of nursing includes health promotion, easing of pain and illness prevention. The code of ethics, however, dictates that apart from that, the respect to human life must be part of the job. Respect to human life means cultural rights, right to choice and life and respectful and dignified treatment among others.

The nursing profession, like the larger medical field, is compounded with various dilemmas. Ethical dilemmas make nurses encounter moral distress. This is because, in most situations, they feel that they failed or were restricted to do what they consider ‘right’ (Wood, 2014). Some nurses, on the encounter of this, dare to speak it out with the colleagues or the management while others don’t. Such a scenario is often compounded by the Hippocratic Oath that these individuals have to take when commencing their careers. They often heave under such challenges, but again cannot be allowed to speak about them. Here are some of the most common ethical dilemmas that nurses encounter while performing their duties and what can be done.

Honesty in controversial to information

Nurses need to acquire information about the patient’s history to attain quality care. At the same time, they need to give the information about the patient’s condition with the patient or the family of the patient. This becomes a hurdle because they are not sure of the kind of information, the time and the manner in which they can present it to the parties in question (Carlise & Zoboli, 2015). The dilemma comes in if they should tell the patient’s condition or if they should let the patient enjoy a stress-free life during their last days. It is therefore up to the intelligence and common sense of the nurse to determine and ascertain the best course of action to take under such circumstances. This, is never easy. Families, on the other hand, withdraw or fail to provide truthful information about the patient for the purposes of protecting them. The misinformation may lead to adverse outcomes which lead to unethical conduct to the respective nurse.

The Nurse Control against the Freedom of the Patient

This is one of the most common ethical dilemmas in the nursing profession. Incorporated in the principles of ethics is the right to choice and cultural rights. The two give the patient the freedom of rejection of the medical advice given by the nurse or the physician. Remember, nurses are highly educated and experienced professionals who understand the most efficient and profound clinical course to tackling an action. If the patient refuses their advice, doesn’t that mean that they will have to comply with the course the patient wants even if it gives the less optimal outcome? But again, what can ,and should the nurse do, when it gets to this?

Closely related to this are personal, religious or cultural beliefs of a patient in controversial to a nurse’s empirical and science-based knowledge (Shapira, 2009. Even though it is a matter of life and death, some religious or cultural beliefs forbid some of the medical procedures. For instance, blood transfusion; there are some cultures and religions that forbid it.  In case of such an incidence that the nurse will have nothing but to watch a patient die, builds up moral distress.

The Reproductive Rights

This is another huge dilemma faced by nurses. The argument is seen between the pro-life and the pro-choice individuals. If the nurse is pro-life, it will be hard for them to respect the decision of a patient who wants to terminate a pregnancy. The other side’s hurdle comes in, in the manner that a patient wants to keep a pregnancy yet from the assessment, it threatens their life. The pro-choice nurses are faced with the dilemma of if they should support the patient’s decision or not. Once again, it is up to the nurse’s discretion to try and choose what would be the best course of action to take under such circumstances.

The Management of Resources

This usually happens when the cost of treatment is too high due to the patient’s critical conditions which can be described as the vegetative or futile state. The resources to save the lives of these patients could be costly, and it thus becomes a very difficult decision for the nurses to redirect the costs to the patients. It becomes nigh hard to draw a line of this decision from being personal to financial. The family is grieving, and when it comes to ensuring that a loved one’s life is saved, there is no resource that is not well spent. The nurse thus takes this decision, but they are eventually charged with the ‘big picture’ maintenance perspective while in real senses, they are dealing with critical personal situations.

The ethical challenges in nursing have mostly been taken as part of the job. In one way or the other, there is nothing normal with what makes one uncomfortable. Nurses, therefore, do not have to sit back but should seek for help. There are organizations that help nurses with ethical dilemma issues, for instance, the American Nursing Association. The organization offers statements on human rights and ethics. The statements could help nurses to overcome their challenges. Other hospitals have organized committees to deal with such (Wood, 2014). Nurses are very important part of the healthcare system-they care.

• Carlise, N. R. D., Vieira, M & Zoboli, P. C. L. E. (2015). Ethical Problems Experienced by Nurses in Primary Health Care. Retrieved fromhttp://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472015000100112
• Shapira, L. O. (2009). Ethical Dilemma in Nursing: The Experiences of Israel Nurses. Retrieved from http://education.biu.ac.il/files/education/shared/QHR_FINAL_ORLY_SHAPIRA.pdf
• Wood, D. (2014). 10 Best Practices for Addressing Ethical Issues and Moral Distress. Retrieved from https://www.amnhealthcare.com/latest-healthcare-news/10-best-practices-addressing-ethical-issues-moral-distress/

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Ethical Dilemmas in Nursing

Janelle thomas msn, rn.

Nursing is a profession tightly connected to ethics. By taking on a role that involves caring for people dealing with sickness or injury, any nurse doing their job in good faith will be helping people.

Nurses can regularly run into dilemmas about what is the most right and ethical course of action. Each situation is unique and there are often no clear-cut answers, but the following guide can help you better understand some common examples of ethical dilemmas in nursing and how best to handle them.

