Nursing Ethics – Ethical Dilemmas Faced By Nurses Everyday


Ethics is the study of practical reasoning. Nurses face ethical dilemmas on a daily basis. Ethical behavior is determined by many factors. What one person considers ethical may be vastly different from a person approaching a situation with a different point of view.

The word ethics is derived from the Greek word for character. Nurses are charged with using ethical concepts in their delivery of patient care. Ethical concepts include providing care which is good, correct, and rational. Patients need to be provided opportunities to express their freedom of choice in procuring services and determining how they want to be cared for. The ethical nurse recognizes that he or she is obligated to provide individualized care which will assist the patient reach and/ or maintain his or her highest level of wellbeing. Ethical nursing care is based upon rational science and decision making.

There are four core concepts which are essential to a professional nursing practice. They are respect for patient autonomy; the duty to act with beneficence; no maleficence; and justice.

Nurses provide respect for patient autonomy by recognizing and enhancing a patient’s freedom of choice, respecting patient choices, and providing privacy. The National League for Nursing issued a statement which document’s patient rights.  Nurses are expected to uphold the rights of patients and advocate for patients’ who are not able to advocate for themselves.

Nurses demonstrate beneficence by helping people reach their highest level of wellbeing. This may be achieved by providing care directly to an individual patient or developing health care policies which affect a large population.

Nurses are obligated not to harm patients. This is the principal of nonmaleficence.  Nurses often do have to perform procedures which make patients’ feel uncomfortable. An example is administering an injection. A patent needs medication to relieve a symptom, however, in order to relieve a symptom, the nurse may cause discomfort. Nonmaleficence must be balanced by beneficence, while providing care. The intent of the nurse provides a treatment which benefits the patient must outweigh the discomfort caused. The nurse’s intent must be to help, not harm.

Justice and fairness in nursing care is often related to the delivery of services. The current health care reform plan is a result of people recognizing that the current health care system needs revision. Controversy arises over what is fair, equitable, and economically feasible.

Nurses are involved at every level of the healthcare system, making decisions, and assisting with policy development.

Many experts state that the nursing concept of ethical care is an exceptional one which needs to be implemented throughout healthcare. It is similar to the medical model of ethics in that it deals with life and death issues. The nursing model is one of individual patient empowerment. Ethical nurses lead the way for health care reform which emphasizes healing even when curing is impossible. It places quality of life in the forefront.

Ethical dilemmas which nurses face are vast in scope. Examples include diverse topics such as staffing ratios, and end of life care. Dilemmas may occur while caring for patients with disabilities which may place them at risk for self-harm. For example, an elderly patient may want to walk without supervision. The nurse desires to promote independence, but the risk of patient injury due to falls may be great. The dilemma is how to balance the contrasting issues. Which is more important- independence or safety? Each patient, family, and healthcare team faces challenges such as this on a daily basis. Larger challenges may be encountered while working with families who have newborns with physical or mental disabilities. Is it ethical to subject a child to an unproven procedure which will cause pain if it gives them their only chance of survival? Is it best to prolong life when the quality of life is poor?

As caregivers on the front lines of health care, nurses are faced with ethical dilemmas at growing rate. Technology is enabling sick people to survive serious illnesses. Yet recent studies indicate that people are surviving, yet not living well. Nurses have a role in implementing educational and clinical practices which address the issues that high tech care presents.

There are not enough health care resources available in the world. The resources are unequally distributed. Nurses have a role in ensuring that distribution is fair.

Patients with various cultural backgrounds and personal experiences may present with diverse opinions of what is ethical. The nurse can serve as a resource to ensure that each person feels that their opinion counts.

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Patricia Bratianu

Patricia has been a Registered Nurse for almost forty years in a wide variety of settings. As a Registered Nurse, she realized that conventional healthcare was not meeting the needs of all patients. She became an herbalist and obtained a PhD in Natural Health. Patricia is a professional member of the American Herbalist’s Guild, passing the stringent peer reviewed process to become a Registered Herbalist.