Understanding Nursing Ethics and Ethical Dilemmas

Ethics are any set of moral principles that guide a person’s behavior or how they perform an activity such as a job. Nursing ethics are part of the broader idea of medical ethics, which helps medical professionals understand right and wrong as it applies to clinical medicine. Nursing ethics are specifically laid out by the American Nurses Association in their Code of Ethics for Nurses document, which contains nine provisions, including compassion and respect for patients, patient advocacy , and duty to self, among other directives.

As in any profession, ethical dilemmas can arise when a situation presents a choice between breaking or compromising one ethical value over another. Jobs are complex, and while the right thing to do may be obvious in some situations, in others, not so much. Being able to recognize these dilemmas when they arise can make it a little more clear to navigate — and hopefully, make the best possible choice.

4 Examples of Common Ethical Dilemmas in Nursing

Ethical dilemmas can occur anywhere a nurse practices, from the hospital to the clinic to the home. The following ethical dilemmas represent some of the most common clashes that nurses encounter in any setting.

1. Helping a Patient Whose Beliefs Clash with Medical Advice

Whether due to personal beliefs or stubbornness, many patients can be reluctant or even refuse a recommended medical treatment that a nurse has been ordered to administer. For example, a patient may refuse pain medication out of fear of becoming addicted or because they don’t want to be drowsy. This presents a dilemma to a nurse who must choose between a patient’s comfort and their own desires.

What to Do: Ultimately, as long as a patient is making an informed and conscious decision and it does not threaten their life or anyone else’s health, nurses are usually ethically bound to respect a patient’s wishes to refuse medication or treatment. When in doubt, always seek the guidance of a supervisor, manager, or physician.

2. Withholding Information to Save a Patient from Distress

If a nurse learns about a diagnosis or other piece of health information that they know would cause worry and anxiety, it may be tempting to withhold that information to save them from stress. For example, if a patient doesn’t understand the full extent of a particular condition they have been diagnosed with, but you are worried that giving them more information would just make them more upset and inhibit treatment.

What to Do: Nurses are ethically obligated to educate patients to help them make informed treatment decisions. Withholding important information can do them more harm in the long run and potentially cause further distress down the road. Always remember your therapeutic nursing skills and use empathy and compassion when speaking to anxious patients.

3. Having to Choose Between Patients

Dealing with limited resources is a reality that every nurse encounters, and some may have to make tough choices because of it. It is not uncommon to run into a situation where it seems like giving one patient the care he or she needs will require depriving another patient of equally essential care.

What to Do: This is one ethical dilemma that requires careful and respectful judgment on the part of the nurse, as well as collaboration with physicians, managers, and other team members. If presented with a situation like this, nurses should try to make a good faith decision based on the patient’s needs and current health. In the most difficult cases, care can come down to first come first serve if other factors are equal.

4. Dealing with Professional and Personal Boundaries

Nurses are supposed to keep a wall between their professional and personal lives, and personal relationships and emotions should not dictate care or decision making. Despite this, there may be situations where a nurse coincidentally encounters a patient they know personally, or encounter a current patient in a social situation or on social media. An ethical dilemma could arise if a deep personal relationship develops or exists with a patient you are currently helping in any capacity.

What to Do: It is important to gently establish boundaries with a patient who is looking to extend the nurse-patient relationship into a personal relationship. If the patient persists beyond a point you see as an ethical relationship, report this to your supervisor or manager and request having the patient reassigned to another nurse if possible.

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What are some ethical dilemmas nurses have faced in clinical settings and how were they resolved?

Ethical dilemmas are common in nursing practice, and nurses often face challenging situations in clinical settings. Here are some examples of ethical dilemmas that nurses have faced in clinical settings and how they were resolved:

Informed Consent:

• Nurses may encounter situations where patients or their families have not been fully informed about their treatments or clinical prognosis [2] .
• Resolution: Nurses should ensure that patients have all the necessary information to make informed decisions about their care. They can facilitate communication between patients, families, and healthcare providers to address any concerns or questions. Building a strong interdisciplinary team can also help in dealing with these ethical issues [2] .

Disclosing Medical Conditions:

• Nurses may face dilemmas when families request that patients not be told about their medical condition or diagnosis [2] .
• Resolution: Nurses have an obligation to the patient and the ethical principles of truth-telling and promise-keeping. The nursing Code of Ethics requires nurses to be truthful and share information with patients, allowing them to make informed decisions about their care [2] .

Incompetence Among Peers:

• Nurses may observe incompetence in fellow healthcare team members and struggle with speaking up or staying silent [2] .
• Resolution: Nurses have a responsibility to protect the patient, the public, and the profession from potential harm. They should follow organization policies, reach out to supervisory personnel, and show compassion to colleagues. Resolving these dilemmas often requires thinking creatively and exploring options such as talking to the individual in question, assessing their awareness of the incompetence, and encouraging further training or education [2] .

Broader Ethical Issues:

• Nurses may face broader ethical issues such as creating and maintaining an ethical work environment, supporting social justice, and recognizing moral distress [2] .
• Resolution: Nurses have a responsibility to maintain and improve ethical work environments, advocate for social justice, and build moral resilience. They can take action to influence legislatures, government agencies, and other entities to address social determinants of health and unjust systems and structures [2] .

Learn more:

• Ethical Issues in Nursing: Explanations & Solutions
• Nursing Ethics: 4 Common Ethical Dilemmas | AMN Healthcare
• 5 Typical Ethical Dilemmas in Nursing | IntelyCare

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